Exercise training as S-Klotho protein stimulator in sedentary healthy adults: Rationale, design, and methodology

Investigating the Alcohol Effects on the Response to Strenuous Exercise Training: Protocol for a Multidisciplinary Intervention Study in Young Healthy Adults-The BEER-HIIT Study

High-intensity interval training (HIIT) is a time-efficient strategy to improve fitness and performance. Whereas the multiple and negative effects of high intake of alcohol have been widely studied, the effect of moderate alcohol doses after exercise is not clear, and it is currently under debate. For that, a total of 80 young healthy adults are studied and allocated into 5 groups, each including 16 participants. Four groups follow a HIIT program, while the fifth group is a control non-training group. The training groups will be randomized according to the characteristics of the ingested beverage (alcohol beer, beer 0.0%, sparkling water, or ethanol). The effects of HIIT on several aspects of physical performance and mental health in young healthy adults are evaluated, also the concomitant effect of daily and moderate alcohol consumption. The novelty of this study lies in the continuous measurement of the psychological parameters associated with carrying out a highly demanding training program in conjunction with alcohol consumption in moderate quantities, reflecting real-life conditions.

The relationship between sleep quality and gait in people with multiple sclerosis: A pilot study

Background

Gait deficits are common among people with multiple sclerosis (PwMS). Therefore, investigating factors that may influence walking in PwMS is important. Previous studies in older adults and other neurological populations demonstrated the relationship between sleep quality and gait performance. Despite the fact that the prevalence of poor sleep quality is very high among PwMS, little is known about the effect of sleep quality on gait among PwMS.

Objective

This study aimed to explore the relationship between sleep quality and gait performance in PwMS.

Methods

Forty-one PwMS participated in the study between February 2019 and December 2019. Participants were asked to walk at a self-selected speed over 10 m with an inertial measurement unit (IMU) attached over the back. Walking speed, step length (left and right), and step time were calculated. Sleep was estimated objectively using a wrist-worn triaxle-accelerometer; the derived parameters were sleep efficiency (SE) and the number of awakening after sleep onset (NASO).

Results

SE significantly correlated with step length (p = 0 . 02 ). Furthermore, the NASO significantly correlated with gait speed (p = 0 . 03 ), and step-time (p = 0 . 02 ). These correlations remained significant even after adjusting for age and disease duration.

Conclusion

We observed that when corrected for disease duration and age there were relationships between NASO and SE to gait parameters; these observations warrant further investigations.

Exercise-induced changes in plasma S-Klotho levels are associated with the obtained enhancements of heart rate variability in sedentary middle-aged adults: the FIT-AGEING study

The shed form of the Klotho protein (S-Klotho) is considered a biomarker of longevity, but it is still unknown whether the levels are related to heart rate (HR) and heart rate variability (HRV); both of them greatly influenced by the ageing process, physical fitness, exercise, and health status. This study aimed (i) to investigate the association between S-Klotho plasma levels with HR and HRV parameters and (ii) to examine the association of exercise-induced changes in S-Klotho and those obtained in HR and HRV parameters after a 12-week exercise intervention in sedentary middle-aged adults. Sixty-six sedentary middle-aged adults participated in this study (50% women; 45-65 years old). Participants were randomized into 4 groups: (a) a control group (no exercise), (b) a physical activity recommendation from the World Health Organization group, (c) a high-intensity interval training group, and (d) a high-intensity interval training group adding whole-body electromyostimulation. S-Klotho plasma levels, HR, and HRV parameters (SDNN, RMSSD, high frequency, stress score, and sympathetic/parasympathetic ratio) were measured. At baseline, S-Klotho plasma levels were not related to HR and HRV parameters. After the intervention, exercise-induced changes in S-Klotho plasma levels were positively associated with changes in SDNN (β=0.261; R2=0.102; p=0.014) and negatively related to changes in stress score and sympathetic/parasympathetic ratio (all β=-0.257; R2 ranges between 0.092 and 0.131; all p<0.020). Our study suggests that higher S-Klotho plasma levels are related to increased vagal influence and reduced sympathetic tone in the autonomic nervous system in sedentary middle-aged adults after different training programs. ClinicalTrials.gov identifier: CT03334357.

Physical exercise improves memory in sedentary middle-aged adults: Are these exercise-induced benefits associated with S-Klotho and 1,25-dihydroxivitamin D? The FIT-AGEING randomized controlled trial

We aimed to investigate the effect of three types of exercise interventions on memory (i.e., immediate memory (IM), long-term memory (LTM), and recognition). We also investigated whether exercise-induced changes in circulating S-Klotho and 1,25-dihydroxivitamin D (1,25(OH)2 D) levels were related to those observed in memory in healthy middle-aged sedentary adults. A 12-week randomized controlled trial was performed with a parallel-group design. Seventy-four participants (45-65 years old: 53% women) were randomly assigned to (1) no exercise (control) group, (2) concurrent training based on the international physical activity recommendations (PAR) group, (3) high-intensity interval training (HIIT) group, or (4) HIIT plus whole-body electromyostimulation (HIIT-EMS) group. Memory outcomes were assessed using the Wechsler Memory Scale-third edition. S-Klotho plasma levels were determined according to a solid-phase sandwich enzyme-linked immunosorbent assay kit while 1,25(OH)2 D plasma levels were measured using a DiaSorin-Liaison immunochemiluminometric analyzer. IM-Verbal Paired Associates (IM-VPA) and IM-Logical Memory (IM-LM) were improved in both the HIIT and HIIT-EMS groups compared with the control group (all p ≤ 0.045). Exercise-induced changes in S-Klotho plasma levels were positively associated with those observed in IM, LTM, and recognition (all p ≤ 0.007), whereas exercise-induced changes in 1,25(OH)2 D plasma levels were directly related to changes in IM and LTM (all p ≤ 0.048). In conclusion, a 12-week HIIT intervention with or without WB-EMS seems to be the most effective exercise program to improve IM. The significant and positive associations between exercise-induced changes in S-Klotho and 1,25(OH)2 D levels with those observed in memory outcomes suggest that these factors may be potentially related to exercise-induced improvements of memory in middle-aged adults.

Fit-Fat Index is better associated with heart rate variability compared to fitness and fatness alone as indicators of cardiometabolic human health

OBJECTIVES

Cardiorespiratory fitness and fatness indicators have been related to heart rate variability (HRV) parameters. The Fit-Fat Index (FFI) is a single index combining cardiorespiratory fitness and fatness indicators. To the best of our knowledge, no studies have previously analyzed whether FFI are related to cardiac autonomic nervous system activity assessed through HRV parameters. This study aimed (i) to examine the association of cardiorespiratory fitness, fatness indicators, and FFI with HRV parameters; and (ii) to report what of the different fatness indicators included in FFI is better associated with HRV parameters in sedentary adults.

METHODS

One hundred and fifty healthy adults (74 women; 76 men), aged between 18 and 65 years old, participated in this cross-sectional study. We measured cardiorespiratory fitness (maximal oxygen consumption) and fatness indicators (waist-to-height ratio [WHR], fat mass percentage [FM%] and visceral adipose tissue [VAT]). Three FFIs were calculated as the quotient between cardiorespiratory fitness and one out of three possible fatness indicators: Fit-Fat Index calculated waist-to-height ratio (FFIWHR ), Fit-Fat Index calculated with FM% (FFIFM% ), and Fit-Fat Index calculated with VAT (FFIVAT ). HRV parameters were measured in resting conditions using a Polar RS800CX.

RESULTS

FFIWTHR , FFIFM% and FFIVAT were related to different HRV parameters (β ranges between -0.507 and 0.529; R2 ranges between 0.096 and 0.275; all p < .001) and the association was stronger with HRV parameters than the isolated fitness or fatness indicators (β ranges between -0.483 and 0.518; R2 ranges between 0.071 and 0.263; all p < .001). FFIVAT was the index more consistently associated with HRV parameters (β ranges between -0.507 and 0.529; R2 ranges between 0.235 and 0.275; all p < .001).

CONCLUSION

Our study suggests that compound FFIs are better predictors of HRV parameters than either cardiorespiratory fitness or fatness indicators alone. The FFIVAT was the best index in terms of its association to HRV.

High omega-6/omega-3 fatty acid and oxylipin ratio in plasma is linked to an adverse cardiometabolic profile in middle-aged adults

Omega-6 and omega-3 oxylipins may be surrogate markers of systemic inflammation, which is one of the triggers for the development of cardiometabolic disorders. In the current study, we investigated the relationship between plasma levels of omega-6 and omega-3 oxylipins with body composition and cardiometabolic risk factors in middle-aged adults. Seventy-two 72 middle-aged adults (39 women; 53.6±5.1 years old; 26.7±3.8 kg/m²) were included in this cross-sectional study. Plasma levels of omega-6 and omega-3 fatty acids and oxylipins were determined using targeted lipidomic. Body composition, dietary intake, and cardiometabolic risk factors were assessed with standard methods. The plasma levels of the omega-6 fatty acids and derived oxylipins, the hydroxyeicosatetraenoic acids (HETEs; arachidonic acid (AA)-derived oxylipins) and dihydroxy-eicosatrienoic acids (DiHETrEs; AA-derived oxylipins), were positively associated with glucose metabolism parameters (i.e., insulin levels and homeostatic model assessment of insulin resistance index (HOMA); all r≥0.21, P<.05). In contrast, plasma levels of omega-3 fatty acids and derived oxylipins, specifically hydroxyeicosapentaenoic acids (HEPEs; eicosapentaenoic acid-derived oxylipins), as well as series-3 prostaglandins, were negatively associated with plasma glucose metabolism parameters (i.e., insulin levels, HOMA; all r≤0.20, P<.05). The plasma levels of omega-6 fatty acids and derived oxylipins, HETEs and DiHETrEs were also positively correlated with liver function parameters (i.e., glutamic pyruvic transaminase, gamma-glutamyl transferase (GGT), and fatty liver index; all r≥0.22 and P<.05). In addition, individuals with higher omega-6/omega-3 fatty acid and oxylipin ratio showed higher levels of HOMA, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and GGT (on average +36%), as well as lower levels of high-density lipoprotein cholesterol (-13%) (all P<.05). In conclusion, the omega-6/omega-3 fatty acid and oxylipin ratio, as well as specific omega-6 and omega-3 oxylipins plasma levels, reflect an adverse cardiometabolic profile in terms of higher insulin resistance and impaired liver function in middle-aged adults.

Sleep and Anabolic/Catabolic Hormonal Profile in Sedentary Middle-Aged Adults: The FIT-AGEING Study

Sleep quality plays an important role in the modulation of several aging markers. This influence could be explained by aging-induced hormonal changes. Indeed, poor sleep quality has been associated with the development of several endocrine-related health complications. This study examined the relationship of both subjective and objective sleep quantity and quality, with basal levels of selected plasma anabolic and catabolic hormones in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for this study. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI; higher scores indicate worse sleep quality), and objective sleep quality parameters (total sleep time [TST], wake after sleep onset [WASO], and sleep efficiency [SE]) were measured using a wrist-worn accelerometer. Basal levels of plasma dehydroepiandrosterone sulphate (DHEAS), total testosterone, sex hormone binding globulin (SHBG), somatotropin, and cortisol levels, were determined. Free testosterone was calculated from the total testosterone and SHBG levels. No associations of global PSQI score, TST, WASO, and SE with DHEAS, free testosterone, and somatotropin plasma levels were found, neither in men nor in women (all p ≥ 0.05). Global PSQI score was inversely related to cortisol plasma levels in women (p = 0.043). WASO was positively associated with cortisol plasma levels, while SE was negatively associated with cortisol plasma levels in women (all p ≤ 0.027). Sleep quality is not related to levels of plasma anabolic hormones, but to levels of catabolic hormones, in sedentary middle-aged adults. Therefore, these results suggest that potential changes in aging biomarkers associated with sleep disturbances, could be mediated by age-related changes in the catabolic endocrine system.

Ruiz J, Nestares T, Carneiro-Barrera A. Multidisciplinary Prehabilitation and Postoperative Rehabilitation for Avoiding Complications in Patients Undergoing Resection of Colon Cancer: Rationale, Design, and Methodology of the ONCOFIT Study

ONCOFIT is a randomized clinical trial with a two-arm parallel design aimed at determining the influence of a multidisciplinary Prehabilitation and Postoperative Program (PPP) on post-surgery complications in patients undergoing resection of colon cancer. This intervention will include supervised physical exercise, dietary behavior change, and psychological support comparing its influence to the standard care. Primary and secondary endpoints will be assessed at baseline, at preoperative conditions, at the end of the PPP intervention (after 12 weeks) and 1-year post-surgery, and will include: post-surgery complications (primary endpoint); prolonged hospital length of stay; readmissions and emergency department call within 1-year after surgery; functional capacity; patient reported outcome measures targeted; anthropometry and body composition; clinical/tumor parameters; physical activity levels and sedentariness; dietary habits; other unhealthy habits; sleep quality; and fecal microbiota diversity and composition. Considering the feasibility of the present intervention in a real-life scenario, ONCOFIT will contribute to the standardization of a cost-effective strategy for preventing and improving health-related consequences in patients undergoing resection of colon cancer with an important clinical and economic impact, not only in the scientific community, but also in clinical practice.

Linoleic acid-derived oxylipins and isoprostanes plasma levels are influenced by 1,25-Dihydroxyvitamin D levels in middle-aged sedentary adults: The FIT-AGEING study

INTRODUCTION

Vitamin D - concretely its active form 1,25-dihydroxyvitamin D (1,25(OH)₂D) - maintains several physiological processes. Oxylipins are oxidized lipids derived from ω-6 and ω-3 polyunsaturated fatty acids involved in inflammation. Little is known about the association of 1,25(OH)₂D with inflammatory parameters in middle-aged populations - who could be at risk of vitamin D deficiency -. The aim of this study was to investigate the relationship between 1,25(OH)₂D plasma levels with circulating white blood cells, platelets counts and oxylipins levels.

MATERIALS AND METHODS

A total of 74 (53 % women) middle-aged (40-65 years old) adults were recruited for this cross-sectional study. 1,25(OH)₂D plasma levels were measured using an immunochemiluminometric assay. White blood cells and platelets were analyzed by hemocytometry. ω-6 and ω-3 oxylipins plasma levels were measured using liquid chromatography - tandem mass spectrometry. Simple and multiple linear regression models, and Pearson correlation analyses, were performed to study the association of 1,25(OH)₂D levels with WBC and platelets counts, and oxylipins, respectively.

RESULTS

1,25(OH)₂D plasma levels were positively related with linoleic acid-derived oxylipins and isoprostanes plasma levels, whereas an inverse relationship with dihomo-γ-linolenic acid/linoleic acid and arachidonic acid/linoleic acid ratios was unveiled. No significant associations were observed for circulating ω-3 oxylipins, white blood cells levels or platelets count.

CONCLUSIONS

Linoleic acid-derived oxylipins and isoprostanes plasma levels may be influenced by 1,25(OH)₂D plasma levels. Further investigations are needed to elucidate the impact of other vitamin D forms upon circulating oxylipins levels.

A Systematic Study into the Effects of Long-Term Multicomponent Training on the Cognitive Abilities of Older Adults with Neurodegenerative Disorders

Cognition includes all processes through which a person becomes aware of their situation, needs, goals, and necessary actions. Regular specialized cognitive and neuromotor simulation exercises have improved various cognitive processes, including memory, speed of reasoning, and problem-solving skills. This review focuses on understanding the efficacy of long-term multicomponent exercise interventions to mitigate and delay the effects on cognitive abilities in older adults with neurodegenerative disorders. The main criteria for final studies were randomised controlled trials with a minimum of a 24-week intervention. The Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, B-On, Sport Discus, Scielo, APA PsycINFO, Psychology and Behavioural Sciences, Academic Search Complete, Medline (PubMed), ERIC, and Google Scholar databases were checked. The search occurred between April 2022 and July 2022. A total of 19 studies were used in this review. The initial search identified 6.835 studies. In the first screening, a total of 6474 studies were excluded. After this, 361 studies were analysed by co-authors and did not meet the specific final criteria and were excluded. In total, 19 studies were included in the final analysis, and 14 papers met all requirements previously defined.

Associations between heart rate variability and maximal fat oxidation in two different cohorts of healthy sedentary adults

BACKGROUND AND AIMS

Resting heart rate variability (HRV) and maximal fat oxidation (MFO) during exercise are both considered as a noninvasive biomarkers for early detection of cardiovascular risk factors. Thus, this study aimed to analyze the relationship between resting HRV parameters and MFO during exercise, and the intensity of exercise that elicit MFO (Fat_max) in healthy sedentary adults.

METHODS AND RESULTS

A total of 103 healthy young adults (22.2 ± 2.3 years old, 67% female; from the ACTIBATE cohort) and 67 healthy middle-aged adults (53.1 ± 5.0 years old, 52% female; from the FIT-AGEING cohort) were included in this cross-sectional study. HRV was assessed using a Polar RS800CX heart rate monitor, while MFO and Fat_max were determined during a graded exercise treadmill test using indirect calorimetry. No significant associations were observed for healthy young adults (standardized β coefficients ranged from -0.063 to 0.094, and all P ≥ 0.347) and for middle-aged adults (standardized β coefficients ranged from -0.234 to 0.090, and all P ≥ 0.056). Nevertheless, only a weak association was observed between one HRV parameter in time-domain (the percentage of R-R intervals that shows a difference higher than 50 ms [pNN50]) and MFO in the cohort of middle-aged adults (β coefficient = -0.279, and P = 0.033).

CONCLUSION

The results of this study suggest that resting HRV parameters are not associated with MFO and Fat_max during exercise in two independent cohorts of healthy sedentary young and middle-aged adults, respectively.

Different exercise training modalities similarly improve heart rate variability in sedentary middle-aged adults: the FIT-AGEING randomized controlled trial

PURPOSE

This study aimed to investigate the influence of different exercise training modalities on heart rate variability (HRV) in sedentary middle-aged adults; and to study whether changes in health-related outcomes (i.e., body composition and cardiometabolic risk) are associated with those hypothetical HRV changes in sedentary middle-aged adults.

METHODS

A total of 66 middle-aged adults (53.6 ± 4.4 years old; 50% women) were enrolled in the FIT-AGEING study. We conducted a 12-week randomized controlled trial. The participants were randomly assigned to 4 groups: (a) a control group (no exercise); (b) a physical activity recommendation from the World Health Organization group (PAR); (c) a high-intensity interval training group (HIIT); and (d) a high-intensity interval training group adding whole-body electromyostimulation (HIIT + EMS).

RESULTS

All exercise training modalities induced changes in HRV parameters (all P ≤ 0.001) without statistical differences between them (all P > 0.05). We found associations between changes in body composition and cardiometabolic risk and exercise-related changes in HRV.

CONCLUSION

Our results suggest that different exercise interventions (i.e., PAR, HIIT and HIIT + EMS) induced an enhancement of HRV in sedentary middle-aged adults. Our findings support the notion that exercise-related changes in HRV are associated with changes in body composition and cardiometabolic risk after the intervention program CLINICAL TRIAL REGISTRY: NCT03334357 (ClinicalTrials.gov). November 7, 2017 retrospectively registered.

Effect of Different Exercise Training Modalities on Fasting Levels of Oxylipins and Endocannabinoids in Middle-Aged Sedentary Adults: A Randomized Controlled Trial

This study aimed to investigate the effects of different exercise training programs on fasting plasma levels of oxylipins, endocannabinoids (eCBs), and eCBs-like molecules in middle-aged sedentary adults. A 12-week randomized controlled trial was conducted using a parallel group design. Sixty-five middle-aged adults (40-65 years old) were randomly assigned to: (a) no exercise (control group), (b) concurrent training based on international physical activity recommendations (PAR group), (c) high-intensity interval training (HIIT group), and (d) HIIT together with whole-body electromyostimulation (HIIT + EMS group). Plasma levels of oxylipins, eCBs, and eCBs-like molecules were determined in plasma samples before and after the intervention using targeted lipidomics. Body composition was assessed through dual-energy X-ray absorptiometry, and dietary intake through a food frequency questionnaire and three nonconsecutive 24-hr recalls. The physical activity recommendations, HIIT, and HIIT-EMS groups showed decreased plasma levels of omega-6 and omega-3-derived oxylipins, and eCBs and eCBs-like molecules after 12 weeks (all Δ ≤ -0.12; all p < .05). Importantly, after Bonferroni post hoc corrections, the differences in plasma levels of omega-6 and omega-3 oxylipins were not statistically significant compared with the control group (all p > .05). However, after post hoc corrections, plasma levels of anandamide and oleoylethanolamide were increased in the physical activity recommendations group compared with the control group (anandamide: Δ = 0.05 vs. -0.09; oleoylethanolamide: Δ = -0.12 vs. 0.013, all p ≤ .049). In conclusion, this study reports that a 12-week exercise training intervention, independent of the modality applied, does not modify fasting plasma levels of omega-6 and omega-3 oxylipins, eCBs, and eCBs-like molecules in middle-aged sedentary adults.

Exercise Training Attenuates Cardiac Vulnerability and Promotes Cardiac Resistance to Isoproterenol-Induced Injury Following Hookah Smoke Inhalation in Male Rats: Role of Klotho and Sirtuins

Hookah smoking is on the rise around the world. Present study investigated the heart resistance to harmful stress following long-term waterpipe tobacco smoking (WTS) and moderate-intensity exercise training intervention in male Wistar rats. Animals were randomly divided into a non-ischemic heart control group and four ischemic heart groups including ISO (isoproterenol-treated), Ex + ISO (subjected to exercise plus ISO), S + ISO (exposed to hookah smoke plus ISO), and Ex + S + ISO (subjected to exercise along with hookah smoke plus ISO). After eight weeks of training and WTS, heart ischemia induced by isoproterenol injections. Then, cardiac functional indices and some biochemical and histopathological parameters were assessed. WTS + ISO reduced systolic pressure, ± dP/dt max, and contractility indices (P < 0.001 vs. ISO group) and increased end diastolic pressure and Tau index (P < 0.001 vs. ISO) of the left ventricle. Also, WTS + ISO was associated with an increase in Bax protein level and Bax/Bcl-2 ratio (P < 0.05 and P < 001, respectively, vs. ISO group) as apoptotic markers of heart tissue. Hookah smoke significantly decreased SIRT1 (P < 0.05 and P < 0.001, respectively, vs. ISO) and klotho (P < 0.01 and P < 0.001, respectively, vs. ISO) in serum and heart, and SIRT3 and pS9-GSK-3β (P < 001 and P < 0.05, respectively, vs. ISO) in heart tissue. Combination of exercise with WTS prevented the hookah smoke-induced alterations in apoptotic markers, cardiac functional indices, and SIRT1, SIRT3, klotho, and pS9-GSK-3β proteins. The findings demonstrated that hookah smoke inhalation intensifies ventricular dysfunction and decreases heart resistance to harmful stresses. Moderate-intensity exercise training attenuated these complications partly through recovering the klotho and sirtuins levels and apoptosis-survival balancing.

Association of Energy and Macronutrients Intake with S-Klotho Plasma Levels in Middle-Aged Sedentary Adults: A Cross-Sectional Study

BACKGROUND

The ageing process can be influenced by energy intake and different macronutrients within the diet. The soluble form of the α-Klotho gene (called S-Klotho) is widely considered as a powerful anti-ageing biomarker.

OBJECTIVE

To analyze the association of energy, dietary energy density and macronutrient intake with S-Klotho plasma levels in middle-aged sedentary adults.

METHODS

A total of 72 (52.8% women) middle-aged sedentary adults (53.7 ± 5.2 years old) participated in the study. Energy and macronutrients intake (i.e. fat, carbohydrate and protein) were assessed using three non-consecutive 24-h recalls. S-Klotho plasma levels were measured in the Ethylenediaminetetraacetic acid (EDTA) plasma using a solid-phase sandwich enzyme-linked immunosorbent assay.

RESULTS

No association was observed between energy, dietary energy density or macronutrient intake and S-Klotho plasma levels in men (all P≥ 0.1). We found an inverse association between energy, protein and carbohydrate intake with S-Klotho plasma levels in women (all P≤0.043), which disappeared after controlling for age, lean mass index and sedentary time. An inverse association was observed between dietary energy density and S-Klotho plasma levels in women after controlling for covariates (all P≤0.05).

CONCLUSION

In summary, the present study showed an inverse association of dietary energy density with S-Klotho plasma levels in middle-aged women. In addition, our data suggest that the associations between energy and macronutrient intake could be highly dependent on lean mass and sedentary time.

1,25-dihydroxyvitamin D and cardiometabolic risk in healthy sedentary adults: The FIT-AGEING study

BACKGROUND

A growing body of scientific works investigating the physio-pathological mechanisms behind cardiovascular disease has suggested that vitamin D deficiency could play a key role on its development. However, it remains unclear whether its active form (1,25-dihydroxyvitamin D [1,25(OH)₂D] is associated with cardiometabolic risk factors in healthy individuals. The aim of the present study was to investigate the relationships of 1,25(OH)₂D plasma levels with cardiometabolic risk factors in a sample of healthy sedentary adults.

METHODS

A total of 73 adults (~53% women; 54 ± 5 years old) were included in the current cross-sectional study. A sex-specific cardiometabolic risk score (MetScore) was calculated for each subject based on clinical parameters (i.e., waist circumference, systolic and diastolic blood pressure, plasma glucose, high-density lipoprotein cholesterol, and triglycerides) according to the International Diabetes Federation's clinical criteria. Plasma levels of 1,25(OH)₂D were measured using a DiaSorin Liaison® immunochemiluminometric analyzer.

RESULTS

No significant association was detected between 1,25(OH)₂D and MetScore (β = 0.037, R² = 0.001, p = 0.77), independently of age, sex and fat body mass index. A significant inverse association were observed between 1,25(OH)₂D and waist circumference (β = -0,303, R² = 0.092, p = 0.01). These results were consistent after controlling by potential confounders.

CONCLUSION

In summary, the present results suggest that 1,25(OH)₂D plasma levels are not associated with either cardiometabolic risk factors or insulin resistance in healthy sedentary adults. However, an inverse association of 1,25(OH)₂D plasma levels with central adiposity was observed in our study sample.

Effect of Exercise Training on 1,25(OH)2D Levels: The FIT-AGEING Randomized Controlled Trial

BACKGROUND

Vitamin D deficiency is currently endemic worldwide and is considered as an important factor in the development of several chronic conditions. Physical exercise has been postulated as an auspicious strategy to counteract age-related disorders preventing premature mortality. However, the effects of chronic exercise training on 1,25-dihydroxyvitamin D [1,25(OH)₂D] is unclear. This 12-week randomized controlled trial aimed to investigate the effects of different training modalities on 1,25(OH)₂D in healthy sedentary adults.

HYPOTHESIS

Exercise training will increase 1,25(OH)₂D in the study cohort.

STUDY DESIGN

Randomized controlled clinical trial.

LEVEL OF EVIDENCE

Level 1.

METHODS

A total of 89 healthy sedentary adults (53% women; 53.5 ± 4.9 years old) were enrolled in the FIT-AGEING study. The participants were randomized to (1) a control group (no exercise), (2) physical activity recommendation from the World Health Organization (PAR group), (3) high-intensity interval training (HIIT group), and (4) HIIT adding whole-body electromyostimulation training (HIIT + EMS). 1,25(OH)₂D plasma levels were measured using a DiaSorin Liaison immunochemiluminometric analyzer.

RESULTS

Compared with the control group, 1,25(OH)₂D increased in PAR (Δ = 10.99 ± 3.44 pg/mL; P = 0.01), HIIT (Δ = 11.63 ± 3.51 pg/mL; P = 0.009), and HIIT + EMS groups (Δ = 14.01 ± 3.59 pg/mL; P = 0.001) without statistical differences between them (all Ps > 0.1).

CONCLUSION

In summary, the results show that a 12-week exercise intervention produced an increment of 1,25(OH)₂D independently of age, sex, and exercise modality in healthy sedentary adults.

CLINICAL RELEVANCE

The implementation of physical exercise could be considered a strategy not only aiming to reverse the seasonal decrease of 1,25(OH)₂D in winter explained by low sunlight exposure but also for obtaining subsequent increases of this hormone even in these a priori adverse conditions.

Deciphering the constrained total energy expenditure model in humans by associating accelerometer-measured physical activity from wrist and hip

The constrained total energy expenditure (TEE) model posits that progressive increases in physical activity (PA) lead to increases in TEE; but after certain PA threshold, TEE plateaus. Then, a compensatory reduction in the expenditure of non-essential activities constrains the TEE. We hypothesized that high PA levels as locomotion associate with a compensatory attenuation in arm movements. We included 209 adults (64% females, mean [SD] age 32.1 [15.0] years) and 105 children (40% females, age 10.0 [1.1] years). Subjects wore, simultaneously, one accelerometer in the non-dominant wrist and another in the hip for ≥ 4 days. We analyzed the association between wrist-measured (arm movements plus locomotion) and hip-measured PA (locomotion). We also analyzed how the capacity to dissociate arm movements from locomotion influences total PA. In adults, the association between wrist-measured and hip-measured PA was better described by a quadratic than a linear model (Quadratic-R² = 0.54 vs. Linear-R² = 0.52; P = 0.003). Above the 80th percentile of hip-measured PA, wrist-measured PA plateaued. In children, there was no evidence that a quadratic model fitted the association between wrist-measured and hip-measured PA better than a linear model (R² = 0.58 in both models, P = 0.25). In adults and children, those with the highest capacity to dissociate arm movements from locomotion—i.e. higher arm movements for a given locomotion—reached the highest total PA. We conclude that, in adults, elevated locomotion associates with a compensatory reduction in arm movements (probably non-essential fidgeting) that partially explains the constrained TEE model. Subjects with the lowest arm compensation reach the highest total PA.

The effects of three types of exercise training on steroid hormones in physically inactive middle-aged adults: a randomized controlled trial

PURPOSE

Physical inactivity and ageing are associated with imbalances in anabolic/catabolic steroid hormones, jeopardizing health. We investigated the effects of three types of training on plasma steroid hormone levels in physically inactive, middle-aged adults.

METHODS

A 12-week randomized controlled trial was performed with a parallel-group design. A total of 67 (36 women) middle-aged adults (45-65 years old) were randomly assigned to (1) no exercise (control), (2) concurrent training based on the international physical activity recommendations (PAR), (3) high-intensity interval training (HIIT), or (4) HIIT plus whole-body electromyostimulation (HIIT + EMS). The training volume in the PAR group was 150 min/week at 60-65% of the heart rate reserve for aerobic training and ~ 60 min/week at 40-50% of the one-repetition maximum for resistance training. The training volume in the HIIT and HIIT + EMS groups was 40-65 min/week at > 95% of the maximum oxygen uptake in long interval sessions, and > 120% of the maximum oxygen uptake in short interval sessions.

RESULTS

Compared to the control group, dehydroepiandrosterone sulfate increased in the PAR, HIIT, and HIIT + EMS groups (~ 14%, ~ 14%, and ~ 20%, respectively; all P < 0.01). Cortisol decreased in the PAR, HIIT, and HIIT + EMS groups (~ - 17%, ~ - 10%, and ~ - 23%, respectively; all P ≤ 0.05). Testosterone increased in the HIIT and HIIT + EMS groups (~ 28%, and ~ 16%, respectively; all P ≤ 0.01). Free testosterone increased in the HIIT and HIIT + EMS groups (~ 30% and ~ 18% respectively; all P ≤ 0.01). No significant increase in sex hormone-binding globulin was observed (P = 0.869).

CONCLUSION

Our findings suggest that HIIT, with or without whole-body EMS, can significantly enhance steroid hormones status in previously physically inactive middle-aged adults. The PAR program led to slight improvements than the HIIT and HIIT + EMS groups despite the application of a higher training volume.

CLINICAL TRIAL REGISTRY

NCT03334357 (ClinicalTrials.gov). November 7, 2017 retrospectively registered.

Relationships between diet and basal fat oxidation and maximal fat oxidation during exercise in sedentary adults

BACKGROUND AND AIMS

To study the relationships between different dietary factors (i.e., energy, macronutrient and fatty acid intake, food group consumption, and dietary pattern) and basal fat oxidation (BFox) and maximal fat oxidation during exercise (MFO) in sedentary adults.

METHOD AND RESULTS

A total of 212 (n = 130 women; 32.4 ± 15.1 years) sedentary healthy adults took part in the present study. Information on the different dietary factors examined was gathered through a food frequency questionnaire and three nonconsecutive 24 h recalls. Energy and macronutrient intakes and food consumption were then estimated and dietary patterns calculated. BFox and MFO were measured by indirect calorimetry following standard procedures. Our study shows that dietary fiber intake was positively associated with BFox after taking into consideration the age, sex, and energy intake. A significant positive association between nut consumption and BFox was observed, which became nonsignificant after taking into consideration the age and energy intake. Fat intake and the dietary quality index (DQI), and the DQI for the Mediterranean diet were positively associated with MFO, which was attenuated after taking sex, age, and energy intake into consideration.

CONCLUSION

A higher dietary fiber intake and fat intake are associated with higher BFox and MFO, respectively, in sedentary adults.

CLINICAL TRIALS

ClinicalTrials.gov, ID: NCT02365129 (https://clinicaltrials.gov/ct2/show/study/NCT02365129) & ID: NCT03334357 (https://clinicaltrials.gov/ct2/show/NCT03334357).

Heart rate rather than heart rate variability is better associated with cardiorespiratory fitness in adults

This study aimed to examine the association of heart rate (HR) and heart rate variability (HRV) with cardiorespiratory fitness (CRF) in adults. This cross-sectional study included 204 participants: 132 young adults (67% women; 22.3 ± 2.3 years) and 72 middle-aged adults (53% women; 53.2 ± 5 years). HR and HRV were measured using a Polar RS800CX heart rate monitor. CRF was assessed using a metabolic cart during an incremental test. HR was negatively associated with CRF relative to body weight (BW) in young adults adjusting for sex, age, and physical activity (β ranged from -0.200 to -0.195; all P ≤ 0.022). These associations disappeared after including fat mass as a covariate (all P ≥ 0.106) while remained significant after adjusting for fat-free mass (FFM; all P ≤ 0.008). Neither HR nor HRV variables were associated with CRF expressed as absolute values or relative to FFM in young and middle-aged adults after adjusting for the abovementioned covariates (all P ≥ 0.074). Our results suggest that HR rather than HRV is better associated with CRF relative to BW in young adults. However, this association seems to be explained by the inclusion of fat mass in the calculation of CRF relative to BW.Highlights Heart rate and heart rate variability variables have been associated with cardiorespiratory fitness.Our present results, and previous literature, suggest that the "simple" measurement of the heart rate could be easier to obtain and interpret than the heart rate variability variables.The heart rate variable rather than the heart rate variability variables is better associated with cardiorespiratory fitness relative to body weight in healthy young adults.

Uncertain association between maximal fat oxidation during exercise and cardiometabolic risk factors in healthy sedentary adults

The present work examines the relationships between maximal fat oxidation during a graded exercise test (MFO), the intensity of exercise that elicits MFO (Fat_max), and traditional cardiometabolic risk factors in healthy, sedentary adults. A total of 119 (81 women) young, sedentary adults (22.1 ± 2.2 years old), and 71 (37 women) middle-aged, sedentary adults (53.4 ± 4.9 years old) participated in the current study. Systolic and diastolic blood pressures were determined following standard procedures. Plasma glucose, insulin, total cholesterol, high-density lipoprotein cholesterol and triglycerides were determined in a fasted state and the homeostatic model assessment of insulin resistance index and low-density lipoprotein cholesterol levels subsequently calculated. A sex and age group-specific cardiometabolic risk Z-score was also calculated for each subject based on waist circumference, systolic and diastolic blood pressure, plasma glucose, high-density lipoprotein cholesterol and triglycerides. MFO and Fat_max were determined using a walking graded exercise test using indirect calorimetry. No clear association was seen of MFO and Fat_max with any cardiometabolic risk factor (all P≥0.05), except for a weak, inverse association between Fat_max and the fatty liver index (P=0.027). Similarly, neither MFO nor Fat_max was apparently associated with the cardiometabolic risk Z-score (all P≥0.05). The current findings suggest an uncertain association of MFO and Fat_max during a graded exercise test with the cardiometabolic profile of healthy, sedentary adults.HighlightsThe study of the physiological mechanisms that trigger the onset of metabolic disorders has received considerable attention in recent years, with changes in MFO and Fat_max being highlighted as a potential key factor.This work shows that MFO and Fat_max during a graded exercise test are not associated with the cardiometabolic profile in sedentary, healthy adults.Further studies are needed to elucidate which other physiological disorders are related to cardiometabolic risk.

1,25-Dihydroxyvitamin D and S-Klotho Plasma Levels: The Relationship Between Two Renal Antiaging Biomarkers Mediated by Bone Mineral Density in Middle-Aged Sedentary Adults

The main active metabolite of vitamin D, the 1,25-dihydroxyvitamin D (1,25(OH)₂D), and the shed form of the α-Klotho gene (S-Klotho) play an important role in aging-related physiological processes and are currently considered powerful antiaging renal biomarkers. We aimed to investigate the relationship between 1,25(OH)₂D and S-Klotho plasma levels in middle-aged sedentary healthy adults. We also aimed to study the mediation role of body composition, physical activity levels, dietary parameters, and blood markers in the association between 1,25(OH)₂D and S-Klotho plasma levels. A total of 73 middle-aged sedentary adults (53.4% women; 53.7 ± 5.1 years old) were enrolled in this cross-sectional study. The 1,25(OH)₂D plasma levels were measured using a DiaSorin Liaison^® immunochemiluminometric analyzer. S-Klotho plasma levels were measured using a solid-phase sandwich enzyme-linked immunosorbent assay. Body composition analysis was performed using dual-energy X-ray absorptiometry scanner. A tendency toward a negative association was observed between 1,25(OH)₂D and S-Klotho plasma levels (β = -0.222, R² = 0.049, p = 0.059). The association was attenuated after controlling for age and sex and become significant after controlling for fat mass index. In addition, the association between 1,25(OH)₂D and S-Klotho levels was indirectly influenced by bone mineral density (BMD), with a percentage of mediation of 31.40%. Our study shows that 1,25(OH)₂D is negatively associated with S-Klotho plasma levels in middle-aged sedentary adults, which is partially mediated by BMD. Clinicaltrial.gov: ID: NCT03334357.

Role of physical activity and fitness on sleep in sedentary middle-aged adults: the FIT-AGEING study

The association of physical activity and fitness with sleep still remains unclear since there is a lack of studies in this field of research using objective measurements of these variables. This study aimed to investigate the association of objectively-measured sedentariness, physical activity levels, and physical fitness with sleep quantity and quality in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for the present study. Cardiorespiratory fitness was measured through a maximal treadmill test, and muscular strength by extension and flexion peak torque, and by the hand grip test. Physical activity and objective sleep parameters were determined through accelerometry, and subjective sleep by the Pittsburgh Sleep Quality Index (PSQI). Reduced levels of sedentariness, greater VO_2max, and greater muscular strength were positively related to improved objective sleep quantity and quality (all P ≤ 0.05). Furthermore, higher levels of overall physical activity, VO_2max, and muscular strength were related to better subjective sleep quantity and quality (all P ≤ 0.05). Reduced sedentariness and increased physical activity and fitness may be a potential prevention and/or treatment pathway to reduce sleep disturbances and, in general, to improve patients physical and psychological health for a successful aging process.

Cardiovascular Risk Factors and Heart Rate Variability: Impact of the Level of the Threshold-Based Artefact Correction Used to Process the Heart Rate Variability Signal

The associations between cardiovascular disease (CVD) risk factors and heart rate variability (HRV) have shown some inconsistencies. To examine the impact of the different Kubios threshold-based artefact correction levels on the associations between different CVD risk factors and a heart rate variability (HRV) score in three independent human cohorts. A total of 107 children with overweight/obesity, 132 young adults, and 73 middle-aged adults were included in the present study. Waist circumference and the HRV score were negatively associated using the medium and the strong Kubios filters in children (β = -0.22 and - 0.24, P = 0.03 and 0.02 respectively) and the very strong Kubios filter in middle-aged adults (β = -0.39, P = 0.01). HDL-C was positively associated with the HRV score across Kubios filters (β ranged from 0.21 to 0.31, all P ≤ 0.04), while triglycerides were negatively associated with the HRV score using the very strong Kubios filter in young adults (β = -0.22, P = 0.02). Glucose metabolism markers (glucose, insulin, and HOMA index) were inversely associated with the HRV score across Kubios filters in young adults (β ranged from -0.29 to -0.22; all P ≤ 0.03). Importantly, most of these associations disappeared after including HR as a covariate, especially in children and young adults. It should be mandatory to report the Kubios filter used and to include the HR (as a confounder factor) to allow the comparability of the results across different studies.

Assessment of autonomous nerve system through non-linear heart rate variability outcomes in sedentary healthy adults

Background

Heart rate variability (HRV) is a psycho-physiological phenomenon with broad health implications. Different data analysis methods have been used to assess the autonomic nervous system activity, but the validation of new indexes that accurately describe its balance through non-invasive methods (i.e., HRV analysis) is of clinical interest. This study aimed: (i) to evaluate the association of the Stress Score (SS) and the Sympathetic/Parasympathetic Ratio (S/PS) with time domain and frequency domain analysis of HRV, and (ii) to set reference values of SS and S/PS in sedentary healthy adults.

Methods

A total of 156 sedentary healthy adults (38.4 ± 15.57 years old, 81 women), aged were involved in this study. HRV was measured for 15 min in a supine position at rest. SS and S/PS were calculated from the non-linear HRV analyses based on Poincare Plot.

Results

Stress Score showed a non-linear negative power-law relationship with SDNN (β = -0.969; R ² = 0.963; P < 0.001), RMSSD (β = -0.867; R ² = 0.722; P < 0.001), high frequency (β = -0.834; R ² = 0.752; P =< 0.001), low frequency (β = -0.627; R ² = 0.330; P < 0.001), SD1 (β = -0.867; R ² = 0.722; P < 0.001) and SD2 (β = -1.000; R ² > 0.999; P < 0.001). There was observed a negative cubic relationship between SS with PNN50 (β = -1.972; R ² = 0.644; P < 0.001). A linear regression model was conducted between SS with Ratio Low/High Frequency (β = 0.026; R ² < 0.001; P = 0.750). Non-linear power-law regression models were built between S/PS and SDNN (β = -0.990; R ² = 0.981; P < 0.001), RMSSD (β = -0.973; R ² = 0.939; P < 0.001), high frequency (β = -0.928; R ² = 0.970; P < 0.001), low frequency (β = -2.344; R ² = 0.557; P < 0.001), SD1 (β = -0.973; R ² = 0.939; P < 0.001) and SD2 (β = -0.611; R ² = 0.908; P < 0.001). A non-linear negative regression model was built between S/PS and PNN50 (β = -3.412; R ² = 0.868; P < 0.001). A linear regression model was conducted between S/PS and SD2/SD1 (β = 0.075; R ² = 0.006; P < 0.001).

Conclusion

Our results support the use of SS as a sympathetic activity marker, and S/PS as an indicator of the sympathetic and parasympathetic activity of the autonomic nervous system in sedentary healthy adults.

Is Sleep Associated with the S-Klotho Anti-Aging Protein in Sedentary Middle-Aged Adults? The FIT-AGEING Study

Sleep and Klotho have both been closely related to the ageing process, both playing a substantial role in the endocrine and immune systems and, thereby, in oxidative stress and chronic inflammation. However, there are no studies elucidating the relationship between sleep and Klotho. Therefore, this study investigated the association of sleep quantity and quality with the shed form of the α-Klotho gene (S-Klotho plasma levels) in sedentary middle-aged adults. A total of 74 volunteers (52.7% women; aged 53.7 ± 5.1) were recruited for the present study. Objective sleep quality parameters (total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE)) were determined using a wrist-worn accelerometer over seven consecutive days, and the subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI; higher scores indicate worse sleep quality). The S-Klotho plasma levels were measured in the ethylenediaminetetraacetic acid plasma using a solid-phase sandwich enzyme-linked immunosorbent assay. Objective sleep parameters were associated with the S-Klotho plasma levels only after including the age, fat mass percentage, and lean mass index as covariates. A direct relationship was observed between the subjective sleep quality (inverse of PSQI scores) and the S-Klotho plasma levels in sedentary middle-aged adults. Improving sleep quantity and quality could be considered an anti-aging therapeutic approach for the prevention, slowing, and even reversal of the physiological decline and degenerative pathologies that are certainly related to the aging process.

Inter- and intra-researcher reproducibility of heart rate variability parameters in three human cohorts

Heart rate variability (HRV) is a valid and non-invasive indicator of cardiac autonomic nervous system functioning. Short-term HRV recordings (e.g., 10 min long) produce data that usually is manually processed. Researcher subjective decision-making on data processing could produce inter- or intra-researcher differences whose magnitude has not been previously quantified in three independent human cohorts. This study examines the inter- and intra-researcher reproducibility of HRV parameters (i.e., the influence of R–R interval selection by different researchers and by the same researcher in different moments on the quantification of HRV parameters, respectively) derived from short-term recordings in a cohort of children with overweight/obesity, young adults and middle-age adults. Participants were recruited from 3 different studies: 107 children (10.03 ± 1.13 years, 58% male), 132 young adults (22.22 ± 2.20 years, 33% males) and 73 middle-aged adults (53.62 ± 5.18 years, 48% males). HRV was measured using a Polar RS800CX heart rate monitor. The intraclass correlation coefficient (ICC) ranged from 0.703 to 0.989 and from 0.950 to 0.998 for inter-and intra-researcher reproducibility, respectively. Limits of agreement for HRV parameters were higher for the inter-researcher processing compared with the intra-researcher processing. On average, the intra-researcher differences were 31%, 62%, and 80% smaller than the inter-researchers differences based on Coefficient of Variation in children, young and middle-aged adults, respectively. Our study provides the quantification of the inter-researcher and intra-researcher differences in three independent human cohorts, which could elicit some clinical relevant differences for HRV parameters. Based on our findings, we recommend the HRV data signal processing to be performed always by the same trained researcher and we postulate a development of algorithms for an automatic ECG selection.

Influence of daily beer or ethanol consumption on physical fitness in response to a high-intensity interval training program. The BEER-HIIT study

BACKGROUND

High-intensity interval training (HIIT) is an effective approach to improve physical fitness, but consuming beer, which is a regular practice in many physically active individuals, may interfere with these effects. The purposes of this study were to investigate the effects of a 10-week (2 days/week) HIIT program on cardiorespiratory fitness, muscle strength and power parameters, and also to assess the possible influence on them of a moderate consumption of beer (at least from Monday to Friday) or its alcohol equivalent.

METHODS

Young (24 ± 6 years old) healthy adults (n = 73, 35 females) were allocated to five groups. Four groups participated in the HIIT intervention program while the fifth group was a control Non-Training group (n = 15). Participants in the training groups chose whether they preferred receiving alcohol or alcohol-free beverages. Those choosing alcohol were randomized to either beer or ethanol intake: (i) T-Beer group (alcohol beer, 5.4%; n = 13) or (ii) T-Ethanol (sparkling water with vodka, 5.4%; n = 14). Those choosing alcohol-free intake were randomized to (iii) T-Water group (sparkling water, 0.0%; n = 16), or (iv) T-0.0Beer group (alcohol-free beer, 0.0%; n = 15). Men ingested 330 ml of the beverage at lunch and 330 ml at dinner; women ingested 330 ml at dinner. Before and after the intervention, maximal oxygen uptake in absolute and relative terms (VO2max.), maximal heart rate, total test duration, hand grip strength and four types of vertical jumps were measured.

RESULTS

HIIT induced significant improvements in absolute and relative values of VO2max, and total test duration (all p < 0.05) in all the training groups; also, clinical improvements were found in hand grip strength. These positive effects were not influenced by the regular intake of beer or alcohol. No changes in the vertical jumps occurred in any of the groups.

CONCLUSIONS

A moderate beer or alcohol intake does not mitigate the positive effect of a 10-week HIIT on physical fitness in young healthy adults.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03660579. Registered 20 September 2018. Retrospectively registered.

Association of Basal Metabolic Rate and Nutrients Oxidation with Cardiometabolic Risk Factors and Insulin Sensitivity in Sedentary Middle-Aged Adults

This cross-sectional study aimed to examine the association of basal metabolic rate (BMR) and basal fat and carbohydrate oxidation (BFox and BCHox, respectively) with cardiometabolic risk factors and insulin sensitivity in sedentary middle-aged adults. A total of 71 healthy sedentary adults (37 women) aged 40–65 years participated in the current study. Data were collected during the baseline assessments of the FIT-AGEING randomized controlled trial. BMR was measured via indirect calorimetry, and BFox and BCHox estimated by stoichiometric equations. Blood pressure, glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides plasma levels were selected as cardiometabolic risk factors and assessed following standard procedures. We observed positive associations of BMR with plasma insulin and the homeostatic model assessment of insulin resistance index (HOMA; all p < 0.05) which were attenuated or disappeared after controlling by sex, age, and/or lean mass. There were positive associations between BFox and the quantitative insulin sensitivity check index (QUICKI; p < 0.015), while negative associations were noted between BFox and plasma insulin and HOMA (p < 0.015). There was a significant negative association between BCHox with QUICKI (p < 0.01), whereas significant positive relationships were obtained when BCHox was associated with plasma insulin and HOMA (p < 0.01). These associations persisted in almost all cases when controlling by sex, age and/or lean mass. No further relationships were found when BMR, BFox, and BCHox were associated with other cardiometabolic risk factors. In conclusion, our study findings support that greater BFox and lower BCHox are related to improved insulin sensitivity, whereas BMR seems to be not associated with neither cardiometabolic risk nor insulin sensitivity in sedentary middle-aged adults. Further intervention studies are necessary to well-understand the physiological mechanism implied in this relationship.

Association between sleep quality and time with energy metabolism in sedentary adults

The aim of the present study was to investigate the relationship of sleep quality and time with basal metabolic rate (BMR) and fuel oxidation in basal conditions and during exercise in sedentary middle-aged adults. We also studied the mediation role of dietary intake and adherence to the traditional Mediterranean Diet in the relationship between sleep parameters and energy metabolism parameters.A secondary analysis of the FIT-AGEING study was undertaken. 70 middle-aged sedentary adults (40-65 years old) participated in the present study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and wrist accelerometers (ActiSleep, Actigraph, Pensacola, Florida, USA) for 7 consecutive days. BMR was measured with indirect calorimetry and fuel oxidation was estimated through stoichiometric equations. Maximal fat oxidation was determined by a walking graded exercise test and dietary intake with 24 h recalls. Adherence to the traditional Mediterranean diet was assessed through the PREDIMED questionnaire. PSQI global score (poor sleep quality) was associated with lower basal fat oxidation (BFox), both expressed in g/min and as a percentage of BMR, independently of confounders. We did not find any association between other sleep and energy metabolism parameters. No mediating role of the dietary intake or PREDIMED global score was observed in the association of PSQI and BFox. In conclusion, our study showed that a subjective poor sleep quality was associated with lower BFox, which is not mediated by dietary intake in sedentary adults.

Exercise training improves sleep quality: A randomized controlled trial

BACKGROUND

Exercise holds promise as a non-pharmacological intervention for the improvement of sleep quality. Therefore, this study investigates the effects of different training modalities on sleep quality parameters.

MATERIAL & METHODS

A total of 69 (52.7% women) middle-aged sedentary adults were randomized to (a) control group, (b) physical activity recommendation from the World Health Organization, (c) high-intensity interval training (HIIT) and (d) high-intensity interval training group adding whole-body electromyostimulation training (HIITEMS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) scale and accelerometers.

RESULTS

All intervention groups showed a lower PSQI global score (all P < .022). HIIT-EMS group improved all accelerometer parameters, with higher total sleep time and sleep efficiency, and lower wake after sleep onset (all P < .016). No differences were found between groups in any sleep quality parameter.

CONCLUSION

In conclusion, exercise training induced an improvement in subjective sleep quality in sedentary middleaged adults. Moreover, HIIT-EMS training showed an improvement in objective sleep quality parameters (total sleep time, sleep efficiency and wake after sleep onset) after 12 weeks of exercise intervention. The changes observed in the HIIT-EMS group were not statistically different to the other exercise modalities.

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

BACKGROUND

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

AIMS

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

METHODS

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

OUTCOMES

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

RESULTS

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

CLINICAL IMPLICATIONS

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

STRENGTHS AND LIMITATIONS

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

CONCLUSION

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

Impact of the Method Used to Select Gas Exchange Data for Estimating the Resting Metabolic Rate, as Supplied by Breath-by-Breath Metabolic Carts

The method used to select representative gas exchange data from large datasets influences the resting metabolic rate (RMR) returned. This study determines which of three methods yields the lowest RMR (as recommended for use in human energy balance studies), and in which method the greatest variance in RMR is explained by classical determinants of this variable. A total of 107 young and 74 middle-aged adults underwent a 30 min RMR examination using a breath-by-breath metabolic cart. Three gas exchange data selection methods were used: (i) steady state (SSt) for 3, 4, 5, or 10 min, (ii) a pre-defined time interval (TI), i.e., 6–10, 11–15, 16–20, 21–25, 26–30, 6–25, or 6–30 min, and (iii) “filtering”, setting thresholds depending on the mean RMR value obtained. In both cohorts, the RMRs yielded by the SSt and filtering methods were significantly lower (p < 0.021) than those yielded by the TI method. No differences in RMR were seen under the different conditions of the SSt method, or of the filtering method. No differences were seen between the methods in terms of the variance in RMR explained by its classical determinants. In conclusion, the SSt and filtering methods return the lowest RMRs and intra-measurement coefficients of variation when using breath-by-breath metabolic carts.

Metabolic rate in sedentary adults, following different exercise training interventions: The FIT-AGEING randomized controlled trial

BACKGROUND & AIMS

This study compares the influence of different exercise training programs on basal metabolic rate (BMR) and fat oxidation, in basal conditions (BFox) and during exercise (MFO), in sedentary, middle-aged adults.

METHODS

The study subjects of this 12 week-long, randomised controlled trial, were 71 middle-aged adults (age 53.5 ± 4.9 years; 52% women). Subjects were randomly assigned to one of the following groups: (1) no exercise, (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT group), and (4) high intensity interval training plus whole-body electromyostimulation (HIIT + EMS group). Subject BMR, BFox and MFO were determined by indirect calorimetry before and after the intervention.

RESULTS

The HIIT + EMS subjects showed significant increases in BFox following the intervention compared with the control group (all P = 0.043); no such differences were seen in the PAR and HIIT compared with the control group (all P ≥ 0.1). A significant increase in post-intervention MFO was noted for the HIIT and HIIT + EMS group compared to the non-exercise control group (P < 0.05); no such difference was seen in the PAR group compared to the control group (all P ≥ 0.05).

CONCLUSIONS

Twelve weeks of high intensity interval training plus whole-body electromyostimulation may increase the BFox and MFO of middle-aged sedentary adults. These findings have important clinical implications; a well-designed high-intensity interval training program plus whole-body electromyostimulation might be followed to help combat the appearance of chronic metabolic diseases characterized by metabolic inflexibility in middle-aged sedentary adults, though it will be necessary to determine how long the effects last.

Impact of Using Different Levels of Threshold-Based Artefact Correction on the Quantification of Heart Rate Variability in Three Independent Human Cohorts

Heart rate variability (HRV) is a non-invasive indicator of autonomic nervous system function. HRV recordings show artefacts due to technical and/or biological issues. The Kubios software is one of the most used software to process HRV recordings, offering different levels of threshold-based artefact correction (i.e., Kubios filters). The aim of the study was to analyze the impact of different Kubios filters on the quantification of HRV derived parameters from short-term recordings in three independent human cohorts. A total of 312 participants were included: 107 children with overweight/obesity (10.0 ± 1.1 years, 58% men), 132 young adults (22.2 ± 2.2 years, 33% men) and 73 middle-aged adults (53.6 ± 5.2 years, 48% men). HRV was assessed using a heart rate monitor during 10–15 min, and the Kubios software was used for HRV data processing using all the Kubios filters available (i.e., 6). Repeated-measures analysis of variance indicated significant differences in HRV derived parameters in the time-domain (all p < 0.001) across the Kubios filters in all cohorts, moreover similar results were observed in the frequency-domain. When comparing two extreme Kubios filters, these statistical differences could be clinically relevant, e.g. more than 10 ms in the standard deviation of all normal R-R intervals (SDNN). In conclusion, the results of the present study suggest that the application of different Kubios filters had a significant impact on HRV derived parameters obtained from short-term recordings in both time and frequency-domains.

Dietary Inflammatory Index and S-Klotho Plasma Levels in Middle-Aged Adults

Background: Soluble Klotho (S-Klotho) is an aging suppressor with a close link with inflammation. However, it is still unknown whether the dietary inflammatory potential is associated with S-Klotho plasma level. We aimed to investigate the association of the Dietary Inflammatory Index (DII) with S-Klotho plasma levels in middle-aged sedentary adults. Methods: 73 middle-aged sedentary adults (40–65 years old) participated in the present study. DII was determined from 28 dietary items obtained by 24 h recalls and food frequency questionnaires. The S-Klotho plasma levels were measured using a solid-phase sandwich enzyme-linked immunosorbent assay. Results: a weak positive association was observed between DII and S-Klotho plasma levels (β = 52.223, R² = 0.057, p = 0.043), which disappeared after controlling for body mass index (p = 0.057). Conclusions: A pro-inflammatory dietary pattern measured with the DII was slightly and positively associated with S-Klotho plasma levels in middle-aged sedentary adults.

Relationship between plasma S-Klotho and cardiometabolic risk in sedentary adults

This cross-sectional study investigates the relationship between the shed form of the Klotho protein (S-Klotho) in plasma, and cardiometabolic risk in healthy, sedentary adults. The study subjects were 214 healthy, sedentary adults (~64% women). Data were collected during the baseline assessments of two randomized controlled trials: The FIT-AGEING study (n=74 [~50% women] middle-aged adults aged 40-65 years) and the ACTIBATE study (n=140 [~70% women] young adults aged 18-25 years). A sex-specific cardiometabolic risk score was calculated for each subject based on waist circumference, systolic and diastolic blood pressure, and plasma glucose, high-density lipoprotein cholesterol and triglycerides. A significant inverse relationship was detected between S-Klotho and the cardiometabolic risk score of both the middle-aged men and women (β=-0.658, R²=0.433, P<0.001 and β=-0.442, R²=0.195, P=0.007) which persisted after adjusting for actual age, energy intake, and VO₂max. No significant association was found between S-Klotho and cardiometabolic risk score for the young, healthy adults (P>0.5), nor for the young, healthy men and women when analysed separately (all P>0.1). In conclusion, in healthy, sedentary, middle-aged adults, but not in young, healthy, sedentary adults, higher plasma S-Klotho concentrations are associated with a lower cardiometabolic risk score.

Exercise and Dementia

Several experimental and human studies documented the preventive and therapeutic effects of exercise on various diseases as well as the normal physiological function of different systems during aging. The findings of several basic animal studies and clinical investigations identified the advantageous effects of exercise as non-pharmaceutical intervention on dementia and Alzheimer's disease (AD). The main positive effects suggested for exercise are less cognitive and behavioral impairment or decline, development of health-associated conditions (stress, sleep), reduction of dementia risk factors including chronic non-communicable disease (diabetes, cardiovascular disease), increase in neurotrophins, enhancement of brain blood flow, angiogenesis, neurogenesis, synaptogenesis and synaptic plasticity in the brain memory-related region (e.g., hippocampus), and reduction of neuroinflammation and apoptosis. However, regarding the controversial evidence in literature, designing standard clinical and experimental studies to reveal the correlation between physical activity and dementia sign and symptom including biomarker alternation, brain supramolecular and molecular changes, and neuropsychological manifestation is necessary for preparation of effective guidelines and recommendations.

Cardiorespiratory Fitness May Influence Metabolic Inflexibility During Exercise in Obese Persons

CONTEXT

We examined whether obese individuals have a reduced maximal fat oxidation (MFO) and the intensity that elicit MFO (Fatmax) compared with normal weight and overweight persons, taking into account their level of cardiorespiratory fitness.

METHODS

The study subjects were 138 sedentary adults (87 women) aged 30.1 ± 13.6 years. Based on their body mass index, subjects were categorized as being of normal weight (n = 66), overweight (n = 48), or obese (n = 24). MFO and Fatmax were determined for all subjects by indirect calorimetry, using a walking graded exercise test. MFO was expressed in absolute terms (g/min) and relative to whole-body lean mass (mg/kgleanmass/min). Cardiorespiratory fitness was assessed via a maximal treadmill test.

RESULTS

No differences in absolute MFO and Fatmax values were seen between the obese, normal weight, and overweight subjects (all P > 0.2), although after adjusting for cardiorespiratory fitness, the obese subjects returned significantly higher values than did their normal weight and overweight counterparts (all P < 0.03). However, when expressed with respect to lean mass, the MFO of the normal weight subjects was significantly greater than that of the overweight and obese subjects, independent of age, sex, or cardiorespiratory fitness.

CONCLUSIONS

Obese individuals have higher absolute MFO values when cardiorespiratory fitness is taken into account, but when expressed with respect to lean mass, normal weight individuals show a greater capacity to oxidize fat during exercise per unit of metabolically active tissue independent of age, sex, or cardiorespiratory fitness. These findings suggest that obese individuals may suffer from metabolic inflexibility during exercise.

Exercise Training as a Treatment for Cardiometabolic Risk in Sedentary Adults: Are Physical Activity Guidelines the Best Way to Improve Cardiometabolic Health? The FIT-AGEING Randomized Controlled Trial

This 12-week randomized controlled trial investigates the effects of different training modalities on cardiometabolic risk in sedentary, middle-aged adults, and examines whether alterations in cardiometabolic risk are associated with changes in those health-related variables that are modifiable by exercise training. The study subjects were 71 middle-aged adults (~54 years old; ~50% women) who were randomly assigned to one of the following treatment groups: (1) no exercise (control group), (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT) group, or (4) HIIT plus whole-body electromyostimulation (HIIT+EMS group). A cardiometabolic risk score was calculated based on the International Diabetes Federation's clinical criteria. A significant reduction in cardiometabolic risk was observed for all exercise training groups compared to the control group (all p < 0.05), which persisted after adjusting potential confounders (all p < 0.05). However, the HIIT+EMS group experienced the most significant reduction (p < 0.001). A significant inverse relationship was detected between the change in lean mass and the change in cardiometabolic risk (p = 0.045). A 12-week exercise training programs-especially the HIIT+EMS program-significantly reduced cardiometabolic risk in sedentary, middle-aged adults independent of sex, age, and cardiorespiratory fitness.

Dietary differences between metabolically healthy overweight-obese and metabolically unhealthy overweight-obese adults

The aim of the study is to determine the differences in dietary parameters (energy and nutrient intake, adherence to the Mediterranean diet and consumption of food groups) in metabolically healthy overweight-obese (MHOO) v. metabolically unhealthy overweight-obese (MUOO) middle-aged adults. A total of fifty-one middle-aged adults were classified as MHOO or MUOO. BMI and blood pressure were evaluated following the recommendations. HDL, TAG and blood glycaemia were measured in blood samples. Blood pressure was also assessed. Dietary factors were assessed through three 24-h recalls, a validated FFQ and the PREvención con DIeta MEDiterránea (PREDIMED) questionnaire. All variables were evaluated between September and October 2016 and 2017. Our results showed that MHOO individuals registered a higher fish consumption (P = 0·035) and higher compliance (lower consumption) in the commercial sweets and confectionery item of the PREDIMED questionnaire (P = 0·036). No differences were noted in other dietary factors including energy and nutrient intake, consumption of other food groups and in the PREDIMED total score. A near-significant trend toward significance was observed in nuts consumption, wine and fish items of the PREDIMED questionnaire. In conclusion, higher fish consumption and a higher compliance in the commercial sweets and confectionery item of the PREDIMED questionnaire were observed in MHOO middle-aged adults.

Relationship between 1,25-Dihydroxyvitamin D and Body Composition in Middle-Aged Sedentary Adults: The FIT-AGEING Study

Vitamin D deficiency is a worldwide health problem that, in addition to its well-known negative effects on musculoskeletal health, has been related to a wide range of acute and chronic age-related diseases. However, little is known about the association of body composition with the active, hormonal form of vitamin D, 1,25-dihydroxyvitamin D plasma levels (1,25(OH)₂D). Therefore, the aim of this study was to investigate the association of 1,25(OH)₂D with body composition including lean and fat body mass as well as bone mineral density (BMD) in middle-aged sedentary adults. A total of 73 (39 women) middle-aged sedentary adults (53.7 ± 5.1 years old) participated in the current study. We measured weight and height, and we used dual energy X-ray absorptiometry to measure lean body mass, fat body mass and BMD. Body mass index (BMI), lean mass index (LMI), and fat mass index (FMI) were calculated. 1,25(OH)₂D was measured using a DiaSorin Liaison® immunochemiluminometric analyzer. The results showed a negative association of 1,25(OH)₂D with BMI, LMI and BMD (β = −0.274, R² = 0.075, p = 0.019; β = −0.268, R² = 0.072, p = 0.022; and β = −0.325, R² = 0.105, p = 0.005, respectively), which persisted after controlling for age and sex. No significant differences in 1,25(OH)₂D across body weight status were observed after controlling for the same covariates. In summary, our results suggest that 1,25(OH)₂D could be negatively associated with BMI, LMI and BMD whereas no association was found with FMI in middle-aged sedentary adults.

Interdisciplinary Weight Loss and Lifestyle Intervention for Obstructive Sleep Apnoea in Adults: Rationale, Design and Methodology of the INTERAPNEA Study

Obesity is a major risk factor for obstructive sleep apnoea (OSA), the most common sleep-disordered breathing related to neurocognitive and metabolic syndromes, type II diabetes, and cardiovascular diseases. Although strongly recommended for this condition, there are no studies on the effectiveness of an interdisciplinary weight loss and lifestyle intervention including nutrition, exercise, sleep hygiene, and smoking and alcohol cessation. INTERAPNEA is a randomised controlled trial with a two-arm parallel design aimed at determining the effects of an interdisciplinary tailored weight loss and lifestyle intervention on OSA outcomes. The study will include 84 males aged 18–65 with a body mass index of ≥25 kg/m² and severe to moderate OSA randomly assigned to usual care (i.e., continuous positive airway pressure), or interdisciplinary weight loss and lifestyle intervention combined with usual care. Outcomes will be measured at baseline, intervention end-point, and six-month post-intervention, including apnoea-hypopnoea index (primary outcome), other neurophysical and cardiorespiratory polysomnographic outcomes, sleep quality, daily functioning and mood, body weight and composition, physical fitness, blood biomarkers, health-related quality of life, and cost-effectiveness. INTERAPNEA may serve to establish a cost-effective treatment not only for the improvement of OSA and its vast and severe comorbidities, but also for a potential remission of this condition.

Diurnal Variation of Maximal Fat-Oxidation Rate in Trained Male Athletes

Purpose: To analyze the diurnal variation of maximal fat oxidation (MFO) and the intensity that elicits MFO (Fatmax) in trained male athletes. Methods: A total of 12 endurance-trained male athletes age 24.7 (4.1) y participated in the study. The authors measured MFO, Fatmax, maximum oxygen uptake (VO2max), and VO2 percentage at ventilatory threshold 2 with a graded exercise protocol performed on 2 days separated by 1 wk. One test was performed in the morning and the other in the afternoon. The authors assessed the participants’ chronotype using the HÖME questionnaire. Results: MFO and Fatmax were greater in the afternoon than in the morning (Δ = 13%, P < .001 and Δ = 6%, P = .001, respectively), whereas there were similar VO2max and ventilatory threshold 2 in the morning, than in the afternoon test (Δ = 0.2%, P = .158 and Δ = 7%, P = .650, respectively). There was a strong positive association between VO2max and MFO in both morning and afternoon assessments (R2 = .783, P = .001 and R2 = .663, P < .001, respectively). Similarly, there was a positive association between VO2max and Fatmax in both morning and afternoon assessments (R2 = .406, P = .024 and R2 = .414, P = .026, respectively). Conclusion: MFO and Fatmax may partially explain some of the observed diurnal variation in the performance of endurance sports.

Association of basal metabolic rate and fuel oxidation in basal conditions and during exercise, with plasma S-klotho: the FIT-AGEING study

S-klotho, the shed form of α-klotho, is thought to be an ageing suppressor with functions related to the physiology of energy metabolism. However, it remains unknown whether ageing biomarkers such as S-klotho and/or chronological ageing are associated in any way with basal metabolic rate (BMR) and fuel oxidation in basal conditions and during exercise. The present work investigates the association of BMR and fuel oxidation in basal conditions and during exercise, with plasma S-klotho in middle-aged, sedentary adults. BMR was measured by indirect calorimetry in 74 such subjects (53% women; age 53.7±5.1 years) following standard procedures, and their fuel oxidation estimated via stoichiometric equations. The maximal fat oxidation during exercise (MFO) and the intensity of exercise that elicits MFO (Fat_max) were determined using a walking graded exercise test. No relationship was seen between BMR and plasma S-klotho (P>0.1), although both basal fat oxidation and MFO showed positive associations with this protein (both P<0.001); these relationships persisted after controlling for age, sex and fat mass. However, no significant associations were seen between BMR, basal fat oxidation or MFO and chronological age (all P>0.1). The present findings suggest that basal fat oxidation and MFO are strongly associated with plasma S-klotho in middle-aged sedentary adults. These results support the idea that metabolic flexibility is a powerful predictor of biological ageing.

Optimizing Maximal Fat Oxidation Assessment by a Treadmill-Based Graded Exercise Protocol: When Should the Test End?

Maximal fat oxidation during exercise (MFO) and the exercise intensity eliciting MFO (Fatmax) are considered important factors related to metabolic health and performance. Numerous MFO and Fatmax data collection and analysis approaches have been applied, which may have influenced their estimation during an incremental graded exercise protocol. Despite the heterogeneity of protocols used, all studies consistently stopped the MFO and Fatmax test when the respiratory exchange ratio (RER) was 1.0. It remains unknown however whether reaching a RER of 1.0 is required to have an accurate, reliable, and valid measure of MFO and Fatmax. We aimed to investigate the RER at which MFO and Fatmax occurred in sedentary and trained healthy adults. A total of 166 sedentary adults aged between 18 and 65 years participated in the study. MFO and Fatmax were calculated by an incremental graded exercise protocol before and after two exercise-based interventions. Our findings suggest that a graded exercise protocol aiming to determine MFO and Fatmax could end when a RER = 0.93 is reached in sedentary healthy adults, and when a RER = 0.90 is reached in trained adults independently of sex, age, body weight status, or the Fatmax data analysis approach. In conclusion, we suggest reducing the RER from 1.0 to 0.95 to be sure that MFO is reached in outliers. This methodological consideration has important clinical implications, since it would allow to apply smaller workload increments and/or to extend the stage duration to attain the steady state, without increasing the test duration.

Impact of different exercise training modalities on energy and nutrient intake and food consumption in sedentary middle-aged adults: a randomised controlled trial

BACKGROUND

Exercise could influence energy and macronutrient intake, which could have an important role on body composition changes in response to exercise. The present study aimed to investigate the effects of different training modalities in energy and macronutrient intake, and whether changes in energy and macronutrient intake influences changes in body composition in response to different training modalities.

METHODS

A 12-week randomised controlled trial was conducted. Eighty middle-aged sedentary adults were randomised to: (i) a control group; (ii) physical activity recommendation from the World Health Organization; (iii) high-intensity interval training; and (iv) whole-body electromyostimulation training. Dietary intake was assessed using the average of three 24-h recalls.

RESULTS

High-intensity interval training and whole-body electromyostimulation training groups showed lower fibre intake and higher dietary energy density. Our results showed a negative association was found between changes in energy intake and changes in lean mass index. No association was found between changes in protein intake and changes in lean mass index.

CONCLUSIONS

In conclusion, we observed a higher dietary energy density and lower fibre intake in high-intensity training groups.