Effects of Swimming and Cycling Exercise Intervention on Vascular Function in Patients With Osteoarthritis

The interplay between osteoarthritis and osteoporosis: Mechanisms, implications, and treatment considerations - A narrative review

This comprehensive review examines the relationship between osteoarthritis (OA) and osteoporosis (OP), two common disorders in the elderly. OA involves joint cartilage degeneration and pain, while OP leads to fractures due to reduced bone mass. Despite different pathologies, both conditions share risk factors such as age and genetics. Studies reveal mixed results: some show higher bone mineral density (BMD) in OA patients, suggesting an inverse relationship, while others find no significant link. Proposed mechanisms include mechanical loading, bone remodeling, and inflammation. Clinical strategies focus on maintaining bone health in OA and monitoring joint health in OP, with treatments like bisphosphonates and exercise. Understanding these interactions is crucial for developing integrated treatments to improve patient outcomes and quality of life. Further research is needed to clarify these complex mechanisms.

The effect of transcutaneous auricular vagus nerve stimulation on cycling ergometry and recovery in healthy young individuals

BACKGROUND

It is aimed to examine the potential benefits and effects of the use of transcutaneous auricular vagus nerve stimulation (VNS) for sporting purposes on recovery, fatigue, and sportive performance level.

METHODS

In this study, 90 people between the ages of 18-23 were participated. They were randomly divided into three groups as bilateral sham, unilateral left, and bilateral VNS. A 4-day protocol was applied to the participants. Cycling exercise was performed with maximum performance for 30 min under the same watt load. Pulse, systolic and diastolic blood pressure, distance, pain, fatigue, lactic acid level, and autonomic nervous system were evaluated.

RESULTS

Within the groups, there was a statistically significant difference between the data (p < .05) except for the distance covered parameter. When we compare the groups, in addition to the distance traveled in all groups, there is no statistically significant difference in the 1st day 1st measurement and 2nd measurement data of all parameters (p > .05 When we compared the data according to days, there was a statistically significant difference between bilateral stimulation (BS) and unilateral stimulation, only pain and fatigue levels (p < .05).

CONCLUSION

In our study, we saw that BS application gave positive results in reducing pain and fatigue due to cycling exercise compared to other applications. Similar results were obtained when we evaluated the data on a daily basis. We believe that VNS will be beneficial in reducing pain and fatigue, especially during and after the competition halftime.

Hypotensive Effects of Aquatic Exercise Training in Older Adults

BACKGROUND

Although regular exercise can help reduce blood pressure (BP), older adults often struggle with adhering to land-based exercise due to barriers such as arthritis pain, functional limitations, and fear of falling. Aquatic exercise is a good alternative mode of exercise that may reduce barriers and improve adherence. However, limited evidence is available on the effectiveness of aquatic exercise in reducing BP in older adults with isolated systolic hypertension. This study aimed to determine the effects of an 8-week aquatic exercise program on arterial BP in older adults.

METHODS

Twenty-five participants were randomized to a control (n = 12, 81 ± 8 years) or aquatic exercise group (n = 13, 83 ± 7 years). The exercise group received aquatic cognitive-motor training at a moderate-intensity for 45 minutes per session three times per week for 8 weeks. The non-exercising control group received a 1-hour fall prevention seminar and was asked to maintain their normal physical activity level.

RESULTS

Baseline characteristics were not different between the groups. After 8 weeks, the exercise group had reductions in systolic BP (135 ± 11 vs. 126 ± 13 mm Hg, P < 0.01) and pulse pressure (PP) (68 ± 8 vs. 60 ± 8 mm Hg, P < 0.01) without significant change in diastolic BP. There were no significant changes in the control group.

CONCLUSION

Aquatic cognitive-motor training performed at a moderate-intensity was effective in inducing clinically meaningful reductions in systolic BP and PP in older adults.

Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis

OBJECTIVE

The objective of the study was to evaluate the effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis (KOA).

METHODS

Five databases (PubMed, Embase, Cochrane Library, CINAHL, Web of Science Core Collection) were searched for relevant randomized controlled trials (RCTs) published from database inception to 2 August 2022. The Cochrane Collaboration's standards were followed for study selection, eligibility criteria, data extraction and statistics, using the Cochrane Collaboration Risk of Bias Tool and PEDro for quality assessment. A meta-analysis and subgroup analyses, stratified by control condition and intervention duration, were conducted using RevMan 5.4. The study was reported in compliance with the PRISMA statement.

RESULTS

A total of 12 independent RCTs with 1442 participants were included. The meta-analysis showed that the home-based exercise interventions significantly reduced pain in individuals with KOA (SMD =  - 0.32, 95% CI [- 0.41, - 0.22], p < .01) and improved physical function (SMD =  - 0.25, 95% CI [- 0.47, - 0.02], p = .03) and quality of life (SMD = 0.63, 95% CI [0.41, 0.85], p < .001). Subgroup analysis revealed that home-based exercise interventions were superior to health education and no treatment, in terms of pain and physical function, and similar to clinic-based exercise and pharmacologic treatment.

CONCLUSIONS

The effect of home-based exercise intervention is significantly better than health education and no treatment for reducing knee pain and improving physical function, and was able to achieve the effects of clinic-based exercise treatment and pharmacologic treatment. With regard to quality of life, the unsupervised home strength exercise intervention showed a significant effect compared with the health education control and combined with cognitive behavioural therapies may produce better results. Although home-based intervention provides effective treatment options for individuals with clinical treatment limitations, individual disease complications and the dosimetry of exercise need to be considered in practice. Furthermore, growing evidence supports the effectiveness of Tai Chi in the rehabilitation of KOA.

Effect of IoT-based power cycling and quadriceps training on pain and function in patients with knee osteoarthritis: A randomized controlled trial protocol

BACKGROUND

Knee osteoarthritis (KOA) is a chronic musculoskeletal disease affecting the entire joint. Exercise therapy is the core treatment plan for non-surgical treatment of KOA, and tele-rehabilitation is also applied to KOA, but there is a lack of research on the comparison of pain and function recovery between different exercise methods combined Internet respectively. The study aims to compare the effects of power cycling and quadriceps training combined with online guidance separately on KOA mitigation of pain, recovery of function, quality of life, and adherence of participants in the community, compared to the control group.

METHODS

This study is a single-blind, 12-week parallel randomized controlled trial. Seventy-two participants aged ≥ 50 years with KOA will be randomized into either the power cycling group, the quadriceps group or the control group. The intervention will be performed three times per week during 12 weeks. Outcome measures will be assessed at baseline, and at 4, 8, and 12 weeks after allocation. The primary outcome will be self-reported pain, assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcomes will include mitigation of knee pain, quality of life, improvement of functional physical performance, adherence of participants.

DISCUSSION

By summarizing the study's strengths and limitations, this trial results may guide tele-rehabilitation of KOA in the community.Trial registration: The study was registered in the clinical trial registry ChiCTR2200059255, 27/04/2022.

The effect of aerobic exercise on pulse wave velocity in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials

A growing body of research examines the effect of aerobic exercise on pulse wave velocity (PWV) in middle-aged and elderly people, while findings of available studies were conflicting. The aim of this study was to explore the effect of aerobic exercise on PWV in middle-aged and elderly people. Searches were performed in PubMed, Web of Science, and EBSCO databases. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. We included studies that satisfied the following criteria: (1) eligible studies should be randomized controlled trials (RCTs); (2) eligible studies should include both an intervention and a control group; (3) eligible studies should use the middle-aged or elderly people as subjects; and (4) eligible studies should use PWV as the outcome measure. From 972 search records initially identified, 11 studies with a total of 12 exercise groups (n = 245) and 11 control groups (n = 239) were eligible for meta-analysis. There was a significant effect of aerobic exercise on reducing PWV in middle-aged and elderly people [weighted mean difference (WMD), –0.75 (95% CI, –1.21 to –0.28), p = 0.002]. Specifically, a higher intensity [vigorous-intensity, –0.74 (–1.34 to –0.14), p = 0.02; moderate-intensity, –0.68 (–1.49 to 0.12), p = 0.10], a younger age [45 years ≤ age < 60 years, –0.57 (–0.78 to –0.37), p < 0.00001; age ≥ 60 years, –0.91 (–2.10 to 0.27), p = 0.13], a better health status [healthy, –1.19 (–2.06 to –0.31), p = 0.008; diseased, –0.32 (–0.64 to –0.01), p = 0.04], and a lower basal body mass index (BMI) [BMI < 25, –1.19 (–2.06 to –0.31), p = 0.008; 25 ≤ BMI < 30, –0.52 (–0.92 to –0.12), p = 0.01; BMI ≥ 30, –0.09 (–0.93 to 0.76), p = 0.84] were associatedwith larger reductions in PWV. Aerobic exercise, especially vigorous-intensity aerobic exercise, contributed to reducing PWV in middle-aged and elderly people. The effect of aerobic exercise on improving PWV was associated with characteristics of the participants. Specifically, a younger age, a better health status, and a lower basal BMI contributed to more significant reductions in PWV.

Effects of High-Intensity Aquatic or Bicycling Training in Athletes with Unilateral Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is one of the most common overuse injuries experienced by athletes. It is characterized by pain and functional deficits that lead to decreased performance, thereby limiting sports activity. Therefore, optimal training interventions are required to improve physical fitness and function while minimizing pain due to PFPS. This study aimed to compare and analyze the effects of high-intensity aquatic training (AT) and bicycling training (BT) in male athletes with PFPS. Fifty-four athletes with PFPS were divided into AT and BT intervention groups. Intervention training was conducted three times per week for 8 weeks. Cardiorespiratory fitness was evaluated using the graded exercise test (GXT) based on peak oxygen uptake (VO₂ peak), and anaerobic threshold. For the knee strength test, extension and flexion were performed and measured using isokinetic equipment. One-leg hop tests and the Y-balance test (YBT) were performed to evaluate dynamic balance, and the International Knee Documentation Committee (IKDC) scoring system was used for subjective knee evaluation. The GXT, YBT, and IKDC scores were reported according to the group and duration of the intervention. After training, VO₂ peak, YBT, knee extension strength, and IKDC score improved significantly in both the AT and BT groups compared with the pre-training values. Furthermore, the AT group exhibited significant improvement compared with the BT group. We demonstrated that AT and BT effectively improved the symptoms and muscle strength of athletes with PFPS who were only able to engage in limited high-intensity field training. AT produced a modestly better effect than BT.

Effect of Aquatic Exercise Training on Aortic Hemodynamics in Middle-Aged and Elderly Adults

Aquatic exercise is an attractive form of exercise that utilizes the various properties of water to improve physical health, including arterial stiffness. However, it is unclear whether regular head-out aquatic exercise affects aortic hemodynamics, the emerging risk factors for future cardiovascular disease. The purpose of this study was to investigate whether head-out aquatic exercise training improves aortic hemodynamics in middle-aged and elderly people. In addition, to shed light on the underlying mechanisms, we determined the contribution of change in arterial stiffness to the hypothesized changes in aortic hemodynamics. Twenty-three middle-aged and elderly subjects (62 ± 9 years) underwent a weekly aquatic exercise course for 15 weeks. Aortic hemodynamics were evaluated by pulse wave analysis via the general transfer function method. Using a polar coordinate description, companion metrics of aortic pulse pressure (PPC = √{(systolic blood pressure)² + (diastolic blood pressure)²}) and augmentation index (AIxC = √{(augmentation pressure)² + (pulse pressure)²}) were calculated as measures of arterial load. Brachial-ankle (baPWV, reflecting stiffness of the abdominal aorta and leg artery) and heart-ankle (haPWV, reflecting stiffness of the whole aortic and leg artery) pulse wave velocities were also measured. The rate of participation in the aquatic training program was 83.5 ± 13.0%. Aortic systolic blood pressure, pulse pressure, PPC, AIxC, baPWV, and haPWV decreased after the training (P < 0.05 for all), whereas augmentation index remained unchanged. Changes in aortic SBP were correlated with changes in haPWV (r = 0.613, P = 0.002) but not baPWV (r = 0.296, P = 0.170). These findings suggest that head-out aquatic exercise training may improve aortic hemodynamics in middle-aged and elderly people, with the particular benefits for reducing aortic SBP which is associated with proximal aortic stiffness.

Benefits of electroacupuncture and a swimming association when compared with isolated protocols in an osteoarthritis model

Background and aim

Osteoarthritis (OA) is characterized by pain and inflammation. Electroacupuncture (EA) and swimming (SW) are non-pharmacological interventions recommended for treating OA. The study evaluated the benefits of electroacupuncture (EA) and swimming (SW) association when compared with isolated protocols in an OA rodent model. Experimental.

Procedures

An ankle monoarthritis model was induced in rats by applying Complete Freund's Adjuvant (CFA). After seven days of induced OA, the groups were submitted to EA (ST36 and the GB 30 Acupoint), SW, or the EA + SW protocol. The nociceptive behavior was measured by the Von Frey test, the Cold Stimulation test, and the Paw Flick Immersion test. Inflammatory activity was evaluated by measuring TNF levels, myeloperoxidase, NAGase, immunological parameters and the histology from the subcutaneous tissue.

Results

Compared to CFA group, EA decreased the nociceptive scores in the cold stimulation test (p < 0.05), and it also increased the latency time in thermal cold (p < 0.01) and heat hyperalgesia (p < 0.001). Also, EA reduced NAGase (p < 0.01). SW reduced the edema (p < 0.05) and did not increase the inflammatory infiltrates or congestion, neither in the histological measurements nor by analyzing the levels of TNF. The association of EA + SW decreased the neutrophils and the monocytes, MPO (p < 0.05), and the glutamate levels in the cerebrospinal fluid (CSF, p < 0.001).

Conclusion

There were statistical differences between combination therapy and monotherapy as seen by the inflammatory parameters, which could be associate to the delay of the chronification osteoarthritis retardation. However, EA + SW did not show benefits when compared to isolated protocols in nociceptive behavior.

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Electroacupuncture (EA) extended the latency time in the thermal hyperalgesia assay.

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The swimming protocol did not increase the inflammatory infiltrates.

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EA and swimming decreased the glutamate levels in the cerebral spinal fluid.

Examining the relationship between arterial stiffness and swim-training volume in elite aquatic athletes

PURPOSE

Factors such as prone body position, hydrostatic pressure, and intermittent breath-holding subject aquatic athletes to unique physical and environmental stressors during swimming exercise. The relationship between exposure to aquatic exercise and both arterial stiffness and wave reflection properties is not well-understood. This study assessed central artery stiffness and wave reflection properties in elite pool-swimmers (SW), long-distance open-water swimmers (OW), and water polo players (WP) to examine the relationship between these variables and aquatic exercise.

METHODS

Athletes competing in SW, OW and WP events at the FINA World Championships were recruited. Carotid-femoral pulse wave velocity, and pulse wave analysis were used to quantify arterial stiffness, and central wave reflection properties.

RESULTS

Athletes undertook differing amounts of weekly swimming distance in training according to their discipline (SW: 40.2 ± 21.1 km, OW: 59.7 ± 28.4 km, WP: 11.4 ± 6.3 km; all p < 0.05). Pulse wave velocity (Males [SW: 6.0 ± 0.6 m/s, OW: 6.5 ± 0.8 m/s, WP: 6.7 ± 0.9 m/s], Females [SW: 5.4 ± 0.6 m/s, OW: 5.3 ± 0.5 m/s, WP: 5.2 ± 0.8 m/s; p = 0.4]) was similar across disciplines for females but was greater in male WP compared to male SW (p = 0.005). Augmentation index (Males [SW: - 3.4 ± 11%, OW: - 9.6 ± 6.4%, WP: 1.7 ± 10.9%], Females [SW: 3.5 ± 13.5%, OW: - 13.2 ± 10.7%, WP: - 2.8 ± 10.7%]) was lower in male OW compared to WP (p = 0.03), and higher in female SW compared to OW (p = 0.002). Augmentation index normalized to a heart rate of 75 bpm was inversely related to weekly swim distance in training (r = - 0.27, p = 0.004).

CONCLUSIONS

This study provides evidence that the central vasculature of elite aquatic athletes differs by discipline, and this is associated with training load.

The Association Between Cardiovascular Function, Measured as FMD and CVC, and Long-Term Aquatic Exercise in Older Adults (ACELA Study): A Cross-Sectional Study

Introduction

Cardiovascular aging is implicated in the development of cardiovascular disease (CVD). Aquatic exercise is being considered as a co-adjuvant form of rehabilitation, but there is limited evidence for its cardiovascular risk-reduction properties for older people. Our study aimed to address this by exploring the cardiovascular effects of long-term aquatic exercise in older adults in comparison to those who are either inactive or engaged in land-based/mixed training by measurement of micro- and macro-circulation. Flow Mediated Dilatation (FMD) was the primary outcome.

Methods

This was a pragmatic, 4-group, cross-sectional study. Eighty normotensive adults constituted four (n = 20) groups. The Aqua group (aged 63.7 ± 7 years) and Land group (aged 65 ± 6 years) consisted of participants engaged in aquatic and land-based training, respectively. The mixed group (Mix) (aged 66 ± 6 years) consisted of participants engaged in both land-based and aquatic training. Self-reported training consisted of ≥2/week for ≥6 months (mean sessions/week = 4 ± 1, 4 ± 1, and 5 ± 2 for each group, respectively). The sedentary group (Sed) (aged 63 ± 6 years) consisted of people who were sedentary for ≥6 months (mean sessions/week 0 ± 0). The primary outcome was %FMD. Secondary outcomes included raw cutaneous vascular conductance (CVC) and CVC max.

Results

Statistically significant differences (%FMD, raw CVC variables other than baseline) were found between each of the exercise groups (Aqua, Land, Mix) and the sedentary group (Sed) (i.e., 11.2 (4.2) vs. 5.0 (2.3); p < 0.0005, between the Aqua group and Sed group, for %FMD). No specific advantage could be attributed to any one of the exercise groups.

Conclusion

We reported improvements in NO-mediated endothelial function at micro- and macro-circulatory levels, observing no differences between exercise modes. Our findings provide evidence for the role of aquatic exercise as a "shield" against CVD in older populations.

Stationary cycling exercise for knee osteoarthritis: A systematic review and meta-analysis

OBJECTIVE

To evaluate effects of stationary cycling exercise on pain, function and stiffness in individuals with knee osteoarthritis.

DATA SOURCES

Systematic search conducted in seven databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, and CNKI) from inception to September 2020.

REVIEW METHODS

Included studies were randomized-controlled trials involving stationary cycling exercise conducted on individuals with knee osteoarthritis. End-trial weighted mean difference (WMD) and 95% confidence interval (CI) were analyzed, and random-effects models were used. Methodological quality and risk bias were assessed by using the Physiotherapy Evidence Database scale and Cochrane Collaboration tool, respectively.

RESULTS

Eleven studies with 724 participants were found, of which the final meta-analysis was performed with eight. Compared to a control (no exercise), stationary cycling exercise resulted in reduced pain (WMD 12.86, 95% CI 6.90-18.81) and improved sport performance (WMD 8.06, 95% CI 0.92-15.20); although most of the meta-analysis results were statistically significant, improvements in stiffness (WMD 11.47, 95% CI 4.69-18.25), function (WMD 8.28, 95% CI 2.44-14.11), symptoms (WMD 4.15, 95% CI -1.87 to 10.18), daily living (WMD 6.43, 95% CI 3.19 to 9.66) and quality of life (WMD 0.99, 95% CI -4.27 to 6.25) for individuals with knee osteoarthritis were not greater than the minimal clinically important difference values for each of these outcome measures.

CONCLUSIONS

Stationary cycling exercise relieves pain and improves sport function in individuals with knee osteoarthritis, but may not be as clinically effective for improving stiffness, daily activity, and quality of life.

Nonsurgical Management of Cartilage Defects of the Knee: Who, When, Why, and How?

The nonoperative practitioner managing individuals with cartilage defects should use a patient-centered, multifaceted approach that aims to individualize treatment to provide optimal benefit. These include addressing modifiable risk factors for disease progression and instituting interventions such as weight loss, nutrition, physical activity, and potentially regenerative medicine strategies. This review will focus on these nonoperative treatment strategies with a focus on when treatments are necessary, who will benefit from these approaches, why they are specifically appropriate, and, finally, how these treatments directly modify the structure of a patient's cartilage and resulting symptoms.

Under-appreciated and Overlooked Modes of Exercises on Key Vascular Functions

The arterial system has two primary functions. The conduit function is to transport adequate supply of oxygen and nutrients to the tissues, and the cushioning function is to buffer and cushion the pulsatile pressure exerted by intermittent ventricular contractions. The impairments in these two functions often result from physiological changes characterized by endothelial dysfunction and arterial stiffening. Habitual physical exercise has been advocated to combat these physiological dysfunctions. However, exercise is remarkably diverse, as it can be performed in different media (water, land or snow), seasons (winter or summer), and settings (individual, pair or team). In contrast to mainstream modes of exercise including walking and running, many of the alternative or "minor" forms of exercise have been under-researched by investigators in research fields and overlooked by clinicians and practitioners in clinical settings. It remains largely unknown whether these alternative forms of exercise are associated with favorable changes in arterial stiffness and endothelium-dependent vasodilation. The current review introduces and summarizes research investigations that evaluated the impacts of these under-appreciated and overlooked exercises and their impacts on key markers of vascular functions in humans.

Effects of a short-term increase in physical activity on arterial stiffness during hyperglycemia

We examined the effects of increasing physical activity on arterial stiffness during hyperglycemia. Nineteen glucose-intolerant elderly participated in the study. We randomly assigned 10 participants to increase their daily activity in everyday life, regardless of the time or intensity, for 1 month (PAI group) (age, 74.6 ± 1.3 years; mean ± SE) and nine participants to maintain their level of activity (CON group) (age, 79.2 ± 2.1 years; mean ± SE). The 75-g oral glucose tolerance test was conducted in each participant in both groups before and after the start of the intervention to confirm glucose intolerance. Brachial-ankle pulse wave velocity and cardio-ankle vascular index significantly increased from baseline at 30, 60, and 90 min after the 75-g glucose ingestion after the intervention in the CON group (p<0.05), but not in the PAI group. Heart-brachial pulse wave velocity did not change compared to baseline after the 75-g glucose ingestion in either group and did not change from baseline at 30, 60, and 90 min after the 75-g glucose ingestion before and after the intervention in both groups. The present findings indicate that a short-term increase in physical activity suppresses the increase in arterial stiffness after glucose intake.

The Effect of Head-Out Aquatic Exercise on Arterial Stiffness in Middle-Aged and Elderly People

Aquatic exercise is ideal for older adults because it mitigates weight-bearing stress. However, the effect of head-out aquatic exercise on arterial stiffness, a strong future cardiovascular disease (CVD) risk, remains unclear. We determined whether head-out aquatic exercise would mitigate arterial stiffness in middle-aged and elderly people. In 25 middle-aged and older people (9 men, mean age 64 ± 8 years), blood pressure (BP) and brachial-ankle pulse wave velocity (baPWV) were measured before and after a supervised aquatic exercise training program (60 min, 1 session/week, 14 sessions) which mainly consisted of walking, stretching, and muscle strengthening in water. In the pooled subjects, systolic BP tended to decrease (p = 0.07) after the training intervention, whereas no significant changes were observed, including baPWV (from 1,537 ± 301 to 1,496 ± 308 cm/s). In the sub-analysis, by dividing subjects into a healthy group (n = 13) and a CVD risk group (n = 12), no significant interaction between time and group was seen in BP. On the other hand, baPWV decreased significantly in the healthy group (from 1,476 ± 299 to 1,365 ± 215 cm/s) but not in the CVD risk group (from 1,603 ± 301 to 1,637 ± 339 cm/s). The current study demonstrates that regular head-out aquatic exercise, even at a low frequency, could mitigate CVD risk in apparently healthy middle-aged and older people.

Effects of heated water-based versus land-based exercise training on vascular function in individuals with peripheral artery disease

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with poor vascular function, walking impairment, and reduced quality of life. Land-based exercise therapy (LBET) is frequently recommended to improve walking and reduce symptoms. Recently, evidence has suggested that heated-water exercise therapy (HWET) is an effective intervention for PAD. However, the efficacy of LBET versus HWET in PAD patients had not been elucidated. Therefore, we sought to compare effects of LBET with HWET on cardiovascular function, exercise tolerance, physical function, and body composition in PAD patients. PAD patients (n = 53) were recruited and randomly assigned to a LBET group (n = 25) or HWET group (n = 28). The LBET group performed treadmill walking, whereas the HWET group performed walking in heated water for 12 wk. Leg (legPWV) and brachial-to-ankle arterial stiffness (baPWV), blood pressure (BP), ankle-brachial index (ABI), 6-min walking distance (6MWD), claudication onset time (COT), physical function, and body composition were assessed before and after 12 wk. There were significant group-by-time interactions (P < 0.05) for legPWV, BP, 6MWD, COT, body composition, and resting metabolic rate (RMR). Both groups significantly reduced (P < 0.05) legPWV, BP, and body fat percentage, and HWET measures were significantly lower than LBET measures. Both groups significantly increased 6MWD, COT, and RMR, and HWET group measures were significantly greater than LBET measures. A time effect was noted for baPWV reduction in both groups (P < 0.05). These results suggest that both LBET and HWET improve cardiovascular function, exercise tolerance, and body composition, and HWET showed considerably greater improvements compared with LBET in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that although land-based exercise therapy is effective for reducing arterial stiffness and blood pressure in patients with peripheral artery disease (PAD), heated-water exercise therapy demonstrates greater benefits on vascular function. The greater improvements in muscular strength, time to onset of claudication, and exercise tolerance after heated-water exercise therapy may have clinical implications for improving quality of life in patients with PAD. The heated-water exercise therapy intervention demonstrated relatively higher exercise training adherence (∼88%) compared with the land-based exercise intervention (∼81%).

Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis

Objectives

We systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.

Data sources

PubMed, CINAHL, Scopus; inception to January 2019.

Eligibility criteria

Randomised clinical trials (RCT), cohort studies, case series.

Design

We summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.

Results

Interventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.

Conclusions

In studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.

PROSPERO registration number

CRD42018087859.

Exploring Cerebrovascular Function in Osteoarthritis: "Heads-up"

Individuals with osteoarthritis (OA) are at greater risk of cardiovascular and cerebrovascular incidents; yet, cerebrovascular control remains uncharacterized. Our primary outcome was to acquire cerebrovascular control metrics in patients with OA and compare measures to healthy control adults (CTL) without OA or cardiovascular complications. Our primary covariate was a 10-year risk factor for cardiovascular and stroke incidents, and secondary covariates were other cardiovascular disease risk factors (i.e., body mass index, carotid intima media thickness, and brachial flow-mediated dilation). Our secondary outcomes were to assess anatomical and functional changes that may be related to cerebrovascular reactivity were also acquired such as white matter lesion volume and brief cognitive assessments. In 25 adults (n = 13 CTL, n = 12 OA), under hypercapnia, magnetic resonance imaging (3T) was used to acquire a "Global Cerebrovascular Reactivity" index across the larger intracranial cerebral arteries and white matter lesions, and transcranial Doppler was used for both middle cerebral artery hemodynamic responses to hypercapnia and to assess autoregulation via a sit-to-stand task. Compared to CTL, OA had lower "Global Cerebrovascular Reactivity" index responses to hypercapnia, autoregulatory responses, and greater white matter lesions (P < 0.05). These differences persisted after covarying for the outlined primary and secondary covariates. Patients with OA, in the absence of known cardiovascular disease, can exhibit pre-clinical and impaired (compared to CTL) peripheral and cerebrovascular control metrics.

Effects of Tai Chi on Cerebral Hemodynamics and Health-Related Outcomes in Older Community Adults at Risk of Ischemic Stroke: A Randomized Controlled Trial

This study investigated the effects of Tai Chi compared with no exercise control on the cerebral hemodynamic parameters and other health-related factors in community older adults at risk of ischemic stroke. A total of 170 eligible participants were randomly allocated to Tai Chi or control group. The cerebral hemodynamic parameters and physical fitness risk factors of cardiovascular disease were measured at baseline, 12 weeks, and 24 weeks. After the 12-week intervention, Tai Chi significantly improved the minimum of blood flow velocity (BFVmin); BFVmean; pulsatility index and resistance index of the right anterior cerebral artery; and BFVmax, BFVmin, and BFVmeanparameters of the right middle cerebral artery. Tai Chi training also decreased triglyceride, fasting blood glucose, and homocysteine levels, and improved balance ability. Therefore, the supervised 12-week Tai Chi exercise had potential beneficial effects on cerebral hemodynamics, plasma risk factors, and balance ability in older community adults at risk of ischemic stroke.

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

Impacts of aquatic walking on arterial stiffness, exercise tolerance, and physical function in patients with peripheral artery disease: a randomized clinical trial

Peripheral artery disease (PAD) is an atherosclerotic disease that is associated with attenuated vascular function, cardiorespiratory capacity, physical function, and muscular strength. It is essential to combat these negative effects on health by incorporating lifestyle interventions to slow disease progression, such as exercise. We sought to examine the effects of aquatic walking exercise on cardiovascular function, cardiorespiratory capacity [maximal volume of oxygen consumption (V̇o_2max)], exercise tolerance [6-min walking distance (6MWD)], physical function, muscular strength, and body composition in patients with PAD. Patients with PAD (n = 72) were recruited and randomly assigned to a 12-wk aquatic walking training group (AQ, n = 35) or a control group (CON, n = 37). The AQ group performed walking and leg exercises in waist-to-chest-deep water. Leg arterial stiffness [femoral-to-ankle pulse wave velocity (legPWV)], heart rate (HR), blood pressure (BP), ankle-to-brachial index (ABI), V̇o_2max, 6MWD, physical function, muscular strength, body composition, resting metabolic rate (RMR), and flexibility were measured before and after 12 wk. There were significant group × time interactions (P < 0.05) after 12 wk for legPWV and HR, which significantly decreased (P < 0.05) in AQ, and V̇o_2max, 6MWD, physical function, and muscular strength, which significantly increased (P < 0.05) in AQ, compared with no changes in CON. There were no significant differences (P > 0.05) for BP, ABI, RMR, or flexibility after 12 wk. Interestingly, there was relatively high adherence (84%) to the aquatic walking exercise program in this population. These results suggest that aquatic walking exercise is an effective therapy to reduce arterial stiffness and resting HR and improve cardiorespiratory capacity, exercise tolerance, physical function, and muscular strength in patients with PAD.NEW & NOTEWORTHY The results of this study reveal for the first time that aquatic walking exercise can decrease arterial stiffness and improve exercise tolerance, cardiorespiratory capacity, and muscular strength in patients with peripheral artery disease (PAD). Aquatic walking exercise training demonstrates relatively high exercise adherence in this population. Aquatic walking exercise training may be a useful therapeutic intervention for improving physical function in patients with PAD.

Short-Term Water- and Land-Based Exercise Training Comparably Improve Exercise Capacity and Vascular Function in Patients After a Recent Coronary Event: A Pilot Randomized Controlled Trial

Background

We hypothesized that a 2-week twice daily aquatic endurance plus calisthenics exercise training program: (i) increases aerobic exercise capacity (peak oxygen uptake/ V ˙ O₂peak), (ii) improves endothelium-dependent flow-mediated vasodilation (FMD), and (iii) reduces circulating markers of low-grade inflammation and hemostasis, as compared to land-based endurance plus calisthenics exercise training or no exercise in patients undergoing short-term residential cardiac rehabilitation after a recent coronary artery disease (CAD) event.

Methods

Patients with a recent myocardial infarction or revascularization procedure were randomized into two interventional groups and a control group. The interventional groups underwent supervised aerobic endurance plus calisthenics exercise training either in thermo-neutral water or on land at moderate intensity (60-80% of the peak heart rate achieved during symptom-limited graded exercise testing) for 30 min twice daily for 2 weeks (i.e., 24 sessions). The control group was deferred from supervised exercise training for the 2-week duration of the intervention, but was advised low-to-moderate intensity physical activity at home while waiting. At baseline and after the intervention period, all participants underwent estimation of aerobic exercise capacity, brachial artery flow-mediated dilatation (FMD, measured ultrasonographically at rest and during reactive hyperemia after 4.5 min of forearm cuff inflation), markers of cardiac dysfunction (NT-proBNP), inflammation (hsCRP, IL-6, IL-8, IL-10), cell adhesion (ICAM, P-selectin), and hemostasis (fibrinogen, D-dimer).

Results

A total of 89 patients (mean age 59.9 ± 8.2 years, 77.5% males, V ˙ O₂peak at baseline 14.8 ± 3.5 ml kg^-1 min^-1) completed the study. Both exercise modalities were safe (no significant adverse events recorded) and associated with a significant improvement in V ˙ O₂peak as compared to controls: age and baseline V ˙ O₂peak-adjusted end-of-study V ˙ O₂peak increased to 16.7 (95% CI 16.0-17.4) ml kg^-1 min^-1 with land-based training (p < 0.001 for change from baseline) and to 18.6 (95% CI 17.9-19.3) ml kg^-1 min^-1 with water-based training (p < 0.001 for change from baseline), but not in controls (14.9 ml kg^-1 min^-1; 95% CI 14.2-15.6; p = 0.775 for change from baseline). FMD also increased in both intervention groups (from 5.5 to 8.8%, p < 0.001 with land-based, and from 7.2 to 9.2%, p < 0.001 with water-based training, respectively), as compared to controls (p for change 0.629). No significant changes were detected in biomarkers of inflammation, cell adhesion or hemostasis, whereas levels of NT-proBNP (marker of cardiac dysfunction) decreased in the water-based training group (p = 0.07 vs. controls).

Conclusion

Endurance plus calisthenics exercise training in thermo-neutral water is safe, and improves aerobic exercise capacity and vascular function in patients undergoing short-term residential cardiac rehabilitation after a recent CAD event.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT02831829.

Socioeconomic differences in swimming ability among children in Malmö, southern Sweden: Initial results from a community-level intervention

Aims: To investigate to what extent socioeconomic differences in swimming abilities persist among children in the city of Malmö, Sweden, after a community-level swimming intervention programme in public primary schools. Methods: A compulsory swimming education programme was launched in 2014 in second grade (at age 8) in all public primary schools in Malmö, Sweden. Data for the present study on sociodemographic conditions and self-reported swimming ability in fourth grade (age 10) were used for the last birth cohort unexposed (n = 1695) and the first birth cohort exposed (n = 1773) to the intervention. Results: The swimming ability was 78 and 77%, respectively, in the pre- and post-intervention cohorts. Significantly lower self-reported swimming ability was found both pre- and post-intervention among children with support activities in school, with parents born outside Europe, North America and Australia, with manual working, unemployed or studying parents and in children enrolled in schools with socioeconomic index below median. Conclusions: The findings do not suggest that sociodemographic differences in swimming ability have decreased in the first birth cohort exposed to the community-level intervention in Malmö. Striking differences in self-reported swimming ability were noted when the children reached the fourth grade both pre- and post-intervention with marked lower abilities in socially disadvantaged groups. Monitoring of swimming abilities should continue for the present, and similar interventions aimed at reducing inequalities among children. Efforts to increase water comfort at preschool age ought to be considered.

Chronic Physiological Effects of Swim Training Interventions in Non-Elite Swimmers: A Systematic Review and Meta-Analysis

BACKGROUND

Swimming is a popular and potentially health-enhancing exercise, but has received less scientific attention compared with other exercise modes.

OBJECTIVE

The objective of the study was to determine the chronic (long-term) effect of pool swim training on physiological outcomes in non-elite or non-competitive swimming participants.

DESIGN

This study was a systematic review with a meta-analysis.

DATA SOURCES

We searched the electronic databases PubMed, EMBASE and CENTRAL from inception to March 2017.

ELIGIBILITY CRITERIA

The eligibility criteria included randomised controlled trials, quasi-randomised controlled trials and controlled trials of chronic (long-term) swimming interventions in non-elite or non-competitive swimming participants, with a physiological outcome measure.

RESULTS

Our search of 6712 records revealed 29 eligible studies. Swimming had a significant and clinically meaningful effect on maximal oxygen uptake compared with the control in an analysis including multiple populations (mean difference 6.32 mL/kg/min; 95% confidence interval 4.33-8.31), and subgroup analyses of healthy children/adolescents (mean difference 7.93 mL/kg/min; 95% confidence interval 3.31-12.55) and those with asthma (mean difference 9.67 mL/kg/min; 95% confidence interval 5.84-13.51) and healthy adults (mean difference 5.87 mL/kg/min; 95% confidence interval 2.93-8.81). Swimming also resulted in significant improvements in other cardiorespiratory fitness-related outcomes such as maximal minute ventilation (mean difference 0.61 L/min; 95% confidence interval 0.17-1.05), submaximal exercise performance (standardised mean difference 0.64; 95% confidence interval 0.14-1.13) and total exercise test time (mean difference 4.27 min; 95% confidence interval 2.11-6.42). Compared with the control, swimming had significant favourable effects on body mass (mean difference - 2.90 kg, 95% confidence interval - 5.02 to - 0.78), body fat percentage in multiple populations (mean difference - 1.92%; 95% confidence interval - 3.25 to - 0.60) and healthy children/adolescents (mean difference - 1.92%; 95% confidence interval - 4.64 to - 0.80) and lean mass (mean difference 1.96 kg; 95% confidence interval 0.21-3.71), but negative effects on waist circumference in a pooled analysis of two studies involving adults with hypertension (mean difference 4.03 cm; 95% confidence interval 2.58-5.49). Regarding lung function, significant effects of swimming vs. the control were found only for peak expiratory volume in analyses including children/adolescents combined with healthy adults (mean difference 58.74 L/min; 95% confidence interval 29.70-87.78) and children/adolescents with asthma alone (mean difference 63.49 L/min; 95% confidence interval 25.01-101.97). Based on limited data, swimming had similar effects to other exercise modes, except for higher post-intervention body mass index values with swimming vs. running in healthy adults (mean difference 1.18 kg/m²; 95% confidence interval 0.54-1.81).

CONCLUSIONS

Swimming may offer robust beneficial effects on cardiorespiratory fitness and body composition across multiple populations and effects may be comparable to other exercise modes. Future randomised controlled trials are required to establish the effectiveness of swimming on physiological outcomes in healthy populations and those with non-communicable disease.

Acute effects of walking in water on vascular endothelial function and heart rate variability in healthy young men

AIM

Aquatic exercise might improve endothelial function due to hydrostatic pressure increasing blood flow and causing shear stress to the endothelium. However, the acute effect of aerobic exercise in water on endothelial function is unclear. The present study compares the acute effect of aerobic exercise at moderate intensity in water and on land on endothelial function.

METHODS

Nine healthy young men walked on a treadmill for 30 min while immersed in water up to the xiphoid at 30.0 ± 0.2°C and on land at an intensity equivalent to 60% heart rate reserve in a crossover trial. Brachial artery flow-mediated dilation (FMD) was measured at baseline and at 30 and 60 min after exercise. Autonomic nervous activity was compared among conditions at the heart rate variability (HRV) during exercise.

RESULTS

FMD significantly decreased at 30 min after exercise on land trial (p < 0.05), but did not change after the aquatic trial. However, FMD was significantly higher after aquatic trial than land trial (p < 0.05) at 30 and 60 min after exercise, whereas heart rate, blood pressure, and HRV did not significantly differ between them.

CONCLUSION

These findings demonstrate that aerobic exercise in water suppressed the decrease in FMD compared with that on land, regardless of autonomic nervous activity.

Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review

Systematic reviews of self-management programs for osteoarthritis suggest minimal evidence of benefit and indicate substantial heterogeneity in interventions. The purpose of this scoping review was to describe the nature of self-management interventions provided to patients with osteoarthritis focusing on the inclusion and type of education and social support components. We searched PsycINFO, EMBASE, MEDLINE, and Cochrane Library databases from 1990 to 2016 to identify studies addressing community-based management strategies for osteoarthritis that included aspects of disease-specific education and ongoing social support. Results are presented as a narrative synthesis to facilitate integration of diverse evidence. Data were extracted from 23 studies that met our inclusion and exclusion criteria, describing complex, multicomponent interventions for osteoarthritis. All studies included education components, and 18 of these were osteoarthritis-specific. Social support was most often offered through peers and health care professionals, but also through exercise trainers/instructors and researchers, and lasted between 5 and 52 weeks. We charted positive social interaction offered by peers in group settings and emotional/informational support offered by health care professionals. Overall, descriptions of self-management provided limited documentation of the rationale or content of the programs. This suggests that more precise definitions of the theoretical underpinnings, components, and mechanisms would be useful for greater insight into best practices for osteoarthritis self-management programs.

Osteoarthritis, cerebrovascular dysfunction and the common denominator of inflammation: a narrative review

OBJECTIVE

Population-based cohort studies suggest an association between osteoarthritis (OA) and cerebrovascular disease, yet the mechanisms underlying vascular comorbidities in OA remain unclear. The purpose of this narrative review is to discuss the literature examining inflammation in OA with a focus on physiological mechanisms, and whether overlapping mechanisms exist in cerebrovascular dysfunction.

METHOD

A literature search was conducted in PubMed using combinations of search terms: osteoarthritis, cerebrovascular (disease/dysfunction/risk), cardiovascular (disease/dysfunction/risk), aging/ageing, inflammation, inflammatory mediators, cytokine, c-reactive protein, interleukin, advanced glycation end-products, metabolic syndrome, reactive oxidative species, cognitive impairment, (vascular-related) dementia, small cerebral vessel disease, endothelial function, blood-brain barrier, gender/sex, hypertension, peripheral vascular health, and physical activity. Reference lists of identified articles were also researched manually.

RESULTS

Overlapping inflammatory factors that may contribute to onset and progression of both OA and cerebrovascular dysfunction are presented. We describe oxidative mechanisms involving pro-inflammatory cytokines and oxidative species, advanced glycation end-products, sex hormones, microvascular dysfunction and osteoprotegerin, and their specific roles in potentially contributing to OA and cerebrovascular dysfunction.

CONCLUSION

Synthesis of the current literature suggests future investigations may benefit from directly testing cerebrovascular hemodynamics and cognitive function in individuals with or at risk of OA to elucidate common physiological mechanisms.

Effects of 8-week swimming training on carotid arterial stiffness and hemodynamics in young overweight adults

BACKGROUND

Exercise has been found to either reduce or increase arterial stiffness. Land-based exercise modalities have been documented as effective physical therapies to decrease arterial stiffness. However, these land-based exercise modalities may not be suitable for overweight individuals, in terms of risks of joint injury. The purpose of this study was to determine the effects of 8-week swimming training and 4-week detraining on carotid arterial stiffness and hemodynamics in young overweight adults.

METHODS

Twenty young male adults who were overweight were recruited and engaged in 8-week of swimming training and 4-week detraining. Five individuals withdrew due to lack of interest and failure to follow the training protocol. Body Fat Percentage (BFP) and carotid hemodynamic variables were measured on a resting day at the following intervals: baseline, 4 weeks, 8 weeks after swimming training and 4 weeks after detraining. A repeated analysis of variance (ANOVA) was used to assess the differences between baseline and each measurement. When significant differences were detected, Tukey's test for post hoc comparisons was used.

RESULTS

Eight-week swimming training at moderate intensity decreased BFP, including the trunk and four extremities. Additionally, the BFP of the right and left lower extremities continued to decrease in these overweight adults 4 weeks after ceasing training. Carotid arterial stiffness decreased, while there were no significant changes in arterial diameters. Blood flow velocity, flow rate, maximal and mean wall shear stress increased, while systolic blood pressure and peripheral resistance decreased. No significant differences existed in minimal wall shear stress and oscillatory shear stress.

CONCLUSIONS

Eight-week swimming training at moderate intensity exhibited beneficial effects on systolic blood pressure, arterial stiffness and blood supply to the brain in overweight adults. Moreover, maximal and mean wall shear stress increased after training. It is worth noting that these changes in hemodynamics did not last 4 weeks. Therefore, further studies are still warranted to clarify the underlying relationship between improvements in arterial stiffness and alterations in wall shear stress.

Low Relative Lean Mass is Associated with Increased Likelihood of Abdominal Aortic Calcification in Community-Dwelling Older Australians

Age-related loss of skeletal muscle is associated with increased risk of functional limitation and cardiovascular (CV) mortality. In the elderly abdominal aortic calcification (AAC) can increase CV risk by altering aortic properties which may raise blood pressure and increase cardiac workload. This study investigated the association between low muscle mass and AAC in community-dwelling older Australians. Data for this cross-sectional analysis were drawn from a 2010 sub-study of the Melbourne Collaborative Cohort Study in the setting of community-dwelling older adults. Three hundred and twenty-seven participants [mean age = 71 ± 6 years; mean BMI = 28 ± 5 kg/m(2); females n = 199 (62 %)] had body composition determined by dual-energy x-ray absorptiometry (DXA) and AAC determined by radiography. Participants were stratified into tertiles of sex-specific BMI-normalised appendicular lean mass (ALM). Those in the lowest tertile were considered to have low relative muscle mass. Aortic calcification score (ACS) was determined visually as the extent of calcification on the aortic walls between L1 and L4 vertebrae (range: 0-24). Severe AAC was defined as ACS ≥ 6. Prevalence of any AAC was highest in participants with low relative muscle mass (74 %) compared to the middle (65 %) and upper (53 %) tertiles (p trend = 0.006). The lower ALM/BMI tertile had increased odds (Odds ratio = 2.3; 95 % confidence interval: 1.1-4.6; p = 0.021) of having any AAC; and having more severe AAC (2.2; 1.2-4.0; p = 0.009) independent of CV risk factors, serum calcium and physical activity. AAC is more prevalent and severe in community-dwelling older adults with low relative muscle mass. Maintaining muscle mass could form part of a broader primary prevention strategy in reducing AAC.

Arterial stiffness of lifelong Japanese female pearl divers

Japanese female pearl divers called Ama specialize in free diving in the cold sea for collecting foods and pearls in oysters. Exercising in the water combined with marked bradycardia and pressor responses provides a circulatory challenge to properly buffer or cushion elevated cardiac pulsations. Because Ama perform repeated free dives throughout their lives, it is possible that they may have adapted similar arterial structure and function to those seen in diving mammals. We compared arterial stiffness of lifelong Japanese pearl divers with age-matched physically inactive adults living in the same fishing villages. A total of 115 Japanese female pearl divers were studied. Additionally, 50 physically inactive adults as well as 33 physically active adults (participating in community fitness programs) living in the same coastal villages were also studied. There were no differences in age (∼65 yr), body mass index, and brachial blood pressure between the groups. Measures of arterial stiffness, cardio-ankle vascular index and β-stiffness index were lower (P < 0.05) in pearl divers and physically active adults than in their physically inactive peers. Augmentation pressure and augmentation index adjusted for the heart rate of 75 beats/min were lower (P < 0.05) in pearl divers than in other groups. These results indicate that lifelong Japanese pearl divers demonstrate reduced arterial stiffness and arterial wave reflection compared with age-matched physically inactive peers living in the same fishing villages.