Promoting Physical Activity and Exercise

Personal activity intelligence and mortality - Data from the Aerobics Center Longitudinal Study

IMPORTANCE

Personal activity intelligence (PAI) is a novel activity metric that can be integrated into self-assessment heart rate devices, and translates heart rate variations during exercise into a weekly score. Previous studies relating to PAI have been conducted in the same populations from Norway where the PAI metric has been derived, limiting generalizability of the results.

OBJECTIVE

To test whether PAI is associated with total and cause-specific mortality in a large cohort from the United States.

DESIGN

Aerobics Center Longitudinal Study (ACLS) - a prospective cohort between January 1974 and December 2002 with a mean follow-up of 14.5 years.

SETTING

Population-based.

PARTICIPANTS

56,175 relatively healthy participants (26.5% women) who underwent extensive preventive medical examinations at Cooper Clinic (Dallas, TX).

EXPOSURE

Personal activity intelligence (PAI) score per week was estimated and divided into 4 groups (PAI scores of 0, ≤50, 51-99, and ≥100).

MAIN OUTCOMES AND MEASURES

Total and cause-specific mortality.

RESULTS

During a median follow-up time of 14.9 (interquartile range, 6.7-21.4) years, there were 3434 total deaths including 1258 cardiovascular (CVD) deaths. Compared with the inactive (0 PAI) group, participants with a baseline weekly ≥100 PAI had lower risk of mortality: adjusted hazard ratio (AHR), 0.79: 95% CI, 0.71-0.87 for all-cause mortality, and AHR, 0.72: 95% CI, 0.60-0.87 for CVD mortality among men; AHR, 0.85: 95% CI, 0.64-1.12 for all-cause mortality, and AHR, 0.48: 95% CI, 0.26-0.91 for CVD mortality among women. For deaths from ischemic heart disease (IHD), PAI score ≥100 was associated with lower risk in both men and women (AHR, 0.70: 95% CI, 0.55-0.88). Obtaining ≥100 weekly PAI was also associated with significantly lower risk of CVD mortality in pre-specified age groups, and in participants with known CVD risk factors. Participants with ≥100 weekly PAI gained 4.2 (95% CI, 3.5-4.6) years of life when compared with those who were inactive at baseline.

CONCLUSIONS AND RELEVANCE

PAI is associated with long-term all-cause, CVD, and IHD, mortality. Clinicians and the general population can incorporate PAI recommendations and thresholds in their physical activity prescriptions and weekly physical activity assessments, respectively, to maximize health outcomes.

KEY POINTS

Question: What is the association between personal activity intelligence (PAI), a novel activity metric, and mortality in a large cohort from the United States?

FINDINGS

In this prospective study of 56,175 healthy participants at baseline, followed-up for a mean of 14.5 years, ≥100 PAI score/week was associated with significant 21% lower risk of all-cause and 30% lower risk of CVD mortality in comparison with inactive people. Participants with ≥100 PAI/week lived on average 4.2 years longer compared with inactive. Meaning: PAI is associated with long-term all-cause and CVD mortality. Clinicians and general population may incorporate PAI recommendations into weekly physical activity assessments to maximize CVD prevention.

Sarcopenia, sarcopenic overweight/obesity and risk of cardiovascular disease and cardiac arrhythmia: A cross-sectional study

BACKGROUND

Sarcopenia is an age-dependent skeletal muscle disorder that is common in patients with heart failure. The current study aimed to investigate the associations of sarcopenia with carotid atherosclerosis, cardiovascular disease and cardiac arrhythmia in a middle-aged and elderly population without clinical heart failure.

METHODS

A total of 2432 participants (992 men and 1440 women) from Shanghai Changfeng Study were included for analysis. The degree of sarcopenia was measured using height-adjusted appendicular skeletal muscle mass (ASM/height²). Carotid plaques were detected by carotid artery ultrasonography, and myocardial ischemia, infarction and cardiac arrhythmia were diagnosed based on electrocardiogram, past history and clinical manifestations.

RESULTS

Sarcopenia was associated with higher prevalence of carotid atherosclerosis (26.4% vs 20.4%, P = 0.027), myocardial infarction (4.0% vs 1.1%, P = 0.001), and premature ventricular contraction (4.0% vs 2.0%, P = 0.034) in the participants with normal body weight, and higher prevalence of carotid atherosclerosis (45.0% vs 31.2%, P = 0.016), myocardial infarction (10.0% vs 4.3%, P = 0.020) and atrial fibrillation (7.5% vs 1.3%, P < 0.001) in those with overweight/obese status. After adjustment for age, gender, cigarette smoking, alcohol drinking, menopausal status in women and other metabolic and inflammatory confounding factors, sarcopenia was independently associated with the risk of myocardial infarction in the whole population, and the risk of atrial fibrillation in the overweight/obese participants (all P < 0.05). Compared with nonsarcopenic lean participants, the risk of myocardial infarction was gradually increased in sarcopenic lean (OR 3.08 [1.28-7.45], P = 0.012) and sarcopenic overweight/obese participants (OR 4.07 [1.31-12.62], P = 0.015). For the atrial fibrillation, the participants with either sarcopenia or overweight/obesity alone showed no higher risk. However, concomitant sarcopenia and overweight/obesity was associated with approximately 5-fold risk of atrial fibrillation (OR 5.68 [1.34-24.12], P = 0.019) after multiple adjustment.

CONCLUSION

Sarcopenia is associated with myocardial infarction and atrial fibrillation in middle-aged and elderly adults without clinical heart failure.

The relationships among the skeletal muscle mass index, cardiorespiratory fitness and the prevalence of coronary artery disease in the elderly population

OBJECTIVE

Few studies have investigated the association between cardiorespiratory fitness (CRF) impairment and coronary artery disease (CAD) and the mediating mechanism. Therefore, we investigated the impact of skeletal muscle mass (SMM) on the relationship between CRF and coronary artery disease (CAD) in elderly people.

METHODS

In this cross-sectional study, 109 elderly patients with coronary artery stenosis ≥50% were included in the CAD group, and 148 patients with coronary artery stenosis <50% were included as controls. Mediation analyses were performed to determine the role of the skeletal muscle index (SMI) in the relationship between CRF and the prevalence of CAD. A receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of CRF markers and the SMI.

RESULTS

The oxygen pulse, VO₂ max, and MET max were significantly associated with the SMI. In the multiple logistic regression analyses, the oxygen pulse and SMI were both independently correlated with the prevalence of CAD. The mediation analyses showed that the SMI affects the relationship between CRF markers (oxygen pulse, VO₂ max, and MET max) and the prevalence of CAD. The receiver operating characteristic (ROC) curve analysis showed that when CRF and the SMI are considered together, the predictive power for CAD is stronger than that of the CRF alone.

CONCLUSION

Enhancing CRF can facilitate improvement in SMM and decrease the prevalence of CAD in the elderly population. The addition of the SMI to CRF markers may increase the predictive value of CAD.

Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease

Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 (p = 0.24) and 0.55 (p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 (p = 0.38) for the intermediate and 0.47 (p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP.

Anxiety disorders in patients with cardiopulmonary diseases: A brief review

This manuscript reviews the current literature involving clinical anxiety and cardiopulmonary disease, considers the hypothesized physiological mechanisms for anxiety, and discusses the use of exercise as a treatment for both anxiety and cardiopulmonary diseases. The literature summary consists of original investigations, meta-analysis, commentaries, and review publications in order to better understand the biological and psychological mechanisms for using exercise as treatment and to provide details specific to cardiopulmonary disease and anxiety management. A gap in the literature exists concerning the anxiolytic effects of exercise as a psychological and physical treatment in cardiopulmonary populations. The findings from this review support further investigation into the use of exercise to ameliorate the burden of anxiety in cardiopulmonary disease patients. This review evaluates the current literature surrounding cardiopulmonary disease and anxiety. A systematic literature search identified articles discussing the prevalence, association, and risk of anxiety in cardiopulmonary patients. Though depression is often studied in this population, recent investigation supports a need for further research regarding anxiety in cardiopulmonary patients. Treatment to manage patients' psychological profile can reduce exacerbations of known disease, reduce hospital readmission, and improve functional capacity, and overall quality of life.

Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: A systematic review and meta-analysis

Resistance training (RT) is a powerful first-line intervention for the management of type 2 diabetes mellitus (T2DM). Nonetheless, the effects of the most frequent RT (hypertrophy training [HT] and muscular endurance training [MERT]) employed for the management of T2DM, and which type of RT might exert superior effects, remain elusive. Thus, this review aims to assess the effects of HT and MERT on glycaemic control, physical fitness, body composition, lipid profile, blood pressure, C-reactive protein, and quality of life in patients with T2DM; to analyse which particular RT is more effective; to assess the effects of general RT; and to identify RT components, characteristics of patients, and medications that could mediate the effects of RT. Randomized controlled trials (RCT) and non-RCT (RT≥ 4 weeks) in adults with T2DM were selected. Both HT and MERT improved HbA1c, insulin levels and sensitivity, muscle strength, body mass index, waist circumference, and fat mass. Additionally, HT improved glucose, cardiorespiratory fitness, fat percentage, lean body mass, lipid profile, systolic blood pressure, and C-reactive protein, and MERT improved weight. Overall, HT and MERT exert beneficial effects well comparable with aerobic training. Both types of RT can be used as potent therapeutic interventions for the management of T2DM depending on patients' limitations/preferences.

Differential relationships between waist circumference and cardiorespiratory fitness among people with and without type 2 diabetes

Adults with type 2 diabetes mellitus tend to exhibit an increased level of central adiposity, augmenting their risk of further non-communicable diseases (NCDs). Importantly, consistent evidence demonstrates a significant, negative association between cardiorespiratory fitness (CRF) and waist circumference (WC). However, no previous studies have investigated differences in these CRF-related reductions in WC between adults with and without diabetes. This study used data from the Aerobic Center for Longitudinal Studies, conducted between 1970 and 2006 among predominately Non-Hispanic White, middle-to-upper class adults in Texas. Quantile regression models were used to estimate CRF-related differences in WC between persons with and without diabetes. Age, height, smoking status and birth cohort served as covariates. The analytic sample included 45901 adults. Significantly larger reductions in WC were observed among adults with diabetes as compared to without diabetes across all WC percentiles. Among males, high CRF levels were associated with significant reductions, as compared to their low-fit counterparts, in WC as large as 21.9 cm for adults without diabetes and as large as 27 cm for adults with diabetes. Among females, high CRF levels were associated with significant reductions, as compared to their low-fit counterparts, in WC as large as 22.3 and 30.0 cm for adults without and with diabetes, respectively. This study demonstrated that higher CRF is associated with significant reductions in WC, with greater magnitudes found among adults with diabetes, especially among the most centrally obese, highlighting the necessity of exercise prescription in this clinical population potentially leading to lower risks of future NCDs.

Effect of cardiac rehabilitation on cognitive function in elderly patients with cardiovascular diseases

BACKGROUND

Cognitive function is an important factor for secondary prevention in elderly patients with cardiovascular diseases. The objective of this study was to evaluate the impact of cardiac rehabilitation (CR) on the improvement of cognitive function.

METHODS

A total of 66 consecutive elderly patients (≥70 years old) with cardiovascular diseases were prospectively enrolled. The change in cognitive function during 6 months was compared between the patients with monthly CR (at least once per month; n = 27) and those without monthly CR (n = 39). Cognitive function was evaluated using the Mini-mental State Examination (MMSE) and Frontal Assessment Battery (FAB).

RESULTS

There was no significant difference in baseline characteristics between the 2 groups. The change in the MMSE score was significantly greater in patients with monthly CR than in those without monthly CR (2.3 ± 0.4 vs. -0.1 ± 0.3 points; p <0.001). Among the MMSE items, the change in temporal orientation and attention and calculation was significantly greater in the monthly CR group than in the non-monthly CR group (0.8 ± 0.7 vs. -0.1 ± 0.8 points [p <0.001] and 1.0 ± 1.5 vs. -0.1 ± 0.1 points [p <0.001], respectively). The general linear model revealed that monthly CR (effect estimate, 1.455; 95% confidence interval, 0.747-2.163; p <0.001) was independently associated with the change in the MMSE score.

CONCLUSIONS

Cognitive function may improve with regular CR. These results might partly explain the efficacy of CR for secondary prevention.

Cardiorespiratory Fitness Is an Independent Predictor of Cardiovascular Morbidity and Mortality and Improves Accuracy of Prediction Models

BACKGROUND

Although cardiorespiratory fitness (CRF) is a strong independent predictor of adverse cardiovascular outcomes, it is not considered as a risk enhancer by current guidelines.

METHODS

We evaluated asymptomatic self-referred adults aged 40 to 79 years of age, free of cardiovascular disease at baseline, who were screened annually and completed baseline exercise stress test. Baseline CRF was dichotomized into 2 groups: low (metabolic equivalents < 8) and high. The primary endpoint was the composite of death, nonfatal acute coronary syndrome, and stroke after excluding subjects diagnosed with metastatic cancer during follow-up.

RESULTS

Study population included 15,445 subjects with median age of 49 years (interquartile range: 44-55). During median follow-up of 8 years 1362 (9%) subjects developed the study endpoint. Kaplan-Meier survival analysis showed that both fitness and atherosclerotic cardiovascular disease (ASCVD) were associated with developing of the study endpoint (P < 0.001 for both). Cox regression model with adjustment for ASCVD risk consistently showed that lower fitness was associated with a significant 23% higher risk to develop the study endpoint (P = 0.001). Continuous net reclassification improvement analysis showed an overall improvement of 11.4% (95% confidence interval, 8%-14.6%; P value < 0.001) in the accuracy of classification when fitness was added to the ASCVD model.

CONCLUSIONS

Low CRF is a strong independent predictor of the cardiovascular morbidity and mortality in asymptomatic adults. Addition of fitness to the pooled cohort ASCVD risk significantly improves the accuracy of the model.

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.

COVID-19 immune system and exercise

COVID-19, which became a current issue as a result of the pneumonia cases with unknown etiology in Wuhan City, Hubei Province of China on December 31, 2019, has started to spread throughout the world and deaths related to it have increased rapidly. Isolation, which is an important step in the control of this disease, has many physiological and psychological effects. Initiating a sudden quarantine situation means a radical change in the lifestyle of the population. Changing lifestyles and behaviours may result in insufficient levels of physical activity and inadequate movement, which increases the risk of developing conditions such as diabetes, hypertension, cardiovascular diseases and respiratory diseases. During quarantine, it is essential to stay active and maintain a physical exercise routine for mental and physical health. It is very important people should continue their active lives at home so that their lifestyles do not change and their health conditions do not deteriorate. The aim of the study is to determine the exercises that can be done during the COVID-19 outbreak and the points to be considered during the exercises. ​Extended English summary is in the end of Full Text PDF (TURKISH) file.   Özet Çin’in Hubei Eyaleti, Vuhan Şehrinde, 31 Aralık 2019’da etiyolojisi bilinmeyenpnömoni vakaları ile gündeme gelen COVID-19 dünyaya yayılmaya başlamış ve buna bağlı ölümler hızla artmıştır. Bu hastalığın kontrolünde önemli basamak olan izolasyonun fizyolojik ve psikolojik birçok etkisi vardır. Ani bir karantina durumunun başlatılması, nüfusun yaşam tarzında radikal bir değişiklik anlamına gelmektedir. Değişen yaşam biçimleri ve davranışları, yetersiz fiziksel aktivite seviyesi ve yetersiz hareket ile sonuçlanabilir ve bu durum diyabet, hipertansiyon, kardiyovasküler hastalıklar, solunum yolu hastalıkları gibi durumların oluşma riskini artırır. Karantina sırasında, zihinsel ve fiziksel sağlık için aktif kalmak ve fiziksel bir egzersiz rutini korumak esastır. İnsanların yaşam tarzlarının değişmemesi ve sağlıklarının bozulmaması için evde aktif yaşama devam etmeleri çok önemlidir. Yapılan çalışmanın amacı, COVID-19 salgını esnasında yapılabilecek egzersizler ve egzersiz esnasında dikkat edilmesi gereken hususların belirtilmesidir.

Physical activity and risk of cardiovascular disease by weight status among U.S adults

PURPOSE

We sought to determine whether the association between physical activity and 10-year cardiovascular disease (CVD) risk varies among normal weight, overweight, and obese adults in a nationally-representative sample of the United States.

METHODS

Data were from the National Health and Nutrition Examination Survey 2007-2016. A subset of 22,476 participants aged 30-64 years was included with no CVD history. Physical activity level was self-reported and stratified into sedentary (0 min/week), inactive (1-149 mins/week), or active (≥150 mins/week) of moderate or vigorous activities. Framingham risk scores were classified as low/intermediate (<20%) or high 10-year CVD risk (≥20%).

RESULTS

The average age of the population was 45.9 years, 52.3% were female, 33.6% were overweight (BMI 25.0-29.9kg/m2), and 35.7% were obese (BMI≥30kg/m2). Individuals who were overweight and obese had a higher 10-year CVD risk compared to those with normal weight (9.5 vs. 10.1 vs. 6.3%, P<0.001). The association of physical activity and high 10-year CVD risk differed by weight status. Among overweight and obese adults, individuals engaged in any physical activity had lower odds ofhigh 10-year CVD risk compared to sedentary individuals (overweight: OR active = 0.48, 95% CI: 0.36-0.64; OR inactive = 0.53, 95% CI: 0.45-0.86; obese: OR active = 0.50, 95% CI: 0.37-0.68; OR inactive = 0.66, 95% CI: 0.49-0.89). Among normal weight adults, individuals who were physically active had lower odds of high 10-year CVD risk (OR = 0.59, 95% CI: 0.28-0.87). When compared the joint effects of physical activity level and weight status, physical activity was associated with a larger magnitude of reduced odds of 10-year CVD risk than weight status.

CONCLUSION

Participation in any level of physical activity is associated with a lower 10-year CVD risk for overweight and obese adults. Future studies are needed to identify effective modes and doses of exercise that offer optimal CVD benefits for populations with different weight statuses.

Exercise capacity, physical activity, and health-related quality of life in adults with CHD

OBJECTIVES

The aim of this study was to assess exercise capacity, physical activity, and health-related quality of life within a broad and unselected group of adults with CHD.

DESIGN

From April 2009 to February 2014, 1310 patients were assessed for suitability to participate in this single-centre cross-sectional study. Seven hundred and forty-seven (57%) patients were included, performed a submaximal bicycle test, and answered questionnaires regarding physical activity and health-related quality of life. Exercise capacity, physical activity, and health-related quality of life were compared with reference values and correlations were studied.

RESULTS

The exercise capacities of men and women with CHD were 58.7 and 66.3%, respectively, of reference values. Approximately, 20-25% of the patients did not achieve the recommended amount of physical activity. In addition, men scored significantly less points on 7 out of 10 scales of health-related quality of life and women in 6 out of 10 scales, compared with reference values. The strongest correlation was between exercise capacity and the Short Form-36 (physical function).

CONCLUSIONS

Exercise capacity was impaired in all adults with CHD, including those with less complicated CHD. One-quarter of the patients did not achieve the recommended levels of physical activity. Exercise tests followed by individualised exercise prescriptions may be offered to all patients with CHD aiming to increase exercise capacity, levels of physical activity, improve health-related quality of life, and reduce the risk of acquired life-style diseases.

The obesity epidemic - Nature via nurture: A narrative review of high-income countries

Over the last three decades, the prevalence of obesity has increased rapidly in populations around the world. Despite a wealth of research, the relative contributions of the different mechanisms underlying this global epidemic are not fully understood. While there is growing consensus that the rapid rise in obesity prevalence has been driven by changes to the environment, it is evident that biology plays a central role in determining who develops obesity and who remains lean in the current obesogenic environment. This review summarises evidence on the extent to which genes and the environment influence energy intake and energy expenditure, and as a result, contribute to the ongoing global obesity epidemic. The concept of genetic susceptibility to the environment driving human variation in body weight is discussed.

Association of Intensive Lifestyle Intervention, Fitness, and Body Mass Index With Risk of Heart Failure in Overweight or Obese Adults With Type 2 Diabetes Mellitus: An Analysis From the Look AHEAD Trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) is associated with a higher risk for heart failure (HF). The impact of a lifestyle intervention and changes in cardiorespiratory fitness (CRF) and body mass index on risk for HF is not well established.

METHODS

Participants from the Look AHEAD trial (Action for Health in Diabetes) without prevalent HF were included. Time-to-event analyses were used to compare the risk of incident HF between the intensive lifestyle intervention and diabetes support and education groups. The associations of baseline measures of CRF estimated from a maximal treadmill test, body mass index, and longitudinal changes in these parameters with risk of HF were evaluated with multivariable adjusted Cox models.

RESULTS

Among the 5109 trial participants, there was no significant difference in the risk of incident HF (n=257) between the intensive lifestyle intervention and the diabetes support and education groups (hazard ratio, 0.96 [95% CI, 0.75-1.23]) over a median follow-up of 12.4 years. In the most adjusted Cox models, the risk of HF was 39% and 62% lower among moderate fit (tertile 2: hazard ratio, 0.61 [95% CI, 0.44-0.83]) and high fit (tertile 3: hazard ratio, 0.38 [95% CI, 0.24-0.59]) groups, respectively (referent group: low fit, tertile 1). Among HF subtypes, after adjustment for traditional cardiovascular risk factors and interval incidence of myocardial infarction, baseline CRF was not significantly associated with risk of incident HF with reduced ejection fraction. In contrast, the risk of incident HF with preserved ejection fraction was 40% lower in the moderate fit group and 77% lower in the high fit group. Baseline body mass index also was not associated with risk of incident HF, HF with preserved ejection fraction, or HF with reduced ejection fraction after adjustment for CRF and traditional cardiovascular risk factors. Among participants with repeat CRF assessments (n=3902), improvements in CRF and weight loss over a 4-year follow-up were significantly associated with lower risk of HF (hazard ratio per 10% increase in CRF, 0.90 [95% CI, 0.82-0.99]; per 10% decrease in body mass index, 0.80 [95% CI, 0.69-0.94]).

CONCLUSIONS

Among participants with type 2 diabetes mellitus in the Look AHEAD trial, the intensive lifestyle intervention did not appear to modify the risk of HF. Higher baseline CRF and sustained improvements in CRF and weight loss were associated with lower risk of HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00017953.

Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial

OBJECTIVE

To establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS).

METHODS

The study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4-9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded.

RESULTS

Overall, 235 patients with ACS (median age 76 (73-81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70-90) vs 70 (50-80) points, p<0.001 and at 1 year 75 (70-87) vs 65 (50-80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04).

CONCLUSIONS

The proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit.

TRIAL REGISTRATION NUMBER

NCT03021044.

Effects of resveratrol or estradiol on postexercise endothelial function in estrogen-deficient postmenopausal women

Regular exercise enhances endothelial function in older men, but not consistently in estrogen-deficient postmenopausal women. Estradiol treatment improves basal endothelial function and restores improvements in endothelial function (flow-mediated dilation, FMD) to aerobic exercise training in postmenopausal women; however, estradiol treatment is controversial. Resveratrol, an estrogen receptor ligand, enhances exercise training effects on cardiovascular function and nitric oxide (NO) release in animal models, but impairs exercise training effects in men. We conducted a randomized cross-over, double-blinded, placebo-controlled pilot study to determine whether acute (single dose) resveratrol (250-mg tablet) or estradiol (0.05 mg/day transdermal patch) treatment enhances FMD at rest and after a single bout of moderate-intensity aerobic exercise in healthy estrogen-deficient postmenopausal women (n = 15, 58.1 ± 3.2 yr). FMD was measured before and after (30, 60, and 120 min) a 40-min bout of moderate-intensity treadmill exercise (60-75% peak heart rate) under the respective conditions (separated by 1-2 wk). FMD was higher (P < 0.05) before exercise and at all post-exercise time points in the resveratrol and estradiol conditions compared to placebo. FMD was increased from baseline by 120 min postexercise in the estradiol condition (P < 0.001), but not resveratrol or PL conditions. Consistent with our previous findings, estradiol also enhances endothelial function in response to acute endurance exercise. Although resveratrol improved basal FMD, there was no apparent enhancement of FMD to acute exercise and, therefore, may not act as an estradiol mimetic.NEW & NOTEWORTHY The benefits of endurance exercise training on endothelial function are diminished in estrogen-deficient postmenopausal women, but estradiol treatment appears to restore improvements in endothelial function in this group. We show that basal endothelial function is enhanced with both acute estradiol and resveratrol treatments in estrogen-deficient postmenopausal women, but endothelial function is only enhanced following acute endurance exercise with estradiol treatment.

Re-evaluating the causes and consequences of non-resolving inflammation in chronic cardiovascular disease

Cardiac injuries, like heart attacks, drive the secondary pathology with advanced heart failure. In this process, non-resolving inflammation is a prime component of accelerated cardiovascular disease and subsequent fatal events associated with imbalanced diet, physical inactivity, disrupted circadian rhythms, neuro-hormonal stress, and poly- or co-medication. Laboratory rodents have established that splenic leukocyte-directed resolution mechanisms are essential for cardiac repair after injury. Here, we discuss the impact of three lifestyle-related factors that are prime causes of derailed cardiac healing, putative non-resolving inflammation-resolution mechanisms in cardiovascular diseases, and progressive heart failure after cardiac injury. The presented review resurfaces the lifestyle-related risks and future research directions required to understand the molecular and cellular mechanisms between the causes of cardiovascular disease and their related consequences of non-resolving inflammation.

Association of Changes in Physical Activity and Incidence and Remission of Overall and Abdominal Obesity in 113,950 Adults

OBJECTIVE

This study examined the dose-response relationship between changes in physical activity (PA) and subsequent incidence or remission of overall and abdominal obesity.

METHODS

A total of 113,950 healthy individuals aged ≥ 18 years participating in the Taiwan MJ Cohort were included. Two-year changes in PA between the first and second examination were linked to subsequent development and remission of overall and abdominal obesity.

RESULTS

During a mean 5.6-year follow-up after the second examination, 9,991 and 11,488 individuals developed overall and abdominal obesity, respectively; also, 3,588 and 3,156 participants with obesity lost sufficient weight or reduced their waist circumference to be classified as nonobese. Compared with no changes in PA, the multivariable hazard ratio (95% CI) of overall obesity was 0.95 (0.90-1.00) for a PA increase of 0.01 to 3.74 metabolic equivalent hours (MET-h) per week and 0.86 (0.80-0.91) for a PA increase of ≥ 3.75 MET-h per week. Corresponding values for remission of obesity were 1.00 (0.91-1.09) and 1.16 (1.05-1.28). Similar results were observed for the development and remission of abdominal obesity. Any decrease in PA was not associated with the risk of obesity outcomes when compared with a stable pattern (0 MET-h/week).

CONCLUSIONS

Increasing PA was consistently associated with a progressively lower incidence and higher remission of overall and abdominal obesity.

Impact of sex and myocardial function on association of obesity with mortality in Asian patients with acute heart failure: a retrospective analysis from the STRATS-AHF registry

OBJECTIVES

Impact of sex and myocardial function on the obesity paradox in heart failure (HF) is unknown. We explored whether sex, myocardial function, and left ventricular (LV) geometry explains the protective association of body mass index (BMI) with mortality, and investigated whether metabolic health status affects this association.

DESIGN

A multicentre cohort study with patients with acute HF admitted from January 2009 to December 2016 with a median follow-up of 33.7 months.

SETTING

Three tertiary hospitals.

PARTICIPANTS

A total of 2021 overweight-to-obese (OW) and 1543 normal-weight (NW) patients with acute HF.

MEASUREMENTS

The primary outcome was all-cause mortality. Patients were categorised as either OW (BMI≥23kg/m²) or NW (BMI<23kg/m²). BMI was used as both categorical and continuous variables. Clinical, laboratory and echocardiographic measures, including LV global longitudinal strain (LV-GLS), LV-ejection fraction, LV geometry, were obtained.

RESULTS

During the follow-up period, 1392 patients died (685 OW and 707 NW). BMI was significantly associated with mortality in univariate (HR=0.929 per kg/m², p<0.001) and multivariate analyses (HR=0.954 per kg/m², p<0.001). In multivariable fractional polynomials, higher BMIs were associated with lower mortality overall and in subgroups by sex, LV-GLS and LV geometry, with a steeper association in men (p-interaction <0.001). In women, there were significant interactions of BMI with LV-GLS (p-interaction=0.044) and age (p-interaction=0.040) for mortality; the protective association of BMI with mortality was confined to subgroups with high LV-GLS (>10.1%) or elderly patients (≥75 years). In men, this association was found in all subgroups without significant interaction. Metabolically healthy obese patients had better survival than metabolically unhealthy obese patients (log-rank p<0.001).

CONCLUSIONS

In women, a significant interaction was observed between BMI and age or LV-GLS in association with mortality, suggesting that sex, ageing and myocardial dysfunction can affect the magnitude of the obesity paradox in HF. Metabolic health status provides prognostic information beyond obesity status.

TRIAL REGISTRATION NUMBER

Registry: ClinicalTrials.gov Number: NCT03513653 (https://clinicaltrials.gov/ct2/show/NCT03513653).

Sex-related differences in self-care behaviors of adults with type 2 diabetes mellitus

PURPOSE

To describe sex-related differences in self-care; to identify determinants of self-care according to sex, and to investigate how sex interacts with the effect of clinical and socio-demographic variables on self-care in adults with Type 2 Diabetes Mellitus (T2DM).

METHODS

Cross-sectional multicentre study with a consecutive sampling recruitment strategy, enrolling 540 adults with T2DM at six outpatient diabetes services. Clinical and socio-demographic variables were collected by medical records. Self-care maintenance, monitoring, management, and confidence were measured by the self-care of diabetes inventory.

RESULTS

Females reported higher disease prevention behaviors (P < 0.001), health-promoting behaviors (P < 0.001), body listening (P < 0.001), and symptom recognition (P = 0.010), but lower health-promoting exercise behaviors (P < 0.001). Determinants of self-care were different in male and female patients, where the role of task-specific self-care confidence predicted self-care monitoring (RR = 0.98; P < 0.001) and management (RR = 0.99; P < 0.001) among males, while persistence self-care confidence predicted self-care maintenance (RR = 0.97; P = 0.016) and management (RR = 0.99; P = 0.009) among females.

CONCLUSIONS

Males and females differently perform self-care. Self-care confidence plays a different role predicting self-care behaviors in males and females. Future research should longitudinally describe self-care and its determinants in males and females with T2DM. Sex-specific self-care confidence interventions should be developed to improve self-care in male and female patients with T2DM.

Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.

The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly

Worldwide, elderly people have a higher prevalence of myocardial infarction (MI), which is associated with body function aging and a sedentary lifestyle. In addition to medication, exercise training is a well-established supplementary method to prevent and treat cardiovascular diseases (CVDs). Substantial evidence has shown the value of different intensity exercise programs in the prevention and treatment of MI, and exercise rehabilitation programs are also applicable to elderly patients with MI. Although exercise rehabilitation programs could significantly improve function, quality of life (QoL), and lower mortality and morbidity for people with MI, such programs are underused because their mechanisms are not accurately elucidated. To promote the application of exercise therapy for MI, this review summarizes the benefits and mechanisms of exercise rehabilitation for post-MI patients and provides rationalized proposals for outpatient cardiac rehabilitation.

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.

Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults

Objective

Aim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity.

Research design and methods

The prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate.

Results

After ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m2, which differed by ~0.5 kg/m2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI.

Conclusions

Among Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.

The Effects of Varying Structured Physical Activity Duration on Young Children's and Parents' Activity Levels

Purpose: The purpose of this study was to examine whether structured physical activity (PA) in a family-based community exercise program affects PA of young children and parents. Method: Twenty-two children (mean ± SD; age, 4.9 ± 2.1 years) and their parents (age, 34.3 ± 7.6 years) participated in unstructured PA sessions followed by either short- or long-duration structured PA sessions, while wearing an ActiGraph GT9X activity monitor on their right hip to estimate PA. Independent t-tests compared children's and parents' PA during short- and long-structured PA sessions. Paired t-tests compared short- versus long-structured PA sessions. A mixed model ANOVA compared PA during unstructured versus structured sessions and between children and parents. Results: Children spent proportionately more time in moderate-to-vigorous PA (MVPA) and had higher accelerometer counts/min than parents during short-structured PA (children:60.9 ± 18.8% vs. parents:17.7 ± 6.8%, children:3870 ± 742 vs. parents:1836 ± 556 counts/min, p < .05) and long-structured PA (children:61.1 ± 20.1% vs. parents:12.6 ± 4.9%, children:3415 ± 758 vs. parents:1604 ± 633 counts/min, p < .05). No statistical differences were found between short- and long-structured PA sessions for proportion of time spent in MVPA or counts/min for children or parents (all, p > .05). Children spent proportionally more time in MVPA and had higher counts/min during unstructured PA compared to structured PA (unstructured MVPA:54.4 ± 3.9% vs. structured MVPA:38.2 ± 4.2%, unstructured counts/min:3830 ± 222 vs. structured counts/min:2768 ± 239 counts/min; p < .05). Conclusions: Children were more active than parents during both the unstructured and structured PA sessions. However, unstructured PA sessions resulted in 63-77% and 10-11% of PA recommendations for children and adults, respectively. Family-based exercise programming can provide an opportunity for children and their parents to attain MVPA during the week.

Physical activity without weight loss reduces the development of cardiovascular disease risk factors - a prospective cohort study of more than one hundred thousand adults

PURPOSE

Whether physical activity (PA) might have certain benefits for cardiovascular disease (CVD) primordial prevention even in the absence of clinically significant weight loss is of public health interest. In this study, we examined the independent and combined associations of simultaneous changes in PA and body weight with the subsequent development of major CVD risk factors in adults.

METHODS

This prospective analysis included 116,134 healthy men and women, aged ≥18 years, with at least 3 medical examinations from the Taiwan MJ Cohort. Two-year changes in PA and body weight between the first and second examination were linked to subsequent development of hypertension, hypercholesterolemia, atherogenic dyslipidemia, metabolic syndrome, type 2 diabetes mellitus (T2DM), and chronic inflammation, which were assessed by physical examinations and laboratory tests.

RESULTS

During an average follow-up of 5.7 ± 4.1 years after the second examination, 10,840 individuals developed hypertension, 10,888 hypercholesterolemia, 6078 atherogenic dyslipidemia, 13,223 metabolic syndrome, 4816 T2DM, and 2027 inflammation. Weight gain was associated with a subsequent higher risk of all CVD risk factors, with HR (95%CI) ranging from 1.11 (1.00-1.23) for inflammation to 1.74 (1.67-1.82) for metabolic syndrome, compared with participants who lost weight. A stable weight was also associated with a higher risk of all CVD risk factors except with inflammation. In combined analyses, participants who simultaneously gained weight and decreased PA levels had the highest risk compared with those who lost weight and increased PA. Increasing or maintaining PA reduced the increased subsequent risk of some CVD risk factors among participants who maintained a stable weight or gained weight. Among participants who lost weight, decreased PA was not associated with an increased risk.

CONCLUSIONS

Although weight loss is crucial for the prevention of CVD risk factors, increasing or maintaining PA is also important to prevent them among adults who gain or maintain their weight.

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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Mortality risk comparing walking pace to handgrip strength and a healthy lifestyle: A UK Biobank study

AIMS

Brisk walking and a greater muscle strength have been associated with a longer life; whether these associations are influenced by other lifestyle behaviours, however, is less well known.

METHODS

Information on usual walking pace (self-defined as slow, steady/average, or brisk), dynamometer-assessed handgrip strength, lifestyle behaviours (physical activity, TV viewing, diet, alcohol intake, sleep and smoking) and body mass index was collected at baseline in 450,888 UK Biobank study participants. We estimated 10-year standardised survival for individual and combined lifestyle behaviours and body mass index across levels of walking pace and handgrip strength.

RESULTS

Over a median follow-up of 7.0 years, 3808 (1.6%) deaths in women and 6783 (3.2%) in men occurred. Brisk walkers had a survival advantage over slow walkers, irrespective of the degree of engagement in other lifestyle behaviours, except for smoking. Estimated 10-year survival was higher in brisk walkers who otherwise engaged in an unhealthy lifestyle compared to slow walkers who engaged in an otherwise healthy lifestyle: 97.1% (95% confidence interval: 96.9-97.3) vs 95.0% (94.6-95.4) in women; 94.8% (94.7-95.0) vs 93.7% (93.3-94.2) in men. Body mass index modified the association between walking pace and survival in men, with the largest survival benefits of brisk walking observed in underweight participants. Compared to walking pace, for handgrip strength there was more overlap in 10-year survival across lifestyle behaviours.

CONCLUSION

Except for smoking, brisk walkers with an otherwise unhealthy lifestyle have a lower mortality risk than slow walkers with an otherwise healthy lifestyle.

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.

Complex Determinants of Work Ability in Adults With Congenital Heart Disease and Implications for Clinical Practice

BACKGROUND

"Work ability" is the employees' capacity to meet the demands of their job. As more patients with complex congenital heart disease (CHD) are now reaching adulthood, we assessed work ability and factors impacting livelihood in adult CHD.

METHODS

The work ability index (WAI) questionnaire and patient health questionnaire-9 (PHQ-9) were administered at 2 Midwest adult CHD centres from February 2017 to 2018.

RESULTS

Of the 267 participants (n = 157 males, 59%) with an average age of 35 ± 13 years, the majority (n = 204, 76%) were employed. Patients with complex CHD (n = 103, 39%) were less likely to have enrolled in college or completed a graduate degree (P = 0.0115), and more likely to have an annual income of < $50,000 (P = 0.0056) and lower WAI scores (P = 0.0026) than patients with simple and moderate CHD. Unemployed patients (n = 63, 24%) with complex CHD (n = 27, 43%) were more likely to have higher PHQ-9 scores (P = 0.0242) indicating mild, moderate, or severe depression (P = 0.0482) than unemployed patients with simple and moderate CHD. Patients with complex CHD had lower self-perception of work ability compared with patients with simple and moderate CHD (P = 0.0007). Finally, patients in NYHA Functional Class I had higher WAI scores than NYHA Class III-IV (P < 0.0001).

CONCLUSIONS

This study demonstrates that employed patients with complex CHD have lower education level, income, and work ability. Unemployed patients are more likely to exhibit symptoms of depression and have low self-perception of work ability. Occupational health programs focusing on promoting general health perception, increasing exercise capacity, and improving psychosocial health must be considered to improve work ability in patients with adult CHD to maintain livelihood.

Association between body mass index and fitness in Korean adults according to the lump mean value and Gaussian fitting

The aim of this study was to determine the body mass index (BMI) for the best fitness and effective exercise. This study analyzed data from the Korean national fitness assessment by the Korea Institute of Sport Science (2017). The fitness tests considered were sit-up, standing long jump (SLJ), 20-m multi-stage shuttle run (20-m MSSR), and 10-m shuttle run (10-m SR) tests. The BMIs for the best fitness and widths of the fitness distributions were calculated using the lump mean value and Gaussian fitting. The values of BMI (kg/m²) associated with the best sit-up, SLJ, 20-m MSSR, and 10-m SR scores were 23.4, 22.6, 22.2, and 22.6 for males and 19.0, 18.5, 18.6, and 18.6 for females. The widths (kg/m²) of the sit-up, SLJ, 20-m MSSR, and 10-m SR distributions were 3.65, 3.42, 3.73, and 2.86 for males and 4.84, 4.88, 4.45, and 4.35 for females. The results show that the BMI can be reduced the most and fitness can be increased effectively by the 20-m MSSR for males and the SLJ for females, which could be used to establish personal exercise aims.

Physical Activity and Risk of Metabolic Phenotypes of Obesity: A Prospective Taiwanese Cohort Study in More Than 200,000 Adults

OBJECTIVE

To examine the association between physical activity (PA) and the risk for metabolically unhealthy obesity (MUO) or metabolically healthy obesity (MHO) in Asian adults.

PATIENTS AND METHODS

Data were obtained from 205,745 healthy individuals 18 years or older. Individuals were classified as inactive, lower or upper insufficiently active, active, and high active. Metabolically unhealthy was defined as having 1 or more of the metabolic syndrome criteria, excluding the abdominal obesity criterion.

RESULTS

The percentages of metabolically healthy normal-weight (MHNW), metabolically healthy overweight (MHOW), MHO, and MUO in our cohort were 30.8% (63,408 of 205,745), 5.8% (12,002 of 205,745), 4.1% (8329 of 205,745), and 20.7% (42,564 of 205,745), respectively. During a mean follow-up of 6 (range, 0.5-19) years, among 63,408 MHNW participants, 1890 (3.0%) and 1174 (1.9%) developed MUO and MHO, respectively. Among 12,002 MHOW participants, 3404 (28.4%) developed MUO and 2734 (22.8%) developed MHO. A total of 5506 of 8329 (66.1%) participants moved from MHO to MUO, and 5675 of 42,564 (13.3%) moved from MUO to MHO. Compared with being inactive, MHNW individuals who were active or high active showed lower risk for MUO. Among those with MHOW, being high active was associated with reduced risk for MUO and MHO. Although among MHO participants, PA was not associated with incident MUO, being active or high active was linked to a greater likelihood of moving from MUO to MHO.

CONCLUSION

PA may prevent the development of both MHO and MUO. PA also helps increase the transition from MUO to MHO, which may contribute to reduce the subsequent development of type 2 diabetes mellitus and major cardiovascular disease complications.