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Imboden MT, Harber MP, Whaley MH, Finch WH, Bishop DL, Kaminsky LA. Cardiorespiratory Fitness and Mortality in Healthy Men and Women. J Am Coll Cardiol 2019; 72:2283-2292. [PMID: 30384883 DOI: 10.1016/j.jacc.2018.08.2166] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a well-established inverse relationship between cardiorespiratory fitness (CRF) and mortality. However, this relationship has almost exclusively been studied using estimated CRF. OBJECTIVES This study aimed to assess the association of directly measured CRF, obtained using cardiopulmonary exercise (CPX) testing with all-cause, cardiovascular disease (CVD), and cancer mortality in apparently healthy men and women. METHODS Participants included 4,137 self-referred apparently healthy adults (2,326 men, 1,811 women; mean age: 42.8 ± 12.2 years) who underwent CPX testing to determine baseline CRF. Participants were followed for 24.2 ± 11.7 years (1.1 to 49.3 years) for mortality. Cox-proportional hazard models were performed to determine the relationship of CRF (ml·kg-1·min-1) and CRF level (low, moderate, and high) with mortality outcomes. RESULTS During follow-up, 727 participants died (524 men, 203 women). CPX-derived CRF was inversely related to all-cause, CVD, and cancer mortality. Low CRF was associated with higher risk for all-cause (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.20 to 3.50), CVD (HR: 2.27; 95% CI: 1.20 to 3.49), and cancer (HR: 2.07; 95% CI: 1.18 to 3.36) mortality compared with high CRF. Further, each metabolic equivalent increment increase in CRF was associated with a 11.6%, 16.1%, and 14.0% reductions in all-cause, CVD, and cancer mortality, respectively. CONCLUSIONS Given the prognostic ability of CPX-derived CRF for all-cause and disease-specific mortality outcomes, its use should be highly considered for apparently healthy populations as it may help to improve the efficacy of the individualized patient risk assessment and guide clinical decisions.
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Affiliation(s)
- Mary T Imboden
- Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana
| | | | - W Holmes Finch
- Department of Educational Psychology, Ball State University, Muncie, Indiana
| | - Derron L Bishop
- School of Medicine, Indiana University, Bloomington, Indiana
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana.
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202
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Bond S, Laddu DR, Ozemek C, Lavie CJ, Arena R. Exergaming and Virtual Reality for Health: Implications for Cardiac Rehabilitation. Curr Probl Cardiol 2019; 46:100472. [PMID: 31606141 DOI: 10.1016/j.cpcardiol.2019.100472] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 12/13/2022]
Abstract
Cardiac Rehabilitation (CR) programs, focused on improving the health trajectory of patients with cardiovascular disease, strive to increase physical activity (PA) and cardiorespiratory fitness. However, historically low compliance with recommended PA has prompted exploration of alternatives to traditional courses of exercise therapy. One alternative, exergaming, or the requirement of physical exercise inherent to a video game's activities, has shown to have a promising impact in improving patient self-efficacy for exercise training using digital hardware (eg, the Wii or the Xbox Kinect). Furthermore, novel technologies in virtual reality can provide an engaging, immersive environment for exergaming techniques, maximizing goal-oriented training and building self-efficacy for patients during CR. Many groundbreaking institutions are already calculating energy expenditure of commercially successful virtual reality games and finding promise in the cardiometabolic responses to a number of virtual reality games. Research is still limited in establishing the efficacy of these games, but virtual reality and exergaming are quickly proving to be appropriate and equivalent alternatives to traditional exercise programs. Though studies have examined the impact of prescriptive exergaming on PA, they have yet to examine the potential for genuine integration of game-based motivational techniques and immersive environments into clinical interaction. The purpose of this review is to describe the current body of evidence and the impact and future potential of virtual reality and exergaming. Further, we will introduce the concept of a "Clinical Arcade" as a new approach to integration of these techniques in CR care.
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203
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Laukkanen JA, Kunutsor SK, Ozemek C, Mäkikallio T, Lee DC, Wisloff U, Lavie CJ. Cross-country skiing and running's association with cardiovascular events and all-cause mortality: A review of the evidence. Prog Cardiovasc Dis 2019; 62:505-514. [PMID: 31505192 DOI: 10.1016/j.pcad.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022]
Abstract
A large body of evidence demonstrates positive, graded effects of PA on cardiovascular disease (CVD) morbidity and mortality with increasing intensity compared with lower PA intensity. Running is often designated as a high-intensity PA with substantial evidence supporting its health benefits. Cross-country skiing is among the most demanding aerobic endurance exercises and requires engaging the upper- and lower-body. Cross-country skiing is often regarded as high-intensity PA, which has been associated with significant health benefits. However, a robust body of evidence identifying the dose-response relation between cross-country skiing volume and health outcomes is sparse. Therefore, this review aims to summarize the available evidence linking cross-country skiing with CVD morbidity and all-cause mortality; postulated pathways that may elucidate the relation between these associations; outline areas of ongoing uncertainty; and the implications for primary and secondary CVD prevention. To put the findings into perspective, we also summarized the evidence linking running with CVD morbidity and all-cause mortality. Though a head-to-head comparison is not available, the evidence indicates that performing PA as cross-country skiing associates with lower mortality risk when compared with that observed in those undertaking their PA as running. Potential adverse effects of extreme high weekly doses of cross-country skiing over decades may be cardiac arrhythmias, such as atrial fibrillation. Evidence suggests that cross-country skiing may reduce the risk of CVD events and all-cause mortality via anti-inflammatory pathways, improvements in endothelial function and reduced levels of CVD risk factors, such as lipids, glucose, and blood pressure; and enhancement of cardiorespiratory fitness.
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Affiliation(s)
- Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Medicine, Central Finland Health Care District, Jyväskylä, Finland.
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Timo Mäkikallio
- Division of Cardiology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Duck-Chul Lee
- Department of Kinesiology, College of Human Sciences, Iowa State University, Ames, IA, USA
| | - Ulrik Wisloff
- Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement & Nutrition Sciences, University of Queensland, Australia
| | - Carl J Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
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Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza JL, Izquierdo M, Ruilope LM, Lucia A. Exercise benefits in cardiovascular disease: beyond attenuation of traditional risk factors. Nat Rev Cardiol 2019; 15:731-743. [PMID: 30115967 DOI: 10.1038/s41569-018-0065-1] [Citation(s) in RCA: 403] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite strong scientific evidence supporting the benefits of regular exercise for the prevention and management of cardiovascular disease (CVD), physical inactivity is highly prevalent worldwide. In addition to merely changing well-known risk factors for systemic CVD, regular exercise can also improve cardiovascular health through non-traditional mechanisms. Understanding the pathways through which exercise influences different physiological systems is important and might yield new therapeutic strategies to target pathophysiological mechanisms in CVD. This Review includes a critical discussion of how regular exercise can have antiatherogenic effects in the vasculature, improve autonomic balance (thereby reducing the risk of malignant arrhythmias), and induce cardioprotection against ischaemia-reperfusion injury, independent of effects on traditional CVD risk factors. This Review also describes how exercise promotes a healthy anti-inflammatory milieu (largely through the release of muscle-derived myokines), stimulates myocardial regeneration, and ameliorates age-related loss of muscle mass and strength, a frequently overlooked non-traditional CVD risk factor. Finally, we discuss how the benefits of exercise might also occur via promotion of a healthy gut microbiota. We argue, therefore, that a holistic view of all body systems is necessary and useful when analysing the role of exercise in cardiovascular health.
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Affiliation(s)
- Carmen Fiuza-Luces
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain. .,CIBER de Enfermedades Raras (CIBERER), Madrid, Spain.
| | - Alejandro Santos-Lozano
- i+HeALTH Research Group, Department of Health Sciences, European University Miguel de Cervantes, Valladolid, Spain.,Research Institute of the Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Michael Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Pedro Carrera-Bastos
- Centre for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Malmö, Sweden.,NutriScience - Education and Consulting, Lisbon, Portugal
| | - Oscar Picazo
- NutriScience - Education and Consulting, Lisbon, Portugal
| | - José L Zugaza
- Achucarro - Basque Center for Neuroscience, Bilbao, Spain.,Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country, Leioa, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES), Navarrabiomed, Pamplona, Spain
| | - Luis M Ruilope
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Research Institute of the Hospital 12 de Octubre (i+12), Madrid, Spain
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Myers J, de Souza E Silva CG, Doom R, Fonda H, Chan K, Kamil-Rosenberg S, Kokkinos P. Cardiorespiratory Fitness and Health Care Costs in Diabetes: The Veterans Exercise Testing Study. Am J Med 2019; 132:1084-1090. [PMID: 31047866 DOI: 10.1016/j.amjmed.2019.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes. METHODS Health care costs were quantified among 3924 consecutive men (mean age 58 ± 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 ± 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 ± 1.5 metabolic equivalents; n = 938), fit (9.4 ± 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 ± 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period. RESULTS Age, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 103) (mean ± standard deviation) that were on average $32,178 and $30,816 lower, respectively, than individuals in the least-fit category. For each 1-metabolic equivalent higher fitness, annual cost savings per person were $5,193 and $3,603 for individuals with and without diabetes, respectively. CONCLUSIONS Higher fitness is associated with lower health care costs. Cost savings associated with higher fitness are particularly evident among individuals with diabetes. The economic burden of diabetes may be reduced through interventions that target improvements in fitness.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Calif; Division of Cardiovascular Medicine, Stanford University, Calif.
| | | | - Rachelle Doom
- Veterans Affairs Palo Alto Health Care System, Calif
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Calif
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Calif
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206
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Imboden MT, Harber MP, Whaley MH, Finch WH, Bishop DA, Fleenor BS, Kaminsky LA. The Influence of Change in Cardiorespiratory Fitness With Short-Term Exercise Training on Mortality Risk From The Ball State Adult Fitness Longitudinal Lifestyle Study. Mayo Clin Proc 2019; 94:1406-1414. [PMID: 31303425 DOI: 10.1016/j.mayocp.2019.01.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/04/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the influence of changes in cardiorespiratory fitness (CRF) after exercise training on mortality risk in a cohort of self-referred, apparently healthy adults. PATIENTS AND METHODS A total of 683 participants (404 men, 279 women; mean age: 42.7±11.0 y) underwent two maximal cardiopulmonary exercise tests (CPX) between March 20, 1970, and December 11, 2012, to assess CRF at baseline (CPX1) and post-exercise training (CPX2). Participants were followed for an average of 29.8±10.7 years after their CPX2. Cox proportional hazards models were performed to determine the relationship of CRF change with mortality, with change in CRF as a continuous variable, as well as a categorical variable. A Wald chi-square test was used to compare the coefficients estimating the relationship of peak oxygen consumption (VO2peak) at CPX1 with VO2peak measured at CPX2 with time until death for all-cause mortality. RESULTS During the follow-up period there were 180 deaths. When assessed independently, there were 20% (95% CI, 10-49%) and 38% (95% CI, 7-66%) lower mortality risks per 1 metabolic equivalent improvement in CRF (P<.01) in men and women, respectively, after multivariable adjustment. Those that remained unfit had ∼2-fold higher risk for all-cause mortality compared with those that remained fit and CRF at CPX2 was a stronger predictor of all-cause mortality than at CPX1 (P=.02). CONCLUSION Improving CRF through exercise training lowers mortality risk. Clinicians should encourage individuals to participate in exercise training to improve CRF to lower risk of mortality.
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207
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Xenophontos S, Wilkinson TJ, Gould DW, Watson EL, Viana JL, Smith AC. Peak aerobic capacity from incremental shuttle walk test in chronic kidney disease. J Ren Care 2019; 45:185-192. [PMID: 31355544 DOI: 10.1111/jorc.12293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Assessment of cardiorespiratory fitness is an important outcome in chronic kidney disease (CKD). We aimed to develop a predictive equation to estimate peak oxygen uptake (VO2peak ) and power output (WPeak ), as measured during a cardiopulmonary exercise test (CPET), from the distance walked (DW) during the incremental shuttle walk test (ISWT). METHODS Thirty-six non-dialysing patients with CKD [17 male, age: 61 ± 12 years, eGFR: 25±7 ml/min/1.73 m2 , body mass index (BMI): 31 ± 6 kg/m2 ] carried out laboratory-based CPET on a cycle ergometer and ISWT on two separate occasions. RESULTS Linear regression revealed that DW/BMI was a significant predictor of VO2Peak (r = 0.78) (VO2Peak (ml/min/kg) = [0.5688 × (DW/BMI) (m)] + 11.50). No difference (p = 0.66) between CPET VO2Peak (19.9 ± 5.5 ml/min/kg) and predicted VO2Peak (19.9 ± 4.3 ml/min/kg) was observed. DW multiplied by body mass (BM) was a significant predictor of WPeak (r = 0.80) [WPeak (W) = (0.0018 × (DW × BM)) + 50.47]. No difference (p = 0.97) between CPET WPeak (116.2 ± 38.9 W) and estimated WPeak (113.9 ± 30.1 W) was seen. CONCLUSION The present study demonstrates that VO2Peak and WPeak can be accurately estimated using the DW during an ISWT in CKD populations.
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Affiliation(s)
- Soteris Xenophontos
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Douglas W Gould
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Emma L Watson
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
| | - João L Viana
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI, Maia, Portugal
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
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208
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Winett RA, Ogletree AM. Evidence-Based, High-Intensity Exercise and Physical Activity for Compressing Morbidity in Older Adults: A Narrative Review. Innov Aging 2019; 3:igz020. [PMID: 31380470 PMCID: PMC6658199 DOI: 10.1093/geroni/igz020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Indexed: 12/12/2022] Open
Abstract
Recent research in exercise science has important applications for middle-aged and older adults and points to how the programming of individual and multicomponent interventions including theory-based health behavior change strategies may be improved to compress morbidity by delaying or reducing the disabling process. High-intensity interval training and sprint interval training until recently were seen as only applicable to athletes. But recent lab-based research has adapted these interventions for even older adults and demonstrated their safety with beneficial outcomes on cardiometabolic risk factors comparable to or surpassing the usual lower- to moderate-intensity endurance training, and their potential translatability by showing the efficacy of much lower duration and frequency of training, even by systematic stair climbing. Moreover, people report positive affect while engaged in such training. For a century, resistance training was conceived as weightlifting with heavy weights required. Recent research has shown that using a higher degree of effort with lighter to moderate resistance in simple, time efficient protocols result in gains in strength and muscle mass similar to heavy resistance, as well as improvement of cardiometabolic risk factors, strength, body composition, and cognitive, affective, and functional abilities. More effort-based resistance training with moderate resistance may make resistance training more appealing and accessible to older adults. A key potential translational finding is that with correct technique and a high degree of effort, training with inexpensive, portable elastic bands, useable virtually anywhere, can provide appreciable benefits. More emphasis should be placed on long-term, translational interventions, resources, and programs that integrate interval and resistance trainings. This work may improve public health programs for middle-aged and older adults and reflects an emerging evidence base.
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Affiliation(s)
| | - Aaron M Ogletree
- Health Research and Evaluation, American Institutes for Research, Washington, District of Columbia
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209
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Structured physical activity interventions as a complementary therapy for patients with inflammatory bowel disease - a scoping review and practical implications. BMC Gastroenterol 2019; 19:115. [PMID: 31266461 PMCID: PMC6604412 DOI: 10.1186/s12876-019-1034-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Patients with Inflammatory Bowel Disease (IBD) also suffer from a wide range of additional disorders, which may be caused by the disease, the side effect of the medication, or a lack of physical activity (PA). This results in reduced physical and psychological wellbeing. However, as known from other chronic diseases exercise could be utilized as supportive therapy for IBD patients. Main goals of this article are (a) collecting data of the effects structured physical activity interventions have on validated clinical parameters of IBD and health related symptoms, (b) developing activity recommendations for this clientele. Methods A scoping review was conducted, searching for relevant articles published until May 2018, which investigated the effects of structured exercise interventions in IBD patients. The heterogeneity of the outcomes and the interventions did not support a quantitative synthesis thus, a qualitative discussion of the studies is provided. Results After reviewing 353 records, 13 eligible articles were identified. Five studies investigated aerobic exercise, three studies resistance exercise, three studies mind-body therapies and two studies yoga. The quality of the studies is mixed, and the duration is rather short for exercise interventions. Only few studies assessed validated IBD activity markers or inflammatory biomarkers. Nevertheless, the patients showed an increase in fitness, bone mineral density (BMD), quality of life and a decrease of IBD induced stress and anxiety. No severe adversial events were reported. Conclusion Even though the evidence is limited the application of exercise interventions in IBD patients can be assumed to be safe and beneficial for the patients‘ overall-health, and IBD specific physical and psychosocial symptoms. But there is still a high demand for more thoroughly conducted studies, focussing on important clinical outcome parameters.
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211
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Paluch AE, Pool LR, Isakova T, Lewis CE, Mehta R, Schreiner PJ, Sidney S, Wolf M, Carnethon MR. Association of Fitness With Racial Differences in Chronic Kidney Disease. Am J Prev Med 2019; 57:68-76. [PMID: 31122794 PMCID: PMC6589135 DOI: 10.1016/j.amepre.2019.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Non-white minorities are at higher risk for chronic kidney disease than non-Hispanic whites. Better cardiorespiratory fitness is associated with slower declines in estimated glomerular filtration rate and a lower incidence of chronic kidney disease. Little is known regarding associations of fitness with racial disparities in chronic kidney disease. METHODS A prospective cohort of 3,842 young adults without chronic kidney disease completed a maximal treadmill test at baseline in 1985-1986. Chronic kidney disease status was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 during 10-, 15-, 20-, 25-, and 30-year follow-up assessments (through 2006). Analyses were completed in 2019. Multivariable Cox models were used to determine hazard ratios and 95% CI for incidence of chronic kidney disease. Multivariable models included race, gender, age, field center, education, baseline estimated glomerular filtration rate, and time-varying covariates of healthy diet index, smoking status, alcohol intake, BMI, systolic blood pressure, and fasting glucose. Percent attenuation quantified the association of fitness to racial disparities in chronic kidney disease. RESULTS Chronic kidney disease incidence was higher among blacks (n=83/1,941, 1.61 per 1,000 person years) than whites (43/1,901, 0.82 per 1,000 person years). Every 1-minute shorter treadmill duration was associated with 1.14 (95% CI=1.04, 1.25) times higher risk of chronic kidney disease. Blacks were 1.72 (95% CI=1.13, 2.63) times more likely to develop chronic kidney disease compared with whites. The risk was reduced to 1.54 (95% CI=1.01, 2.39) with fitness added. This suggests that fitness is associated with 20.4% (95% CI=5.8, 43.0%) of the excess risk of chronic kidney disease attributable to race. CONCLUSIONS Low fitness is a modifiable factor that may contribute to the racial disparity in chronic kidney disease.
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Affiliation(s)
- Amanda E Paluch
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rupal Mehta
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Can physical activity ameliorate immunosenescence and thereby reduce age-related multi-morbidity? Nat Rev Immunol 2019; 19:563-572. [DOI: 10.1038/s41577-019-0177-9] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Oldridge N, Pakosh M, Grace SL. A systematic review of recent cardiac rehabilitation meta-analyses in patients with coronary heart disease or heart failure. Future Cardiol 2019; 15:227-249. [PMID: 31161796 DOI: 10.2217/fca-2018-0085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: The aim of the project was to conduct a systematic review of meta-analyses of supervised, home-based or telemedicine-based exercise cardiac rehabilitation (CR) published between July 2011 and April 2018. Materials & methods: Evidence on mortality, hospitalization, peak VO2, exercise capacity, muscle strength and health-related quality of life in patients with coronary heart disease or heart failure referred to CR was obtained by searching six electronic databases. Results: Of the 127 point estimates identified in the 30 CR meta-analyses identified (mortality, n = 12; hospitalization, n = 11; VO2, n = 40; exercise capacity, n = 20; strength, n = 18; health-related quality of life, n = 26), 60% were statistically significant and 35% clinically important. Conclusion: The statistical data are sufficiently robust to promote strategies to improve referral to and participation in CR although evidence for clinical importance needs to be further investigated.
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Affiliation(s)
- Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Maureen Pakosh
- University Health Network, Toronto Rehabilitation - Rumsey Cardiac Centre Library, Toronto, ON, Canada
| | - Sherry L Grace
- School of Kinesiology & Health Science, York University, & University Health Network Toronto, ON, Canada
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Extreme Physical Activity May Increase Coronary Calcification, But Fitness Still Prevails. Mayo Clin Proc Innov Qual Outcomes 2019; 3:103-105. [PMID: 31193848 PMCID: PMC6543500 DOI: 10.1016/j.mayocpiqo.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Association of physical activity and fitness with S-Klotho plasma levels in middle-aged sedentary adults: The FIT-AGEING study. Maturitas 2019; 123:25-31. [DOI: 10.1016/j.maturitas.2019.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
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Ghosh S, Hota M, Chai X, Kiranya J, Ghosh P, He Z, Ruiz-Ramie JJ, Sarzynski MA, Bouchard C. Exploring the underlying biology of intrinsic cardiorespiratory fitness through integrative analysis of genomic variants and muscle gene expression profiling. J Appl Physiol (1985) 2019; 126:1292-1314. [PMID: 30605401 PMCID: PMC6589809 DOI: 10.1152/japplphysiol.00035.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 11/02/2018] [Accepted: 12/09/2018] [Indexed: 12/22/2022] Open
Abstract
Intrinsic cardiorespiratory fitness (CRF) is defined as the level of CRF in the sedentary state. There are large individual differences in intrinsic CRF among sedentary adults. The physiology of variability in CRF has received much attention, but little is known about the genetic and molecular mechanisms that impact intrinsic CRF. These issues were explored in the present study by interrogating intrinsic CRF-associated DNA sequence variation and skeletal muscle gene expression data from the HERITAGE Family Study through an integrative bioinformatics guided approach. A combined analytic strategy involving genetic association, pathway enrichment, tissue-specific network structure, cis-regulatory genome effects, and expression quantitative trait loci was used to select and rank genes through a variation-adjusted weighted ranking scheme. Prioritized genes were further interrogated for corroborative evidence from knockout mouse phenotypes and relevant physiological traits from the HERITAGE cohort. The mean intrinsic V̇o2max was 33.1 ml O2·kg-1·min-1 (SD = 8.8) for the sample of 493 sedentary adults. Suggestive evidence was found for gene loci related to cardiovascular physiology (ATE1, CASQ2, NOTO, and SGCG), hematopoiesis (PICALM, SSB, CA9, and CASQ2), skeletal muscle phenotypes (SGCG, DMRT2, ADARB1, and CASQ2), and metabolism (ATE1, PICALM, RAB11FIP5, GBA2, SGCG, PRADC1, ARL6IP5, and CASQ2). Supportive evidence for a role of several of these loci was uncovered via association between DNA variants and muscle gene expression levels with exercise cardiovascular and muscle physiological traits. This initial effort to define the underlying molecular substrates of intrinsic CRF warrants further studies based on appropriate cohorts and study designs, complemented by functional investigations. NEW & NOTEWORTHY Intrinsic cardiorespiratory fitness (CRF) is measured in the sedentary state and is highly variable among sedentary adults. The physiology of variability in intrinsic cardiorespiratory fitness has received much attention, but little is known about the genetic and molecular mechanisms that impact intrinsic CRF. These issues were explored computationally in the present study, with further corroborative evidence obtained from analysis of phenotype data from knockout mouse models and human cardiovascular and skeletal muscle measurements.
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Affiliation(s)
- Sujoy Ghosh
- Human Genomics Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Monalisa Hota
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Xiaoran Chai
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Jencee Kiranya
- Cardiovascular and Metabolic Disorders Program and Centre for Computational Biology, Duke-National University of Singapore Medical School , Singapore
| | - Palash Ghosh
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School , Singapore
| | - Zihong He
- Human Genomics Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
- Department of Biology, China Institute of Sport Science , Beijing , China
| | - Jonathan J Ruiz-Ramie
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Mark A Sarzynski
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina , Columbia, South Carolina
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center , Baton Rouge, Louisiana
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217
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Laukkanen JA, Lavie CJ, Khan H, Kurl S, Kunutsor SK. Cardiorespiratory Fitness and the Risk of Serious Ventricular Arrhythmias: A Prospective Cohort Study. Mayo Clin Proc 2019; 94:833-841. [PMID: 30935710 DOI: 10.1016/j.mayocp.2018.11.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/19/2018] [Accepted: 11/13/2018] [Indexed: 11/20/2022]
Abstract
Cardiorespiratory fitness (CRF) is an established risk factor for cardiovascular disease outcomes. However, the relationship of CRF with risk of ventricular arrhythmias (VAs) is unknown. We aimed to assess the prospective association of CRF with the risk of serious VAs. Cardiorespiratory fitness, as measured by maximal oxygen uptake, was assessed using a respiratory gas exchange analyzer in 2299 middle-aged men in the Kuopio Ischemic Heart Disease prospective cohort. We corrected for within-person variability in CRF levels using data from repeated measurements 11 years apart. During median follow-up of 25.3 years (interquartile range, 18.7-27.2 years), 73 serious VAs were recorded. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI, 0.53-0.64). In analysis adjusted for age, the hazard ratio (HR) for serious VAs per 1-SD increase in CRF was 0.64 (95% CI, 0.49-0.84). The association persisted on additional adjustment for body mass index, systolic blood pressure, history of hypertension, prevalent coronary heart disease, smoking, history of diabetes, cholesterol level, alcohol consumption, and physical activity (HR, 0.67; 95% CI, 0.51-0.88). The corresponding adjusted HRs (95% CIs) were 0.29 (0.14-0.59) and 0.32 (0.15-0.65), respectively, comparing the top vs bottom tertiles. The associations were stronger on correction for regression dilution bias, remained consistent on exclusion of men with a history of coronary heart disease, and did not vary importantly in several relevant clinical subgroups. Cardiorespiratory fitness is inversely associated with future risk of serious VAs, independently of several cardiovascular disease risk factors. Further research is needed to assess the causal relevance of these findings.
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Affiliation(s)
- Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio; Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Central Finland Health Care District Hospital District, Jyväskylä.
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - Hassan Khan
- Division of Cardiology, Emory University, Atlanta, GA
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, and University of Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, UK
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218
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Whelton SP, Dardari Z, Handy Marshall C, Ahmed H, Brawner CA, Ehrman JK, Keteyian SJ, Mallah MA, Blaha MJ. Relation of Isolated Low High-Density Lipoprotein Cholesterol to Mortality and Cardiorespiratory Fitness (from the Henry Ford Exercise Testing Project [FIT Project]). Am J Cardiol 2019; 123:1429-1434. [PMID: 30827489 DOI: 10.1016/j.amjcard.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/28/2019] [Accepted: 02/05/2019] [Indexed: 12/19/2022]
Abstract
Isolated low high-density lipoprotein cholesterol (HDL-C) is associated with lower fitness and increased mortality. Whether the association between isolated low HDL-C and mortality differs by fitness is uncertain. Patients in the Henry Ford ExercIse Testing Project (FIT Project) completed a physician-referred treadmill stress test and those prescribed lipid-lowering medications or with known cardiovascular disease were excluded. Isolated low HDL-C was defined as HDL-C <40 mg/dl for men and <50 mg/dl for women with low-density lipoprotein cholesterol (LDL-C) and triglycerides <100 mg/dl (n = 688). An optimal lipid panel was defined as HDL-C ≥40 mg/dl for men and ≥50 mg/dl for women with LDL-C and triglycerides <100 mg/dl (n = 2,923). Mortality was ascertained through Social Security Death Index linkage. Patients with isolated low HDL-C had a mean age of 48.9 ± 12.9 years and 62.9% were women. Over a mean follow-up of 10.3 ± 5 years, 12.8% of patients with isolated low HDL-C and 8.7% with optimal lipids died. Compared to individuals with optimal lipids, those with isolated low HDL-C who achieved <6 METs had a lower survival (p = 0.02), whereas there was no mortality difference for those who achieved 6 to 10 METs (p = 0.13) or ≥10 METs (p = 0.66). In adjusted Cox models, the mortality hazard for those with isolated low HDL-C compared with optimal lipids was 1.73 (95% confidence interval [CI] 1.18 to 2.54), 1.90 (95% CI 1.19 to 3.04), and 0.97 (95% CI 0.53 to 1.78) for the METS categories of <6, 6 to 10, and ≥10. In conclusion, individuals with isolated low HDL-C fitness significantly improved risk stratification and only those with lower fitness had an increased totality mortality risk.
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219
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The Role of Dietary Patterns in the Contribution of Cardiorespiratory Fitness in Community-Dwelling Older Chinese Adults in Hong Kong. J Am Med Dir Assoc 2019; 20:558-563. [DOI: 10.1016/j.jamda.2018.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022]
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220
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Amaro-Gahete FJ, De-la-O A, Jurado-Fasoli L, Dote-Montero M, Gutiérrez Á, Ruiz JR, Castillo MJ. Changes in Physical Fitness After 12 Weeks of Structured Concurrent Exercise Training, High Intensity Interval Training, or Whole-Body Electromyostimulation Training in Sedentary Middle-Aged Adults: A Randomized Controlled Trial. Front Physiol 2019; 10:451. [PMID: 31105580 PMCID: PMC6492765 DOI: 10.3389/fphys.2019.00451] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
This study aimed to investigate the influence of different exercise training modalities [(i) a concurrent training based on physical activity recommendation from the World Health Organization group (PAR group), (ii) a high intensity interval training group (HIIT group), and (iii) a high intensity interval training adding whole-body electromyostimulation group (WB-EMS group)] on physical fitness in sedentary middle-aged adults. A total of 89 (52.7% women) middle-aged sedentary adults (53.7 ± 5.1 years old) were enrolled in the FIT-AGING study. Cardiorespiratory fitness was determined by a maximum treadmill test using indirect calorimetry. Lower, upper, and core body muscular strength were assessed by an isokinetic strength test, by the handgrip strength test, and by several core strength endurance tests, respectively. All the exercise types induced similar increases on cardiorespiratory fitness (Δ VO2max ≥ 11%, Δ maximal heart rate ≥ 8%, and Δ total test duration ≥ 14%; all P ≤ 0.034), as well as on muscular strength (Δ extension and flexion peak torque ≥ 10%, Δ total hand grip ≥ 3%, Δ core strength endurance tests ≥ 20%; all P ≤ 0.050) compared with a control group. In conclusion, our results suggest that a 12-week structured exercise intervention improves physical fitness regardless of the training program in sedentary middle-aged adults. Despite slightly greater improvements in some physical fitness variables, the changes observed in the WB-EMS group were not superior to the other exercise programs.
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Affiliation(s)
- Francisco J Amaro-Gahete
- EFFECTS-262 Research Group, Departament of Medical Physiology, School of Medicine, University of Granada, Granada, Spain.,Promoting Fitness and Health Through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Alejandro De-la-O
- EFFECTS-262 Research Group, Departament of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Lucas Jurado-Fasoli
- EFFECTS-262 Research Group, Departament of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Manuel Dote-Montero
- EFFECTS-262 Research Group, Departament of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Ángel Gutiérrez
- EFFECTS-262 Research Group, Departament of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
| | - Jonatan R Ruiz
- Promoting Fitness and Health Through Physical Activity Research Group (PROFITH), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Manuel J Castillo
- EFFECTS-262 Research Group, Departament of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
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221
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Bueno-Antequera J, Oviedo-Caro MÁ, Munguía-Izquierdo D. Feasibility and effects of an exercise-based intervention in prison inmates with psychiatric disorders: the PsychiActive project randomized controlled trial. Clin Rehabil 2019; 33:1661-1671. [PMID: 31018684 DOI: 10.1177/0269215519845133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the feasibility and effects of a 12-week intervention combining aerobic and strength exercises in prison inmates with psychiatric disorders. DESIGN Two parallel-group, randomized controlled trials. SETTING A psychiatric prison hospital. SUBJECTS Forty-one men prison inmates (mean age ± SD = 38.2 ± 9.2 years, mean prison duration ± SD = 2.6 ± 2.5 years) with psychiatric disorders (primarily personality disorder, n = 27; mean illness duration ± SD = 12.0 ± 10.5 years). INTERVENTIONS Participants were randomly allocated to intervention group consisted of exercise plus usual care (n = 21) or control group which received usual care (n = 20) for 12 weeks. The exercise programme included three weekly sessions of group-based moderate-to-high intensity combined exercises designed and supervised by exercise professionals. MAIN MEASURES Fitness and anthropometric measures were assessed using field-based tests (6-minute walk, Incremental Shuttle Walk, Arm-Curl, and Chair-Stand), handgrip dynamometry, bioelectrical impedance, and waist and hip circumferences. RESULTS There were no adverse events, and 10 intervention participants withdrew. The remaining 11 participants attended a mean of 28 sessions, of which nine met the compliance criteria. Between-group change differences substantially favoured the compliance intervention group for the 6-minute walk (+21.2%), Incremental Shuttle Walk (+33.9%), Arm-Curl (+13.8%), waist (-3.5%), waist/height0.5 (-1.7%) (-2.7%), waist/hip (-3.4%), and Body Shape Index (-3.3%) (-3.5%). Additional analysis showed beneficial effects of exercise participation on handgrip strength. CONCLUSION The intervention was safe, had a high dropout rate, and seemed to be effective for improving fitness and anthropometric measures in men prison inmates with psychiatric disorders who attended and participated in the exercise sessions.
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Affiliation(s)
- Javier Bueno-Antequera
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain.,Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain
| | - Miguel Ángel Oviedo-Caro
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain.,Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain
| | - Diego Munguía-Izquierdo
- Physical Performance & Sports Research Center, Department of Sports and Computer Science, Section of Physical Education and Sports, Faculty of Sports Sciences, Universidad Pablo de Olavide, Seville, Spain.,Research Group in Development Movimiento Humano, Universidad de Zaragoza, Zaragoza, Spain.,Biomedical Research Networking Center on Frailty and Healthy Aging, Madrid, Spain
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222
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Liff MH, Hoff M, Fremo T, Wisløff U, Thomas R, Videm V. Cardiorespiratory fitness in patients with rheumatoid arthritis is associated with the patient global assessment but not with objective measurements of disease activity. RMD Open 2019; 5:e000912. [PMID: 31168415 PMCID: PMC6525607 DOI: 10.1136/rmdopen-2019-000912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/14/2019] [Accepted: 03/28/2019] [Indexed: 11/04/2022] Open
Abstract
Objective Patients with rheumatoid arthritis (RA) suffer from more cardiovascular disease (CVD), and develop cardiovascular risk factors at an earlier age than the general population. Cardiorespiratory fitness (CRF) is an important predictor of cardiovascular health. There are few data regarding CRF of RA patients, measured as peak oxygen uptake (VO2peak) by the gold standard method; cardiopulmonary exercise testing. We compared CRF in RA patients to those from a healthy population, and investigated if risk factors for CVD and RA-specific variables including subjective and objective disease activity measures were associated with CRF in RA patients. Methods VO2peak tests of RA patients (n=93) were compared to those of an age-matched and gender-matched healthy population (n=4631) from the Nord-Trøndelag Health Study. Predictors of VO2peak were found using Lasso (least absolute shrinkage and selection operator) regression, followed by standardised multiple linear regression. Results Women with RA ≥40 years and men with RA aged 40-49 years or 60-69 years had up to 20% lower CRF than the healthy population in the same age groups. By relative importance, body mass index (standardised coefficient=-0.25, p<0.001), physical activity level (coefficient=0.21, p<0.001), patient global assessment (PGA; coefficient=-0.14, p=0.006), systolic blood pressure (coefficient=-0.12, p=0.016), resting heart rate (coefficient=-0.11, p=0.032) and smoking (coefficient=-0.10, p=0.046) were significant predictors of CRF (R2=0.82, gender-adjusted and age-adjusted). Conclusion CRF in RA patients was lower than in a healthy population. CRF was associated with common risk factors for CVD and the PGA score. Focusing on fitness in RA patients may improve cardiovascular health.
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Affiliation(s)
- Marthe Halsan Liff
- Department of Rheumatology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Hoff
- Department of Neuromedicine and Movement Science/Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, St. Olavs University Hospital, Trondheim, Norway
| | - Thomas Fremo
- Department of Circulation and Medical Imaging, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Ranjeny Thomas
- Translational Research Institute, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - Vibeke Videm
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St. Olavs University Hospital, Trondheim, Norway
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223
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Myers J, Fonda H, Vasanawala M, Chung K, Segall G, Chan K, Nguyen P. PCI Alternative Using Sustained Exercise (PAUSE): Rationale and trial design. Contemp Clin Trials 2019; 79:37-43. [PMID: 30797041 DOI: 10.1016/j.cct.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) currently claims nearly one million lives yearly in the US, accounting for nearly 40% of all deaths. Coronary artery disease (CAD) accounts for the largest number of these deaths. While efforts aimed at treating CAD in recent decades have concentrated on surgical and catheter-based interventions, limited resources have been directed toward prevention and rehabilitation. CAD is commonly treated using percutaneous coronary intervention (PCI), and this treatment has increased exponentially since its adoption over three decades ago. Recent questions have been raised regarding the cost-effectiveness of PCI, the extent to which PCI is overused, and whether selected patients may benefit from optimal medical therapy in lieu of PCI. One alternative therapy that has been shown to improve outcomes in CAD is exercise therapy; exercise programs have been shown to have numerous physiological benefits, and a growing number of studies have demonstrated reductions in mortality. Given the high volume of PCI, its high cost, its lack of effect on survival and the potential for alternative treatments including exercise, the current study is termed "PCI Alternative Using Sustained Exercise" (PAUSE). The primary aim of PAUSE is to determine whether patients randomized to exercise and lifestyle intervention have greater improvement in coronary function and anatomy compared to those randomized to PCI. Coronary function and anatomy is determined using positron emission tomography combined with computed tomographic angiography (PET/CTA). Our objective is to demonstrate the utility of a non-invasive technology to document the efficacy of exercise as an alternative treatment strategy to PCI.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America.
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Minal Vasanawala
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Kieran Chung
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - George Segall
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Patricia Nguyen
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
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224
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Muntaner-Mas A, Martinez-Nicolas A, Lavie CJ, Blair SN, Ross R, Arena R, Ortega FB. A Systematic Review of Fitness Apps and Their Potential Clinical and Sports Utility for Objective and Remote Assessment of Cardiorespiratory Fitness. Sports Med 2019; 49:587-600. [PMID: 30825094 PMCID: PMC6422959 DOI: 10.1007/s40279-019-01084-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) assessment provides key information regarding general health status that has high clinical utility. In addition, in the sports setting, CRF testing is needed to establish a baseline level, prescribe an individualized training program and monitor improvement in athletic performance. As such, the assessment of CRF has both clinical and sports utility. Technological advancements have led to increased digitization within healthcare and athletics. Nevertheless, further investigation is needed to enhance the validity and reliability of existing fitness apps for CRF assessment in both contexts. OBJECTIVES The present review aimed to (1) systematically review the scientific literature, examining the validity and reliability of apps designed for CRF assessment; and (2) systematically review and qualitatively score available fitness apps in the two main app markets. Lastly, this systematic review outlines evidence-based practical recommendations for developing future apps that measure CRF. DATA SOURCES The following sources were searched for relevant studies: PubMed, Web of Science®, ScopusTM, and SPORTDiscus, and data was also found within app markets (Google Play and the App Store). STUDY ELIGIBILITY CRITERIA Eligible scientific studies examined the validity and/or reliability of apps for assessing CRF through a field-based fitness test. Criteria for the app markets involved apps that estimated CRF. STUDY APPRAISAL AND SYNTHESIS METHODS The scientific literature search included four major electronic databases and the timeframe was set between 01 January 2000 and 31 October 2018. A total of 2796 articles were identified using a set of fitness-related terms, of which five articles were finally selected and included in this review. The app market search was undertaken by introducing keywords into the search engine of each app market without specified search categories. A total of 691 apps were identified using a set of fitness-related terms, of which 88 apps were finally included in the quantitative and qualitative synthesis. RESULTS Five studies focused on the scientific validity of fitness tests with apps, while only two of these focused on reliability. Four studies used a sub-maximal fitness test via apps. Out of the scientific apps reviewed, the SA-6MWTapp showed the best validity against a criterion measure (r = 0.88), whilst the InterWalk app showed the highest test-retest reliability (ICC range 0.85-0.86). LIMITATIONS Levels of evidence based on scientific validity/reliability of apps and on commercial apps could not be robustly determined due to the limited number of studies identified in the literature and the low-to-moderate quality of commercial apps. CONCLUSIONS The results from this scientific review showed that few apps have been empirically tested, and among those that have, not all were valid or reliable. In addition, commercial apps were of low-to-moderate quality, suggesting that their potential for assessing CRF has yet to be realized. Lastly, this manuscript has identified evidence-based practical recommendations that apps might potentially offer to objectively and remotely assess CRF as a complementary tool to traditional methods in the clinical and sports settings.
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Affiliation(s)
- Adrià Muntaner-Mas
- GICAFE "Physical Activity and Exercise Sciences Research Group", University of Balearic Islands, Balearic Islands, Spain.
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
| | - Antonio Martinez-Nicolas
- Chronobiology Research Group, Department of Physiology, Faculty of Biology, University of Murcia, Campus Mare Nostrum, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine in New Orleans, New Orleans, LA, USA
| | - Steven N Blair
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Robert Ross
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden
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225
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Ross R, Goodpaster BH, Koch LG, Sarzynski MA, Kohrt WM, Johannsen NM, Skinner JS, Castro A, Irving BA, Noland RC, Sparks LM, Spielmann G, Day AG, Pitsch W, Hopkins WG, Bouchard C. Precision exercise medicine: understanding exercise response variability. Br J Sports Med 2019; 53:1141-1153. [PMID: 30862704 PMCID: PMC6818669 DOI: 10.1136/bjsports-2018-100328] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
There is evidence from human twin and family studies as well as mouse and rat selection experiments that there are considerable interindividual differences in the response of cardiorespiratory fitness (CRF) and other cardiometabolic traits to a given exercise programme dose. We developed this consensus statement on exercise response variability following a symposium dedicated to this topic. There is strong evidence from both animal and human studies that exercise training doses lead to variable responses. A genetic component contributes to exercise training response variability. In this consensus statement, we (1) briefly review the literature on exercise response variability and the various sources of variations in CRF response to an exercise programme, (2) introduce the key research designs and corresponding statistical models with an emphasis on randomised controlled designs with or without multiple pretests and post-tests, crossover designs and repeated measures designs, (3) discuss advantages and disadvantages of multiple methods of categorising exercise response levels—a topic that is of particular interest for personalised exercise medicine and (4) outline approaches that may identify determinants and modifiers of CRF exercise response. We also summarise gaps in knowledge and recommend future research to better understand exercise response variability.
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Affiliation(s)
- Robert Ross
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA
| | - Lauren G Koch
- Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Mark A Sarzynski
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Wendy M Kohrt
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Neil M Johannsen
- Interventional Resources, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.,School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - James S Skinner
- Department of Kinesiology, Indiana University, Bloomington, Indiana, USA
| | - Alex Castro
- Department of Physical Education, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Brian A Irving
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA.,Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert C Noland
- John S Mcilhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Lauren M Sparks
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA
| | - Guillaume Spielmann
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA.,Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Werner Pitsch
- Economics and Sociology of Sport, Saarland University, Saarbrücken, Saarland, Germany
| | - William G Hopkins
- College of Sport and Exercise Science, Victoria University, Melbourne, Victoria, Australia
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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226
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Pimenta FC, Montrezol FT, Dourado VZ, da Silva LFM, Borba GA, de Oliveira Vieira W, Medeiros A. High-intensity interval exercise promotes post-exercise hypotension of greater magnitude compared to moderate-intensity continuous exercise. Eur J Appl Physiol 2019; 119:1235-1243. [PMID: 30848358 DOI: 10.1007/s00421-019-04114-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Physical exercise is associated with reduced blood pressure (BP). Moderate-intensity continuous exercise (MCE) promotes post-exercise hypotension (PEH), which is highly recommended to hypertensive patients. However, recent studies with high-intensity interval exercise (HIIE) have shown significant results in cardiovascular disease. Thus, this study aimed to analyze PEH in hypertensive subjects submitted to HIIE and compare it to post MCE hypotension. METHODS 20 hypertensive adults (51 ± 8 years), treated with antihypertensive medications, were submitted to two different exercise protocols and a control session. The MCE was performed at 60-70% of VO2 reserve, while HIIE was composed of five bouts of 3 min at 85-95% VO2 reserve with 2 min at 50% of VO2 reserve. The following variables were evaluated during exercise, pre- and post-session: clinical BP, heart rate (HR), double product, perception of effort, body mass, height and body mass index. RESULTS Systolic BP decreased after exercise in both sessions, showing greater decrease after HIIE (- 7 ± 10 and - 11 ± 12 mmHg, after MCE and HIIE, respectively, p ≤ 0.01). Diastolic BP also decreased after both sessions, but there were no significant differences between the two sessions (- 4 ± 8 and - 7 ± 8 mmHg, after MCE and HIIE, respectively). CONCLUSION Both exercise sessions produced PEH, but HIIE generated a greater magnitude of hypotension. The HIIE protocol performed in this study caused a greater cardiovascular stress during exercise; however, it was safe for the studied population and efficient for reducing BP after exercise.
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Affiliation(s)
- Flávia C Pimenta
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Fábio Tanil Montrezol
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, 11015-020, Brazil
| | | | - Gabriela Alves Borba
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil
| | - Wesley de Oliveira Vieira
- Department of Human Movement Sciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, 11015-020, Brazil
| | - Alessandra Medeiros
- Department of Biosciences, Federal University of São Paulo, Rua Silva Jardim, 136, Santos, SP, 11015-020, Brazil.
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227
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Zhao M, Graham I, Cooney MT, Grobbee DE, Vaartjes I, Klipstein-Grobusch K. Determinants of coronary artery disease risk factor management across three world regions. HEART ASIA 2019; 11:e011112. [PMID: 31031827 PMCID: PMC6454324 DOI: 10.1136/heartasia-2018-011112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
Abstract
Background The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD. Methods and results SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region. Conclusions Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
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Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marie Therese Cooney
- St Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Global Geo Health Data Center, Utrecht University, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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228
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Taylor MK, Hernández LM, Schoenherr MR, Stump J. Genetic, Physiologic, and Behavioral Predictors of Cardiorespiratory Fitness in Specialized Military Men. Mil Med 2019; 184:e474-e481. [DOI: 10.1093/milmed/usz033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/18/2018] [Accepted: 02/07/2019] [Indexed: 12/15/2022] Open
Abstract
AbstractIntroductionCardiorespiratory fitness (CRF) is a crucial performance requirement of specialized military occupations. Age and physical activity are established predictors of CRF, but it is not clear how these predictors combine with each other and/or with genetic predisposition. The goal of this study was to derive inclusive explanatory models of CRF in US Navy Explosive Ordnance Disposal (EOD) operators, synthesizing conventional (e.g., age, body composition, and physical activity) and novel influences (e.g., genetic variance).Materials and MethodsIn this cross-sectional study, 40 male, active duty EOD operators completed a graded exercise test to assess maximal oxygen consumption and ventilatory threshold (VT) using the Bruce protocol. Aerobic performance was further quantified via time of test termination and time at which VT was achieved. Body composition was determined via dual x-ray absorptiometry, and physical activity was assessed by self-report. Genetic variants underlying human stress systems (5HTTLPR, BclI, −2 C/G, and COMT) were assayed. Descriptive analyses were conducted to summarize subject characteristics. Hypotheses were tested with linear regression models. Specifically, separate univariate regression models first determined associations between each of the independent and dependent variables. This protocol was approved by the Naval Health Research Center Institutional Review Board (NHRC.2015.0013).ResultsIn univariate regression models, age, body composition, physical activity, and 5HTTLPR consistently predicted CRF and/or aerobic performance (R2 range 0.07–0.55). Multivariate regression models routinely outperformed the univariate models, explaining 36–62% of variance.ConclusionThis study signifies a shift toward inclusive explanatory models of CRF and aerobic performance, accounting for combined roles of genetic, physiologic, and behavioral influences. Although we were able to quantify combined effects, we were unable to evaluate interaction effects (e.g., gene–gene, gene–behavior) due to limited statistical power. Other limitations are that this specialized military population may not readily generalize to broader populations, and the current sample was all male. Considering these limitations, we aim to replicate this study in various populations, both male and female. Despite its limitations, this study reflects a shift toward more comprehensive predictive models of CRF, explaining the unique and shared contributions of genetic predisposition, physiology, and behavior. These findings have implications for assessment, selection, and training of specialized military members, and may also impact mission success and survivability. Future studies are needed to better characterize additive, interactive, and mediated effects.
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Affiliation(s)
- Marcus K Taylor
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA
| | - Lisa M Hernández
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA
- Leidos, Inc., 140 Sylvester Road, San Diego, CA
| | - Matthew R Schoenherr
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA
- Leidos, Inc., 140 Sylvester Road, San Diego, CA
| | - Jeremiah Stump
- Explosive Ordnance Disposal Training and Evaluation Unit One, NAS North Island, San Diego, CA
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229
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Temporal Changes in a Novel Metric of Physical Activity Tracking (Personal Activity Intelligence) and Mortality: The HUNT Study, Norway. Prog Cardiovasc Dis 2019; 62:186-192. [DOI: 10.1016/j.pcad.2018.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/22/2022]
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230
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Jae SY, Kurl S, Kim HJ, Franklin BA, Kunutsor SK, Kang M, Laukkanen JA. Is There an "Asymptote of Gain" Beyond Which Further Increases in Cardiorespiratory Fitness Convey No Additional Benefits on Mortality and Atrial Fibrillation? Mayo Clin Proc 2019; 94:545-547. [PMID: 30832795 DOI: 10.1016/j.mayocp.2018.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/08/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Sae Young Jae
- Department of Sport Science, Graduate School of Urban Public Health, University of Seoul, Republic of Korea
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hyun Jeong Kim
- Department of Sport Science, University of Seoul, Republic of Korea
| | - Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan
| | - Setor K Kunutsor
- Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Mira Kang
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Faculty of Sport and Health Science, University of Jyväskylä, Jyväskylä, Finland
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231
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Baumfalk DR, Opoku-Acheampong AB, Caldwell JT, Ade CJ, Copp SW, Musch TI, Behnke BJ. Effects of prostate cancer and exercise training on left ventricular function and cardiac and skeletal muscle mass. J Appl Physiol (1985) 2019; 126:668-680. [PMID: 30571286 DOI: 10.1152/japplphysiol.00829.2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Prostate cancer was found to reduce cardiac and left ventricle (LV) masses in association with diminished exercise capacity in rats. We tested the hypothesis that exercise training will mitigate prostate cancer-induced cardiac and skeletal muscle atrophy and improve LV function versus sedentary tumor-bearing counterparts. Copenhagen rats ( n = 39; ~5 mo old) were randomized into four groups: exercise-trained tumor-bearing (EXTB) or control (EXCON) and sedentary tumor-bearing (SEDTB) or control (SEDCON). Dunning R-3327 prostate cancer cells were injected orthotopically in 19 of the 39 animals. Treadmill exercise training was performed for 60 min/day for ~30 days. Animals underwent echocardiography to examine ventricle dimensions "Pre-" cancer injection or exercise (PRE) and 15 (Post 1) and 32-35 (Post 2) days after cancer cell injection with tissues collected after Post 2. LV TNF-α and IL-6 concentrations were measured post mortem. Cardiac and LV mass of SEDTB animals were lower than all groups ( P < 0.05). Tumor mass was negatively correlated with LV mass in EXTB (-0.75, P < 0.02) and SEDTB animals (-0.72, P < 0.02). EXCON group had higher stroke volume Post 2 assessment compared with both sedentary groups ( P < 0.05) but not EXTB animals. No difference in LV [IL-6] or [TNF-α] was found between the cancer groups. The current investigation demonstrates prostate cancer, independent of anticancer treatment, significantly reduces cardiac mass and LV mass as well as locomotor muscle masses. However, moderate-intensity exercise training can mitigate cardiac and skeletal muscle atrophy with prostate cancer and preserve the cardiac phenotype (i.e., mass and function) to that of the healthy sedentary group. NEW & NOTEWORTHY This study demonstrates the atrophic effects of prostate cancer on cardiac and skeletal muscle mass independent of anticancer treatment(s) that can be mitigated with moderate-intensity exercise. These findings have important implications for potentially improving the quality of life as well as therapeutic outcomes for patients with prostate cancer.
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Affiliation(s)
- Dryden R Baumfalk
- Department of Kinesiology, Kansas State University , Manhattan, Kansas
| | | | - Jacob T Caldwell
- Department of Kinesiology, Kansas State University , Manhattan, Kansas
| | - Carl J Ade
- Department of Kinesiology, Kansas State University , Manhattan, Kansas.,Johnson Cancer Research Center, Kansas State University , Manhattan, Kansas
| | - Steven W Copp
- Department of Kinesiology, Kansas State University , Manhattan, Kansas
| | - Timothy I Musch
- Department of Kinesiology, Kansas State University , Manhattan, Kansas.,Department of Anatomy and Physiology, Kansas State University , Manhattan, Kansas
| | - Bradley J Behnke
- Department of Kinesiology, Kansas State University , Manhattan, Kansas.,Johnson Cancer Research Center, Kansas State University , Manhattan, Kansas
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232
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Ozemek C, Lavie CJ, Rognmo Ø. Global physical activity levels - Need for intervention. Prog Cardiovasc Dis 2019; 62:102-107. [PMID: 30802461 DOI: 10.1016/j.pcad.2019.02.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
Substantial evidence shows that physical inactivity (PI) and sedentary behavior (SB) increases the risk of many chronic diseases and shortens life expectancy. We describe evidence that certain domains of physical activity (PA) in the United States (US) population have declined substantially over 5 decades. The prevalence of PI is very high worldwide, which has contributed to 6%-10% of the burden of many chronic diseases and premature mortality. Reduction or elimination of PI would likely produce substantial increases in life expectancy of the world's population. Great efforts are needed to reduce PI and SB and increase levels of PA in the US and worldwide.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy and Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School -the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Øivind Rognmo
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
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233
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Whitsel LP, Arena R, Kaminsky LA, Berrigan D, Katzmarzyk PT, Calitz C, Grossmeier J, Pshock J, Lobelo F, Pronk NP. Assessing Physical Activity, Sedentary Behavior, and Cardiorespiratory Fitness in Worksite Health Promotion. Am J Health Promot 2019; 33:318-326. [DOI: 10.1177/0890117118816750e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Laurie P. Whitsel
- Department of Policy Research and Translation, American Heart Association, Washington, DC, USA
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, USA
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Peter T. Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University, Rouge, LA, USA
| | - Chris Calitz
- Center for Workplace Evaluation, American Heart Association, Dallas, TX, USA
| | | | | | - Felipe Lobelo
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicolaas P. Pronk
- Health Partners Institute and Harvard T.H. Chan School of Public Health, Minneapolis, MN, USA; Boston, MA, USA
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234
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Castro A, Duft RG, Ferreira MLV, de Andrade ALL, Gáspari AF, Silva LDM, de Oliveira-Nunes SG, Cavaglieri CR, Ghosh S, Bouchard C, Chacon- Mikahil MPT. Association of skeletal muscle and serum metabolites with maximum power output gains in response to continuous endurance or high-intensity interval training programs: The TIMES study - A randomized controlled trial. PLoS One 2019; 14:e0212115. [PMID: 30742692 PMCID: PMC6370248 DOI: 10.1371/journal.pone.0212115] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/26/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Recent studies have begun to identify the molecular determinants of inter-individual variability of cardiorespiratory fitness (CRF) in response to exercise training programs. However, we still have an incomplete picture of the molecular mechanisms underlying trainability in response to exercise training. OBJECTIVE We investigated baseline serum and skeletal muscle metabolomics profile and its associations with maximal power output (MPO) gains in response to 8-week of continuous endurance training (ET) and high-intensity interval training (HIIT) programs matched for total units of exercise performed (the TIMES study). METHODS Eighty healthy sedentary young adult males were randomized to one of three groups and 70 were defined as completers (> 90% of sessions): ET (n = 30), HIIT (n = 30) and control (CO, n = 10). For the CO, participants were asked to not exercise for 8 weeks. Serum and skeletal muscle samples were analyzed by 1H-NMR spectroscopy. The targeted screens yielded 43 serum and 70 muscle reproducible metabolites (intraclass > 0.75; coefficient of variation < 25%). Associations of baseline metabolites with MPO trainability were explored within each training program via three analytical strategies: (1) correlations with gains in MPO; (2) differences between high and low responders to ET and HIIT; and (3) metabolites contributions to the most significant pathways related to gains in MPO. The significance level was set at P < 0.01 or false discovery rate of 0.1. RESULTS The exercise programs generated similar gains in MPO (ET = 21.4 ± 8.0%; HIIT = 24.3 ± 8.5%). MPO associated baseline metabolites supported by all three levels of evidence were: serum glycerol, muscle alanine, proline, threonine, creatinine, AMP and pyruvate for ET, and serum lysine, phenylalanine, creatine, and muscle glycolate for HIIT. The most common pathways suggested by the metabolite profiles were aminoacyl-tRNA biosynthesis, and carbohydrate and amino acid metabolism. CONCLUSION We suggest that MPO gains in both programs are potentially associated with metabolites indicative of baseline amino acid and translation processes with additional evidence for carbohydrate metabolism in ET.
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Affiliation(s)
- Alex Castro
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Renata Garbellini Duft
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | | | - André Luís Lugnani de Andrade
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Arthur Fernandes Gáspari
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Lucas de Marchi Silva
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Cláudia Regina Cavaglieri
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil
| | - Sujoy Ghosh
- Laboratory of Computational Biology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
- Cardiovascular & Metabolic Disorders Program and Center for Computational Biology, Duke-NUS Graduate Medical School, Singapore
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
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235
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Qiu S, Cai X, Yang B, Du Z, Cai M, Sun Z, Zügel M, Michael Steinacker J, Schumann U. Association Between Cardiorespiratory Fitness and Risk of Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring) 2019; 27:315-324. [PMID: 30604925 DOI: 10.1002/oby.22368] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/22/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This meta-analysis aimed to (1) quantify the association of cardiorespiratory fitness (CRF) with type 2 diabetes risk in the general population and statin users and (2) investigate the joint effects of CRF and fatness with type 2 diabetes risk. METHODS Databases were searched for cohort studies reporting the association between CRF and type 2 diabetes risk. Summary hazard ratios (HRs) were obtained using random-effects models. RESULTS Fifteen studies were included. The HRs of type 2 diabetes for every 1-metabolic equivalent increase in CRF were 0.90 (95% CI: 0.86-0.94) for the general population and 0.92 (95% CI: 0.87-0.97) for statin users, and the HRs were linearly shaped (both Pnonlinearity > 0.40). Compared with the nonstatin cohort, there was an increased risk of type 2 diabetes in statin users with the lowest and moderate CRF categories, but this was not present in the highest CRF category. The HR of type 2 diabetes for overweight/obesity-fit category versus normal weight-fit category was larger than that of the normal weight-unfit category versus the normal weight-fit category (Pinteraction = 0.004). CONCLUSIONS There was an inverse and dose-dependent association between CRF and type 2 diabetes risk. High CRF may eliminate the diabetogenic effect from statins, yet decreased body weight index seems superior in preventing type 2 diabetes.
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Affiliation(s)
- Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Bingquan Yang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Ziwei Du
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Min Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Martina Zügel
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | | | - Uwe Schumann
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
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236
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Cardiorespiratory Fitness and Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality in Men With Musculoskeletal Conditions. J Phys Act Health 2019; 16:134-140. [DOI: 10.1123/jpah.2017-0644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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237
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Mitochondrial dynamics in exercise physiology. Pflugers Arch 2019; 472:137-153. [DOI: 10.1007/s00424-019-02258-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/17/2019] [Indexed: 12/11/2022]
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238
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Whitsel LP, Pate RR, Ablah E, Lemon SC, Pronk NP, Wojcik JR, Walker A, Grossmeier J, Pollack KM, Whitsel LP, Bryant CX, Whitsel LP, Arena R, Kaminsky LA, Berrigan D, Katzmarzyk PT, Calitz C, Grossmeier J, Pshock J, Lobelo F, Pronk NP. Editor's Desk: Promoting Physical Activity in the Workplace. Am J Health Promot 2019; 33:312-326. [PMID: 30650994 DOI: 10.1177/0890117118816750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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239
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Kaminsky LA, Arena R, Ellingsen Ø, Harber MP, Myers J, Ozemek C, Ross R. Cardiorespiratory fitness and cardiovascular disease - The past, present, and future. Prog Cardiovasc Dis 2019; 62:86-93. [PMID: 30639135 DOI: 10.1016/j.pcad.2019.01.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/06/2019] [Indexed: 01/12/2023]
Abstract
The importance of cardiorespiratory fitness (CRF) is now well established and it is increasingly being recognized as an essential variable which should be assessed in health screenings. The key findings that have established the clinical significance of CRF are reviewed in this report, along with an overview of the current relevance of exercise as a form of medicine that can provide a number of positive health outcomes, including increasing CRF. Current assessment options for assessing CRF are also reviewed, including the direct measurement via cardiopulmonary exercise testing which now can be interpreted with age and sex-specific reference values. Future directions for the use of CRF and related measures are presented.
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Affiliation(s)
- Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States.
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Øyvind Ellingsen
- Norwegian University Science and Technology and St Olavs University Hospital, Trondheim, Norway
| | - Matthew P Harber
- Clinical Exercise Physiology Program, College of Health, Ball State University, Muncie, IN, United States
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States; School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Robert Ross
- School of Kinesiology and Health Studies, Department of Medicine, Division of Endocrinology and Metabolism, Queens University, Ontario, Canada
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Determining Cardiorespiratory Fitness With Precision: Compendium of Findings From the FRIEND Registry. Prog Cardiovasc Dis 2019; 62:76-82. [DOI: 10.1016/j.pcad.2018.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
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241
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Five Years as Editor-in-Chief. Prog Cardiovasc Dis 2019. [DOI: 10.1016/j.pcad.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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242
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Ando T, Piaggi P, Bogardus C, Krakoff J. VO 2max is associated with measures of energy expenditure in sedentary condition but does not predict weight change. Metabolism 2019; 90:44-51. [PMID: 30385380 PMCID: PMC6317969 DOI: 10.1016/j.metabol.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Energy expenditure measured under sedentary conditions predicts weight change but evidence that directly measured VO2max is associated with weight change is lacking. The aim of this study was to determine the associations of VO2max with measures of predominantly sedentary 24-h thermogenesis, and subsequent weight change. SUBJECTS/METHODS Three hundred fifty-seven individuals (162 females; 27 Blacks, 72 Caucasians, and 258 American Indians) had measures of body composition, resting metabolic rate (RMR), and intermittent treadmill run test for assessment of VO2max. On a separate day, 24-h energy expenditure (EE), diet-induced thermogenesis (DIT) expressed as "awake and fed" thermogenesis (AFT), sleeping metabolic rate (SMR), and spontaneous physical activity (SPA) were measured in a whole-room indirect calorimeter. Follow-up weight for 217 individuals was available (median follow-up time, 9.5 y; mean weight change, 12.4 ± 14.9 kg). RESULTS After adjustment for fat free mass, fat mass, age, sex, and race, a higher VO2max was associated with a higher RMR (β = 68.2 kcal/day per L/min, P < 0.01) and 24-h EE (β = 62.2 kcal/day per L/min, P < 0.05) and including additional adjustment for energy intake higher AFT (β = 66.1 kcal/day per L/min, P = 0.01). Neither SMR (P > 0.2) nor SPA (P > 0.8) were associated with VO2max. VO2max at baseline did not predict follow-up weight after adjustment for baseline weight, follow-up time, sex, and race (P > 0.4). CONCLUSION VO2max is associated with measures of EE including 24-h EE, RMR and DIT implying a common mechanism regulating the energetics of skeletal muscle during exercise and thermogenesis. However, this did not translate to VO2max as a predictor of weight change.
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Affiliation(s)
- Takafumi Ando
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - Paolo Piaggi
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Clifton Bogardus
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Jonathan Krakoff
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
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243
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Andonian BJ, Bartlett DB, Huebner JL, Willis L, Hoselton A, Kraus VB, Kraus WE, Huffman KM. Effect of high-intensity interval training on muscle remodeling in rheumatoid arthritis compared to prediabetes. Arthritis Res Ther 2018; 20:283. [PMID: 30587230 PMCID: PMC6307310 DOI: 10.1186/s13075-018-1786-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023] Open
Abstract
Background Sarcopenic obesity, associated with greater risk of cardiovascular disease (CVD) and mortality in rheumatoid arthritis (RA), may be related to dysregulated muscle remodeling. To determine whether exercise training could improve remodeling, we measured changes in inter-relationships of plasma galectin-3, skeletal muscle cytokines, and muscle myostatin in patients with RA and prediabetes before and after a high-intensity interval training (HIIT) program. Methods Previously sedentary persons with either RA (n = 12) or prediabetes (n = 9) completed a 10-week supervised HIIT program. At baseline and after training, participants underwent body composition (Bod Pod®) and cardiopulmonary exercise testing, plasma collection, and vastus lateralis biopsies. Plasma galectin-3, muscle cytokines, muscle interleukin-1 beta (mIL-1β), mIL-6, mIL-8, muscle tumor necrosis factor-alpha (mTNF-α), mIL-10, and muscle myostatin were measured via enzyme-linked immunosorbent assays. An independent cohort of patients with RA (n = 47) and age-, gender-, and body mass index (BMI)-matched non-RA controls (n = 23) were used for additional analyses of galectin-3 inter-relationships. Results Exercise training did not reduce mean concentration of galectin-3, muscle cytokines, or muscle myostatin in persons with either RA or prediabetes. However, training-induced alterations varied among individuals and were associated with cardiorespiratory fitness and body composition changes. Improved cardiorespiratory fitness (increased absolute peak maximal oxygen consumption, or VO2) correlated with reductions in galectin-3 (r = −0.57, P = 0.05 in RA; r = −0.48, P = 0.23 in prediabetes). Training-induced improvements in body composition were related to reductions in muscle IL-6 and TNF-α (r < −0.60 and P <0.05 for all). However, the association between increased lean mass and decreased muscle IL-6 association was stronger in prediabetes compared with RA (Fisher r-to-z P = 0.0004); in prediabetes but not RA, lean mass increases occurred in conjunction with reductions in muscle myostatin (r = −0.92; P <0.05; Fisher r-to-z P = 0.026). Subjects who received TNF inhibitors (n = 4) or hydroxychloroquine (n = 4) did not improve body composition with exercise training. Conclusion Exercise responses in muscle myostatin, cytokines, and body composition were significantly greater in prediabetes than in RA, consistent with impaired muscle remodeling in RA. To maximize physiologic improvements with exercise training in RA, a better understanding is needed of skeletal muscle and physiologic responses to exercise training and their modulation by RA disease–specific features or pharmacologic agents or both. Trial registration ClinicalTrials.gov Identifier: NCT02528344. Registered on August 19, 2015.
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Affiliation(s)
- Brian J Andonian
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA. .,Division of Rheumatology, Duke University School of Medicine, 40 Duke Medicine Circle Drive, Durham, NC, 27710, USA.
| | - David B Bartlett
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Leslie Willis
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Andrew Hoselton
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Virginia B Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA.,Division of Rheumatology, Duke University School of Medicine, 40 Duke Medicine Circle Drive, Durham, NC, 27710, USA
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA
| | - Kim M Huffman
- Duke Molecular Physiology Institute, Duke University School of Medicine, 300 N Duke St, Durham, NC, 27701, USA.,Division of Rheumatology, Duke University School of Medicine, 40 Duke Medicine Circle Drive, Durham, NC, 27710, USA
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244
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Dela F, Finkenzeller T, Ingersen A, Pötzelsberger B, Müller E. Trajectories of cardio-metabolic health in successful aging. Scand J Med Sci Sports 2018; 29 Suppl 1:44-51. [PMID: 30570171 DOI: 10.1111/sms.13370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/21/2018] [Accepted: 11/14/2018] [Indexed: 01/14/2023]
Abstract
Maximal oxygen uptake (V̇O2max ) and muscle mass decrease with age. The loss of cardiorespiratory fitness and muscle strength is accelerated with physical inactivity and has well-documented consequences for morbidity and all-cause mortality. Participation in exercise training programs will improve one or more of the cardio-metabolic risk factors, but the long-term effects of such programs are questionable. Here, we re-examined 25 old (72 ± 4 years.) men and women who considered him/herself as "success-full agers" and were participants in a 3-month alpine skiing training program 6 years earlier. The program focused on healthy aging and included health questionnaires, measurement of lipids and glycemic parameters in blood and a VO2max test. Thirteen and 12 subjects were in the intervention (IG) and the control group (CG), respectively. In response to the training program, subjects improved their cardio-metabolic risk factors. However, after 6 years all positive effects had disappeared. Approximately 80% of the subjects had total cholesterol and LDL cholesterol above and HDL cholesterol below the recommended values, but these subjects remained the most metabolically deteriorated, including an increase in fasting glucose concentrations. We conclude that people seem to follow their individual trajectory in terms of cardio-metabolic risk factors, and participation in a relatively short lasting exercise training program with emphasis on healthy aging does not change that. Long-lasting change in lifestyle probably requires a continued attentional focus, goal setting, and feedback.
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Affiliation(s)
- Flemming Dela
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,Department of Geriatrics, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Thomas Finkenzeller
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Arthur Ingersen
- Department of Biomedical Sciences, Xlab, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Birgit Pötzelsberger
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - Erich Müller
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
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245
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The Association between the Change in Directly Measured Cardiorespiratory Fitness across Time and Mortality Risk. Prog Cardiovasc Dis 2018; 62:157-162. [PMID: 30543812 DOI: 10.1016/j.pcad.2018.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The relationship between cardiorespiratory fitness (CRF) and mortality risk has typically been assessed using a single measurement, though some evidence suggests the change in CRF over time influences risk. This evidence is predominantly based on studies using estimated CRF (CRFe). The strength of this relationship using change in directly measured CRF over time in apparently healthy men and women is not well understood. PURPOSE To examine the association of change in CRF over time, measured using cardiopulmonary exercise testing (CPX), with all-cause and disease-specific mortality and to compare baseline and subsequent CRF measurements as predictors of all-cause mortality. METHODS Participants included 833 apparently healthy men and women (42.9 ± 10.8 years) who underwent two maximal CPXs, the second CPX being ≥1 year following the baseline assessment (mean 8.6 years, range 1.0 to 40.3 years). Participants were followed for up to 17.7 (SD 11.8) years for all-cause-, cardiovascular disease- (CVD), and cancer mortality. Cox-proportional hazard models were performed to determine the association between the change in CRF, computed as visit 1 (CPX1) peak oxygen consumption (VO2peak [mL·kg-1·min-1]) - visit 2 (CPX2) VO2peak, and mortality outcomes. A Wald-Chi square test of equality was used to compare the strength of CPX1 to CPX2 VO2peak in predicting mortality. RESULTS During follow-up, 172 participants died. Overall, the change in CPX-CRF was inversely related to all-cause, CVD, and cancer mortality (p < 0.05). Each 1 mL·kg-1·min-1 increase was associated with a ~11, 15, and 16% (all p < 0.001) reduction in all-cause, CVD, and cancer mortality, respectively. The inverse relationship between CRF and all-cause mortality was significant (p < 0.05) when men and women were examined independently, after adjusting for years since first CPX, baseline VO2peak, and age. Further, the Wald Chi-square test of equality found CPX2 VO2peak to be a significantly stronger predictor of all-cause mortality than CPX1 VO2peak (p < 0.05). CONCLUSION The change in CRF over time was inversely related to mortality outcomes, and mortality was better predicted by CRF measured at subsequent test than CPX1 CRF. These findings emphasize the importance of adopting lifestyle behaviors that promote CRF, as well as support the need for routine assessment of CRF in clinical practice to better assess risk.
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246
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Ozemek C, Arena R. Precision in Promoting Physical Activity and Exercise With the Overarching Goal of Moving More. Prog Cardiovasc Dis 2018; 62:3-8. [PMID: 30529578 DOI: 10.1016/j.pcad.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 01/24/2023]
Abstract
Physical inactivity is strongly associated with an unfavorable health profile, increasing an individual's risk for developing cardiovascular disease. Initiating a regular exercise routine contributes to improvements in cardiorespiratory fitness, body composition, resting blood pressure, blood glucose, and circulating lipoproteins. However, the extent to which positive changes occur come with significant inter-individual variability within intervention groups; non-responders and responders have been commonly identified across populations, highlighting that not all exercise regimens are universally effective in all individuals and should therefore not be treated as a "one-size fits all" prescription. Recent studies have therefore emphasized reporting the quantity of participants favorably and meaningfully "responding" to varying amounts and intensities of exercise, thereby presenting the opportunity to view exercise prescription in the context of precision medicine. This review will address the impact of varying amounts and intensities of physical activity and exercise, highlighting their impact on key health metrics.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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247
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Fletcher GF, Landolfo C, Niebauer J, Ozemek C, Arena R, Lavie CJ. Reprint of: Promoting Physical Activity and Exercise. J Am Coll Cardiol 2018; 72:3053-3070. [DOI: 10.1016/j.jacc.2018.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022]
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248
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Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3·6 million adults in the UK. Lancet Diabetes Endocrinol 2018; 6:944-953. [PMID: 30389323 PMCID: PMC6249991 DOI: 10.1016/s2213-8587(18)30288-2] [Citation(s) in RCA: 603] [Impact Index Per Article: 100.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND BMI is known to be strongly associated with all-cause mortality, but few studies have been large enough to reliably examine associations between BMI and a comprehensive range of cause-specific mortality outcomes. METHODS In this population-based cohort study, we used UK primary care data from the Clinical Practice Research Datalink (CPRD) linked to national mortality registration data and fitted adjusted Cox regression models to examine associations between BMI and all-cause mortality, and between BMI and a comprehensive range of cause-specific mortality outcomes (recorded by International Classification of Diseases, 10th revision [ICD-10] codes). We included all individuals with BMI data collected at age 16 years and older and with subsequent follow-up time available. Follow-up began at whichever was the latest of: start of CPRD research-standard follow up, the 5-year anniversary of the first BMI record, or on Jan 1, 1998 (start date for death registration data); follow-up ended at death or on March 8, 2016. Fully adjusted models were stratified by sex and adjusted for baseline age, smoking, alcohol use, diabetes, index of multiple deprivation, and calendar period. Models were fitted in both never-smokers only and the full study population. We also did an extensive range of sensitivity analyses. The expected age of death for men and women aged 40 years at baseline, by BMI category, was estimated from a Poisson model including BMI, age, and sex. FINDINGS 3 632 674 people were included in the full study population; the following results are from the analysis of never-smokers, which comprised 1 969 648 people and 188 057 deaths. BMI had a J-shaped association with overall mortality; the estimated hazard ratio per 5 kg/m2 increase in BMI was 0·81 (95% CI 0·80-0·82) below 25 kg/m2 and 1·21 (1·20-1·22) above this point. BMI was associated with all cause of death categories except for transport-related accidents, but the shape of the association varied. Most causes, including cancer, cardiovascular diseases, and respiratory diseases, had a J-shaped association with BMI, with lowest risk occurring in the range 21-25 kg/m2. For mental and behavioural, neurological, and accidental (non-transport-related) causes, BMI was inversely associated with mortality up to 24-27 kg/m2, with little association at higher BMIs; for deaths from self-harm or interpersonal violence, an inverse linear association was observed. Associations between BMI and mortality were stronger at younger ages than at older ages, and the BMI associated with lowest mortality risk was higher in older individuals than in younger individuals. Compared with individuals of healthy weight (BMI 18·5-24·9 kg/m2), life expectancy from age 40 years was 4·2 years shorter in obese (BMI ≥30·0 kg/m2) men and 3·5 years shorter in obese women, and 4·3 years shorter in underweight (BMI <18·5 kg/m2) men and 4·5 years shorter in underweight women. When smokers were included in analyses, results for most causes of death were broadly similar, although marginally stronger associations were seen among people with lower BMI, suggesting slight residual confounding by smoking. INTERPRETATION BMI had J-shaped associations with overall mortality and most specific causes of death; for mental and behavioural, neurological, and external causes, lower BMI was associated with increased mortality risk. FUNDING Wellcome Trust.
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Affiliation(s)
- Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - David A Leon
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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249
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KAMINSKY LEONARDA, HARBER MATTHEWP, IMBODEN MARYT, ARENA ROSS, MYERS JONATHAN. Peak Ventilation Reference Standards from Exercise Testing: From the FRIEND Registry. Med Sci Sports Exerc 2018; 50:2603-2608. [DOI: 10.1249/mss.0000000000001740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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250
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Corres P, Maldonado-Martín S, Gorostegi-Anduaga I, Fryer SM, Jurio-Iriarte B, MartínezAguirre-Betolaza A, Arratibel-Imaz I, Francisco-Terreros S, Pérez-Asenjo J. Is cardiorespiratory fitness independently associated with the biochemical profile in overweight/obese adults with primary hypertension? The EXERDIET-HTA study. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:613-620. [PMID: 30474427 DOI: 10.1080/00365513.2018.1531297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cardiorespiratory fitness (CRF) is positively associated with enhanced cardiovascular health. This cross-sectional study aimed to determine associations between CRF and the biochemical profile of overweight/obese adults diagnosed with primary hypertension (HTN). Does cardiorespiratory fitness (exposure) positively affect the biochemical profile (outcome) in overweight/obese individuals suffering from HTN? Assessment with anthropometric, ambulatory blood pressure monitoring (24 h), CRF (peak oxygen uptake, V̇O2peak) and biochemical analysis was performed on 214 participants (138 men, 76 women). A series of linear and logistic regression analyses were conducted. Participants were divided into CRF tertiles (classified as low, moderate and high CRF). The CRF was independently and inversely associated with aspartate aminotransferase (AST; β = -0.328, p < .05) and alanine aminotransferase (ALT; β = -0.376, p < .01) concentrations. C-reactive protein, AST/ALT ratio, gamma-glutamyl transpeptidase, total cholesterol/high-density lipoprotein cholesterol ratio, glucose, insulin and insulin resistance index (HOMA-IR), were all associated, but not independently, with CRF in linear and/or unadjusted logistic regression models. However, independently, logistic regression revealed that glucose was associated with the moderate CRF group. Findings suggest that a lower CRF is associated with an unhealthy biochemical profile in non-physically active and overweight/obese individuals with HTN. As such, this population should look to increase physical activity in order to improve their CRF and biochemical profile.
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Affiliation(s)
- Pablo Corres
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Sara Maldonado-Martín
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Ilargi Gorostegi-Anduaga
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Simon M Fryer
- b School of Sport and Exercise , University of Gloucestershire , Gloucester , UK
| | - Borja Jurio-Iriarte
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Aitor MartínezAguirre-Betolaza
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Iñaki Arratibel-Imaz
- a Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | | | - Javier Pérez-Asenjo
- d Cardiology Unit , Igualatorio Médico Quirúrgico (IMQ-Amárica) , Vitoria-Gasteiz , Spain
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