Lack of exercise is a major cause of chronic diseases

The association between fatigue and cardiometabolic diseases: Insights from the UK biobank study

BACKGROUND

Cardiometabolic diseases (CMD) are major global health concerns with significant morbidity and mortality. Fatigue, a common but often overlooked symptom, has been postulated as both a potential risk factor for and a consequence of these conditions. However, the relationships between fatigue and CMD remain unclear. This study aimed to investigate the relationship between fatigue and CMD using observational and genetic approaches.

METHOD

Observational study was conducted in the UK biobank. Genetic method was employed a bidirectional MR approach to examine the causal relationship between fatigue and CMD. Genetic variants associated with fatigue were identified through a GWAS, and summary statistics from the largest available GWAS were used to obtain variants associated with stroke, CAD, T2D, and HF. Inverse variance weighting (IVW) was conducted, with weighted median, MR-Egger, and MR-PRESSO as sensitivity analyses. Multivariable MR and mediation analysis were also employed.

RESULTS

Observational analyses indicated that individuals with fatigue had a significantly increased risk of developing stroke (HR 1.44, 95 % CI 1.27-1.63), T2D (HR 1.46, 95 % CI 1.41-1.51), CAD (HR 1.45, 95 % CI 1.4-1.5), and HF (HR 1.60, 95 % CI 1.52-1.68). Mendelian randomization analyses further supported a causal relationship. Additionally, observational and genetic analyses showed T2D was found to be associated with increased levels of fatigue. Mediation analysis identified lipid metabolites as mediators in the relationship between fatigue and CMD.

CONCLUSION

This study highlights a bidirectional relationship between fatigue and CMD, underscoring the importance of considering fatigue in the context of cardiometabolic health.

CLINICAL TRIAL NUMBER

Not applicable.

Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes

The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.

Global trends and hotspots of type 2 diabetes in children and adolescents: A bibliometric study and visualization analysis

BACKGROUND

Epidemiological surveys indicate an increasing incidence of type 2 diabetes mellitus (T2DM) among children and adolescents worldwide. Due to rapid disease progression, severe long-term cardiorenal complications, a lack of effective treatment strategies, and substantial socioeconomic burdens, it has become an urgent public health issue that requires management and resolution. Adolescent T2DM differs from adult T2DM. Despite a significant increase in our understanding of youth-onset T2DM over the past two decades, the related review and evidence-based content remain limited.

AIM

To visualize the hotspots and trends in pediatric and adolescent T2DM research and to forecast their future research themes.

METHODS

This study utilized the terms “children”, “adolescents”, and “type 2 diabetes”, retrieving relevant articles published between 1983 and 2023 from three citation databases within the Web of Science Core Collection (SCI, SSCI, ESCI). Utilizing CiteSpace and VoSviewer software, we analyze and visually represent the annual output of literature, countries involved, and participating institutions. This allows us to predict trends in this research field. Our analysis encompasses co-cited authors, journal overlays, citation overlays, time-zone views, keyword analysis, and reference analysis, etc.

RESULTS

A total of 9210 articles were included, and the annual publication volume in this field showed a steady growth trend. The United States had the highest number of publications and the highest H-index. The United States also had the most research institutions and the strongest research capacity. The global hot journals were primarily diabetes professional journals but also included journals related to nutrition, endocrinology, and metabolism. Keyword analysis showed that research related to endothelial dysfunction, exposure risk, cardiac metabolic risk, changes in gut microbiota, the impact on comorbidities and outcomes, etc., were emerging keywords. They have maintained their popularity in this field, suggesting that these areas have garnered significant research interest in recent years.

CONCLUSION

Pediatric and adolescent T2DM is increasingly drawing global attention, with genes, behaviors, environmental factors, and multisystemic interventions potentially emerging as future research hot spots.

Exercise snacks and physical fitness in sedentary populations

Physical inactivity remains a pressing global public health concern. Prolonged periods of sedentary behavior have been linked to heightened risks of non-communicable diseases such as cardiovascular diseases and type 2 diabetes, while engaging in any form of physical activity can elicit favorable effects on health. Nevertheless, epidemiological research indicates that people often struggle to meet recommended physical activity guidelines, citing time constraints, lack of exercise equipment, and environmental limitations as common barriers. Exercise snacks represents a time-efficient approach with the potential to improve physical activity levels in sedentary populations, cultivate exercise routines, and enhance the perception of the health benefits associated with physical activity. We review the existing literature on exercise snacks, and examine the effects of exercise snacks on physical function and exercise capacity, while also delving into the potential underlying mechanisms. The objective is to establish a solid theoretical foundation for the application of exercise snacks as a viable strategy for promoting physical activity and enhancing overall health, particularly in vulnerable populations who are unable to exercise routinely.

Association between physical activity levels and stroke risk among Chinese adults aged 45 and over based on CHARLS

Stroke is one of the leading causes of death in developing countries, and China bears the largest global burden of stroke. This study aims to investigate the relationship between different dimensions of physical activity levels and stroke risk using a nationally representative database. We performed a cross-sectional analysis using data from the China Health and Retirement Longitudinal Study (CHARLS) 2020. Binary logistic regression models were used to analyze the associations between different dimensions of physical activity levels (intensity, frequency, duration, and total physical activity (TPA)) and stroke risk in Chinese middle-aged and older adults. Subgroups were analyzed according to participants' age, sex, residency, hypertension, dyslipidemia, and diabetes stratification. The results showed that after adjusting for all covariates, almost all frequencies and durations of moderate physical activity (MPA), and high-frequency and long-duration vigorous physical activity (VPA) were associated with lower stroke risk. No significant relationship was observed between light physical activity (LPA) and stroke risk. TPA was categorized into quartiles (Q1, Q2, Q3, Q4). Compared with the first quartile, the third and fourth quartiles were significantly associated with lower stroke risk, with risk reductions of 35% (OR 0.65, 95% CI 0.50-0.84) and 42% (OR 0.58, 95% CI 0.44-0.76), respectively. Subgroup analysis revealed differences in the association between TPA and stroke risk in different populations, and the interaction test indicated no significant interactions between these variables and TPA. Our findings suggested that appropriate participation in physical activity is effective in preventing stroke in middle-aged and older adults. Both MPA and high-frequency or long-duration VPA were significantly associated with lower stroke risk, and keeping TPA at a high level was significantly associated with lower stroke risk.

The interplay of factors in metabolic syndrome: understanding its roots and complexity

Metabolic syndrome (MetS) is an indicator and diverse endocrine syndrome that combines different metabolic defects with clinical, physiological, biochemical, and metabolic factors. Obesity, visceral adiposity and abdominal obesity, dyslipidemia, insulin resistance (IR), elevated blood pressure, endothelial dysfunction, and acute or chronic inflammation are the risk factors associated with MetS. Abdominal obesity, a hallmark of MetS, highlights dysfunctional fat tissue and increased risk for cardiovascular disease and diabetes. Insulin, a vital peptide hormone, regulates glucose metabolism throughout the body. When cells become resistant to insulin's effects, it disrupts various molecular pathways, leading to IR. This condition is linked to a range of disorders, including obesity, diabetes, fatty liver disease, cardiovascular disease, and polycystic ovary syndrome. Atherogenic dyslipidemia is characterized by three key factors: high levels of small, low-dense lipoprotein (LDL) particles and triglycerides, alongside low levels of high-density lipoprotein (HDL), the "good" cholesterol. Such a combination is a major player in MetS, where IR is a driving force. Atherogenic dyslipidemia contributes significantly to the development of atherosclerosis, which can lead to cardiovascular disease. On top of that, genetic alteration and lifestyle factors such as diet and exercise influence the complexity and progression of MetS. To enhance our understanding and consciousness, it is essential to understand the fundamental pathogenesis of MetS. This review highlights current advancements in MetS research including the involvement of gut microbiome, epigenetic regulation, and metabolomic profiling for early detection of Mets. In addition, this review emphasized the epidemiology and fundamental pathogenesis of MetS, various risk factors, and their preventive measures. The goal of this effort is to deepen understanding of MetS and encourage further research to develop effective strategies for preventing and managing complex metabolic diseases.

Accuracy of the Huawei GT2 Smartwatch for Measuring Physical Activity and Sleep Among Adults During Daily Life: Instrument Validation Study

Background

Smartwatches are increasingly popular for physical activity and health promotion. However, ongoing validation studies on commercial smartwatches are still needed to ensure their accuracy in assessing daily activity levels, which is important for both promoting activity-related health behaviors and serving research purposes.

Objective

This study aimed to evaluate the accuracy of a popular smartwatch, the Huawei Watch GT2, in measuring step count (SC), total daily activity energy expenditure (TDAEE), and total sleep time (TST) during daily activities among Chinese adults, and test whether there are population differences.

Methods

A total of 102 individuals were recruited and divided into 2 age groups: young adults (YAs) and middle-aged and older (MAAO) adults. Participants' daily activity data were collected for 1 week by wearing the Huawei Watch GT2 on their nondominant wrist and the Actigraph GT3X+ (ActiGraph) on their right hip as the reference measure. The accuracy of the GT2 was examined using the intraclass correlation coefficient (ICC), Pearson product-moment correlation coefficient (PPMCC), Bland-Altman analysis, mean percentage error, and mean absolute percentage error (MAPE).

Results

The GT2 demonstrated reasonable agreement with the Actigraph, as evidenced by a consistency test ICC of 0.88 (P<.001) and an MAPE of 25.77% for step measurement, an ICC of 0.75 (P<.001) and an MAPE of 33.79% for activity energy expenditure estimation, and an ICC of 0.25 (P<.001) and an MAPE of 23.29% for sleep time assessment. Bland-Altman analysis revealed that the GT2 overestimated SC and underestimated TDAEE and TST. The GT2 was better at measuring SC and TDAEE among YAs than among MAAO adults, and there was no significant difference between these 2 groups in measuring TST (P=.12).

Conclusions

The Huawei Watch GT2 demonstrates good accuracy in step counting. However, its accuracy in assessing activity energy expenditure and sleep time measurement needs further examination. The GT2 demonstrated higher accuracy in measuring SC and TDAEE in the YA group than in the MAAO group. However, the measurement errors for TST did not differ significantly between the 2 age groups. Therefore, the watch may be suitable for monitoring several key parameters (eg, SC) of daily activity, yet caution is advised for its use in research studies that require high accuracy.

Physical exercise, systemic inflammation and adult-onset asthma: a 12-year follow-up study

Objective: Physical exercise in treatment of asthma is scarcely studied with no clear exercise guidelines for asthmatics. We aimed to investigate the associations between physical exercise frequency, systemic inflammation and asthma control. This has not been previously studied in adult-onset asthma.

Methods: This study is part of Seinäjoki Adult Asthma Study (SAAS), where 203 patients with adult-onset asthma were evaluated in 2012-2013. Exercise frequency was recorded with a structured lifestyle questionnaire. Study population was divided into two categories by exercise frequency: Low-frequency group exercised ≤2 times/week and high frequency group >2 times/week. Blood inflammatory markers were measured and IL-6 > 1.55 pg/ml and hs-CRP > 4.12 mg/l indicated systemic inflammation.

Results: High-exercise frequency group had lower levels of hs-CRP (p = 0.007), IL-6 (p = 0.015), suPAR (p = 0.008) and adipsin (p = 0.031) and higher levels of adiponectin (p = 0.010) than low-exercise frequency group. In logistic multivariate regression models, higher-exercise frequency lowered odds for elevated hs-CRP (OR = 0.37, 95% CI 0.15-0.94) and IL-6 levels (OR = 0.43, 95% CI 0.20-0.91), after adjusting for possible confounding factors. There was no difference in lung function tests, asthma control test or airways questionnaire 20 scores between the exercise frequency groups. However, differences were found in single symptom questions; high-exercise frequency group had less symptoms during light housework and laughing but experienced more limitation of activity in self-reports.

Conclusions: Higher-exercise frequency is associated with lower level of systemic inflammation in patients with adult-onset asthma but no clear association was found to asthma outcomes. Exercise frequency may be associated with lesser amount of some individual asthma symptoms.

10-Week Ballroom Dance Program Improves Mood and Influences Health-Related Elements in Healthy Middle-Aged Adults

Introduction: Sedentary lifestyles remain a persistent health issue in Japan. Ballroom dancing has recently gained attention as a potential means of maintaining physical activity, but there are very few reports on Japanese subjects. Exploratory research is therefore needed to investigate the effects of ballroom dancing on the physical and mental health of sedentary middle-aged Japanese adults. The aim of this study was to assess the impact of ballroom dancing on various health-related physical and psychological outcomes in middle-aged adults compared to a control group. Methods: A parallel-group study was carried out. Thirty healthy but inactive middle-aged adults with no previous dance experience were divided into 2 groups: an intervention group which participated in a recreational level ballroom dance program for 10 weeks (60 minutes, once per week) and a control group which had no dance lessons. Subjects completed questionnaires regarding subjective mood changes and daily physical activity. Objective measures of physical fitness, oxidative stress, antioxidant capacity, and autonomic nervous system function were also assessed before (T0) and after 10 weeks (T11) of dance practice. Results: In the subjective questionnaire, the Profile of Mood States 2 (POMS®2) survey, one of the health-related indicators, T-scores of the Total Mood Disturbance (TMD) after the intervention showed a difference (P = .014) between the dance group and the control group. In post hoc tests, increases of autonomic activity and number of days of high-intensity physical activity correlated positively with a reduction in TMD in the dance group. Conclusion: Among inactive middle-aged adults, participation in weekly ballroom dance lessons for 10 weeks improved their psychological mood compared to a control group. The improvement was found to have the positive effects of activating autonomic nervous system activity and increasing high-intensity physical activity. The results suggest that ballroom dancing may be effective in improving exercise habits and physical and mental health.

A Comparison of Physical Activity and Exercise Recommendations for Public Health: Inconsistent Activity Messages Are Being Conveyed to the General Public

We examined the similarities and differences between government-supported public health activity recommendations from the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the National Health Service (NHS), the Department of Health and Aged Care (DHAC), and one of the most renowned public health activity recommendations, the 10,000 Steps Program. The findings derived from our evaluation suggest a lack of consistency in public health activity recommendations, including the nomenclature used to describe aerobic activity, the amount of time required per week to meet the minimum recommendation for moderate and vigorous activity, and variations in the intensities required to meet aerobic activity recommendations. We also found that moderate-intensity activity (3.0 to less than 6.0 METS) is achieved across the lifespan with normal (i.e., mean), rather than vigorous, walking speeds; this suggests the MET level for moderate-intensity activity may need to be re-examined. The suggested strength activities must also be considered to ensure that the activities maintain or improve strength in the general public. Among the reviewed recommendations, none distinguished between physical activity and exercise, which may contribute to the low levels of exercise participation among the general public. Since exercise is medicine, the most recognized government-supported public health activity recommendations should place a greater emphasis on exercise over physical activity. Moreover, given the low levels of activity in the general public, more care should be given to provide a consistent, clear, and direct message regarding activity recommendations.

Managing Cardiovascular Risk in Patients with Autoimmune Diseases: Insights from a Nutritional Perspective

PURPOSE OF REVIEW

Autoimmune diseases manifest as an immune system response directed against endogenous antigens, exerting a significant influence on a substantial portion of the population. Notably, a leading contributor to morbidity and mortality in this context is cardiovascular disease (CVD). Intriguingly, individuals with autoimmune disorders exhibit a heightened prevalence of CVD compared to the general population. The meticulous management of CV risk factors assumes paramount importance, given the current absence of a standardized solution to this perplexity. This review endeavors to address this challenge from a nutritional perspective.

RECENT FINDINGS

Emerging evidence suggests that inflammation, a common thread in autoimmune diseases, also plays a pivotal role in the pathogenesis of CVD. Nutritional interventions aimed at reducing inflammation have shown promise in mitigating cardiovascular risk. The integration of nutritional strategies into the management plans for patients with autoimmune diseases offers a holistic approach to reducing cardiovascular risk. While conventional pharmacological treatments remain foundational, the addition of targeted dietary interventions can provide a complementary pathway to improve cardiovascular outcomes.

Design of the VOILA-intervention study: A 12-week nutrition and resistance exercise intervention in metabolic or mobility compromised Dutch older adults and the response on immune-metabolic, gut and muscle health parameters

BACKGROUND

Exercise and nutrition interventions can slow ageing-induced decline in physiology. However, effects are heterogeneous and usually studied separately per outcome domain. In the VOILA study, we simultaneously study various health outcomes relevant for older adults and the inter-individual heterogeneity in response to a lifestyle intervention.

METHODS

VOILA is a 12-week lifestyle intervention in 3 groups of older adults (≥60 years), with compromised mobility (n=50), compromised metabolic health (n=50), or recovering from total knee replacement (TKR, n=70, of which 20 randomized to standard care only). The intervention includes high-intensity resistance exercise training thrice weekly, nutritional counselling, and nutritional supplements every morning and evening (including 20-25 g whey protein and (evening only) 5.5 g Biotis™ GOS). We measure immune-metabolic, gut health, muscle mass and physical functioning at baseline and after completion of the intervention/standard care. An additional reference group of healthy older adults (n=50) will undergo baseline measurements only.

DISCUSSION

Improvements in various physiological systems are expected, but with differences between groups/individuals. This study will provide insights into how the physiological state of older adults influences the extent of lifestyle-induced health improvements to create better tailored interventions to attenuate biological ageing and improve the health span of subgroups and individuals.

Evolutionary Mismatch and Lifestyle-Related Diseases: A Study of a 6-Month Intensive Lifestyle Intervention

Chronic medical conditions caused by the inadequate adaptation of the body to modern lifestyles, such as physical inactivity and unhealthy diets, are on the rise. This study assessed whether a comprehensive lifestyle intervention, including high volumes of supervised exercise, could improve health outcomes. Eight volunteers with lifestyle-related diseases received a 6-month lifestyle intervention consisting of 8000-10 000 steps/day, 6 moderate-intensity endurance and 3 resistance training sessions per week, a 5-week long hike, and dietary advice. This was followed by 7 months of limited remote supervision, ending 13 months from baseline. The participants (3 females, 5 males; mean age 42.9 years) had conditions including type 2 diabetes (T2D), depression/stress, and metabolic syndrome (MS). After 6 months, body weight decreased significantly by 23 kg (95% CI; -33.7 to -12.2), with a minor non-significant decrease in lean body mass of 1.96 kg (95% CI; -4.34 to 0.27). Maximal oxygen consumption (VO2max) increased by 18.5 mL/O2/kg/min. (95% CI; 13.8-23.1) and systolic and diastolic blood pressures decreased by 33 (95% CI; -39 to -26) and 18 mmHg (95% CI; -23 to -14), respectively. Three of the 4 participants with T2D had normalized glycated hemoglobin (HbA1c) levels, and all showed improved 2-h oral glucose tolerance (OGTT) without pharmacological treatment. Participants with T2D continued to lower HbA1c during the 7-month follow-up period. This 6-month lifestyle intervention restored metabolic health and improved cardiovascular health in 8 participants with lifestyle-related diseases while reducing the need for pharmacological treatments. These findings suggest that comprehensive lifestyle changes can reverse several medical conditions caused by evolutionary mismatch.

Effects of probiotic supplementation with high-intensity interval training on cardiorespiratory endurance and metabolism in Middle-Aged Obese Women

INTRODUCTION

High-intensity interval training (HIIT) has been shown to improve chronic diseases. Probiotics have been found to have similar effects. However, the additive effects of HIIT in combination with probiotics supplementation are unclear. The aim of current study was to investigate whether there were additive effects when implementing both HIIT and probiotics simultaneously.

METHODS

Forty-seven obese middle-aged women (Age: 44.5 ± 5.94 years, body fat percentage: 40.0 ± 4.1%) were recruited and assigned into four groups: control group (C, n = 12), probiotics group (P, n = 12), HIIT group (H, n = 11), and HIIT with probiotics group (HP, n = 12). All the participants consumed probiotics (Lactiplantibacillus plantarum TWK10, 6 × 1010 CFU/day) or placebo supplements daily. Exercise intervention groups conducted HIIT training (85-90% vVO2max for 2 min, followed by a 1-min inactive rest interval, repeated for 7 cycles) 3 sessions per week for 8 weeks. Anthropometry, cardiorespiratory endurance, blood glucose, and lipid profile were measured at baseline and after the 8-week intervention.

RESULTS

After the intervention, there were significant changes between groups in the variations and rates of change in waist circumference, hip circumference, and TTE. The waist circumference in group H significantly increased compared to groups C and P, while group HP did not show significant difference compared to group C. On the other hand, the hip circumference decreased significantly in group HP compared to group C, and the decreased rate in group HP was significantly greater than in groups C and P. Furthermore, the increase rates in TTE were higher in group H and HP compared to group C.

CONCLUSION

HIIT improves TTE but negatively affects waist circumference compared to the control group. However, when combined with probiotics, the probiotics not only help enhance TTE but also counteract the negative impact on waist circumference and further reduce hip circumference, resulting in a synergistic effect.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT06285578.

Complex patterns and determinants of regional multiple chronic conditions across the United States

Noncommunicable chronic diseases (NCDs) are a rapidly growing global public health concern, posing substantial challenges to healthcare systems. The presence of multiple (≥2) chronic conditions (MCC) exacerbates these challenges. In this study, we constructed an integrated MCC network to comprehensively evaluate the impact of NCD prevalence and associated factors on MCC patterns. We identified four distinct MCC patterns, each with its unique set of associated risk factors. Firstly, we found that race, sedentary lifestyles, and smoking habits were significant contributors to the co-occurrence of diabetes, chronic kidney disease, and cancer. Secondly, smoking habits and mental health were identified as risk factors associated with the clusters of high cholesterol, hypertension, coronary heart disease, and arthritis. Furthermore, the comorbidity of chronic obstructive pulmonary disease and asthma was affected by socioeconomic status, smoking habits, and educational attainment, and a noteworthy reciprocal relationship existed between these two MCC combinations. Thirdly, the combination of asthma and obesity is associated with risk factors such as mental health, smoking habits, sedentary lifestyles, and binge drinking behaviors. Finally, the pattern of depression-stroke comorbidity was influenced by risk factors including mental health, age, and sleep duration. Our findings hold valuable implications for healthcare system optimization, offering a pathway to mitigate the escalating burden of NCDs. Additionally, they provide a foundation for scientific strategies aimed at the joint prevention and management of these complex conditions, ultimately enhancing public health and safety on a global scale.

Identification of genetic and immune mechanisms linking preeclampsia and endometrial cancer: a prognostic model for survival and treatment response

Preeclampsia (PE) and endometrial cancer (EC) are two distinct conditions that share common genetic and molecular mechanisms involving immune dysregulation, endothelial dysfunction, and angiogenesis. This study aimed to investigate the potential genetic links between PE and EC, identify key prognostic genes, and develop a risk model to predict overall survival in EC patients. We conducted comprehensive genetic and molecular analyses, revealing significant overlaps in immune and angiogenic pathways between PE and EC. Through LASSO regression and multivariate Cox analysis, we identified five core prognostic genes-FSTL3, PRSS23, IGFBP4, MYDGF, and TSC22D3-that were used to construct a risk model. This model effectively stratified EC patients into high- and low-risk groups, with significant differences in overall survival. Patients in the low-risk group exhibited better 1-, 3-, and 5-year survival outcomes and had higher immune cell infiltration and expression of immune checkpoint-related genes, indicating a more favorable tumor microenvironment. Additionally, the analysis showed that these genes are also implicated in the pathogenesis of PE, highlighting potential shared molecular mechanisms. Our findings suggest that these PE-related genes may serve as valuable prognostic biomarkers for EC and could lead to improved prognostic tools and personalized treatment strategies for EC patients.

Why exercise may never be effective medicine: an evolutionary perspective on the efficacy versus effectiveness of exercise in treating type 2 diabetes

Most cases of type 2 diabetes (T2D) can be prevented by adopting a healthy lifestyle, highlighting that lifestyle modifications should be the primary defence against developing T2D. Although accumulating evidence suggests that exercise can be an efficacious therapy for T2D, especially in conjunction with pharmacological interventions, its long-term effectiveness remains controversial owing to significant adherence challenges. In this narrative review, we combine an evolutionary perspective with epidemiological and prospective interventional studies to examine the efficacy versus effectiveness of varying volumes of exercise prescriptions for treating T2D. Commonly prescribed and recommended volumes of moderate-intensity physical activity (150 min/week) have demonstrated low-to-moderate efficacy in improving glycaemic control, reflected by improvements in glycated haemoglobin levels. Higher exercise volumes have been shown to enhance efficacy. While exercise can be moderately efficacious under the optimal circumstances of short-term exercise interventions (≤1 year), there is little evidence of its long-term effectiveness, primarily due to poor adherence. To date, no study has demonstrated long-term adherence to exercise programmes in individuals with T2D (>1 year). From an evolutionary perspective, the finding that exercise interventions are often ineffective over time is unsurprising. Although often overlooked, humans never evolved to exercise. Exercise is a counter-instinctive behaviour that can be difficult to maintain, even in healthy populations and can be especially challenging for individuals who are unfit or have T2D morbidities. We conclude by presenting several considerations informed by evolutionary logic that may be useful for practitioners, policymakers and advocates of exercise as medicine to improve exercise adherence.

Geographic and Grade-Level Disparities in Student Access to School-Based Physical Education and Physical Activity Opportunities Across 25 US States

BACKGROUND

Most US children and adolescents do not meet recommended daily physical activity (PA) guidelines. Determinants of PA are complex; however, access to opportunities precedes actual PA engagement. Schools are well positioned to support student PA through the provision of physical education (PE) and before, during, and after school PA opportunities through comprehensive (ie, expanded) school PA programming. Monitoring access to school PE and PA opportunities is an essential function of public health. However, there are limited comprehensive data across K-12 settings. Therefore, the purpose of this study was to evaluate students' access to PE and expanded recreation time before, during, and after school PA opportunities in K-12 schools across 25 US states.

METHODS

The US Physical Education and Physical Activity Policy questionnaire was completed by 4845 K-12 PE teachers across 25 states, representing diverse geographical regions, with responses standardized across varying academic calendars. Descriptive statistics were used to illustrate access to PE and PA opportunities.

RESULTS

Access to PE and PA varied, with elementary schools generally providing more opportunities than middle and high schools. There was an overall misalignment with national PE and recess recommendations. Limited before and after school PA opportunities were also reported.

DISCUSSION

The relative dearth of access to PE and expanded PA opportunities currently available to students in relation to national guidelines shows a need for states to prioritize expanding access to PE and recreational PA to reduce disparities. To ensure more equitable student access, collaborative efforts among educators, policymakers, and stakeholders are essential.

An Evaluation of the Effect of App-Based Exercise Prescription Using Reinforcement Learning on Satisfaction and Exercise Intensity: Randomized Crossover Trial

Background

The increasing prevalence of sedentary lifestyles has prompted the development of innovative public health interventions, such as smartphone apps that deliver personalized exercise programs. The widespread availability of mobile technologies (eg, smartphone apps and wearable activity trackers) provides a cost-effective, scalable way to remotely deliver personalized exercise programs to users. Using machine learning (ML), specifically reinforcement learning (RL), may enhance user engagement and effectiveness of these programs by tailoring them to individual preferences and needs.

Objective

The primary aim was to investigate the impact of the Samsung-developed i80 BPM app, implementing ML for exercise prescription, on user satisfaction and exercise intensity among the general population. The secondary objective was to assess the effectiveness of ML-generated exercise programs for remote prescription of exercise to members of the public.

Methods

Participants were randomized to complete 3 exercise sessions per week for 12 weeks using the i80 BPM mobile app, crossing over weekly between intervention and control conditions. The intervention condition involved individualizing exercise sessions using RL, based on user preferences such as exercise difficulty, selection, and intensity, whereas under the control condition, exercise sessions were not individualized. Exercise intensity (measured by the 10-item Borg scale) and user satisfaction (measured by the 8-item version of the Physical Activity Enjoyment Scale) were recorded after the session.

Results

In total, 62 participants (27 male and 42 female participants; mean age 43, SD 13 years) completed 559 exercise sessions over 12 weeks (9 sessions per participant). Generalized estimating equations showed that participants were more likely to exercise at a higher intensity (intervention: mean intensity 5.82, 95% CI 5.59-6.05 and control: mean intensity 5.19, 95% CI 4.97-5.41) and report higher satisfaction (RL: mean satisfaction 4, 95% CI 3.9-4.1 and baseline: mean satisfaction 3.73, 95% CI 3.6-3.8) in the RL model condition.

Conclusions

The findings suggest that RL can effectively increase both the intensity with which people exercise and their enjoyment of the sessions, highlighting the potential of ML to enhance remote exercise interventions. This study underscores the benefits of personalized exercise prescriptions in increasing adherence and satisfaction, which are crucial for the long-term effectiveness of fitness programs. Further research is warranted to explore the long-term impacts and potential scalability of RL-enhanced exercise apps in diverse populations. This study contributes to the understanding of digital health interventions in exercise science, suggesting that personalized, app-based exercise prescriptions may be more effective than traditional, nonpersonalized methods. The integration of RL into exercise apps could significantly impact public health, particularly in enhancing engagement and reducing the global burden of physical inactivity.

Anti-Aging Effect of Traditional Plant-Based Food: An Overview

Aging is a complex process that involves many physiological mechanisms that gradually impair normal cellular and tissue function and make us more susceptible to diseases and death. It is influenced by intrinsic factors like cellular function and extrinsic factors like pollution and UV radiation. Recent scientific studies show that traditional plant-based foods and supplements can help mitigate the effects of aging. Nutraceuticals, which are dietary supplements with medicinal properties, have gained attention for their ability to prevent chronic and age-related diseases. Antioxidants like flavonoids, carotenoids, ascorbic acid, terpenes, tannins, saponins, alkaloids, minerals, etc. found in plants are key to managing oxidative stress, which is a major cause of aging. Well-known plant-based supplements from Bacopa monnieri, Curcuma longa, Emblica officinalis, Ginkgo biloba, Glycyrrhiza glabra, and Panax ginseng have been found to possess medicinal properties. These supplements have been shown to improve cognitive function, reduce oxidative stress, improve overall health, and potentially extend life and enhance the excellence of life. The obtained benefits from these plant species are due to the presence of their bioactive secondary metabolites, such as bacosides in Bacopa monnieri, curcumin in Curcuma longa, ginsenosides in Panax ginseng, and many more. These compounds not only protect against free radical damage but also modulate key biological pathways of aging. Also, traditional fermented foods (tempeh and kimchi), which are rich in probiotics and bioactive compounds, support gut health, boost immune function, and have anti-aging properties. The molecular mechanisms behind these benefits are the activation of nutrient-sensing pathways like AMPK, SIRT/NAD+, and mTOR, which are important for cellular homeostasis and longevity. This review shows the potential of traditional plant-based foods and dietary supplements for healthy aging, and more studies are needed to prove their efficacy and safety in humans. Incorporating these natural products into our diet may be a practical and effective way to counteract the effects of aging and overall well-being. The foremost goal of this review is to emphasize the importance of supporting the body's antioxidant system by consuming the right balance of natural ingredients in the diet.

Effects of 10 weeks of walking-based exercise training on resting substrate oxidation in postmenopausal women with obesity

BACKGROUND AND AIMS

Accumulating evidence supports the effectiveness of moderate-intensity aerobic training on metabolic health, with limited studies investigating change in resting substrate oxidation. The aim of this study was to explore whether 10 weeks of walking-based aerobic training would alter substrate oxidation in postmenopausal women with obesity.

METHODS AND RESULTS

Twenty-four postmenopausal women with obesity who were assigned into the control (n = 12) or exercise groups (n = 12) undertook a 10-week aerobic training program (3 d·week-1) that involved walking exercises at 50-70% of heart rate reserve on a treadmill, with exercise volume increased from 25 to 40 min·day-1. Resting metabolic rate (RMR) and body composition were measured pre- and post-training. Whole-body substrate oxidation was calculated using respiratory data collected during RMR measurement via indirect calorimetry. No significant change was noted (p > 0.05) in resting fat oxidation and carbohydrate oxidation in the exercise group. Resting respiratory exchange ratio and RMR did not alter in response to the training program (p > 0.05).

CONCLUSION

Our results show that a 10-week of moderate-intensity aerobic training does not modify substrate oxidation in postmenopausal women with obesity.

Physical activity and constipation: A systematic review of cohort studies

Background

Constipation significantly impacts quality of life and is a common public health issue. For affected individuals, especially those who are inactive and experience constipation symptoms, it is recommended to engage in physical activity (PA) to improve their condition. However, the relationship between PA and improvement in constipation remains unclear. We performed this systematic review of cohort studies to evaluate this potential association.

Methods

We systematically searched the Embase, Cochrane Library, PubMed, and CINAHL databases for all cohort studies examining the relationship between PA and constipation from the inception of the databases up to 5 November 2023. We calculated the reported risk ratios (RRs) and 95% confidence intervals (CIs), conducted a random effects model, and performed a subgroup analysis based on factors such as gender, geographic region, and PA intensity to comprehensively explore the link between PA and constipation. Furthermore, we used the Newcastle-Ottawa Scale to evaluate the quality of the studies included in our analysis.

Results

The analysis included 13 studies with 119 426 participants and 63 713 cases. The results indicated that higher levels of PA were associated with a decreased risk of constipation compared with lower levels of PA (RR = 0.69; 95% CI = 0.88-0.83) and moderate levels of PA (RR = 0.87; 95% CI = 0.79-0.95). Furthermore, adherence to international PA guidelines was correlated with a significantly reduced risk of constipation (RR = 0.87; 95% CI = 0.81-0.93). Notably, the risk of constipation was lowered among Asian populations (RR = 0.67; 95% CI = 0.56-0.79) and Oceanian populations (RR = 0.72; 95% CI = 0.63-0.83) who engaged in regular PA. Moreover, when comparing the risk of constipation between men and women collectively, PA was associated with a 34% lower risk (RR = 0.66; 95% CI = 0.55-0.80).

Conclusions

The study findings indicated that moderate to high levels of PA significantly reduced the risk of constipation, showing a negative correlation between PA and constipation.

Registration

PROSPERO: CRD42023479653.

Unraveling the Role of the Human Gut Microbiome in Health and Diseases

The human gut is a complex ecosystem that supports billions of living species, including bacteria, viruses, archaea, phages, fungi, and unicellular eukaryotes. Bacteria give genes and enzymes for microbial and host-produced compounds, establishing a symbiotic link between the external environment and the host at both the gut and systemic levels. The gut microbiome, which is primarily made up of commensal bacteria, is critical for maintaining the healthy host's immune system, aiding digestion, synthesizing essential nutrients, and protecting against pathogenic bacteria, as well as influencing endocrine, neural, humoral, and immunological functions and metabolic pathways. Qualitative, quantitative, and/or topographic shifts can alter the gut microbiome, resulting in dysbiosis and microbial dysfunction, which can contribute to a variety of noncommunicable illnesses, including hypertension, cardiovascular disease, obesity, diabetes, inflammatory bowel disease, cancer, and irritable bowel syndrome. While most evidence to date is observational and does not establish direct causation, ongoing clinical trials and advanced genomic techniques are steadily enhancing our understanding of these intricate interactions. This review will explore key aspects of the relationship between gut microbiota, eubiosis, and dysbiosis in human health and disease, highlighting emerging strategies for microbiome engineering as potential therapeutic approaches for various conditions.

Train and Reprogram Your Brain: Effects of Physical Exercise at Different Stages of Life on Brain Functions Saved in Epigenetic Modifications

Multiple studies have demonstrated the significant effects of physical exercise on brain plasticity, the enhancement of memory and cognition, and mood improvement. Although the beneficial impact of exercise on brain functions and mental health is well established, the exact mechanisms underlying this phenomenon are currently under thorough investigation. Several hypotheses have emerged suggesting various possible mechanisms, including the effects of hormones, neurotrophins, neurotransmitters, and more recently also other compounds such as lactate or irisin, which are released under the exercise circumstances and act both locally or/and on distant tissues, triggering systemic body reactions. Nevertheless, none of these actually explain the long-lasting effect of exercise, which can persist for years or even be passed on to subsequent generations. It is believed that these long-lasting effects are mediated through epigenetic modifications, influencing the expression of particular genes and the translation and modification of specific proteins. This review explores the impact of regular physical exercise on brain function and brain plasticity and the associated occurrence of epigenetic modifications. It examines how these changes contribute to the prevention and treatment of neuropsychiatric and neurological disorders, as well as their influence on the natural aging process and mental health.

Physical activity and DNA methylation-based markers of ageing in 6208 middle-aged and older Australians: cross-sectional and longitudinal analyses

Epigenetic age quantifies biological age using DNA methylation information and is a potential pathway by which physical activity benefits general health. We aimed to assess the cross-sectional and longitudinal associations between physical activity and epigenetic age in middle-aged and older Australians. Blood DNA methylation data for 6208 participants (40% female) in the Melbourne Collaborative Cohort Study (MCCS) were available at baseline (1990-1994, mean age, 59 years) and, of those, for 1009 at follow-up (2003-2007, mean age, 69 years). Physical activity measurements (weighted scores at baseline and follow-up and total MET hours per week at follow-up) were calculated from self-reported questionnaire data. Five blood methylation-based markers of ageing (PCGrimAge, PCPhenoAge, bAge, DNAmFitAge, and DunedinPACE) and four fitness-related markers (DNAmGaitspeed, DNAmGripmax, DNAmVO2max, and DNAmFEV1) were calculated and adjusted for age. Linear regression was used to examine the cross-sectional and longitudinal associations between physical activity and epigenetic age. Effect modification by age, sex, and BMI was assessed. At baseline, a standard deviation (SD) increment in physical activity was associated with 0.03-SD (DNAmFitAge, 95%CI = 0.01, 0.06, P = 0.02) to 0.07-SD (bAge, 95%CI = 0.04, 0.09, P = 2 × 10-8) lower epigenetic age. These associations were attenuated after adjustment for other lifestyle variables. Only weak evidence was found for the longitudinal association (N = 1009) of changes in physical activity and epigenetic age (e.g. DNAmFitAge: adjusted β =  - 0.04, 95%CI =  - 0.08, 0.01). The associations were not modified by age, sex, or BMI. In middle-aged and older Australians, higher levels of self-reported physical activity were associated with slightly lower epigenetic age.

Occupational Physical Activity and Regular Exercise Are Inversely Correlated with Thyroid Function in Patients with Hashimoto's Thyroiditis

OBJECTIVE

We evaluated correlations of occupational physical activity (OPA) and recreational exercise (RE), respectively, with thyroid function in patients with Hashimoto's thyroiditis (HT).

METHODS

We included 438 individuals with clinically diagnosed HT. Information on OPA and RE were collected through a self-report questionnaire. We assessed correlations between clinical phenotypes (TSH, T3, T4, fT4, TgAb, TPOAb, thyroid volume, vitamin D) and physical activities (OPA and RE) in all HT patients (ALL) and in two severity-based subgroups of patients (MILD and OVERT).

RESULTS

The main novel findings are significant correlations between increase in OPA and (i) a decrease in fT4 (OVERT, r = -0.265, p = 0.0002 and ALL, r = -0.138, p = 0.006); (ii) an increase in TSH (ALL, r = 0.124, p = 0.014 and OVERT, r = 0.183, p = 0.013) and (iii) an increase in TPOAb antibodies (ALL, r = 0.101, p = 0.045). In contrast, we observed correlations between increase in RE and: (i) a decrease in TSH (OVERT, r = -0.238, p = 0.001); (ii) a decrease in TgAb antibodies (OVERT, r = -0.194, p = 0.01) and (iii) an increase in vitamin D levels (ALL, r = 0.146, p = 0.005 and OVERT, r = 0.173, p = 0.023).

CONCLUSIONS

Our results suggest that, unlike RE, OPA correlates with decreased thyroid function and increased thyroid autoimmunity. Our study proposes that the PA health paradox also applies for the thyroid health.

Effectiveness of physiotherapist-led tele-rehabilitation for older adults with chronic conditions: a systematic review and meta-analysis

BACKGROUND

Older adults live with chronic conditions worldwide. The aim of this systematic review was to determine the effectiveness of physiotherapist-led (PT-led) tele-rehabilitation on various health outcomes.

METHODS

Six databases were searched. Eligible studies were randomized controlled trials that included older adults (≥65 years) who had ≥1 chronic condition, and evaluated tele-rehabilitation (e.g., video, telephone) that was PT-led or overseen. Screening and data extraction were performed in duplicate. Meta-analyses were performed where appropriate. Cochrane's Risk of Bias 2.0 tool was used.

RESULTS

Fifteen studies were included. A meta-analysis of studies of knee osteoarthritis demonstrated that tele-rehabilitation is more effective than usual care for functional mobility (MD= -2.72, 95% CI= -3.56, -1.88, p < 0.001), quadriceps strength (MD= 15.54, 95% CI= 10.14, 20.95, p < 0.001), pain (MD= -1.2, 95% CI= -2.09, -0.39, p = 0.004) and physical function (MD= -5.95, 95% CI= -8.32, -3.58, p < 0.001). No clear differences were found between tele-rehabilitation and usual care or comparator interventions for outcomes related to physical activity level, gait speed, mental health, and quality of life.

CONCLUSIONS

PT-led tele-rehabilitation appears to be comparable to traditional methods at improving outcomes in older adults with various chronic conditions. However, high-quality trials are needed so future conclusions on the effectiveness of tele-rehabilitation can be made.

CRD42023428048.

Emotional Status, Motor Dysfunction, and Cognitive Functioning as Predictors of Quality of Life in Physically Engaged Community-Dwelling Older Adults: A Structural Equation Modeling Approach

The demographic transition has become a reality, and it demands public policies to promote physical and mental health in aging. Group exercise emerges as a cost-effective and accessible alternative to promote active aging on a large scale, but to optimize the effectiveness of these programs, it is crucial to understand the underlying mechanisms that improve quality of life. This study aimed to explore the associations between emotional status, cognitive functioning, motor dysfunction, and their relationship with quality of life in community-dwelling older adults participating in a group physical exercise program. Structural equation modeling was used to explore these relationships in a sample of 190 older adults. Emotional state directly predicted all domains of quality of life. Motor dysfunction predicts the physical health domain of quality of life. Motor dysfunction and cognitive functioning are strongly correlated with emotional status. The fit indices of the final model are acceptable, and it demonstrates that within group-exercise dynamics, emotional status is the main component of quality-of-life promotion. Therefore, professionals designing group physical exercise programs to promote active aging should consider not only physical fitness, but also the integration of psychosocial elements, offering a holistic approach to enhancing overall well-being.

Machine learning predicts peak oxygen uptake and peak power output for customizing cardiopulmonary exercise testing using non-exercise features

PURPOSE

Cardiopulmonary exercise testing (CPET) is considered the gold standard for assessing cardiorespiratory fitness. To ensure consistent performance of each test, it is necessary to adapt the power increase of the test protocol to the physical characteristics of each individual. This study aimed to use machine learning models to determine individualized ramp protocols based on non-exercise features. We hypothesized that machine learning models will predict peak oxygen uptake ( V ˙ O2peak) and peak power output (PPO) more accurately than conventional multiple linear regression (MLR).

METHODS

The cross-sectional study was conducted with 274 (♀168, ♂106) participants who performed CPET on a cycle ergometer. Machine learning models and multiple linear regression were used to predict V ˙ O2peak and PPO using non-exercise features. The accuracy of the models was compared using criteria such as root mean square error (RMSE). Shapley additive explanation (SHAP) was applied to determine the feature importance.

RESULTS

The most accurate machine learning model was the random forest (RMSE: 6.52 ml/kg/min [95% CI 5.21-8.17]) for V ˙ O2peak prediction and the gradient boosting regression (RMSE: 43watts [95% CI 35-52]) for PPO prediction. Compared to the MLR, the machine learning models reduced the RMSE by up to 28% and 22% for prediction of V ˙ O2peak and PPO, respectively. Furthermore, SHAP ranked body composition data such as skeletal muscle mass and extracellular water as the most impactful features.

CONCLUSION

Machine learning models predict V ˙ O2peak and PPO more accurately than MLR and can be used to individualize CPET protocols. Features that provide information about the participant's body composition contribute most to the improvement of these predictions.

TRIAL REGISTRATION NUMBER

DRKS00031401 (6 March 2023, retrospectively registered).

High-energy injuries, combined ligamentous injuries, and joint incongruity as predictors of postoperative shoulder dysfunction in AC joint dislocation surgery

OBJECTIVE

To identify risk factors associated with postoperative shoulder joint dysfunction in patients who underwent surgical intervention for acromioclavicular (AC) joint dislocation, with the aim of enhancing preoperative counselling, surgical planning, and postoperative management to optimize functional outcomes.

METHODS

Patients who underwent surgery for AC joint dislocation between January 2018 and January 2023 at a hospital orthopaedic centre were enrolled into this retrospective study. Inclusion criteria were patients aged ≥18 years with a documented AC joint dislocation who underwent surgical treatment and had a minimum follow-up period >1 year. Patients with pre-existing shoulder conditions, prior shoulder surgeries, or incomplete medical records were excluded. Visual Analog Scale pain score ≥5 and Constant-Murley Score ≤70 was considered indicative of shoulder joint dysfunction. Statistical analyses included univariate and multivariate logistic regression to identify independent risk factors for postoperative shoulder joint dysfunction.

RESULTS

Among 208 included patients, 56 (27%) exhibited shoulder joint dysfunction at the final follow-up. High-energy injury mechanisms, combined coracoclavicular ligament injuries, and lack of coronal plane congruity were identified as significant predictors of postoperative dysfunction. Specifically, high-energy injuries (odds ratio [OR] 5.493, 95% confidence interval [CI] 2.068, 14.590), combined coracoclavicular ligament injuries (OR 0.118, 95% CI 0.032, 0.432), and lack of coronal plane congruity (OR 2.540, 95% CI 1.197, 5.387) were associated with an increased risk of poor shoulder function postoperatively. Other factors, such as age, injury mechanism, and postoperative exercise compliance also contributed to the outcomes. Level of evidence: iv.

CONCLUSIONS

Injury mechanism, ligamentous injuries, and joint congruity are important in determining postoperative shoulder function. Accurate joint reduction and diligent postoperative rehabilitation are crucial for optimal recovery. These findings provide valuable insights for improving patient care and surgical outcomes in AC joint dislocation treatment. Further research is needed to validate these findings and explore additional factors that may influence postoperative shoulder function.

Blending Towards Healthier Lifestyles: The Impact of Regular Fruit and Vegetable Smoothie Consumption on Dietary Patterns and Sustainable Health Behaviors

PURPOSE

This research aimed to characterize the nutritional, health and basic sustainability practices among regular smoothies' consumers (RSC; ≥ 1-2 servings/week for ≥ 2 months).

DESIGN

Cross-sectional survey.

SETTING

Self-report online multiple-choice questionnaire survey of random sample of adults from online retailer database and community.

SAMPLE

193 healthy Israeli adults (75.6% females, mean age 40.65 ± 14.36) completed an online multiple-choice validated survey from May 2022 to August 2023.

MEASURES

Demographic, anthropometric, and lifestyle habits, including physical activity, FV consumption, and sustainability practices.

ANALYSIS

Data were analyzed using chi-square tests for categorical variables and Mann-Whitney tests for non-normally distributed continuous variables. The level of statistical significance was set at .05.

RESULTS

RSC were significantly older (P < .001) and more physically active (P = .025) than occasional smoothie consumers (OSC). They consumed more FV, reaching nutritional recommendations, and exhibited significant lifestyle changes, including reduced meat (P = .013) and processed food consumption (P = .013), and regular meal consumption (P = .045). RSC used fewer disposables (P = .002) compared to OSC and non-smoothie consumers (P = .001). RSC demonstrated a higher incidence of weight reduction compared to weight gain.

CONCLUSION

RSC is significantly associated with health and nutritional sustainability.

Years of running, chronic diseases, and allergies are associated with gradual onset Achilles tendon injuries in 61,252 running race entrants: SAFER XXXIX study

BACKGROUND

Gradual-onset Achilles tendon injuries (GoATIs) in runners are common. Data show that chronic diseases are associated with GoATI.

OBJECTIVE

To determine risk factors associated with a history of GoATIs among long-distance runners (21.1 and 56 km) entering a mass community-based running event.

METHODS

Online pre-race medical screening questionnaire data from 76,654 consenting Two Ocean Marathon race entrants (71.8% entrants) were collected prospectively over 4 years (2012-2015); this cross-sectional study is a retrospective analysis of these data. A total of 617 entrants (0.8%) reported a GoATI in the last 12 months; 60,635 entrants reported no history of any running injury (controls). Categories of factors associated with GoATI were explored (univariate and multiple regression analyses): demographics (age group, sex, race, distance), training/racing history, and history of allergy, history of chronic disease, and Composite Chronic Disease Score. Prevalence and prevalence ratios (PRs; 95% CI) are reported.

RESULTS

Factors associated with a higher prevalence of a history of GoATI (univariate analysis vs. controls) were older age (>31 years) (p < .001), male sex (PR = 1.76; p < .001), and longer race distance (56 km vs. 21.1 km) (PR = 2.06; p < .001). Independent factors associated with a history of GoATI (multiple regression) were increased years of recreational running (PR = 1.17 for every 5-year increase, p < .001), higher Composite Chronic Disease Score (PR = 2.07 for every 2-unit increase, p < .001), and allergy history (PR = 1.98 p < .001).

CONCLUSION

Novel independent factors associated with a history of GoATI in distance runners were increased years of recreational running, chronic disease history, and allergy history. Runners at risk for GoATI could be targeted for injury prevention interventions. Future studies should focus on establishing a causal relationship.

The Significance of Physical Activity Education: A Survey of Medical Students

Introduction

Less than 20% of US adults meet physical activity (PA) recommendations, yet few physicians provide consistent PA counseling. There is limited research on the state of education of PA counseling in medical school curricula. The purpose of this study was to analyze medical students' perspectives on the current state and perceived quality of PA education in medical school.

Methods

An online survey was administered to the students of nine United States medical schools in January 2021. Descriptive statistics were used to analyze results.

Results

Of 5500 invited students, 1182 (21.5%) responded. Only 8% of students received any formal training on PA counseling for patient or self-use throughout their medical education. The majority (64% and 85%, respectively) of respondents felt that both learning more about the benefits of PA and gaining more practical skills in counseling on PA should be requirements to graduate. Students across all medical school years agreed that formal training on patient counseling for PA should be taught more in-depth.

Conclusions

Medical students believe that PA and exercise physiology should comprise more of medical education curricula. Such training may equip students with the tools they believe they need to adequately treat patients effectively throughout their careers.

Exerkine response to acute exercise: Still much to discover

•Exerkines mediate, at least partly, the salutary effects of exercise. •However, the actual responsiveness and time-course profile of most of these molecules remains unknown. •Future research should explore potential factors explaining inter-individual variability in exerkine responses.

Physical Inactivity and its Sociodemographic Determinants among Adults: A Community-Based Study

Introduction

Physical inactivity (PI) is the fourth leading risk factor for global mortality and is potentially modifiable. Understanding its sociodemographic correlates can contribute in planning preventive measures to reduce the same.

Aims and Objectives

1) To estimate the prevalence of PI among adults aged 20-60 years and 2) to identify the sociodemographic determinants of PI among adults.

Material and Methods

A community-based cross-sectional study was done in district Aligarh, Uttar Pradesh. 304 adults aged 20-60 years, giving informed consent were selected by simple random sampling. Pregnant women and those with febrile disease and physical defect were excluded. Predesigned structured proforma and Global Physical Activity Questionnaire were used. Chi-square test and logistic regression analysis were applied using IBM SPSS 23.0.

Results

Prevalence of PI was 47.7% (95% CI: 42.0-52.6). It was significantly higher in urban (55.3% vs 41.1%) than in rural area and among females than in males (68.7% vs 34.9%). PI during work was 74.3%, during travel 78.9%, and during recreation 88.5%. Being female increased odds of PI by almost ten times (adjusted odds atio (AOR) =9.7, 95% CI: 1.6-58.5). Unskilled workers/laborers and farmers (those involved in active occupational work) were found to have lesser odds of PI (AOR = 0.2, 95% CI: 0.1-0.5 and AOR = 0.2, 95% CI: 0.01-0.6, respectively).

Conclusion

PI is highly prevalent among adults. Targeted interventions to increase physical activity in recreational domain are recommended, specially in urban areas and among women. Further studies to explore barriers to physical activity are needed to address this problem.

Initial Exploration of the In Vitro Activation of GLP-1 and GIP Receptors and Pancreatic Islet Cell Protection by Salmon-Derived Bioactive Peptides

This study examines the in vitro effects of a soluble protein hydrolysate (SPH) derived from Atlantic salmon (Salmo salar) on incretin receptor activity and pancreatic islet cell protection to explore the mechanisms underlying SPH's observed benefits on weight loss and metabolic health in overweight individuals. SPH demonstrated a dose-dependent enhancement of glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) receptor activity, with significant increases of 2.4-fold (p < 0.05) and 2.6-fold (p < 0.01) at 10 mg/mL, respectively, compared to the control. Pancreatic islet cell assays showed a substantial proliferation effect, with up to a 57% increase at 50 µL/well, indicating potential protective properties against inflammation-induced cell loss. Notably, the smallest SPH peptide fraction (<1000 Da) exhibited GLP-1 agonist activity comparable to semaglutide, a widely used therapeutic agent, underscoring SPH's potential efficacy in modulating metabolic pathways. These results suggest that SPH not only enhances key incretin signaling but also promotes islet cell health, positioning it as a promising dietary intervention to improve age-related metabolic health, including the weight gain and underlying adverse metabolic changes frequently encountered through the menopause.

The Effects of Aerobic Exercise Training on Testosterone Concentration in Individuals Who are Obese or Have Type 2 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Obesity and type 2 diabetes (T2D) are associated with alterations in testosterone concentrations. While evidence indicates that aerobic training can influence testosterone in healthy populations or females with hyperandrogenism, its impact in individuals with obesity or T2D remains unclear. Thus, the aim of this study was to investigate whether aerobic training can influence circulating testosterone concentrations in individuals with obesity or T2D.

METHODS

EBSCOhost (CINAHL, MEDLINE, SPORTDiscus), PubMed and Embase were searched for articles published until August 2023. Eligible articles included individuals with obesity or T2D that underwent an aerobic exercise intervention with testosterone concentrations measured at baseline and post intervention. Two reviewers independently screened the seven articles included in this meta-analysis and conducted data extraction and risk of bias assessments.

RESULTS

A total of 103 participants (62 men / 41 women) from three randomised controlled trials and four non-randomised controlled trials were included. Effect sizes were computed with random effects models. Aerobic exercise moderately increased testosterone concentrations in men (g = 0.565, 95% CI = 0.307 to 0.822, p < 0.001), but had no significant effect in women (g = -0.523, 95% CI = -1.541, 0.496, p = 0.314). Aerobic exercise had no significant effect on sex hormone-binding globulin or markers of insulin sensitivity (p > 0.05).

CONCLUSIONS

Aerobic training may be used to increase testosterone concentrations in men with obesity or T2D, but potentially has no influence in women. Given the low number of studies, further studies investigating the effect of exercise on circulating sex hormones in men and women with obesity or T2D are needed.

[Physical Activity-Related Health Services in Germany: Relevance and Necessary Framework Conditions - a Position Paper of the DNVF Working Group Physical Activity-Related Health Services Research]

Based on the relevance of an established and broad foundation of physical activity in healthcare, this position paper of the DNVF working group Physical Activity-Related Health Services research presents current conceptual approaches to physical activity-related health services in Germany and highlights the need for interprofessional and interdisciplinary approaches. Three central positions are outlined and elaborated in order to integrate the evidence on health benefits of physical activity and exercise more strongly into healthcare and to show that, against the background of the challenges in the German healthcare system, physical activity-related health services can make a cost-effective and high-quality contribution to improve healthcare. These three positions include 1) the integration of all professional groups involved in healthcare into physical activity-related health services, 2) the greater integration of physical activity professions and physical activity interventions into all healthcare contexts and 3) the systematic consideration of physical activity- and exercise-related expertise in clinical guidelines.

Immune system benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by pulmonary and systemic inflammation. Inflammatory mediators show relationships with shortness of breath, exercise intolerance and health related quality of life. Pulmonary rehabilitation (PR), a comprehensive education and exercise training programme, is the most effective therapy for COPD and is associated with reduced exacerbation and hospitalization rates and increased survival. Exercise training, the primary physiological intervention within PR, is known to exert a beneficial anti-inflammatory effect in health and chronic diseases. The question of this review article is whether exercise training can also make such a beneficial anti-inflammatory effect in COPD. Experimental studies using smoke exposure mice models suggest that the response of the immune system to exercise training is favourably anti-inflammatory. However, the evidence about the response of most known inflammatory mediators (C-reactive protein, tumour necrosis factor α, interleukin 6, interleukin 10) to exercise training in COPD patients is inconsistent, making it difficult to conclude whether regular exercise training has an anti-inflammatory effect in COPD. It is also unclear whether COPD patients with more persistent inflammation are a subgroup that would benefit more from hypothesized immunomodulatory effects of exercise training (i.e., personalized treatment). Nevertheless, it seems that PR combined with maintenance exercise training (i.e., lifestyle change) might be more beneficial in controlling inflammation and slowing disease progress in COPD patients, specifically in those with early stages of disease.

A geographic perspective of the association between physical activity and cardiovascular health: A need for community-level intervention

Cardiovascular diseases (CVDs) are a major cause of death globally, and minority communities are at higher risk of chronic health outcomes. A combination of lifestyle, including physical activity (PA), good nutrition, and reduced stress, can improve life expectancy. This study aimed to analyze the association between CVDs and PA among the adult population (N = 3,956) based on the World Health Organization (WHO) STEPwise Approach to Surveillance (STEPS) survey in Afghanistan. Descriptive statistics, logistic regression, and spatial analytical techniques were used to analyze the data. Based on the WHO STEPS data, the computed prevalence of CVDs, obesity, hypertension, diabetes, and high cholesterol were 7.41%, 45.57%, 34.06%, 9.51%, and 12.16%, respectively. Multivariate logistic analysis indicated that moderate work-related PA was associated with higher odds of CVDs and high cholesterol while inversely associated with obesity. Moderate leisure-related PA was positively associated with obesity. Vigorous leisure-related PA was associated with lower risks of CVDs, obesity, and high cholesterol but had a positive association with hypertension. Spatial analysis revealed a CVD hotspot in the southern region and the risk factors clustered in the northern region. These findings offer valuable insights for community and public health practitioners to design targeted interventions for reducing the burden of CVDs and risk factors in communities in developing countries.

Correlation analysis of the urban community environment and health promotion among adults aged ≥ 55 years: the mediating role of physical activity

BACKGROUND

Physical health (PH), including muscle strength, endurance, and the ability to perform daily physical tasks, gradually declines with increasing age, leading to disability and an increased disease burden. Both the urban community environment (UCE) and physical activity (PA) were linked to PH.

METHODS

A total of 625 participants aged 55 years and older from Haidian and Chaoyang Districts in Beijing, China, were included in the study from September to December 2023.PH was assessed by a combined score of four tests, including BMI, chronic disease, depression and self-rated health.The Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A), Center for Epidemiological Survey-Depression Scale (CES-D), Physical Activity Scale for Elderly (PASE) and Social Support Rate Score (SSRS) were collected. The analysis was carried out with SPSS v.20 and Amos 24, and the results were validated via structural equation modeling (SEM).

RESULTS

The urban community environment was positively associated with the health level of older adults. Specifically, the standardized path coefficients indicate that the influence of the built environment (0.72-0.88) was greater than that of the social environment (0.43-0.55) and personal attributes (0.22-0.37) on older adults' health. Physical activity demonstrated both a mediating effect and an indirect effect, highlighting its significant value as a mediating variable.

CONCLUSIONS

The urban community environment has a positive impact on promoting the physical health of older adults, with the influence of the built environment being greater than that of the social environment and personal attributes on their physical health. Physical activity acts as a mediator between the urban community environment and the physical health of older adults.

Association between cannabis use and physical activity in the United States based on legalization and health status

BACKGROUND

Studies investigating the association between cannabis use and physical activity have had mixed results. This study provided a population-based assessment while determining how the relationship is affected by variables such as cannabis legalization status and chronic medical conditions.

METHODS

Behavior Risk Factor Surveillance System (BRFSS) data were used to evaluate the association between cannabis use and physical activity among adults ages 18 years and older in several states and territories of the U.S. during 2016-2022. Adjusted odds ratios (ORs) measuring the relationship between physical activity in the past 30 days (yes vs. no) and cannabis use in the past 30 days (yes vs. no) based on legalization and health status were estimated using logistic regression.

RESULTS

Physical activity increased from 73.16% in 2016 to 75.72% in 2022 (3.5% increase) and current cannabis use increased from 7.48% in 2016 to 14.71% in 2022 (96.7% increase). Current cannabis use was 6.5% higher in areas of legalized recreational cannabis (vs. not legal) and 0.7% higher in areas of legalized medical cannabis (vs. not legal). For the combined years, the OR measuring the association between cannabis use and physical activity was 1.24 (95% CI 1.10-1.41), after adjusting for age, sex, race/ethnicity, marital status, employment status, education, smoking status, weight classification, legal status, and chronic medical condition. The adjusted OR was 1.47 (95% CI 1.34-1.62) in areas with legalized recreational and medical cannabis (vs. illegal) and 1.05 (95% CI 0.98-1.12) in areas with legalized medical cannabis only (vs. illegal). Having a medical condition was significantly associated with lower prevalence of physical activity in the adjusted models (overall adjusted OR = 0.79, 95% CI 0.73-0.85). However, this significantly lower odds ratio was insignificant for current cannabis users.

CONCLUSIONS

Public policy and personal health behaviors may improve with the findings that legal medical cannabis promotes greater physical activity in those experiencing chronic medical conditions and legal recreational cannabis promotes (even more so) greater physical activity in those not experiencing chronic medical conditions.

A Nationwide Physical Activity Intervention for 654,500 Adults in Singapore: Cost-Utility Analysis

Background

Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising health care expenditure and productivity losses. As Singapore's aging population grows, there is an increased disease burden on Singapore's health systems. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges with the uncertainty of long-term health impact and high implementation costs, hindering their adoption.

Objective

We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health (mHealth) intervention to increase physical activity, from both the health care provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs.

Methods

We used a Markov model to assess the long-term impact of increased physical activity from the NSC on adults aged 17 years and older. A Monte Carlo simulation with 1000 samples was conducted to compare two situations: the NSC conducted yearly for 10 years against a no-intervention situation with no NSC. The model projected inpatient and outpatient costs and mortality arising from diabetes and hypertension, as well as their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. All future costs and QALYs were discounted at 3% per annum. Sensitivity analyses were done to test the robustness of our model results.

Results

We estimated that conducting the NSC yearly for 10 years with a mean cohort size of 654,500 participants was projected to prevent 6200 diabetes cases (95% credible interval 3700 to 9100), 10,500 hypertension cases (95% credible interval 6550 to 15,200), and 4930 deaths (95% credible interval 3260 to 6930). This led to a reduction in health care costs of SGD (Singapore dollar) 448 million (95% credible interval SGD 132 million to SGD 1.09 billion; SGD 1=US $0.73 for the year 2019). There would be 78,800 (95% credible interval 55,700 to 102,000) QALYs gained. Using a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-saving. When indirect costs were included, the NSC was estimated to reduce societal costs by SGD 1.41 billion (95% credible interval SGD 353 million to SGD 3.80 billion). The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance.

Conclusions

In this modeling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension and reducing mortality from these diseases. Our results provide important information for decision-making in countries that may consider introducing similar large-scale physical activity programs.

The association between physical activity and anxiety in college students: parallel mediation of life satisfaction and self-efficacy

Objective

To explore the functions that physical activity (PA), life satisfaction, and self-efficacy have in the process of coping with anxiety among Chinese college students, and to explore the mediating role of life satisfaction and self-efficacy in this process.

Methods

Participants were 358 college students (186 males, 172 females, mean age 20.88, SD = ±1.80). Psychosocial tests including the Physical Activity Rating Scale (PARS-3), College Student Life Satisfaction Scale (CSLSS), General Self-Efficacy Scale (GSES), and Generalized Anxiety Disorder Scale (GAD-7) were completed. Correlations between variables were calculated using Pearson's test. The mediation model was tested using the SPSS 26.0 PROCESS macro and regression bootstrap.

Results

Physical activity showed a negative correlation with anxiety (β = -0.1617, p < 0.001., life satisfaction and self-efficacy played a role in the relationship between physical activity and anxiety. More importantly, physical activity was associated with anxiety through parallel mediating effects of life satisfaction and self-efficacy, with a total mediating effect of 55.34%.

Conclusion

By increasing college students' participation in physical activity, it helps to promote the growth of their life satisfaction and self-efficacy, which is the key to reducing anxiety and promoting college students' mental health.

Reduction in physical activity during Covid-19 lockdowns predicts individual differences in cognitive performance several months after the end of the safety measures

Prior studies suggest that the reductions in physical activity during Covid-19-related lockdowns impacted physical and mental health. Whether reductions in physical activity that occurred during lockdowns also relate to cognitive functions such as memory and attention is less explored. Here, we investigated whether changes in physical activity (PA) that occurred during and following Covid-19-related lockdowns could predict a variety of measures of cognitive performance in 318 young adults. Participants were assessed on their engagement in PA before, during, and after lockdowns. They also completed tests of cognitive control, working memory, and short-term memory following lockdown(s). As expected, engagement in PA decreased during lockdown and returned to near baseline levels thereafter. Decreases in PA during lockdown predicted individual differences in cognitive performance following lockdown. Greater reductions in PA during lockdown were associated with lower scores on the go/no-go task, a measure of cognitive control ability, and the n-back task, a measure of working memory performance. Larger post-lockdown increases in PA were associated with higher scores on the same tasks. Individual differences in pandemic-related stress and insomnia also predicted cognitive outcomes. These findings suggest that reductions of PA can predict cognitive performance, and underscore the importance of maintaining PA for cognitive health, especially in situations such as lockdowns.

Systemic and tissue-specific spexin response to acute treadmill exercise in rats

Spexin (SPX) is a 14-amino-acid peptide that plays an important role in the regulation of metabolism and energy homeostasis. It is well known that a variety of bioactive molecules released into the circulation by organs and tissues in response to acute and chronic exercise, known as exerkines, mediate the benefits of exercise by improving metabolic health. However, it is unclear whether acute exercise affects SPX levels in the circulation and peripheral tissues. This study aimed to determine whether acute treadmill exercise induces plasma SPX levels, as well as mRNA expression and immunostaining of SPX in skeletal muscle, adipose tissue, and liver. Male Sprague Dawley rats were divided into sedentary and acute exercise groups. Plasma, soleus (SOL), extensor digitorum longus (EDL), adipose tissue, and liver samples were collected at six time points (0, 1, 3, 6, 12, and 24 h) following 60 min of acute treadmill exercise at a speed of 25 m/min and 0 % grade. Acute exercise increased plasma SPX levels and induced mRNA expression of Spx in the SOL, EDL, and liver. Immunohistochemical analysis demonstrated that acute exercise led to a decrease in SPX immunostaining in the liver. Taken together, these findings suggest that SPX increases in response to acute exercise as a potential exerkine candidate, and the liver may be one of the sources of acute exercise-induced plasma SPX levels in rats. However, a comprehensive analysis is needed to fully elucidate the systemic response of SPX to acute exercise, as well as the tissue from which SPX is secreted.

Barriers and Benefits of Online Group Exercise Programs for Older Adults

Engaging in regular physical activity offers a myriad of benefits, including the improvement of mental health, social well-being, and cognitive function. Unfortunately, obstacles, such as transportation constraints, time limitations, and inadequate exercise facilities, hinder the regular participation of older adults in physical activity. Online group physical activity programs present a promising solution to enhance the involvement of older adults; however, several barriers impede their effective utilization. To explore these barriers and benefits, we conducted semi-structured interviews with participants and instructors of a community-based exercise program. Thematic analysis of interviews with 12 physical activity instructors and eight program participants unveiled key hindrances, including limited awareness and accessibility of online programs, challenges in assessing performance during exercise sessions, lack of social component, and technological difficulties. On the positive side, the benefits encompass convenience, wide accessibility, and enhanced social comfort. We also deliberate on future considerations to further bolster participation in these programs.

Myokine secretion during moderate-intensity physical activity: Dose-response of interleukin 6 to walking duration

During vigorous physical activity, contracting muscles secrete a variety of immunomodulatory and metabolic factors called myokines that perform a variety of functions. Foremost among these is interleukin 6 (IL-6), which increases fatty acid mobilization and stimulates anti-inflammatory cytokine release. Despite being well characterized in vigorous exercise contexts, whether IL-6 is secreted during moderate-intensity activities such as walking is unclear. This is especially pertinent as regular walking is one of the oldest and most common forms of physical activity and comes with a variety of health benefits, which may be coordinated in part by IL-6 signaling. To test the hypothesis that IL-6 release occurs during evolutionarily normal physical activity contexts like long distance walking, we performed a dose-response experiment to test the effect of walking duration on IL-6 secretion. Thirteen participants completed four moderate-intensity walking trials (55% HRmax) of varying durations (30 min, 1 h, 2 h, and 3 h) in a randomized order with intervening washout periods of at least 1 week. Using a linear mixed effects model, we found that IL-6 levels modestly increased during only the 2 h and 3 h walking trials. These results suggest that small frequent increases in IL-6 signaling may be an important mechanism underlying the health benefits of regular walking. Furthermore, this finding raises the possibility that IL-6 secretion is an adaptation to fuel physical activity, especially during periods of negative energy balance.

Gut microbiome related to metabolic diseases after moderate-to-vigorous intensity exercise

Background objectives

The purpose of this study is to investigate changes in gut microbiota related to metabolic diseases after moderate and high-intensity exercise. A total of 24 participants were divided into three groups: Non-Exercise Group (NEG, n = 8, 28.6 ± 5.3 years, 176.0 ± 7.8 cm, 81.3 ± 14.6 kg), Moderate Intensity Exercise Group (MIEG, n = 8, 26.5 ± 3.3 years, 176.9 ± 5.0 cm, 75.4 ± 9.5 kg), and Vigorous Intensity Exercise Group (VIEG, n = 8, 30.6 ± 5.9 years, 174.2 ± 3.5 cm, 77.8 ± 12.2 kg).

Methods

The participants were selected by assessing physical activity, gut health status, presence of diseases, recent disease diagnoses, and dietary disorders. Those who reported any presence disease or recent disease diagnosis were excluded from the current study. Stool samples were collected after a 10-h fast for gut microbiome analysis. MIEG participants trained at 40-59 % heart rate reserve (HRR) for at least 150 min per week, while VIEG participants trained at ≥ 60 % HRR for at least 90 min per week. After 4 weeks, all participants provided stool samples for gut microbiome analysis.Data analysis was conducted using the Wilcoxon test, with statistical significance set at ≤ 0.05.

Results

The results indicated an increase in Prevotella in MIEG, while Veillonella, Dorea_formicigenerans, and Dorea_longicatena exhibited a decrease (p < 0.05). In VIEG, there was an increase in Bacteroides, Butyricimonas, Odoribacter, and Alistipes (p < 0.05).

Conclusion

These modified microbial groups were associated with factors related to metabolic diseases, including inflammatory bowel disease, obesity, colorectal cancer, diabetes, hypertension, metabolic liver diseases, and ischemic heart diseases. Additional research is essential to delve into the relationship between exercise and these alterations in the microbiome.

Exercise, Neuroprotective Exerkines, and Parkinson's Disease: A Narrative Review

Parkinson's disease (PD) is a prevalent neurodegenerative disease in which treatment often includes an exercise regimen. Exercise is neuroprotective in animal models of PD, and, more recently, human clinical studies have verified exercise's disease-modifying effect. Aerobic exercise and resistance training improve many of PD's motor and non-motor symptoms, while neuromotor therapy and stretching/flexibility exercises positively contribute to the quality of life in people with PD. Therefore, understanding the role of exercise in managing this complex disorder is crucial. Exerkines are bioactive substances that are synthesized and released during exercise and have been implicated in several positive health outcomes, including neuroprotection. Exerkines protect neuronal cells in vitro and rodent PD models in vivo. Aerobic exercise and resistance training both increase exerkine levels in the blood, suggesting a role for exerkines in the neuroprotective theory. Many exerkines demonstrate the potential for protecting the brain against pathological missteps caused by PD. Every person (people) with Parkinson's (PwP) needs a comprehensive exercise plan tailored to their unique needs and abilities. Here, we provide an exercise template to help PwP understand the importance of exercise for treating PD, describe barriers confronting many PwP in their attempt to exercise, provide suggestions for overcoming these barriers, and explore the role of exerkines in managing PD. In conclusion, exercise and exerkines together create a powerful neuroprotective system that should contribute to slowing the chronic progression of PD.