Impact of Cardiorespiratory Fitness on All-Cause and Disease-Specific Mortality: Advances Since 2009

The association between birth by cesarean section and adolescent cardiorespiratory fitness in a cohort of 339,451 Swedish males

Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. Swedish males born by cesarean section achieved lower mean Watt-maximum (− 2.32 W, 95%C.I. − 2.90 to − 1.75) and displayed excess odds of low cardiorespiratory fitness (aOR = 1.08, 95%C.I. 1.05 to 1.11) at conscription in the eighteenth life-year compared to males born vaginally after adjusting for birth characteristics, maternal morbidities and parental socioeconomic position. In the sub-population, males born 1982–1987, there was a greater negative association of elective cesarean section with cardiorespiratory fitness (− 4.42 W, 95%C.I. − 6.27 to − 2.57, p < 0.001) than non-elective cesarean sections (− 1.96 W, 95%C.I. − 3.77 to − 0.16, p = 0.033) as compared to vaginal births. No associations between modes of cesarean delivery and cardiorespiratory fitness levels persisted in the within-family analyses where biological male siblings were compared whilst controlling for factors shared within families. Males born by cesarean section had lower levels of cardiorespiratory fitness eighteen years later compared to males born vaginally. These findings appear to be largely explained by factors of familial confounding.

The effects of exercise training on hypothalamic-pituitary-adrenal axis reactivity and autonomic response to acute stress-a randomized controlled study

BACKGROUND

Exercise training is suggested to have a stress-buffering effect on physiological reactions to acute stress. The so-called cross-stressor adaptation hypothesis is one of many theories behind the plausible effects, proposing that the attenuated physiological reaction seen in trained individuals in response to acute exercise is also seen when the individual is exposed to acute psychosocial stress. However, few randomized controlled trials (RCT) are available in this field. Therefore, the aim of the present trial was to study the effects of a 6-month aerobic exercise intervention on the physiological response to acute laboratory stress.

METHODS

A two-armed RCT including untrained but healthy individuals aged 20-50 years was conducted. Assessments included a peak oxygen uptake test and a psychosocial stress test (the Trier Social Stress Test). A total of 88 participants went through both baseline and follow-up measures (48 in the intervention group and 40 in the control group) with a similar proportion of women and men (20 women and 28 men in the intervention group and 18 women and 22 men in the control group). Outcome measures were adrenocorticotrophic hormone, cortisol, systolic and diastolic blood pressure, and heart rate responses to acute psychosocial stress.

RESULTS

Oxygen uptake and time-to-exhaustion increased significantly following the intervention, while a decrease was seen in the control group. The analyses showed attenuated responses to acute psychosocial stress for all variables in both groups at follow-up, with no differences between the groups. No correlation was seen between amount of exercise training and reactivity to the stress test. Despite the increased oxygen uptake in the intervention group, no differences were seen between the groups for any of the outcome variables at follow-up.

CONCLUSIONS

In this study, the cross-stressor adaptation hypothesis could not be confirmed. Both groups showed decreased reactions indicating a habituation to the stress test.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02051127 . Registered on 31 January 2014-retrospectively registered.

A Hunter-Gatherer Exercise Prescription to Optimize Health and Well-Being in the Modern World

There has been considerable innovation and advancement in the field of exercise and physical activity (PA). In regards to the battle against chronic non-communicable disease, however, we believe the model of PA that would prove most salutary is one closely mimicking that of our hunter-gatherer ancestors. For the purpose of longevity, the human body and our genetic makeup have been evolutionarily adapted to respond best to moderate amounts of high-intensity interval training, in conjunction with high amounts of low intensity exercise. Moreover, to optimize resiliency and cardiorespiratory fitness, a hunter-gatherer fitness regimen must include cross training targeted at flexibility, balance and strength. Though not commonly understood, the health benefits from exercise comprise a reverse J-curve. The endurance athletes residing on the furthest reaches of the PA spectrum appear to lose a substantial portion of the exercise-related longevity and cardiovascular benefits due to cardiac overuse injury. Conversely, there is an emerging body of evidence suggesting leisure time exercise done with peers in a natural environment is significantly superior to that training done in solitude. This idea of the "power of play" lends support to the ancestral model of PA whereby humans are evolutionary adapted to be highly social, outdoor creatures capable of a diverse range of PA at varying intensities.

Association Between Diet Quality and Cardiorespiratory Fitness in Korean Adults: The 2014-2015 National Fitness Award Project

Cardiorespiratory fitness (CRF) is a strong and meaningful indicator for predicting mortality, including cardiovascular disease, as well as simple physical capacity. Healthy eating is thought to be one of the crucial factors associated with an individual’s CRF status, although little research has been done on the relationship between healthy eating and CRF. This study aimed to investigate the association between overall diet quality and CRF among Korean adults. The study involved 937 adults (380 men and 557 women) aged 19‒64 years who participated in the 2014‒2015 Korea Institute of Sports Science Fitness Standards project. Diet quality was assessed by the recommended food score (RFS), and CRF was determined by maximal oxygen uptake (VO_2max) during a treadmill exercise test. Multiple regression model analyses were stratified by age (19–34, 35–49, and 50–64 years) and sex, because both factors greatly influence CRF. After multivariate adjustment, only the 19‒34 age group in both sexes showed a positive association between RFS and VO_2max. Additionally, when physical activity was adjusted, it was still significant in men but only marginally related in women. Our results suggest that better overall diet quality may be associated with a better CRF among young adults aged 19‒34 years in Korea.

Association of Cardiorespiratory Fitness Levels During Youth With Health Risk Later in Life: A Systematic Review and Meta-analysis

IMPORTANCE

Although the associations between cardiorespiratory fitness (CRF) and health in adults are well understood, to date, no systematic review has quantitatively examined the association between CRF during youth and health parameters later in life.

OBJECTIVES

To examine the prospective association between CRF in childhood and adolescence and future health status and to assess whether changes in CRF are associated with future health status at least 1 year later.

DATA SOURCES

For this systematic review and meta-analysis, MEDLINE, Embase, and SPORTDiscus electronic databases were searched for relevant articles published from database inception to January 30, 2020.

STUDY SELECTION

The following inclusion criteria were used: CRF measured using a validated test and assessed at baseline and/or its change from baseline to the end of follow-up, healthy population with a mean age of 3 to 18 years at baseline, and prospective cohort design with a follow-up period of at least 1 year.

DATA EXTRACTION AND SYNTHESIS

Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size.

MAIN OUTCOMES AND MEASURES

Anthropometric and adiposity measurements and cardiometabolic health parameters.

RESULTS

Fifty-five studies were included with a total of 37 563 youths (46% female). Weak-moderate associations were found between CRF at baseline and body mass index (r = -0.11; 95% CI, -0.18 to -0.04; I2 = 59.03), waist circumference (r = -0.29; 95% CI, -0.42 to -0.14; I2 = 69.42), skinfold thickness (r = -0.34; 95% CI, -0.41 to -0.26; I2 = 83.87), obesity (r = -0.15; 95% CI, -0.23 to -0.06; I2 = 86.75), total cholesterol level (r = -0.12; 95% CI, -0.19 to -0.05; I2 = 75.81), high-density lipoprotein cholesterol (HDL-C) level (r = 0.11; 95% CI, 0.05-0.18; I2 = 69.06), total cholesterol to HDL-C ratio (r = -0.19; 95% CI, -0.26 to -0.13; I2 = 67.07), triglyceride levels (r = -0.10; 95% CI, -0.18 to -0.02; I2 = 73.43), homeostasis model assessment for insulin resistance (r = -0.12; 95% CI, -0.18 to -0.06; I2 = 68.26), fasting insulin level (r = -0.07; 95% CI, -0.11 to -0.03; I2 = 0), and cardiometabolic risk (r = -0.18; 95% CI, -0.29 to -0.07; I2 = 90.61) at follow-up. Meta-regression analyses found that early associations in waist circumference (β = 0.014; 95% CI, 0.002-0.026), skinfold thickness (β = 0.006; 95% CI, 0.002-0.011), HDL-C level (β = -0.006; 95% CI, -0.011 to -0.001), triglyceride levels (β = 0.009; 95% CI, 0.004-0.014), and cardiometabolic risk (β = 0.007; 95% CI, 0.003-0.011) from baseline to follow-up dissipated over time. Weak-moderate associations were found between change in CRF and body mass index (r = -0.17; 95% CI, -0.24 to -0.11; I2 = 39.65), skinfold thickness (r = -0.36; 95% CI, -0.58 to -0.09; I2 = 96.84), obesity (r = -0.21; 95% CI, -0.35 to -0.06; I2 = 91.08), HDL-C level (r = 0.05; 95% CI, 0.02-0.08; I2 = 0), low-density lipoprotein cholesterol level (r = -0.06; 95% CI, -0.11 to -0.01; I2 = 58.94), and cardiometabolic risk (r = -0.08; 95% CI, -0.15 to -0.02; I2 = 69.53) later in life.

CONCLUSIONS AND RELEVANCE

This study suggests that early intervention and prevention strategies that target youth CRF may be associated with maintaining health parameters in later life.

Cardiorespiratory fitness assessment among firefighters: Is the non-exercise estimate accurate?

BACKGROUND

Minimum cardiorespiratory fitness (CRF) has been recommended for firefighters due to job requirements. Thus, it is important to identify accurate and readily available methods to assess CRF in this population. Non-exercise CRF estimates (NEx-CRF) have been proposed but this approach requires validation in this population.

OBJECTIVE

To evaluate the accuracy of a NEx-CRF, as compared to a field maximum exercise test, among career military firefighters of both genders using a comprehensive agreement analysis.

METHODS

We evaluated the accuracy of a NEx-CRF estimate compared to the Cooper 12 min running test among 702 males and 106 female firefighters.

RESULTS

Cooper and NEx-CRF tests yielded similar CRF in both genders (differences <1.8±4.7 ml/kg-1.min-1; effect size <0.34). However, NEx-CRF underestimated Cooper-derived CRF among the fittest firefighters. NEx-CRF showed moderate to high sensitivity/specificity to detect fit or unfit firefighters (71.9% among men and 100% among women). Among men, the NEx-CRF method correctly identified most firefighters with less than 11 METs or greater than 13 METs, but showed lower precision to discriminate those with CRF between 11-13 METs.

CONCLUSIONS

The NEx-CRF method to estimate firefighters' CRF may be considered as an alternative method when an exercise-based method is not available or may be used to identify those who require more traditional testing (CRF 11-13 METs).

The Urgent Need to Sit Less and Move More During the COVID-19 Pandemic

The coronavirus disease-2019 (COVID-19) pandemic containment and mitigation strategies may lead to excessive physical inactivity and sedentary behavior, drastically impacting cardiorespiratory fitness and overall health. It is urgent to safely find ways to sit less and move more.

The coronavirus disease-2019 (COVID-19) pandemic containment and mitigation strategies may lead to excessive physical inactivity and sedentary behavior, drastically impacting cardiorespiratory fitness and overall health. It is urgent to safely find ways to sit less and move more.

Cardiorespiratory Fitness as a Correlate of Cardiovascular, Anthropometric, and Physical Risk Factors: Using the Ruffier Test as a Template

Background

Assessment of cardiorespiratory fitness (CRF) is a standard procedure in routine clinical practices. Early identification of risk factors through screening is vital in the fight against chronic diseases. Evaluation of CRF can impose cost implications in the clinical setting; thus, a simple and easy-to-use test is to be advocated. The Ruffier test is a simple test that can assess CRF, and it is necessary to find whether the test reflects the effects of compounding factors in CRF.

Objective

This study aims to determine the association between CRF (estimated VO2max) with cardiovascular, anthropometric, and physical risk factors using the Ruffier test.

Methods

A cross-sectional study with a sample of 52 male participants was conducted. Before the Ruffier test, each participant's body weight, height, waist circumference, skinfold thickness, thigh length, lower-limb length, thigh circumference, physical activity, blood pressure, smoking, diabetes, and pulmonary functions were recorded, and these factors correlated with CRF.

Results

There was a significant inverse relationship found between the estimated VO2max and age, height, body weight, body mass index, waist circumference, a sum of skinfold, fat percentage, thigh length, lower-limb length, thigh circumference, smoking, blood pressure, heart rates, and diabetes (p < 0.05). A significant positive correlation was found between the estimated VO2max with physical activity and respiratory functions (p < 0.05). In the multivariable model, body weight and resting heart rate were significantly inversely associated with the estimated VO2max(p < 0.05).

Conclusion

Using the Ruffier test, various risk factors of CRF are correlated with the estimated VO2max. This test reflects the effects of different compounding factors on CRF; therefore, it can be used in routine clinical practices to identify the risk factors early.

Peak oxygen uptake and incident coronary heart disease in a healthy population: the HUNT Fitness Study

AIMS

The majority of previous research on the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is based on indirect assessment of CRF in clinically referred predominantly male populations. Therefore, our aim was to examine the associations between VO2peak measured by the gold-standard method of cardiopulmonary exercise testing and fatal and non-fatal coronary heart disease (CHD) in a healthy and fit population.

METHODS AND RESULTS

Data on VO2peak from 4527 adults (51% women) with no previous history of cardiovascular or lung disease, cancer, and hypertension or use of antihypertensive medications participating in a large population-based health-study (The HUNT3 Study), were linked to hospital registries and the cause of death registry. Average VO2peak was 36.0 mL/kg/min and 44.4 mL/kg/min among women and men, and 83.5% had low 10-year risk of CVD at baseline. Average follow-up was 8.8 years, and 147 participants reached the primary endpoint. Multi-adjusted Cox-regression showed 15% lower risk for the primary endpoint per one-MET (metabolic equivalent task) higher VO2peak [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77-0.93], with similar results across sex. The highest quartile of VO2peak had 48% lower risk of event compared with the lowest quartile (multi-adjusted HR 0.52, 95% CI 0.33-0.82). Oxygen pulse and ventilatory equivalents of oxygen and carbon dioxide also showed significant predictive value for the primary endpoint.

CONCLUSION

VO2peak was strongly and inversely associated with CHD across the whole fitness continuum in a low-risk population sample. Increasing VO2peak may have substantial benefits in reducing the burden of CHD.

Exercise-induced oxidative stress: Friend or foe?

The first report demonstrating that prolonged endurance exercise promotes oxidative stress in humans was published more than 4 decades ago. Since this discovery, many ensuing investigations have corroborated the fact that muscular exercise increases the production of reactive oxygen species (ROS) and results in oxidative stress in numerous tissues including blood and skeletal muscles. Although several tissues may contribute to exercise-induced ROS production, it is predicted that muscular contractions stimulate ROS production in active muscle fibers and that skeletal muscle is a primary source of ROS production during exercise. This contraction-induced ROS generation is associated with (1) oxidant damage in several tissues (e.g., increased protein oxidation and lipid peroxidation), (2) accelerated muscle fatigue, and (3) activation of biochemical signaling pathways that contribute to exercise-induced adaptation in the contracting muscle fibers. While our understanding of exercise and oxidative stress has advanced rapidly during the last decades, questions remain about whether exercise-induced increases in ROS production are beneficial or harmful to health. This review addresses this issue by discussing the site(s) of oxidant production during exercise and detailing the health consequences of exercise-induced ROS production.

Continuous Compared to Accumulated Walking-Training on Physical Function and Health-Related Quality of Life in Sedentary Older Persons

The present study aimed to analyze the impact of overground walking interval training (WIT) in a group of sedentary older adults, comparing two different dose-distributions. In this quasi-experimental and longitudinal study, we recruited twenty-three sedentary older adults (71.00 ± 4.10 years) who were assigned to two groups of WIT. The continuous group (CWIT) trained for 60 min/session in the morning, while the accumulated group (AWIT) performed the same duration and intensity of exercise, but it was distributed twice a day (30 min in the morning and 30 more in the afternoon). After 15 weeks of an equal external-load training (3 days/week), Bonferroni post-hoc comparisons revealed significant (p < 0.050) and similar large improvements in both groups in cardiorespiratory fitness and lower limb strength; even larger gains in preferred walking speed and instrumental daily life activity, which was slightly superior for CWIT; and improvements in agility, which were moderate for CWIT and large for AWIT. However, none of the training protocols had an impact on the executive function in the individuals, and only the AWIT group improved health-related quality of life. Although both training protocols induced a general significant improvement in physical function in older adults, our results showed that the accumulative strategy should be recommended when health-related quality of life is the main target, and the continuous strategy should be recommended when weakness may be a threat in the short or medium term.

Cardiorespiratory Fitness and the Risk of First Acute Myocardial Infarction: The HUNT Study

Background

The majority of studies evaluating cardiorespiratory fitness (CRF) as a cardiovascular risk factor use cardiovascular mortality and not cardiovascular disease events as the primary end point, and generally do not include women. The aim of this study was to investigate the association of estimated CRF (eCRF) with the risk of first acute myocardial infarction (AMI).

Methods and Results

We included 26 163 participants (51.5% women) from the HUNT study (Nord‐Trøndelag Health Study), with a mean age of 55.7 years, without cardiovascular disease at baseline. Baseline eCRF was grouped into tertiles. AMI was derived from hospital records and deaths from the Norwegian Cause of Death Registry. We used Fine and Gray regression modeling to estimate subdistribution hazards ratio (SHR) of AMI, accounting for competing risk of death. During a mean (range) follow‐up of 13 (0.02–15.40) years (347 462 person‐years), 1566 AMI events were recorded. In fully adjusted models men in the 2 highest eCRF had 4% (SHR: 0.96, 95% CI: 0.83–1.11) and 10% (SHR: 0.90, 95% CI: 0.77–1.05) lower SHR of AMI, respectively, when compared with men in the lowest tertile. The corresponding numbers in women were 12% (SHR: 0.88, 95% CI: 0.72–1.08) and 25% (SHR: 0.75, 95% CI: 0.60–0.95).

Conclusions

eCRF was inversely associated with risk of AMI event among women but not in men. Our data suggest that high eCRF may have substantial benefit in reducing the risk of AMI. Therefore, our data suggest that an increased focus on eCRF as a cardiovascular disease risk marker in middle‐aged and older adults is warranted.

Laboratory medicine: health evaluation in elite athletes

The need to evaluate the health status of an athlete represents a crucial aim in preventive and protective sports science in order to identify the best diagnostic strategy to improve performance and reduce risks related to physical exercise. In the present review we aim to define the main biochemical and haematological markers that vary significantly during and after sports training to identify risk factors, at competitive and professional levels and to highlight the set up of a specific parameter's panel for elite athletes. Moreover, we also intend to consider additional biomarkers, still under investigation, which could further contribute to laboratory sports medicine and provide reliable data that can be used by athlete's competent staff in order to establish personal attitudes and prevent sports injuries.

Reference values and secular trends for cardiorespiratory fitness in children and adolescents with obesity

AIM

To present specific reference values for cardiorespiratory fitness (CRF) in children with obesity and to analyse secular trends of CRF in the studied population.

METHODS

Cardiorespiratory fitness, the maximal oxygen uptake (VO₂ max), was estimated with the Åstrand-Rhyming submaximal bicycle test, in 705 Swedish children (356 girls, 8-20 years) with obesity according to the International Obesity Task Force (IOTF). Data were collected from 1999 to 2013. Secular trends, analysed with multiple linear regression, were adjusted for age, height and body mass index standard deviation score (BMI SDS).

RESULTS

All children had low CRF compared with normal weight standards but there was a marked variability of CRF in children with obesity, which was possible to quantify with the developed obesity specific CRF reference values. The mean value of absolute VO₂ max (L/min) increased with age and relative VO₂ max (mL/kg/min) decreased with age in both boys and girls. There was a negative secular trend in both sexes (P < .001).

CONCLUSION

These are the first obesity specific reference values of CRF in children enabling clinical evaluation in childhood obesity treatment. Cardiorespiratory fitness in children with obesity has declined the last decades, indicating that also within this vulnerable group physical activity has gone down.

Effectiveness of a brief lifestyle intervention targeting mental health staff: analysis of physical fitness and activity in the Keeping Our Staff in Mind study

BACKGROUND

People with mental illness die on average 15 years less than the general population, primarily to cardiometabolic disease. Lifestyle interventions are effective in reducing cardiometabolic risk but are not routinely provided to mental health consumers. Lifestyle interventions targeting mental health staff may be beneficial in changing culture surrounding physical health and subsequently improving consumer outcomes. This study examines exercise and fitness outcomes of a targeted lifestyle intervention directed at Australian mental health staff.

METHODS

A pragmatic single-arm intervention study was conducted within an Australian public mental health service. Mental health staff were provided a five-session individualised lifestyle intervention (incorporating exercise and nutritional counselling) over 5 weeks. Two waves of the programme were delivered between 2015 and 2016. This paper examines the exercise and fitness outcomes of the second wave of the study. Participants were assessed at baseline and at a 16-week follow-up. The primary exercise outcome was a measurement of cardiorespiratory fitness. Secondary outcomes included self-reported physical activity and a measurement of handgrip strength.

RESULTS

A total of 106 staff participated in this component of the study. Cardiorespiratory fitness increased significantly from baseline to follow-up (p<0.001). Significant improvements to physical activity occurred with decreases in sedentary time (p<0.0005) and increases in moderate-to-vigorous physical activity (p<0.005).

CONCLUSION

Lifestyle interventions incorporating exercise counselling may improve the physical health of mental health staff. Such strategies may be effective in improving culture surrounding physical health and/or increasing the effectiveness of lifestyle interventions targeting mental health consumers.

Exercise: The ultimate treatment to all ailments?

Extensive clinical research has provided robust evidence that exercise is a cost‐effective measure to substantially alleviate the burden of a large number of diseases, many of which belong to the cardiovascular (CV) spectrum. In terms of cardiac benefit, the positive effects of exercise are attributed to improvements in standard risk factors for atherosclerosis, as well as to its positive impact on several pathophysiological mechanisms for CV diseases. For secondary prevention, exercise, optimally in the context of a cardiac rehabilitation program, has been shown to improve functional capacity and survival. Clinicians should encourage physical activity and provide exercise recommendations for all patients, taking into consideration any underlying pathology. In the present review, the benefits of exercise for the prevention and treatment of major CV risk factors and heart conditions are analyzed.

Long-Term Effects in the EXERDIET-HTA Study: Supervised Exercise Training vs. Physical Activity Advice

Purpose: To determine whether improvements in cardiorespiratory fitness (CRF), blood pressure (BP) and body composition previously seen after a 16-week exercise intervention (POST) with hypocaloric diet are maintained following six months (6M) of unsupervised exercise time. Methods: Overweight/obese, physically inactive participants with primary hypertension (HTN) (n = 190) were randomly assigned into an attention control group (physical activity recommendations) or one of three supervised exercise groups. After POST, all participants received diet and physical activity advice for the following 6M but no supervision. All anthropometric and physiological measurements were taken pre and post the 16-week supervised intervention period, as well as after 6M of no supervision. Results: After 6M: 1) body mass (BM) (Δ = 2.5%) and waist circumference (Δ = 1.8%) were higher (P < .005) than POST, but lower (P < .005) than pre-intervention (BM, Δ = -5.1%; waist circumference, Δ = -4.7%), with high-volume and high-intensity interval training group revealing a higher BM reduction (Δ = -6.4 kg) compared to control group (Δ = -3.5 kg); 2) BP variables were higher (P < .001) compared to POST with no change from pre-intervention; and 3) CRF was higher compared to pre-intervention (Δ = 17.1%, P < .001) but lower than POST (Δ = -5.7%, P < .001). Conclusions: When an overweight/obese population with HTN attains significant improvements in cardiometabolic health POST intervention with diet restriction, there is a significant reduction following 6M when exercise and diet supervision is removed, and only recommendations were applied. These results suggest the need for a regular, systematic and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health.

An NMR-Based Approach to Identify Urinary Metabolites Associated with Acute Physical Exercise and Cardiorespiratory Fitness in Healthy Humans-Results of the KarMeN Study

Knowledge on metabolites distinguishing the metabolic response to acute physical exercise between fit and less fit individuals could clarify mechanisms and metabolic pathways contributing to the beneficial adaptations to exercise. By analyzing data from the cross-sectional KarMeN (Karlsruhe Metabolomics and Nutrition) study, we characterized the acute effects of a standardized exercise tolerance test on urinary metabolites of 255 healthy women and men. In a second step, we aimed to detect a urinary metabolite pattern associated with the cardiorespiratory fitness (CRF), which was determined by measuring the peak oxygen uptake (VO_2peak) during incremental exercise. Spot urine samples were collected pre- and post-exercise and 47 urinary metabolites were identified by nuclear magnetic resonance (NMR) spectroscopy. While the univariate analysis of pre-to-post-exercise differences revealed significant alterations in 37 urinary metabolites, principal component analysis (PCA) did not show a clear separation of the pre- and post-exercise urine samples. Moreover, both bivariate correlation and multiple linear regression analyses revealed only weak relationships between the VO_2peak and single urinary metabolites or urinary metabolic pattern, when adjusting for covariates like age, sex, menopausal status, and lean body mass (LBM). Taken as a whole, our results show that several urinary metabolites (e.g., lactate, pyruvate, alanine, and acetate) reflect acute exercise-induced alterations in the human metabolism. However, as neither pre- and post-exercise levels nor the fold changes of urinary metabolites substantially accounted for the variation of the covariate-adjusted VO_2peak, our results furthermore indicate that the urinary metabolites identified in this study do not allow to draw conclusions on the individual's physical fitness status. Studies investigating the relationship between the human metabolome and functional variables like the CRF should adjust for confounders like age, sex, menopausal status, and LBM.

Interindividual Variation in Cardiorespiratory Fitness: A Candidate Gene Study in Han Chinese People

Cardiorespiratory fitness, as assessed through peak oxygen uptake (VO2peak), is a powerful health indicator. We aimed to evaluate the influence of several candidate causal genetic variants on VO2peak level in untrained Han Chinese people. A total of 1009 participants (566 women; age [mean ± SD] 40 ± 14 years, VO2peak 29.9 ± 7.1 mL/kg/min) performed a maximal incremental cycling test for VO2peak determination. Genomic DNA was extracted from peripheral whole blood, and genotyping analysis was performed on 125 gene variants. Using age, sex, and body mass as covariates, and setting a stringent threshold p-value of 0.0004, only one single nucleotide polymorphism (SNP), located in the gene encoding angiotensin-converting enzyme (rs4295), was associated with VO2peak (β = 0.87; p < 2.9 × 10-4). Stepwise multiple regression analysis identified a panel of three SNPs (rs4295 = 1.1%, angiotensin II receptor type 1 rs275652 = 0.6%, and myostatin rs7570532 = 0.5%) that together accounted for 2.2% (p = 0.0007) of the interindividual variance in VO2peak. Participants carrying six 'favorable' alleles had a higher VO2peak (32.3 ± 8.1 mL/kg/min) than those carrying only one favorable allele (24.6 ± 5.2 mL/kg/min, p < 0.0001). In summary, VO2peak at the pre-trained state is partly influenced by several polymorphic variations in candidate genes, but they represent a minor portion of the variance.

A Pilot Study of Cardiorespiratory Fitness, Adiposity, and Cardiometabolic Health in Youth With Overweight and Obesity

OBJECTIVE

To conduct a preliminary assessment of the relationships between cardiorespiratory fitness, adiposity, and cardiometabolic health using gold standard measures in diverse youth ranging from overweight to severe obesity.

METHODS

Twenty of 30 participants (mean [SD]; age 13.2 [1.8] y, 55% female, 45% African American) met the criteria for VO2peak during a graded cycle ergometer test to volitional fatigue. The body composition was measured by dual-energy X-ray absorptiometry (percentage of body fat, fat mass index, and fat-free mass) and magnetic resonance imaging (abdominal visceral and subcutaneous [SAT] adipose tissue). The VO2peak was expressed relative to fat-free mass. Fasting lipid levels, glycemic biomarkers, and vital signs were examined individually and used in a composite cardiometabolic risk score. Accelerometer-measured physical activity and sedentary time were included as covariates.

RESULTS

VO2peak was negatively associated with abdominal SAT (r = -.49, P < .05), but not visceral adipose tissue or markers of cardiometabolic health. The association between SAT and VO2peak was partly explained by habitual sedentary time.

CONCLUSIONS

We demonstrated a significant negative association between cardiorespiratory fitness and SAT in a diverse group of high-risk youth. The inclusion of rigorous, laboratory-based measures and youth with severe obesity extends the previous work in pediatric populations.

Effect of acupuncture in physiological parameters and endurance running performance

BACKGROUND

Few studies have examined the effect of acupuncture (AC) treatment in aerobic capacity and endurance performance in healthy adults. Thus, the aim of the present study was to evaluate the effects of AC on selected physiological parameters and 3 km running performance.

METHODS

Twenty-four healthy subjects with low to moderate aerobic capacity participated in the study and randomly assigned in two groups: AC group (ACG - N.=14) and control group (CG - N.=10). The subjects completed an incremental test to exhaustion and a 3 km race on a treadmill to evaluate their physiological responses and endurance running performance respectively, prior and after 4 weeks (8 sessions, twice a week) of acupuncture treatment.

RESULTS

AC treatment had a significant main effect in T3km [F(1, 21)=7.173, P=0.014, partial η2=0.255], as well as in VT [F(1, 21)=8.476, P=0.008, partial η2=0.288] and HRmax@3km [F(1, 21)=4.930, P=0.038, partial η2=0.190], after controlling for the effect of the pre-test, while no other significant main effects were detected.

CONCLUSIONS

Healthy physically active adults significantly improved their endurance running performance after 4 weeks of AC treatment. This is mainly due to the enhancement of the speed corresponding with VT, comparing with their baseline values.

Cardiorespiratory and metabolic responses to exercise testing during lower-body positive pressure running

Exercise reduces the future cardiometabolic disease risk. However, not everyone can participate in routine physical activity because of obesity or orthopedic impairments. Body weight-supported (BWS) exercise may be an option for these individuals. Unfortunately, very little data are available with regard to BWS running in untrained healthy individuals. Yet, this information is important to assess the potential use of lower-body positive pressure (LBPP) treadmill running for the prevention of cardiometabolic disease. Twenty healthy but untrained participants (10 females, mean age 31.5 yr) were included in this study. Participants completed two exercise tests (one with 100% and one with 60% body wt) in randomized order on a LBPP treadmill. Expired gas data and heart rate (HR) were collected continuously. Blood lactate, blood pressure (BP), pulse wave velocity (PWV), and rating of perceived exertion (RPE) were measured during a 2-min break after each stage. Oxygen uptake increased significantly independent of BWS but was lower with BWS. Furthermore, we identified a significant correlation between HR and RPE independent of BWS. BP and PWV showed a large heterogeneity in response to BWS. The lower O₂ requirement when running with BWS may help untrained individuals to adapt to an exercise regimen. Future research needs to explore the heterogenetic response of blood pressure and pulse wave velocity to LBPP BWS between individuals.NEW & NOTEWORTHY Lower-body positive pressure body weight-supported exercise has a lower metabolic and cardiovascular demand. Furthermore, heart rate and rating of perceived exertion are highly correlated independent of body weight support. Our data support the further examination of lower-body positive pressure exercise training for cardiovascular disease risk groups.

Enhancing the assessment of cardiorespiratory fitness using field tests

OBJECTIVE

To establish normative values and reference equations of the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT) and unsupported upper limb exercise test (UULEX) for Portuguese adults.

DESIGN

Cross-sectional study. Descriptive statistics and differences between age decades and genders were explored using univariate general linear models to compute reference values. Reference equations were established with a forward stepwise multiple regression.

SETTING

General community.

PARTICIPANTS

In total, 645 adult volunteers without disabilities [43% male, mean age 55.1 (standard deviation 23.6) years] were recruited from the university campus and surrounding community.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Data on age, gender, height, weight, body mass index and smoking status were collected using a structured questionnaire. Physical activity was evaluated using the Brief Physical Activity Assessment Tool. Participants performed two repetitions of the 6MWT, ISWT and UULEX, and the best repetition was used for analysis.

RESULTS

Overall, performance was better in males than in females, and decreased with age. Participants' performance was significantly reduced after the sixth decade of life compared with the other decades (P<0.001). Reference equations were: 6MWT=226.93-(5.00×age)+(360.41×height), R²=71%; ISWT=393.81-(17.98×age)+(185.64×gender)+(775.88×height), R²=83%; and UULEX=16.71-(0.14×age)+(2.66×gender), R²=57%.

CONCLUSION

Leg or arm exercise field tests are affected significantly by age and gender. These results will aid health professionals to interpret the results of field tests obtained from healthy or diseased adult populations.

Predictors of Sexual Desire and Sexual Function in Sedentary Middle-Aged Adults: The Role of Lean Mass Index and S-Klotho Plasma Levels. The FIT-AGEING Study

BACKGROUND

Unhealthy lifestyle and aging negatively impact sexuality; consequently, the prevalence of sexual problems increases sharply in middle-aged adults, but the determinants of low sexual desire and sexual dysfunction are not fully elucidated.

AIMS

To investigate the association of cardiometabolic profile, free testosterone plasma levels, body composition, physical fitness, and S-Klotho plasma levels with sexual desire and sexual function in middle-aged sedentary adults.

METHODS

Seventy-four (39 women) sedentary middle-aged adults (45-65 years old) were recruited for the present cross-sectional study.

OUTCOMES

The blood samples were collected in the morning (12 h of fasting) to determine cardiometabolic biomarkers and free testosterone and S-Klotho plasma levels. The cardiometabolic risk score was calculated based on the International Diabetes Federation's clinical criteria, quantitative insulin sensitivity check index, and homeostatic model assessment of insulin resistance index. A dual-energy X-ray absorptiometry scanner was used to determine the lean mass index (LMI) and the fat mass index. Maximal oxygen uptake was determined by a maximum treadmill test using indirect calorimetry. Muscular strength was measured with knee extensor isokinetic dynamometry (60° s^-1). Sexual desire was assessed with the Sexual Desire Inventory 2. Sexual function was assessed with the Massachusetts General Hospital-Sexual Functioning Questionnaire.

RESULTS

After age adjustment, free testosterone plasma levels were associated with solitary sexual desire in women (R² = 0.193, β = 0.342, P = .044). The LMI was associated with solitary sexual desire in men (R² = 0.258, β = 0.445, P = .024) and sexual function in women (R² = 0.470, β = -0.607, P < .001). S-Klotho plasma levels were associated with solitary sexual desire and sexual function in men (R² = 0.412, β = 0.817, P = .001; R² = 0.193, β = -0.659, P = .021, respectively) and with dyadic sexual desire and sexual function in women (R² = 0.270, β = 0.508, P = .020; R² = 0.467, β = -0.676, P < .001, respectively).

CLINICAL IMPLICATIONS

S-Klotho plasma levels may represent a potential new biomarker for sexual desire and sexual function. Lean body mass development may benefit sexual desire and sexual function.

STRENGTHS AND LIMITATIONS

Strengths include the analysis of novel and diverse biomarkers of health for sexual desire and sexual function. Limitations include the cross-sectional design and a relatively small sample size; thus, results should be interpreted cautiously and in the study population context.

CONCLUSION

S-Klotho plasma levels were strongly associated with dyadic sexual desire, solitary sexual desire, and sexual function in sedentary middle-aged adults. The LMI was also positively associated with solitary sexual desire and sexual function in men and women, respectively. Dote-Montero M, De-la-O A, Castillo MJ, et al. Predictors of Sexual Desire and Sexual Function in Sedentary Middle-Aged Adults: The Role of Lean Mass Index and S-Klotho Plasma Levels. The FIT-AGEING Study. J Sex Med 2020;17:665-677.

Active and Fit Communities. Associations between Neighborhood Walkability and Health-Related Fitness in Adults

There are many health benefits of regular physical activity and improving physical fitness levels can reduce the risk of chronic disease. Accumulating evidence suggests the neighborhood built environment is important for supporting physical activity; however, few studies have investigated the contribution of the neighborhood built environment to fitness levels. We examined the associations between objectively-determined and self-reported neighborhood walkability and overall and specific components of perceived health-related fitness (cardiorespiratory, muscular strength, and flexibility) in a random sample of 592 adults from two areas of Calgary (Canada). Participants provided complete data to an online questionnaire capturing perceived cardiorespiratory fitness (CRF), muscular strength (MST), flexibility, moderate-to-vigorous intensity physical activity (MVPA), resistance training, and sociodemographic characteristics. The questionnaire also captured participant’s perceptions of their neighborhood’s walkability (Physical Activity Neighborhood Environment Scale; PANES) and the physical activity supportiveness of neighborhood parks (Park Perceptions Index; PPI). Objectively-measured neighborhood walkability was estimated using Walk Score^®. The average (SD) age of participants was 46.6 (14.8) years and 67.2% were female. Participants, on average, participated in at least 30-minutes of MVPA on 3.4 (2.1) days/week and undertook resistance training 2.0 (1.8) days/week. Adjusting for covariates, Walk Score^® was not associated with any fitness outcomes. Adjusting for covariates, the PANES index was positively associated (p < 0.05) with CRF, MST, flexibility, and overall fitness and the PPI was positively associated (p < 0.05) with all fitness outcomes except MST. Our findings provide novel preliminary evidence suggesting the neighborhood built environment may be important for supporting higher health-related fitness levels in adults.

Entering Cardiac Rehabilitation With Peripheral Artery Disease: A RETROSPECTIVE COMPARISON TO CORONARY ARTERY DISEASE

PURPOSE

Supervised exercise is recommended for patients with peripheral artery disease (PAD) and patients with coronary artery disease (CAD). Both conditions share common etiology as atherosclerotic diseases. The clinical profile, cardiorespiratory fitness, and exercise prescriptions of PAD, CAD, and patients with concomitant PAD and CAD (BOTH) have yet to be compared upon entry into cardiac rehabilitation (CR).

METHODS

Cardiopulmonary, demographic, and anthropometric assessments were conducted at entry to CR between January 2006 and December 2017.

RESULTS

Among 9701 consecutively enrolled patients, there were 94.6% with CAD (n = 9179), 1.5% with PAD (n = 143), and 3.9% with BOTH (n = 379). Only 5.4% (n = 522) of all patients entering CR had a diagnosis of PAD. Compared with CAD, patients with PAD and BOTH were older (mean ± SD = 62.5 ± 11.1 vs 67.9 ± 11.4 and 69.2 ± 9.8 yr, P < .01), had higher resting systolic blood pressure (124 ± 17 vs 130 ± 17 and 133 ± 18 mm Hg, P < .01), had lower cardiorespiratory fitness (19.7 ± 6.3 vs 15.6 ± 4.8 and 15 ± 4.5 mL/kg/min, P < .01), and were more likely to have diabetes (25% vs 35% and 41%, P < .01), abdominal obesity (39% vs 54% and 51%, P < .01), and initially prescribed lower-intensity exercise (84.4 ± 14.1 vs 74.1 ± 15.7 and 70.0 ± 14.6 m/min exercise pace, P < .01), reflecting the complex nature of patients diagnosed with PAD.

CONCLUSIONS

Patients referred with PAD have a cardiovascular risk profile that places them at a greater risk for a repeat or first cardiac event compared with patients with CAD. Referral to structured exercise and risk factor modification programs should be considered to aid in the management of PAD.

Exercise and Depressive Disorder

Depression is a psychiatric disorder characterized by low mood, loss of interest/enjoyment, and reduced energy and one of the five leading causes of disability and a major contributor to all-cause mortality worldwide. People with depression have, between others, a reduced life expectancy, worse quality of life and cardiorespiratory fitness, and increased risk of type 2 diabetes, compared to the general population. Furthermore, the economic burden of mental disorders including depression is evident, and it is expected to increase to more than double by 2030. Therefore, reducing the growing burden of mental disorders such as depression should be a health priority. Improved prevention and treatment are two key factors that may reduce the burden of depression. Pharmacological- and psychotherapy-based interventions have been traditionally considered for treating depression disorders; however, there is an increasing amount of scientific evidence confirming that physical activity and physical exercise should be highly considered in prevention and treatment of depressive disorders. In this chapter, we aim to summarize and discuss the research progress of physical activity and exercise in prevention and treatment of depressive disorder. Specifically, we summarized and discussed the research progress of the prognostic use of physical activity for incident depression, the importance of sedentary behavior and other outcomes typically improved by physical activity/exercise such as cardiorespiratory fitness for future depression, the research progress of the evidence of the benefits of exercise in people with depression disorders, the resistance training effects in adults and older adults with depression, and the recommendations for the prescription of exercise for people with depression.

Exercise and Schizophrenia

Schizophrenia is a psychiatric disorder characterized by distortions of thinking and perception, with no strictly pathognomonic symptoms that can be divided into positive, negative, and cognitive symptom domains. People with schizophrenia have, between others, a reduced life expectancy and cardiorespiratory and muscular fitness and increased risk of cardiovascular disease, metabolic syndrome, obesity, hypertension, and hyperlipidemia compared to the general population. Furthermore, the economic burden of mental disorders including schizophrenia is evident and it is expected to increase to more than double by 2030. Therefore, reducing the growing burden of mental disorders such as schizophrenia should be a health priority. Improved prevention and treatment are two key factors that may reduce the burden of schizophrenia. Pharmacological- and psychotherapy-based interventions have been traditionally considered for treating schizophrenia disorders; however, there is an increasing amount of scientific evidence confirming that physical activity and physical exercise should be highly considered in prevention and treatment of schizophrenia disorders. In this chapter, we aim to summarize and discuss the research progress of physical activity and exercise in prevention and treatment of schizophrenia disorder. Specifically, we summarized and discussed the research progress of the prognostic use of physical activity for incident schizophrenia; the importance of other outcomes typically improved by physical activity/exercise such as obesity and fitness (cardiorespiratory and muscular fitness) for future schizophrenia; the research progress of the evidence of the benefits of exercise in people with schizophrenia disorders differentiating between effects of exercise on varied health outcomes, cognitive functioning, and cardiorespiratory fitness; and finally the clinical practice recommendations.

Sedentary Behavior, Exercise, and Cardiovascular Health

Sedentary behavior and physical inactivity are among the leading modifiable risk factors worldwide for cardiovascular disease and all-cause mortality. The promotion of physical activity and exercise training (ET) leading to improved levels of cardiorespiratory fitness is needed in all age groups, race, and ethnicities and both sexes to prevent many chronic diseases, especially cardiovascular disease. In this state-of-the-art review, we discuss the negative impact of sedentary behavior and physical inactivity, as well as the beneficial effects of physical activity /ET and cardiorespiratory fitness for the prevention of chronic noncommunicable diseases, including cardiovascular disease. We review the prognostic utility of cardiorespiratory fitness compared with obesity and the metabolic syndrome, as well as the increase of physical activity /ET for patients with heart failure as a therapeutic strategy, and ET dosing. Greater efforts at preventing sedentary behavior and physical inactivity while promoting physical activity, ET, and cardiorespiratory fitness are needed throughout the healthcare system worldwide and particularly in the United States in which the burden of cardiometabolic diseases remains extremely high.

Association between redox state of human serum albumin and exercise capacity in older women: A cross-sectional study

AIM

Oxidative stress plays a key role in declining exercise capacity, which is one of the major health problems in old age. The redox state of human serum albumin (HSA) has been considered a biomarker reflecting oxidative stress; however, its relationship to exercise capacity in older people remains to be examined. We aimed to examine the redox state of HSA as a potential biomarker of exercise capacity in community-dwelling older women.

METHODS

We analyzed 125 women aged ≥75 years. Exercise capacity was evaluated using 6-min walk distance (6MWD). The redox state of HSA was analyzed using the high-performance liquid chromatography post-column bromocresol green reaction method. The fraction of human mercaptalbumin in HSA (f[HMA]) was considered the redox state of HSA. Pearson's correlation coefficient (r) or Spearman's correlation coefficient (ρ) was used to assess correlations between 6MWD, f(HMA) and HSA. The association between 6MWD and f(HMA) was further examined using multivariate linear regression analysis adjusted for age, diabetes mellitus, renal function, number of medications, HSA and knee extensor isometric strength.

RESULTS

The 6MWD was significantly correlated with f(HMA; ρ = 0.44, P < 0.001), but not with HSA (r = 0.05, P = 0.562). The f(HMA) was not significantly correlated with HSA (ρ = 0.03, P = 0.769). Multivariate linear regression analysis showed that f(HMA) was independently associated with 6MWD (standardized β = 0.27, P = 0.004).

CONCLUSIONS

The findings of this study suggest that f(HMA) might serve as a novel biomarker for exercise capacity in community-dwelling older women. Geriatr Gerontol Int 2019; ••: ••-••.

Criterion validity of the Ekblom-Bak and the Åstrand submaximal test in an elderly population

Purpose

The aim of this study was to validate the submaximal Ekblom-Bak test (EB-test) and the Åstrand test (Å-test) for an elderly population.

Methods

Participants (n = 104), aged 65–75 years, completed a submaximal aerobic test on a cycle ergometer followed by an individually adjusted indirect calorimetry VO₂max test on a treadmill. The HR from the submaximal test was used to estimate VO₂max using both the EB-test and Å-test equations.

Results

The correlation between measured and estimated VO₂max using the EB method and Å method in women was r = 0.64 and r = 0.58, respectively and in men r = 0.44 and r = 0.44, respectively. In women, the mean difference between estimated and measured VO₂max was − 0.02 L min⁻¹ (95% CI − 0.08 to 0.04) for the EB method and − 0.12 L min⁻¹ (95% CI − 0.22 to − 0.02) for the Å method. Corresponding values for men were 0.05 L min⁻¹ (95% CI − 0.04 to 0.14) and − 0.28 L min⁻¹ (95% CI − 0.42 to − 0.14), respectively. However, the EB method was found to overestimate VO₂max in men with low fitness and the Å method was found to underestimate VO₂max in both women and men. For women, the coefficient of variance was 11.1%, when using the EB method and 19.8% when using the Å method. Corresponding values for men were 11.6% and 18.9%, respectively.

Conclusion

The submaximal EB-test is valid for estimating VO₂max in elderly women, but not in all elderly men. The Å-test is not valid for estimating VO₂max in the elderly.

Electronic supplementary material

The online version of this article (10.1007/s00421-019-04275-7) contains supplementary material, which is available to authorized users.

Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis

Background

High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living.

Objective

We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults.

Methods

We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment.

Results

Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness.

Conclusions

mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.

Lifestyle Interventions with a Focus on Nutritional Strategies to Increase Cardiorespiratory Fitness in Chronic Obstructive Pulmonary Disease, Heart Failure, Obesity, Sarcopenia, and Frailty

Cardiorespiratory fitness (CRF) is an independent predictor for all-cause and disease-specific morbidity and mortality. CRF is a modifiable risk factor, and exercise training and increased physical activity, as well as targeted medical therapies, can improve CRF. Although nutrition is a modifiable risk factor for chronic noncommunicable diseases, little is known about the effect of dietary patterns and specific nutrients on modifying CRF. This review focuses specifically on trials that implemented dietary supplementation, modified dietary pattern, or enacted caloric restriction, with and without exercise training interventions, and subsequently measured the effect on peak oxygen consumption (VO₂) or surrogate measures of CRF and functional capacity. Populations selected for this review are those recognized to have a reduced CRF, such as chronic obstructive pulmonary disease, heart failure, obesity, sarcopenia, and frailty. We then summarize the state of existing knowledge and explore future directions of study in disease states recently recognized to have an abnormal CRF.

Marital status, telomere length and cardiovascular disease risk in a Swedish prospective cohort

OBJECTIVE

To investigate if marital status is associated with risk of cardiovascular disease (CVD) and to explore the potential influence of leucocyte telomere length (LTL), a marker of biological ageing, on such association.

DESIGN

Population-based prospective cohort study SETTINGS: Swedish Twin Registry.

PARTICIPANTS

Based on the Screening Across the Lifespan Twin Study from the Swedish Twin Registry, we included 10 058 twins born between 1900 and 1958 who underwent an interview between 1998 and 2002 during which information about marital status was collected. Blood samples from these participants were subsequently collected between 2004 and 2008 and used for LTL assessment using quantitative PCR technique.

MAIN OUTCOME MEASURES

Incident cases of CVD were identified through the Swedish Patient Register and Causes of Death Register through December 31, 2016. Multivariable linear regression and Cox proportional hazards regression models were used to estimate the regression coefficients (βs) and HRs with 95% CIs respectively. Potential confounders included age, sex, educational attainment and body mass index.

RESULTS

A total of 2010 participants were diagnosed with CVD during a median follow-up of 9.8 years. LTL was shorter among individuals living singly, including those who were divorced or separated (β:-0.014, 95% CI: -0.035, 0.007), widowed (β:-0.035, 95% CI: -0.061, -0.010), or living alone (β:-0.033, 95% CI: -0.052, -0.014), than individuals who were married or cohabitating. One SD increase of LTL was associated with a lower risk of CVD (HR: 0.79, 95% CI: 0.66, 0.93). Individuals who were divorced or separated, widowed, or living alone had a higher risk of CVD than individuals who were married or cohabitating. The summary HR of CVD was 1.21 (95% CI: 1.08, 1.35) when comparing individuals who were living singly, regardless of reason, with the individuals who were married or cohabitating. LTL appeared to mediate little of the association between marital status and CVD (HR additionally adjusted for LTL: 1.20; 95% CI: 1.08, 1.34).

CONCLUSIONS

Living singly, regardless of reason, was associated with a shorter LTL and a higher risk of CVD. The association between marital status and CVD was however not greatly attributable to telomere shortening.

Promoting physical activity in primary and secondary prevention

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Effects of Physical Activity, Exercise, and Fitness on Obesity-Related Morbidity and Mortality

Obesity is associated with increased prevalence of cardiovascular (CV) disease (CVD) risk factors, which may adversely impact CV structure and function and may increase the prevalence of most CVD, particularly heart failure (HF) and coronary heart disease (CHD). Physical activity (PA), exercise training (ET) and cardiorespiratory fitness (CRF) are all associated with marked reductions in most CVD, including HF and CHD. Additionally, PA/ET and, especially CRF, markedly alter the relationship between adiposity and subsequent major CVD outcomes and dramatically impact the "obesity paradox," which are all reviewed, including attention to the debate regarding "fitness versus fatness" for long-term prognosis, including in patients with established CVD.

Dietary inflammatory index and prevalence of overweight and obesity in Brazilian graduates from the Cohort of Universities of Minas Gerais (CUME project)

OBJECTIVES

The aim of this study was to evaluate the independent association of the dietary inflammatory index (DII®) score with overweight and obesity in Brazilian participants of the Cohort of Universities of Minas Gerais (CUME project).

METHODS

This was a cross-sectional study consisting of 3,151 graduates and postgraduates (2197 women) with a mean (SD) age of 36.3 y (±9.4 y). Sociodemographic characteristics, lifestyle, and anthropometric data were assessed via online self-reported questionnaire. Additionally, a validated food frequency questionnaire with 144 food items was used to generate energy-adjusted DII (E-DII^TM) scores, which evaluated the inflammatory potential of the diet.

RESULTS

The prevalence of overweight and obesity were 28.2% and 11%, respectively. Participants in the highest E-DII quartile (most proinflammatory diet) were more likely to be smokers/former smokers; sedentary; and consumers of red and ultra-processed meats, fats and oils (excluding olive oil), bottled fruit juices and soft drinks, sugars, sweets, and higher overall caloric intake, compared with the first quartile of E-DII. Both men and women in the fourth E-DII quartile had the highest prevalence of overweight and obesity (prevalence ratio [PR], 1.35; 95% confidence interval [CI], 1.14-1.59 and PR, 1.97; 95% CI, 1.20-3.22, respectively, in men; PR, 1.38; 95% CI, 1.17 to 1.65 and PR, 1.95; 95% CI, 1.31-2.90, respectively, in women).

CONCLUSION

The most proinflammatory dietary pattern was associated with a higher prevalence of overweight and obesity and other unhealthy lifestyles including being sedentary, smoking, and consuming a obesogenic diet.

Pilates Method Improves Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis

Cardiorespiratory fitness has been postulated as an independent predictor of several chronic diseases. We aimed to estimate the effect of Pilates on improving cardiorespiratory fitness and to explore whether this effect could be modified by a participant's health condition or by baseline VO2 max levels. We searched databases from inception to September 2019. Data were pooled using a random effects model. The Cochrane risk of bias (RoB 2.0) tool and the Quality Assessment Tool for Quantitative Studies were performed. The primary outcome was cardiorespiratory fitness measured by VO2 max. The search identified 527 potential studies of which 10 studies were included in the systematic review and 9 in the meta-analysis. The meta-analysis showed that Pilates increased VO2 max, with an effect size (ES) = 0.57 (95% CI: 0.15-1; I2 = 63.5%, p = 0.018) for the Pilates group vs. the control and ES = 0.51 (95% CI: 0.26-0.76; I2 = 67%, p = 0.002) for Pilates pre-post effect. The estimates of the pooled ES were similar in both sensitivity and subgroup analyses; however, random-effects meta-regressions based on baseline VO2 max were significant. Pilates improves cardiorespiratory fitness regardless of the population's health status. Therefore, it may be an efficacious alternative for both the healthy population and patients suffering from specific disorders to achieve evidenced-based results from cardiorespiratory and neuromotor exercises.

Increase in Physical Activity After Bariatric Surgery Demonstrates Improvement in Weight Loss and Cardiorespiratory Fitness

Background

Low cardiorespiratory fitness is strongly associated with cardiovascular diseases and mortality. Although increased physical activity can improve cardiorespiratory fitness, this relationship has not been examined in a large bariatric population undergoing perioperative care focusing on long-term lifestyle change.

Objectives

To evaluate changes in physical activity, weight loss, and cardiorespiratory fitness up to 24 months after bariatric surgery, and to evaluate the relationships of change in physical activity with weight loss and change in cardiorespiratory fitness.

Materials and Methods

Four thousand seven hundred eighty-five patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy between January 2012 and December 2014 were included. Physical activity was assessed by the Baecke questionnaire (work, leisure, and sport activity) and cardiorespiratory fitness, defined as VO₂max relative to fat-free mass (VO₂max/FFM), was assessed by the Åstrand test.

Results

Twenty-four months postoperative, significant improvements were seen in sport and leisure activity assessments (n = 3548, P < 0.001), weight loss (n = 3695, P < 0.001), and VO₂max/FFM (n = 1852, P < 0.001). Furthermore, regression analysis showed that change in leisure activity was positively associated with weight loss (n = 3535, ß = 1.352, P < 0.001) and change in sport activity was positively associated with change in VO₂max/FFM (n = 1743, ß = 1.730, P < 0.001).

Conclusion

Bariatric surgery complemented by a comprehensive bariatric care program can lead to improvement in physical activity, as well as weight loss and improvement in cardiorespiratory fitness. The positive associations of change in leisure activity with weight loss and change in sport activity with cardiorespiratory fitness suggest that bariatric care programs can enhance postoperative outcomes by improving the patient’s physical activity.

Physical Activity Practice and Healthy Lifestyles Related to Resting Heart Rate in Health Sciences First-Year Students

The expression lifestyle describes a frame of expressed behaviors, usually in the form of patterns of consumption, that defines how an individual or social group fits into society. It presents as a focus of interest by researchers in this field, who classically favor the study of alcohol consumption, tobacco, eating habits, and physical activity. The aim of this study was to identify the relationship between physical activity and healthy lifestyles, especially in terms of eating habits, tobacco, alcohol consumption, resting habits, and resting heart rate (RHR) in Health Sciences first-year students. A total of 177 students of both genders participated, of whom 31 (17.5%) were male and 146 (82.5%) were female, with a mean age of 20.20 years, from 18 to 30 years. The data collection instrument used was the Healthy Lifestyle Questionnaire (EVS), using SPSS 21.0 for descriptive statistics and the Cronbach α to evaluate the internal consistency of the questionnaires. A level of significance was adopted with a margin of error of 5% for a probability of at least 95% using the Kolmogorov-Smirnov technique and Mann-Whitney test for comparisons between practitioners’ students and genders. The results obtained demonstrate more favorable results in all variables in students practicing physical activity with significant differences in eating habits and RHR. In terms of gender, there were significant differences in all variables except for eating habits. We conclude that students practicing physical activity present more favorable results in terms of lifestyles combined with lower RHR values, considered as positive factors in terms of quality of life.

Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A 'call to action' from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology

The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of 'big data' and the use of animal models could help unravel inter-individual responses to exercise parameters and thus influence hypothesis-building for translational research in exercise-based cardiovascular rehabilitation.

Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults

The aim was to investigate sex- and age-specific associations between cardiorespiratory fitness, all-cause and cause-specific mortality, and cardiovascular disease (CVD) morbidity. 266.109 participants (47% women, 18-74 years) free from CVD, participating in occupational health service screenings in 1995-2015 were included. CRF was assessed as estimated maximal oxygen consumption (estVO₂max) using a submaximal cycle test. Incident cases of first-time CVD event and death from any cause were ascertained through national registers. There were 4244 CVD events and 2750 cases of all-cause mortality during mean 7.6 years follow-up. Male gender, higher age and lower estVO₂max were associated with higher all-cause mortality and CVD morbidity incidence rates. Risk reductions with increasing estVO₂max were present in all age-groups of men and women. No obvious levelling off in risk was identified in the total cohort. However, women and older age-groups showed no further reduction in higher aggregated estVO₂max levels. CVD specific mortality was more associated with estVO₂max compared to tumor specific mortality. The risk for all-cause mortality and CVD morbidity decreased by 2.3% and 2.6% per increase in 1 ml·min^-1·kg^-1 with no significant sex-differences but more pronounced in the three lower estVO₂max categories for all-cause mortality (9.1%, 3.8% and 3.3%, respectively). High compared to lower levels of estVO₂max was not related to a significantly elevated mortality or morbidity. In this large cohort study, CVD morbidity and all-cause mortality were inversely related to estVO₂max in both men and women of all age-groups. Increasing cardiorespiratory fitness is a clear public health priority.