Potential benefits of exercise on blood pressure and vascular function

Effects of 12 Weeks of Combined Exercise Training in Normobaric Hypoxia on Arterial Stiffness, Inflammatory Biomarkers, and Red Blood Cell Hemorheological Function in Obese Older Women

BACKGROUND/OBJECTIVES

The present study examined the effect of 12-week combined exercise training in normobaric hypoxia on arterial stiffness, inflammatory biomarkers, and red blood cell (RBC) hemorheological function in 24 obese older women (mean age: 67.96 ± 0.96 years).

METHODS

Subjects were randomly divided into two groups (normoxia (NMX; n = 12) and hypoxia (HPX; n = 12)). Both groups performed aerobic and resistance exercise training programs three times per week for 12 weeks, and the HPX group performed exercise programs in hypoxic environment chambers during the intervention period. Body composition was estimated using bioelectrical impedance analysis equipment. Arterial stiffness was measured using an automatic waveform analyzer. Biomarkers of inflammation and oxygen transport (tumor necrosis factor alpha, interleukin 6 (IL-6), erythropoietin (EPO), and vascular endothelial growth factor (VEGF)), and RBC hemorheological parameters (RBC deformability and aggregation) were analyzed.

RESULTS

All variables showed significantly more beneficial changes in the HPX group than in the NMX group during the intervention. The combined exercise training in normobaric hypoxia significantly reduced blood pressure (systolic blood pressure: p < 0.001, diastolic blood pressure: p < 0.001, mean arterial pressure: p < 0.001, pulse pressure: p < 0.05) and brachial-ankle pulse wave velocity (p < 0.001). IL-6 was significantly lower in the HPX group than in the NMX group post-test (p < 0.001). Also, EPO (p < 0.01) and VEGF (p < 0.01) were significantly higher in the HPX group than in the NMX group post-test. Both groups showed significantly improved RBC deformability (RBC EI_3Pa) (p < 0.001) and aggregation (RBC AI_3Pa) (p < 0.001).

CONCLUSIONS

The present study suggests that combined exercise training in normobaric hypoxia can improve inflammatory biomarkers and RBC hemorheological parameters in obese older women and may help prevent cardiovascular diseases.

Effects of High-Intensity Interval Training on the Parameters Related to Physical Fitness and Health of Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

As a novel and time-efficient exercise form, high-intensity interval training (HIIT) has shown great potential in improving health-related physical fitness among diverse populations. However, empirical evidence on its efficacy among the elderly has not been well summarized. This systematic review and meta-analysis aimed to determine the effect of HIIT interventions on the parameters related to physical fitness and health of older adults, including resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiorespiratory fitness (CRF), body mass index (BMI), body fat percent (BF%), waist circumference (WC), muscular endurance (ME), muscular strength (MS), muscular power (MP), balance and flexibility, compared to non-exercise and other-exercise (e.g., moderate-intensity continuous training, resistance training) conditions.

METHODS

Literature published from January 2000 to May 2023 was collected through extensive searches across eight databases and relevant review papers. Randomized controlled trials (RCTs) featuring a minimum 2-week exercise intervention for older adults (≥ 60 years) were included. The pooled effect size of Hedges'g was estimated using random-effects models in R. Meta-regression was performed for both categorical (health status, duration of training programme, and frequency) and continuous moderators (mean age, male rate, and attrition rate).

RESULTS

Forty-four eligible RCTs with 1863 participants (52.1% female; 60.5-81.2 years) were included in the quantitative analysis. Compared to non-exercise condition, HIIT significantly improved resting HR (g = -0.36, 95%CI = [-0.67, -0.05], P = 0.032), SBP (g = -0.29, 95%CI = [-0.54, -0.03], P = 0.008), CRF (g = 0.77, 95%CI = [0.51, 1.04], P < 0.001), BF% (g = -0.26, 95%CI = [-0.41, -0.11], P = 0.006), MS (g = 0.47, 95%CI = [0.23, 0.71], P = 0.004), ME (g = 0.65, 95%CI = [0.10, 1.19], P = 0.036), and balance (e.g., timed-up-and-go) (g = -0.79, 95%CI = [-1.19, -0.40], P = 0.035). Compared to other-exercise condition, HIIT significantly improved resting HR (g = -0.11, 95%CI = [-0.21, -0.01], P = 0.029), SBP (g = -0.14, 95%CI = [-0.28, -0.01], P = 0.038), and CRF (g = 0.23, 95%CI = [0.07, 0.38], P = 0.008). No significant difference was found between HIIT and non-exercise condition for DBP, BMI and WC, as well as between HIIT and other-exercise condition for DBP, BMI, BF%, WC, ME, and balance (all P > 0.05). Meta-regression indicated that mean age moderated the HIIT effect on resting HR (b = -0.02, P = 0.014; HIIT vs. other-exercise condition) and SBP (b = 0.03, P = 0.048; HIIT vs. non-exercise), and attrition rate moderated the effect on CRF (b = 0.03, P = 0.007; HIIT vs. non-exercise).

CONCLUSION

This study supports the efficacy of HIIT in improving resting HR, SBP, CRF, BF%, MS, ME and balance among older adults. More empirical evidence is needed to determine the efficacy of HIIT for MP and flexibility in this population.

TRIAL REGISTRATION

PROSPERO CRD42022316246.

Effect of Mat Pilates Training on Blood Pressure, Inflammatory, and Oxidative Profiles in Hypertensive Elderly

To determine the effects of mat Pilates training on blood pressure, inflammatory, and antioxidative markers in hypertensive elderly people, 34 hypertensive subjects aged 60-75 years were randomly divided into a control group (CON; n = 17) and a mat Pilates training group (MP; n = 17). The CON participants conducted normal daily activities and participated in neither organized exercises nor sports training, while those in the MP group received mat Pilates training for 60 min three times/week for 12 weeks. Parameters including blood pressure, cardiovascular function, nitric oxide (NO), tumor necrotic factor-alpha (TNF-α), superoxide dismutase (SOD), and malonaldehyde (MDA) were collected at baseline and the end of 12 weeks. The MP group had significantly decreased blood pressure, improved cardiovascular variables, decreased MDA and TNF-α, and increased NO and SOD compared with the CON group and the pre-training period (p < 0.05). In conclusion, these findings demonstrate the positive effects of 12 weeks of mat Pilates training in terms of reducing blood pressure and increasing blood flow related to improvements in anti-inflammatory and antioxidative markers in hypertensive elderly people. Mat Pilates training might be integrated as an alternative therapeutic exercise modality in clinical practice for hypertensive elderly individuals.

Effect of high-intensity interval training and moderate-intensity continuous training on cardiovascular risk factors in adolescents: Systematic review and meta-analysis of randomized controlled trials

BACKGROUND

In recent years, cardiovascular diseases in adolescents have become more serious. High intensity interval training (HIIT) and moderate intensity continuous training (MICT) have been shown to improve cardiovascular diseases in adolescents. Meta-analysis was conducted to compare the effects of HIIT and MICT on cardiovascular risk factors in adolescents.

METHODS

Randomised controlled trials of HIIT and MICT for cardiovascular risk factors in adolescents up to January 2023 were searched using authoritative databases such as CNKI, Web of Science, PubMed, and EBSCO. Data analysis was performed using Review Manage 5.4 and Stata 14.0.

RESULTS

A total of 12 studies involving 468 participants, mean age 15.19±4.35, were included in the study. The findings showed that compared with MICT, HIIT reduced adolescents' body weight (SMD=-0.18, 95 %CI=-0.58, 0.21) and increased maximal oxygen uptake (SMD=0.56, 95 %CI=0.20, 0.93) and high-density lipoprotein (SMD=-0.47, 95 % CI=-1.11, 0.17), and improved systolic blood pressure (SMD=-0.35, 95 %CI=-0.78, 0.09), glucose (SMD=-1.53, 95 %CI=-2.93, -0.13), and insulin (SMD=-0.66, 95 % CI=-1.73, 0.41), p<0.05. HIIT and MICT improved BMI, fat mass, diastolic blood pressure, triglycerides, total cholesterol, and LDL, with no significant difference between these training types.

CONCLUSION

HIIT was better than MICT for improving cardiovascular health in adolescents, with better effects on body weight, BMI, fat mass, systolic blood pressure, diastolic blood pressure, maximal oxygen uptake, triglyceride, total cholesterol, LDL, HDL, glucose, and insulin levels.

Gut microbiota are differentially correlated with blood pressure status in African American collegiate athletes: A pilot study

Hypertension (HTN) is common among athletes and the most recent epidemiologic data reports that cardiovascular (CV) sudden death is significantly greater in African Americans (AAs). Gut microbial dysbiosis (a poorly diverse stool microbial profile) has been associated with HTN in sedentary people but microbial characteristics of athletes with HTN are unknown. Our purpose was to differentiate microbiome characteristics associated with BP status in AA collegiate athletes. Thirty AA collegiate athletes were stratified by normal BP (systolic BP (SBP) ≤130 mmHg; n = 15) and HTN (SBP ≥130 mmHg; n = 15). 16S rRNA gene sequencing was performed on stool samples to identify microbes at the genus level. We did not observe any significant differences in alpha diversity, but beta diversity was different between groups. Principal coordinate analysis was significantly different (PERMANOVA, p < 0.05, R = 0.235) between groups. Spearman rank correlations showed a significant (p < 0.05) correlation between systolic BP and abundances for Adlercreutzia (R = 0.64), Coprococcus (R = 0.49), Granulicatella (R = 0.63), and Veillonella (R = 0.41). Gut microbial characteristics were associated with differentially abundant microbial genus' and BP status. These results will direct future studies to define the functions of these microbes associated with BP in athletes.

The physiologic benefits of optimizing cardiorespiratory fitness and physical activity - From the cell to systems level in a post-pandemic world

Cardiovascular (CV) disease (CVD) is a leading cause of premature death and hospitalization which places a significant strain on health services and economies around the World. Evidence from decades of empirical and observational research demonstrates clear associations between physical activity (PA) and cardiorespiratory fitness (CRF) which can offset the risk of mortality and increase life expectancy and the quality of life in patients. Whilst well documented, the narrative of increased CRF remained pertinent during the coronavirus disease 2019 (COVID-19) pandemic, where individuals with lower levels of CRF had more than double the risk of dying from COVID-19 compared to those with a moderate or high CRF. The need to better understand the mechanisms associated with COVID-19 and those that continue to be affected with persistent symptoms following infection (Long COVID), and CV health is key if we are to be able to effectively target the use of CRF and PA to improve the lives of those suffering its afflictions. Whilst there is a long way to go to optimise PA and CRF for improved health at a population level, particularly in a post-pandemic world, increasing the understanding using a cellular-to-systems approach, we hope to provide further insight into the benefits of engaging in PA.

Comparing the effects of different exercises on blood pressure and arterial stiffness in postmenopausal women: A systematic review and meta-analysis

The present study aimed to compare the efficacy of different exercises on systolic blood pressure (SBP), diastolic blood pressure (DBP), and aortic pulse wave velocity (PWV) in postmenopausal women. We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, Web of Science, PubMed, and Cochrane library databases, up to July 2022. The randomized controlled trials (RCTs) were selected following the inclusion criteria. We assessed study quality with the PEDro scale. The Stata software was used for statistical analysis. Twenty-three papers (26 RCTs) and 729 participants were included. Meta-analysis demonstrated that exercise decreased SBP (WMD = -6.74 mmHg, 95%CI: -9.08, -4.41, p = 0.000), DBP (WMD = -4.13 mmHg, 95%CI: -5.78, -2.48, p = 0.000) and aortic PWV (WMD = -0.79 m/s, 95%CI: -1.02, -0.56, p = 0.000). Aerobic exercise can significantly decrease SBP (WMD = -7.97 mmHg, 95%CI: -12.99, -2.60, p = 0.003) and DBP (WMD = -5.97 mmHg, 95%CI: -8.55, -3.39, p = 0.000). Resistance exercise can significantly decrease SBP (WMD = -5.62 mmHg, 95%CI: -9.00, -2.23, p = 0.001), DBP (WMD = -1.87 mmHg, 95%CI: -2.75, -0.99, p = 0.000) and aortic PWV (WMD = -0.67 m/s，95%CI: -0.98, -0.36, p = 0.000). Combined aerobic and resistance exercise can significantly decrease SBP (WMD = -5.42 mmHg, 95%CI: -10.17, -0.68, p = 0.025). The efficacy of mind-body exercise (Tai Chi/Yoga) on SBP, DBP, and aortic PWV were not obvious (p > 0.05). Exercise significantly improved SBP, DBP, and aortic PWV in postmenopausal women. Aerobic exercise decreased SBP and DBP. Resistance exercise decreased SBP, DBP, and aortic PWV. Additionally, further research is required to confirm the efficacy of mind-body exercise (Tai Chi/Yoga) on blood pressure and arterial stiffness.

Comparison of different types of exercise training on resting blood pressure in 30-45 years old adults: a randomised controlled trial

Hypertension is the most metastasizing non-communicable disease, which has affected more than 1.4 billion people, worldwide. Exercise is the core management strategy for hypertensive individuals. Extensive literature is available for each kind of exercise that is isometric hand grip training (IHGT), resistance training (RT), and aerobic training (AT). However, the comparison between these exercise regimens has not been done in a single trial. The trial was conducted on 126 subjects in Hisar, an urban area of Haryana (INDIA), from July 2017 to December 2018. Subjects were randomly assigned to four groups: control (n=33), IHGT (n=32), RT (n=31), and AT (n=30). Study variables were measured at baseline, 2nd week, 4th week, 6th week, and also after the 8th week of intervention. Experimental groups showed significant reduction in all the components of blood pressure in comparison to control group. The RT group showed maximum reduction in blood pressure in comparison to other regimens (systolic blood pressure: RT > IHGT > AT; diastolic blood pressure: RT > AT > IHGT). However, the difference between the groups is not statistically significant (P>0.05). The study findings reveal that different kind of exercise regimens are equally effective in lowering blood pressure among pre hypertensive and stage 1 hypertension adults.

A Sports Nutrition Perspective on the Impacts of Hypoxic High-Intensity Interval Training (HIIT) on Appetite Regulatory Mechanisms: A Narrative Review of the Current Evidence

High-intensity interval training (HIIT) and low-oxygen exposure may inhibit the secretion of appetite-stimulating hormones, suppress appetite, and inhibit dietary intake. Physiological changes affecting appetite are frequent and include appetite hormone (ghrelin, leptin, PYY, and GLP-1) effects and the subjective loss of appetite, resulting in nutritional deficiencies. This paper is a narrative review of the literature to verify the HIIT effect on appetite regulation mechanisms and discusses the possible relationship between appetite effects and the need for high-intensity exercise training in a hypoxic environment. We searched MEDLINE/PubMed and the Web of Science databases, as well as English articles (gray literature by Google Scholar for English articles) through Google Scholar, and the searched studies primarily focused on the acute effects of exercise and hypoxic environmental factors on appetite, related hormones, and energy intake. In a general normoxic environment, regular exercise habits may have accustomed the athlete to intense training and, therefore, no changes occurred in their subjective appetite, but there is a significant effect on the appetite hormones. The higher the exercise intensity and the longer the duration, the more likely exercise is to cause exercise-induced appetite loss and changes in appetite hormones. It has not been clear whether performing HIIT in a hypoxic environment may interfere with the exerciser’s diet or the nutritional supplement intake as it suppresses appetite, which, in turn, affects and interferes with the recovery efficiency after exercise. Although appetite-regulatory hormones, the subjective appetite, and energy intake may be affected by exercise, such as hypoxia or hypoxic exercise, we believe that energy intake should be the main observable indicator in future studies on environmental and exercise interventions.

Standalone sauna vs exercise followed by sauna on cardiovascular function in non-naïve sauna users: A comparison of acute effects

BACKGROUND AND AIMS

Sauna bathing and aerobic exercise have each been shown to affect cardiovascular function. However, direct comparisons between standalone sauna bathing and a combination of exercise and sauna on vascular indices remain limited. Therefore, we conducted a cross-over study using matched durations to explore the hemodynamic changes of sauna exposure when compared to a combination of aerobic exercise and sauna exposure.

METHODS

Participants (N = 72) with at least one cardiovascular risk factor underwent, on two separate occasions: (a) a 30-minute sauna at 75°C (SAUNA) and (b) the combination of a 15-minute cycling exercise at 75% maximum heart rate followed by 15-minute sauna exposure (EX+SAUNA). Relative changes to arterial stiffness (PWV), augmentation index (Alx), brachial systolic and diastolic blood pressure (SBP and DBP), central SBP (cSBP), mean arterial pressure (MAP), and heart rate (HR) were compared PRE-POST and pre- to 30-minutes post-intervention (PRE-POST30).

RESULTS

Baseline SBP and DBP were 143 (SD 18) mmHg and 86 (SD 10) mmHg, respectively. From PRE-POST, SAUNA had lower DBP (mean difference [95% CI] 2.5 [1.0, 4.1], P = .002) and MAP (2.5 [0.6, 4.3], P = .01). However, EX+SAUNA had lower SBP (-2.7 [-4.8, -0.5], P = .02), DBP (-1.8 [-3.3, -0.4], P = .01), and MAP (-2.0 [-3.5, -0.5], P = .009) PRE-POST30. There were no statistically significant differences between SAUNA and EX+SAUNA for other measured parameters.

CONCLUSION

This study demonstrated that when matched for duration, EX+SAUNA and SAUNA elicit comparable acute hemodynamic alterations in middle-aged participants with cardiovascular risk factors. The sauna is a suitable option for acute blood pressure reductions in those who are unable to perform aerobic exercise, and may be a viable lifestyle treatment option to improve blood pressure control.

Effects of High-Intensity Interval Training and Moderate-Intensity Continuous Training on Cardiometabolic Risk Factors in Overweight and Obesity Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials

Background: The purpose of this review was to compare the effectiveness of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on cardiometabolic risk factors of obese children and adolescents. Methods: Relevant studies published in PubMed, MEDLINE and Web of Science databases were searched. Only randomized controlled trials (RCTs) that examined the effect of HIIT and MICT on children and adolescents with obesity were included. Meta-analyses were conducted to determine the effect of HIIT on cardiometabolic risk factors using STATA software and potential moderators were explored (i.e., study duration, training modalities, work/rest ratio and work duration time). Results: Twelve RCTs involving 325 participants were included in the meta-analysis. HIIT showed more positive effects on maximal oxygen uptake (VO2max; SMD = 0.87, 95% CI: 0.39 to 1.35, p = 0.000) and systolic blood pressure (SBP; SMD = -0.64, 95% CI: -1.05 to -0.22, p = 0.003) than MICT. However, when compared with MICT, HIIT caused no significant differences in body weight, body mass index, body fat percentage, diastolic blood pressure and glycolipid metabolism markers. Furthermore, subgroup analysis showed that the effects of HIIT on VO2max and SBP were significantly different regarding protocol factors, such as modality, duration, training time, training settings, work/rest ratio and work duration. Conclusions: HIIT has a positive role in promoting cardiometabolic risk factors in obese children and adolescents. Moreover, when compared with MICT, HIIT had a more significant effect on improving cardiorespiratory fitness and systolic blood pressure. The factors of HIIT protocol had an important influence on the intervention effects of childhood obesity.

Frequency of daily tooth brushing and subsequent cardiovascular events

OBJECTIVE

Although previous studies have shown an inverse association between the frequency of daily tooth brushing and cardiovascular risk factors, research on cardiovascular events is limited. This study aimed to evaluate the association between the frequency of daily tooth brushing and subsequent cardiovascular events.

METHODS AND RESULTS

A retrospective longitudinal study was conducted at a hospital in Tokyo, Japan. We included all participants who underwent health check-ups from 2005 to 2011 and followed up to 2018. Our outcomes were the development of cardiovascular events. Outcomes were compared by the frequency of daily tooth brushing with a generalized estimating equation, adjusting for potential confounders. A total of 71 221 participants were included. The mean age was 45.6 years and 50.3% were male. During a median follow-up of 2061 (interquartile range: 933-3311) days, 1905 participants developed cardiovascular events. The adjusted odds ratios (ORs) of cardiovascular events increased in a dose-dependent manner as the frequency of tooth brushing decreased. Even those who brushed their teeth once in a day had a higher adjusted OR of stroke (1.22; 95% confidence interval, 1.01-1.48) than did those who brushed after every meal.

CONCLUSIONS

Frequent tooth brushing was inversely associated with subsequent cardiovascular events in a dose-dependent manner. Even brushing one's teeth once a day may be related to an increased likelihood of stroke than brushing one's teeth after every meal. Less frequent tooth brushing may be considered to be a marker for subsequent cardiovascular disease and coronary heart disease, rather than a risk factor.

Exercise-Training Regulates Apolipoprotein B in Drosophila to Improve HFD-Mediated Cardiac Function Damage and Low Exercise Capacity

Apolipoprotein B plays an essential role in systemic lipid metabolism, and it is closely related to cardiovascular diseases. Exercise-training can regulate systemic lipid metabolism, improve heart function, and improve exercise capacity, but the molecular mechanisms involved are poorly understood. We used a Drosophila model to demonstrate that exercise-training regulates the expression of apoLpp (a homolog of apolipoprotein B) in cardiomyocytes, thereby resisting heart insufficiency and low exercise capacity caused by obesity. The apoLpp is an essential lipid carrier produced in the heart and fat body of Drosophila. In a Drosophila genetic screen, low expression of apoLpp reduced obesity and cardiac dysfunction induced by a high-fat diet (HFD). Cardiac-specific inhibition indicated that reducing apoLpp in the heart during HFD reduced the triglyceride content of the whole-body and reduced heart function damage caused by HFD. In exercise-trained flies, the result was similar to the knockdown effect of apoLpp. Therefore, the inhibition of apoLpp plays an important role in HFD-induced cardiac function impairment and low exercise capacity. Although the apoLpp knockdown of cardiomyocytes alleviated damage to heart function, it did not reduce the arrhythmia and low exercise capacity caused by HFD. Exercise-training can improve this condition more effectively, and the possible reason for this difference is that exercise-training regulates climbing ability in ways to promote metabolism. Exercise-training during HFD feeding can down-regulate the expression of apoLpp, reduce the whole-body TG levels, improve cardiac recovery, and improve exercise capacity. Exercise-training can downregulate the expression of apoLpp in cardiomyocytes to resist cardiac function damage and low exercise capacity caused by HFD. The results revealed the relationship between exercise-training and apoLpp and their essential roles in regulating heart function and climbing ability.

Effect of high-intensity interval training on cardiometabolic risk factors in childhood obesity: a meta-analysis

INTRODUCTION

This systematic review with meta-analysis aimed to quantify the effectiveness of high-intensity interval training (HIIT) on the cardiometabolic health of obese children and adolescents.

EVIDENCE ACQUISITION

Relevant articles were sourced from PubMed, Embase, the Web of Science, EBSCO, the Cochrane Library and China National Knowledge Infrastructure (CNKI). Randomized controlled trials were included if they employed participants aged 7-19 years. Outcomes included fasting glucose (FG), fasting insulin (FI), homeostasis model assessment-insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triacylglycerol (TG), total cholesterol (TC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline and postintervention and compared with those in the control group. Data analysis and synthesis were completed by Revman 5.3 software and Stata 12.0 software (StataCorp LLC., College Station, TX, USA).

EVIDENCE SYNTHESIS

Eight trials involving 379 participants were identified. HIIT significantly decreased the FI, HOMA-IR, TC, TG, LDL-c and SBP in participants with obesity. With regard to changes in blood glucose and lipids, participants who underwent HIIT showed great improvement in FI (mean difference: -3.09 µU/mL, 95% confidence interval [CI] -3.71 to -2.46, P<0.0001), HOMA-IR (mean difference: -0.64, 95% CI -0.82 to -0.46, P<0.0001), TG (mean difference: -0.21 mmol/L, 95% CI -0.31 to -0.10, P<0.0001) and LDL-c (mean difference: -0.35 mmol/L, 95% CI -0.48 to -0.22, P<0.001) than the control group. Similar results were found for SBP (mean difference: -3.61 mmHg, 95% CI -5.85 to -1.37, P=0.002). However, no significant differences in changes in FG, HDL-c and DBP were observed between HIIT and control groups.

CONCLUSIONS

HIIT can produce a positive effect on cardiometabolic risk factors in obese children and adolescents. HIIT may be an alternative and effective training method for managing childhood obesity.

The Potential Mediation of the Effects of Physical Activity on Cognitive Function by the Gut Microbiome

The population of older adults is growing dramatically worldwide. As older adults are at greater risk of developing disorders associated with cognitive dysfunction (i.e., dementia), healthcare costs are expected to double by 2040. Evidence suggests dementia may be slowed or prevented by lifestyle interventions, including physical activity (PA). PA is associated with improved cognitive function and may reduce risk for dementia by mitigating known risk factors (i.e., cardiovascular diseases) and/or by enhancing neurochemical processes. An emerging area of research suggests the gut microbiome may have similar neuroprotective effects. Altering the gut microbiome has been found to target physiological processes associated with dementia risk, and it influences gut-brain-microbiome axis signaling, impacting cognitive functioning. The gut microbiome can be altered by several means (i.e., disease, diet, prebiotics, probiotics), including PA. As PA and the gut microbiome independently influence cognitive function and PA changes the composition of the gut microbiome, cognitive improvement due to PA may be partially mediated by the gut microbiome. The present article provides an overview of the literature regarding the complex associations among PA, cognitive function, and the gut microbiome, as well as their underlying biological mechanisms. A comprehensive, theoretical model integrating evidence for the potential mediation is proposed.

Comparative Effectiveness of High-Intensity Interval Training and Moderate-Intensity Continuous Training for Cardiometabolic Risk Factors and Cardiorespiratory Fitness in Childhood Obesity: A Meta-Analysis of Randomized Controlled Trials

Purpose: The main objective of this meta-analysis was to compare the effectiveness of high-intensity interval training (HIIT) and of moderate-intensity continuous training (MICT) on cardiometabolic health in childhood obesity and determine whether HIIT is a superior form of training in managing obese children's metabolic health.

Methods: Relevant studies published in PubMed, Web of Science, Embase, the Cochrane Library, EBSCO, and CNKI were searched, restricted to those published from inception to 1 October 2019. Only randomized controlled trials (RCTs) depicting the effect of HIIT on childhood obesity were included.

Results: Nine RCTs involving 309 participants were included in the meta-analysis. Among the 309 participants, 158 subjects were randomized for HIIT, while the others were randomized for MICT. Significant differences were observed in the body weight (mean difference [MD] = −5.45 kg, p = 0.001), body mass index (BMI; MD = −1.661 kg/m², p = 0.0001), systolic blood pressure (SBP; MD = −3.994 mmHg, p = 0.003), and diastolic blood pressure (DBP; MD = −3.087 mmHg, p = 0.0001) in the HIIT group relative to the baseline values. Similar effects were found in the MICT group, as depicted by the significantly decreased values for body weight (MD = −4.604 kg, p = 0.0001), BMI (MD = −2.366 kg/m², p = 0.0001), SBP (MD = −3.089 mmHg, p = 0.019), and DBP (MD = −3.087 mmHg, p = 0.0001). However, no significant differences were observed in the changes in body weight, BMI, SBP, or DBP between the HIIT and MICT groups. Furthermore, our studies showed that both HIIT and MICT could significantly improve VO_2peak (HIIT, MD = 4.17 ml/kg/min, 95% CI: 3.191 to 5.163, p = 0.0001; MICT, MD = 1.704 ml/kg/min, 95% CI: 0.279 to 3.130, p = 0.019). HIIT also showed more positive effects on VO_2peak (SMD = 0.468, 95% CI: 0.040 to 0.897, p = 0.006) than MICT.

Conclusion: HIIT positively affects the cardiometabolic risk factors in childhood obesity. Similar positive effects on body composition and blood pressure were established. Moreover, HIIT can improve cardiorespiratory fitness more significantly than MICT. These findings indicate that HIIT may be an alternative and effective training method for managing childhood obesity.

PROSPERO Registration Number: CRD42018111308.

Low Dose Resistance Exercise: A Pilot Study Examining Effects on Blood Pressure and Augmentation Index Between Intensities

INTRODUCTION

The effects of resistance exercise on vascular function are unclear.

AIM

To investigate the acute haemodynamic (blood pressure and augmentation index) and rate of perceived exertion (RPE) response to two types of resistance exercises of equal workload-a set of unilateral 35% of one repetition maximum (1RM) quadriceps extension and a set of unilateral 70% 1RM quadriceps extension.

METHODS

Twenty two young healthy males completed both exercises on separate days. Heart rate, central and peripheral systolic and diastolic blood pressure (BP), augmentation pressure, augmentation index (AIx), augmentation index at a heart rate of 75 beats per minute (AIx75), and RPE were measured using applanation tonometry before exercise, immediately after exercise, 5 min after exercise and 15 min after exercise.

RESULTS

AIx75 was significantly lower 5 min after exercising at 35% of 1RM than 70% of 1RM. Systolic blood pressure was significantly lower at 5 min post exercise for both intensities. There was no significant difference in RPE between conditions or time points.

CONCLUSIONS

Results suggest that changes in blood pressure and augmentation index vary depending on the intensity of resistance exercise regardless of the volume of exercise carried out. Changes in AIx75 in response to resistance exercise may be independent of changes in BP.

Relationship between lifestyle pattern and blood pressure - Iranian national survey

We aimed to evaluate the relationship between different lifestyle patterns and blood pressure. This study is based on the national survey of the risk factors for non-communicable diseases in Iran in 2012. A total of 8244 people aged 25–70 years old have been enrolled in the survey. Clustering on the individual data of lifestyle factors (nutrition, physical activity, and smoking) were carried out using self-organizing neural network method. Multivariable regression models were used to determine the relationship between blood pressure and the clusters. This study revealed seven lifestyle clusters in the national survey. The first cluster had a healthier lifestyle (15%), and the rest of the clusters had at least one or more lifestyle-related risk factors. Among all the clusters, people in two clusters, i.e. one characterized by consumption of sugar-sweetened beverages, salt, and fast foods, and the other one characterized by physical inactivity, were more exposed to the risk of hypertension (odds ratios of 1.44 and 1.12, respectively). People in another cluster who were 100% smokers and had a very high level of work-related physical activity were about 30% less likely to experience elevated blood pressure. Although a lifestyle with cigarette smoking was associated with a reduction in blood pressure, this might be due to other related factors, such as work-related physical activity, which lower blood pressure. Of course, this hypothesis still needs to be further studied in the future.

Daily domain-specific time-use composition of physical behaviors and blood pressure

Background

Previous research has shown contrasting effects on hypertension for occupational and leisure-time physical behaviors—physical activity and sedentary behavior and time in bed. However, (a) none of these studies have addressed the compositional property of the physical behaviors and (b) most knowledge on the association between domain-specific physical behaviors and hypertension relies upon self-reported physical behaviors information primarily on white-collar worker study samples. We aimed to be the first to disentangle the relationship between technically measured 24-h time-use behaviors in work and leisure domains and blood pressure among blue-collar workers using a compositional data analysis approach.

Methods

Workers (n = 669) wore accelerometers to measure daily minutes of work and leisure sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), and time in bed which were isometrically log-transformed. Cross-sectional linear association between time-use composition and systolic (SBP) and diastolic (DBP) blood pressure were determined using compositional isotemporal substitutions models.

Results

The time-use composition at the work and leisure domains was significantly associated with SBP (F = 4.98, p < 0.001) and DBP (F = 2.91, p = 0.008). Reallocating sedentary time to remaining behaviors within each domain—work and leisure—was favorably associated with SBP. Similar results were observed when reallocating time in bed from the remaining leisure behaviors. Results for reallocating time to/from MVPA and LPA at both domains were non-significant. Results regarding all physical behaviors for DBP were generally non-significant.

Conclusions

Time-use composition of physical behaviors at work and leisure is associated with blood pressure among blue-collar workers. At both domains, reallocating sedentary time to remaining behaviors, especially to time in bed at leisure may reduce blood pressure. Our results, based on a compositional data approach, can be used to better design accurate and comprehensive time-use recommendations both at work and leisure for high-risk groups like blue-collar workers.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0766-1) contains supplementary material, which is available to authorized users.

Youth with epilepsy: Their insight into participating in enhanced physical activity study

PURPOSE

We aimed to explore (i) the impact that a motivated walking program had on youth with epilepsy and (ii) the facilitators and barriers to implementing and sustaining the program.

METHODS

Data were gathered using semi-structured interviews with the intervention group of a randomized controlled trial to study the effect of enhanced physical activity on youth with epilepsy. Participants had active epilepsy and were 8-14 years at recruitment. All wore an activity tracker for a year and received coaching via phone calls during the first six months to encourage reaching a step goal, which they then attempted to maintain independently for the following six months. Nine participants and one parent per child were separately interviewed at six months. Eleven participants including the original nine, and one parent per youth, were interviewed at twelve months. Data collection and analysis used a phenomenological research framework and coded the data according to the International Classification of Functioning, Disability and Health (the ICF). This was done in order to capture all relevant impacts of the intervention.

RESULTS

Physical activity was associated with benefits in all components of the ICF. Changes in personal factors such as improved attitude, confidence, and insight into activity were emphasized. Parents also experienced personal benefits as a result of their child engaging in the program.

CONCLUSIONS

Physical activity had positive effects in many aspects of the lives of the participants and their parents. The ICF was a relatively useful and effective system for coding qualitative research. These findings should assist in development of future exercise programs.

A novel principled method for the measurement of vascular robustness uncovers hidden risk for premature CVD death

The detection of high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor scores is a major challenge. Systems biology suggests that the vasculature's functional robustness against risk factor challenges may serve as a novel discriminator of mortality risk under similar risk factor loads. However, principled methods to measure vascular robustness are not available. To develop a score for the vasculature's functional robustness we used a recently presented method that applies computational physiological modeling to the quantitation of vascular function. We hypothesized that the expected inverse robustness-mortality association is verifiable as a significant robustness-calendar age trend in a cross-sectional investigation of a population cohort of risk factor-challenged individuals. Using only functional parameters of the cardiovascular system we applied multivariate linear regression to derive from our study population of 372 adults gender-specific multivariate robustness scoring algorithms. For any individual, the deviation of his/her robustness score from the value of the regression function characterizes the deviation of the individual’s fatal CVD event probability from its age-appropriate fatal CVD event probability. Robustness correlated linearly with calendar age in our risk factor-challenged but not in our unchallenged cohorts. This observation supports the hypothesis of preferential elimination of less robust individuals along the aging trajectory under risk factor challenges. We conclude that physiologically principled scoring for vascular robustness may serve as a biomarker of vulnerability to CVD risk factor challenges, prognosticating otherwise undetectable elevated risk for premature CVD mortality.

NEW & NOTEWORTHY We developed a principled method for the derivation of a vascular robustness score that we translated into a correction factor for calendar age. We demonstrated the score’s potential to uncover risk for premature cardiovascular death in apparently healthy young adults whose risk elevation remains hidden in conventional risk factor models.

Continuous Glucose Monitoring and Exercise in Type 1 Diabetes: Past, Present and Future

Prior to the widespread use of continuous glucose monitoring (CGM), knowledge of the effects of exercise in type 1 diabetes (T1D) was limited to the exercise period, with few studies having the budget or capacity to monitor participants overnight. Recently, CGM has become a staple of many exercise studies, allowing researchers to observe the otherwise elusive late post-exercise period. We performed a strategic search using PubMed and Academic Search Complete. Studies were included if they involved adults with T1D performing exercise or physical activity, had a sample size greater than 5, and involved the use of CGM. Upon completion of the search protocol, 26 articles were reviewed for inclusion. While outcomes have been variable, CGM use in exercise studies has allowed the assessment of post-exercise (especially nocturnal) trends for different exercise modalities in individuals with T1D. Sensor accuracy is currently considered adequate for exercise, which has been crucial to developing closed-loop and artificial pancreas systems. Until these systems are perfected, CGM continues to provide information about late post-exercise responses, to assist T1D patients in managing their glucose, and to be useful as a tool for teaching individuals with T1D about exercise.

Vascular robustness: The missing parameter in cardiovascular risk prediction

Undetected high risk for premature death of cardiovascular disease (CVD) among individuals with low-to-moderate risk factor scores is an acknowledged obstacle to CVD prevention. The vasculature's functional robustness against risk factor derailment may serve as a novel discriminator of mortality risk under similar risk factor loads. To test this assumption, we hypothesized that the expected inverse robustness-mortality association is verifiable as a significant trend along the age spectrum of risk factor-challenged cohorts.

This is a retrospective cohort study of 372 adults (mean age 56.1 years, range 21–92; 45% female) with a variety of CV risk factors.

An arterial model (VascAssist 2, iSYMED GmbH, Germany) was used to derive global parameters of arterial function from non-invasively acquired pulse pressure waves. Participants were stratified by health status: apparently healthy (AH; n = 221); with hypertension and/or hypercholesterolemia (CC; n = 61); with history of CV event(s) (CVE; n = 90). Multivariate linear regression was used to derive a robustness score which was calibrated against the CVD mortality hazard rate of a sub-cohort of the LURIC study (n = 1369; mean age 59.1 years, range 20–75; 37% female).

Robustness correlated linearly with calendar age in CC (F(1, 59) = 10.42; p < 0.01) and CVE (F(1, 88) = 40.34; p < 0.0001) but not in the AH strata, supporting the hypothesis of preferential elimination of less robust individuals along the aging trajectory under risk factor challenges.

Vascular robustness may serve as a biomarker of vulnerability to CVD risk factor challenges, prognosticating otherwise undetectable elevated risk for premature CVD mortality.

•

Vascular robustness is proposed as parameter to improve CV risk prediction.

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Vascular robustness may be expressed as a correction factor to calendar age.

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A vascular robustness score identifies hidden risk in young adults.

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Validation studies are warranted to assess the discriminatory power of robustness.

The effect of regular aquatic exercise on blood pressure: A meta-analysis of randomized controlled trials

Background

No meta-analysis has examined the effect of regular aquatic exercise on blood pressure. The purpose of this study was to perform a meta-analysis to evaluate the effects of regular aquatic exercise on blood pressure.

Design

A meta-analysis of randomized controlled trials.

Methods

Databases were searched for literature published up to April 2017. The randomized controlled trials analysed involved healthy adults, an intervention group that only performed aquatic exercise and a control group that did not exercise, no other intervention, and trials indicated mean systolic blood pressure or diastolic blood pressure. The net change in blood pressure was calculated from each trial, and the changes in blood pressure were pooled by a random effects model, and the risk of heterogeneity was evaluated. Subgroup analysis of subjects with hypertension, subjects who performed endurance exercise (or not), and subjects who only swam (or not) was performed, and the net changes in blood pressure were pooled.

Results

The meta-analysis examined 14 trials involving 452 subjects. Pooled net changes in blood pressure improved significantly (systolic blood pressure −8.4 mmHg; diastolic blood pressure −3.3 mmHg) and the changes in systolic blood pressure contained significant heterogeneity. When subjects were limited to those with hypertension, those who performed endurance exercise and subjects who did not swim, pooled net changes in systolic and diastolic blood pressure decreased significantly, but the heterogeneity of systolic blood pressure did not improve.

Conclusion

Like exercise on land, aquatic exercise should have a beneficial effect by lowering blood pressure. In addition, aquatic exercise should lower the blood pressure of subjects with hypertension, and other forms of aquatic exercise besides swimming should also lower blood pressure.

Effectiveness of functional training on cardiorespiratory parameters: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Functional training is a new training vision that was prepared from the gesture imitation of daily activities. Although your use has become popular in clinical practice, the influence of the several cardiorespiratory adjustments performed during the functional training in different populations and conditions is unknown. So, the aim of this systematic review was to gather information in the literature regarding the influence of functional training on cardiorespiratory parameters.

METHODS

We conducted search strategies on MEDLINE, PEDro, EMBASE, SportDiscus and Cochrane to identify randomized controlled trials investigating the effects of functional training on cardiorespiratory parameters. Methodological quality of the included studies was assessed using the PEDro scale. Grading of Recommendations Assessment, Development and Evaluation (GRADE) summarized the evidence.

RESULTS

Five original studies were included. Effects favoured functional training on oxygen consumption (VO₂ ) at intermediate-term follow-up: weighted mean difference -1·0 (95% CI: 5·4-3·3), P = 0·642, and a small and not clinically important effect observed on VO₂ favouring control at intermediate-term follow-up (i.e. mean difference of 1·30 (95% CI 1·07-1·53), P<0·001).

CONCLUSION

According to the GRADE system, there is very low quality evidence that functional training is better than other interventions to improve cardiovascular parameters. This result encourages new searches about the theme.

Influences of body mass index and physical activity on hypertension and stroke in Korean adult males: 10-year longitudinal study

[Purpose]

Routinely performed health screening results of 5,624,503 Korean men between ages 20 to 70 obtained from the National Health Insurance Service (2002-2013) were assessed for this study. Data of subjects who met the initial criteria were divided into three groups based on their BMI: normal weight (18.5 to <25.0 kg/m2), overweight (25.0 to <30.0 kg/m2), and obese (≥30.0 kg/m2) groups. The results were further sub-divided by physical activity frequencies (days/week). The disease codes for hypertension and stroke were provided by the National Health Insurance Service for the adjusted relative risks (RR) assessment with the Cox proportional hazard model.

[Methods]

Routinely performed health screening results of 5,624,503 Korean men between ages 20 to 70 obtained from the National Health Insurance Service (2002-2013) were assessed for this study. Data of subjects who met the initial criteria were divided into three groups based on their BMI: normal weight (18.5 to <25.0 kg/m²), overweight (25.0 to <30.0 kg/m²), and obese (≥30.0 kg/ m²) groups. The results were further sub-divided by physical activity frequencies (days/ week). The disease codes for hypertension and stroke were provided by the National Health Insurance Service for the adjusted relative risks (RR) assessment with the Cox proportional hazard model.

[Results]

Significant RRs of hypertension and stroke were shown in the overweight moderately active group (3 – 4 days/week). In addition, significant RR of hypertension was shown in the normal weight moderately active group. No significance was seen in the obese group in all physical activity frequencies.

[Conclusion]

Regularly performed moderate amount of physical activity may be beneficial in reducing the risk for hypertension and stroke. However, the effects of excessive body weight may override the positive effects of physical activity on the occurrence of hypertension and stroke.

Self-rated physical fitness and estimated maximal oxygen uptake in relation to all-cause and cause-specific mortality

This study investigated the longitudinal associations of self-rated physical fitness and estimated maximal oxygen uptake (VO2max) with all-cause and cause-specific mortality. A total of 59 741 participants in the Finnish National FINRISK Study Cohort had data on self-rated physical fitness and covariates. A subsample of 4823 participants had estimated VO2max data. Follow-up ranged from 3 to 38 years. Associations of self-rated physical fitness and VO2max with mortality were analyzed using multivariate Cox proportional hazard models. The study showed that poor self-rated physical fitness was related to all-cause mortality (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.8-2.0) and mortality due to cardiovascular (HR 2.0, 95% CI 1.9-2.2), cerebrovascular (HR 1.9, 95% CI 1.6-2.2) and respiratory diseases (HR 2.1, 95% CI 1.9-2.4), trauma (HR 1.7, 95% CI 1.3-2.0), infections (HR 1.8, 95% CI 1.3-2.7), dementia (HR 1.9, 95% CI 1.6-2.3), and cancer (HR 1.7, 95% CI 1.5-1.9). Coexisting higher age, physical inactivity, male gender, and severe chronic conditions further increased the risk. In men, higher VO2max was associated with a lower risk of lung cancer mortality (HR 0.8, 95% CI 0.7-0.96). Based on the results, self-rated physical fitness reflects a combination of unfavorable biological and lifestyle-related factors, which increase mortality risk. A simple question about perceived physical fitness may reveal at-risk individuals who would benefit from more intensive treatment of chronic conditions and other interventions aiming to promote better fitness and well-being.

Arterial stiffness and cognitive impairment

BACKGROUND

Arterial stiffness is one of the earliest indicators of changes in vascular wall structure and function and may be assessed using various indicators, such as pulse-wave velocity (PWV), the cardio-ankle vascular index (CAVI), the ankle-brachial index (ABI), pulse pressure (PP), the augmentation index (AI), flow-mediated dilation (FMD), carotid intima media thickness (IMT) and arterial stiffness index-β. Arterial stiffness is generally considered an independent predictor of cardiovascular and cerebrovascular diseases. To date, a significant number of studies have focused on the relationship between arterial stiffness and cognitive impairment.

OBJECTIVES AND METHODS

To investigate the relationships between specific arterial stiffness parameters and cognitive impairment, elucidate the pathophysiological mechanisms underlying the relationship between arterial stiffness and cognitive impairment and determine how to interfere with arterial stiffness to prevent cognitive impairment, we searched PUBMED for studies regarding the relationship between arterial stiffness and cognitive impairment that were published from 2000 to 2017. We used the following key words in our search: "arterial stiffness and cognitive impairment" and "arterial stiffness and cognitive impairment mechanism". Studies involving human subjects older than 30years were included in the review, while irrelevant studies (i.e., studies involving subjects with comorbid kidney disease, diabetes and cardiac disease) were excluded from the review.

RESULTS

We determined that arterial stiffness severity was positively correlated with cognitive impairment. Of the markers used to assess arterial stiffness, a higher PWV, CAVI, AI, IMT and index-β and a lower ABI and FMD were related to cognitive impairment. However, the relationship between PP and cognitive impairment remained controversial. The potential mechanisms linking arterial stiffness and cognitive impairment may be associated with arterial pulsatility, as greater arterial pulsatility damages the cerebral microcirculation, which causes various phenomena associated with cerebral small vessel diseases (CSVDs), such as white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and lacunar infarctions (LIs). The mechanisms underlying the relationship between arterial stiffness and cognitive impairment may also be associated with reductions in white matter and gray matter integrity, medial temporal lobe atrophy and Aβ protein deposition. Engaging in more frequent physical exercise; increasing flavonoid and long-chain n-3 polyunsaturated fatty acid consumption; increasing tea, nitrite, dietary calcium and vitamin D intake; losing weight and taking medications intended to improve insulin sensitivity; quitting smoking; and using antihypertensive drugs and statins are early interventions and lifestyle changes that may be effective in preventing arterial stiffness and thus preventing cognitive impairment.

CONCLUSION

Arterial stiffness is a sensitive predictor of cognitive impairment, and arterial stiffness severity has the potential to serve as an indicator used to facilitate treatments designed to prevent or delay the onset and progression of dementia in elderly individuals. Early treatment of arterial stiffness is beneficial and recommended.

Changes in intraocular pressure after exercise test

BACKGROUND

The decrease in intraocular pressure (IOP) within exercise has been recently suggested; however, this change remained ambiguous following exercise test. The present study aimed to assess changes in IOP induced by exercise test in patients who suspected to coronary artery disease (CAD) and indicated for exercise test evaluation.

METHODS

In a cross-sectional study at the cardiovascular research center of Amin Heart Hospital in Isfahan, 101 eyes from 51 consecutive patients suspected to CAD aged 30-70 years referred for exercise testing were evaluated. IOP was measured at the three time points of before exercise test as well as 5 and 20 min after completing exercise test using Schiotz tonometer. All exercise tests were programmed by the treadmill.

RESULTS

The mean IOP in all assessed eyes was 16.12 ± 2.61 mmHg initially that was gradually decreased to 13.79 ± 2.40 mmHg 5 min after the exercise test, but elevated to 15.67 ± 2.26 mmHg 20 min after the test. Assessing IOP following exercise testing showed a significant decrease in IOP in 75 eyes (74.3%), remained unchanged in 19.8% of eyes, and even elevated in 5.9% of eyes. There was a significant direct association between patients' age and IOP changes assessed by the Pearson's correlation test (r = 0.350,P = 0.009). No significant difference was revealed in the trend of the changes in IOP after exercise test between men and women, between left-sided and right-sided eyes as well as between different body mass index subgroups.

CONCLUSION

IOP temporarily reduced after exercise test, but return to baseline value shortly after test. This lowering is more evident in advanced aging.

Vascular Aging: Implications for Cardiovascular Disease and Therapy

The incidence and prevalence of cardiovascular disease is highest among the elderly, in part, due to deleterious effects of advancing age on the heart and blood vessels. Aging, a known cardiovascular risk factor, is progressively associated with structural and functional changes to the vasculature including hemodynamic disturbance due to increased oxidative stress, premature cellular senescence and impairments in synthesis and/or secretion of endothelium-derived vasoactive molecules. These molecular and physiological changes lead to vessel wall stiffening and thickening, as well as other vascular complications that culminate to loss of vascular tone regulation and endothelial function. Intriguingly, the vessel wall, a biochemically active structure composed of collagen, connective tissue, smooth muscle and endothelial cells, is adversely affected by processes involved in premature or normal aging. Notably, the inner most layer of the vessel wall, the endothelium, becomes senescent and dysfunctional with advancing age. As a result, its ability to release vasoactive molecules such as acetylcholine (ACh), prostacyclin (PGI2), endothelium-derived hyperpolarizing factor (EDHF), and nitric oxide (NO) is reduced and the cellular response to these molecules is also impaired. By contrast, the vascular endothelium increases its generation and release of reactive oxygen (ROS) and nitrogen (RNS) species, vasoconstrictors such as endothelin (ET) and angiotensin (AT), and endogenous inhibitors of NO synthases (NOSs) to block NO. This skews the balance of the endothelium in favor of the release of highly tissue reactive and harmful molecules that promote DNA damage, telomere erosion, senescence, as well as stiffened and hardened vessel wall that is prone to the development of hypertension, diabetes, atherosclerosis and other cardiovascular risk factors. This Review discusses the impact of advancing age on cardiovascular health, and highlights the cellular and molecular mechanisms that underlie age-associated vascular changes. In addition, the role of pharmacological interventions in preventing or delaying age-related cardiovascular disease is discussed.

Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies

The current review clarifies the cardiometabolic health effects of high-intensity interval training (HIIT) in adults. A systematic search (PubMed) examining HIIT and cardiometabolic health markers was completed on 15 October 2015. Sixty-five intervention studies were included for review and the methodological quality of included studies was assessed using the Downs and Black score. Studies were classified by intervention duration and body mass index classification. Outcomes with at least 5 effect sizes were synthesised using a random-effects meta-analysis of the standardised mean difference (SMD) in cardiometabolic health markers (baseline to postintervention) using Review Manager 5.3. Short-term (ST) HIIT (<12 weeks) significantly improved maximal oxygen uptake (VO₂ max; SMD 0.74, 95% CI 0.36 to 1.12; p<0.001), diastolic blood pressure (DBP; SMD -0.52, 95% CI -0.89 to -0.16; p<0.01) and fasting glucose (SMD -0.35, 95% CI -0.62 to -0.09; p<0.01) in overweight/obese populations. Long-term (LT) HIIT (≥12 weeks) significantly improved waist circumference (SMD -0.20, 95% CI -0.38 to -0.01; p<0.05), % body fat (SMD -0.40, 95% CI -0.74 to -0.06; p<0.05), VO₂ max (SMD 1.20, 95% CI 0.57 to 1.83; p<0.001), resting heart rate (SMD -0.33, 95% CI -0.56 to -0.09; p<0.01), systolic blood pressure (SMD -0.35, 95% CI -0.60 to -0.09; p<0.01) and DBP (SMD -0.38, 95% CI -0.65 to -0.10; p<0.01) in overweight/obese populations. HIIT demonstrated no effect on insulin, lipid profile, C reactive protein or interleukin 6 in overweight/obese populations. In normal weight populations, ST-HIIT and LT-HIIT significantly improved VO₂ max, but no other significant effects were observed. Current evidence suggests that ST-HIIT and LT-HIIT can increase VO₂ max and improve some cardiometabolic risk factors in overweight/obese populations.

Habitual exercise decreases systolic blood pressure during low-intensity resistance exercise in healthy middle-aged and older individuals

Since aerobic exercise (e.g., walking) and resistance exercise (e.g., lifting objects and mopping) are both parts of the activities of daily living, an exaggerated elevation in systolic blood pressure (SBP) during aerobic and resistance exercise is an early marker of cardiovascular disease. This study investigated the effects of habitual exercise on SBP during low-intensity resistance exercise using both cross-sectional and interventional approaches. First, in 57 normotensive women (61.9 ± 1.0 yr of age), daily physical activity level, as assessed by triaxial accelerometry, was correlated with SBP during resistance exercise at 20 and 40% of the 1 repetition maximum ( r = −0.408 and r = −0.348, respectively). Maximal oxygen uptake was correlated with SBP during exercise at 20% ( r = −0.385) and 40% ( r = −0.457). Physical activity level or maximal oxygen uptake was identified as a predictor of SBP during the exercise in stepwise regression analysis, independent of SBP at rest and other factors ( R2= 0.729–0.781). Second, 66 men and women (64.6 ± 0.9 yr of age) participated in a 6-wk intervention as a part of the training (walking, 4.3 ± 0.3 days/wk, 55.6 ± 4.1 min/day, 70.7 ± 1.2% of maximal heart rate) or control group. SBP during resistance exercise in the training group decreased after the intervention (before vs. after: 20%, 143 ± 4 vs. 128 ± 4 mmHg; and 40%, 148 ± 5 vs. 134 ± 4 mmHg). In the control group, there were no significant differences in SBP before and after the intervention. SBP during resistance exercise after the intervention was lower in the training group relative to the control group. These results suggest that habitual exercise decreases SBP during low-intensity resistance exercise.

Baseline subendocardial viability ratio influences left ventricular systolic improvement with cardiac rehabilitation

OBJECTIVE

Subendocardial viability ratio (SEVR), defined as diastolic to systolic pressure-time integral ratio, is a useful tool reflecting the balance between coronary perfusion and arterial load. Suboptimal SEVR creating a supply-demand imbalance may limit favorable cardiac response to cardiac rehabilitation (CR). To explore this hypothesis, we designed a study to analyze the relationship between baseline SEVR and response to CR in patients with coronary artery disease (CAD).

METHODS

In this prospectively study, after baseline arterial tonometry, echocardiography, and cardiopulmonary exercise tests (CPETs), patients undergone 20 sessions of CR. Post-CR echocardiographic and CPET measurements were obtained for comparison.

RESULTS

Final study population was comprised of fifty subjects. Study population was divided into two subgroups by median SEVR value (1.45, interquartile range 0.38). Although both groups showed significant improvements in peak VO2, significant improvements in oxygen pulse (πO2) (from 16.1±3.4 to 19.1±4.8 mL O2.kg-1.beat-1; p<0.001) and stroke volume index (from 31±5 to 35±6 mL; p=0.008) were observed in only the patients in the above-median subgroup. The change in πO2 was also significantly higher in the above-median SEVR subgroup (2.9±3.3 vs. 0.5±2.4; p=0.007).

CONCLUSION

Our study shows that baseline supply-demand imbalance may limit systolic improvement response to CR in patients with CAD.

Former male elite athletes and risk of hypertension in later life

OBJECTIVE

The aim of this study was to assess whether a former career as an elite athlete protects from hypertension in later life. We hypothesized that vigorous physical activity during young adulthood protects against hypertension later in life.

METHODS

The study population (n = 3440) consists of 2037 former male elite athletes and 1403 matched controls. Of those, 599 (392 former athletes, 207 controls) participated in a clinical study in 2008. The athletes were divided into three groups: endurance, mixed and power sports. Assessment of hypertension was based on athletes' entitlement to reimbursable antihypertensive medication from the Finnish Social Insurance Institution; among the clinical study participants, this was also based on self-reported current use of antihypertensive drugs or measured hypertension. The current volume of leisure-time physical activity (LTPA) was determined by questionnaires.

RESULTS

Among the participants, the former athletes had lower age-adjusted prevalence of hypertension than the controls [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.49-0.98] and the endurance athletes had the lowest OR (OR 0.43, 95% CI 0.23-0.80). OR for the prevalence of hypertension decreased (OR 0.90, 95% CI 0.84-0.96 per 10 metabolic equivalent hours/week) when there was an increase in the volume of LTPA. The former athletes without blood pressure-lowering medication had significantly lower SBP than the controls [139.2 mmHg (SD 18.7) vs. 144.2 mmHg (SD 19.5)] (P = 0.027).

CONCLUSION

A former career as an elite athlete seems to be associated with a lower prevalence of hypertension in later life. The volume of current LTPA was inversely related to prevalence of hypertension.

An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis

This research studied the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis, using a longitudinal intervention design with a matched reference sample. In participants in the intervention group, scores on the EQ-VAS, which measured HRQoL, improved from 57.6 to 63.3 (SD = 17.8) (p = 0.05), and HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l. (p = 0.02). There was no significant change in body weight among participants. The results of this study indicate that a lifestyle intervention based on group meetings improves HRQoL in patients with psychosis and provides small improvements in metabolic risk factors.

European Code against Cancer 4th Edition: Physical activity and cancer

Physical activity is a complex, multidimensional behavior, the precise measurement of which is challenging in free-living individuals. Nonetheless, representative survey data show that 35% of the European adult population is physically inactive. Inadequate levels of physical activity are disconcerting given substantial epidemiologic evidence showing that physical activity is associated with decreased risks of colon, endometrial, and breast cancers. For example, insufficient physical activity levels are thought to cause 9% of breast cancer cases and 10% of colon cancer cases in Europe. By comparison, the evidence for a beneficial effect of physical activity is less consistent for cancers of the lung, pancreas, ovary, prostate, kidney, and stomach. The biologic pathways underlying the association between physical activity and cancer risk are incompletely defined, but potential etiologic pathways include insulin resistance, growth factors, adipocytokines, steroid hormones, and immune function. In recent years, sedentary behavior has emerged as a potential independent determinant of cancer risk. In cancer survivors, physical activity has shown positive effects on body composition, physical fitness, quality of life, anxiety, and self-esteem. Physical activity may also carry benefits regarding cancer survival, but more evidence linking increased physical activity to prolonged cancer survival is needed. Future studies using new technologies - such as accelerometers and e-tools - will contribute to improved assessments of physical activity. Such advancements in physical activity measurement will help clarify the relationship between physical activity and cancer risk and survival. Taking the overall existing evidence into account, the fourth edition of the European Code against Cancer recommends that people be physically active in everyday life and limit the time spent sitting.

High-intensity training reduces intermittent hypoxia-induced ER stress and myocardial infarct size

Chronic intermittent hypoxia (IH) is described as the major detrimental factor leading to cardiovascular morbimortality in obstructive sleep apnea (OSA) patients. OSA patients exhibit increased infarct size after a myocardial event, and previous animal studies have shown that chronic IH could be the main mechanism. Endoplasmic reticulum (ER) stress plays a major role in the pathophysiology of cardiovascular disease. High-intensity training (HIT) exerts beneficial effects on the cardiovascular system. Thus, we hypothesized that HIT could prevent IH-induced ER stress and the increase in infarct size. Male Wistar rats were exposed to 21 days of IH (21-5% fraction of inspired O2, 60-s cycle, 8 h/day) or normoxia. After 1 wk of IH alone, rats were submitted daily to both IH and HIT (2 × 24 min, 15-30m/min). Rat hearts were either rapidly frozen to evaluate ER stress by Western blot analysis or submitted to an ischemia-reperfusion protocol ex vivo (30 min of global ischemia/120 min of reperfusion). IH induced cardiac proapoptotic ER stress, characterized by increased expression of glucose-regulated protein kinase 78, phosphorylated protein kinase-like ER kinase, activating transcription factor 4, and C/EBP homologous protein. IH-induced myocardial apoptosis was confirmed by increased expression of cleaved caspase-3. These IH-associated proapoptotic alterations were associated with a significant increase in infarct size (35.4 ± 3.2% vs. 22.7 ± 1.7% of ventricles in IH + sedenary and normoxia + sedentary groups, respectively, P < 0.05). HIT prevented both the IH-induced proapoptotic ER stress and increased myocardial infarct size (28.8 ± 3.9% and 21.0 ± 5.1% in IH + HIT and normoxia + HIT groups, respectively, P = 0.28). In conclusion, these findings suggest that HIT could represent a preventive strategy to limit IH-induced myocardial ischemia-reperfusion damages in OSA patients.

Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular-Arterial Coupling in Patients With Systolic Heart Failure

BACKGROUND

Success of cardiac rehabilitation (CR) is generally assessed by the objective improvement in peak volume of inhaled oxygen (VO2) measured by cardiopulmonary exercise test (CPX). However, cardiac mechanical efficiency and ventricular-arterial coupling (VAC) are the other important dimensions of the heart failure pathophysiology, which are not included in CPX-derived data. The effect of cardiac rehabilitation on left ventricular (LV) efficiency or VAC in unselected heart failure patients has not been studied thus far.

METHODS AND RESULTS

Thirty patients with an ejection fraction of ≤45% were recruited for 20 sessions of exercise-based CR. Noninvasive LV pressure-volume loops were constructed and VAC was calculated with the help of applanation tonometry and echocardiography before and after CR. VAC showed an improved mechanical efficiency profile and increased significantly from 0.56±0.18 to 0.67±0.21 (P=0.02). LV mechanical efficiency improved from 43.9±9.1% to 48.8±9.1% (P=0.01). The change in peak VO2 was not in a significant correlation with the change in VAC (r=-0.18; P=0.31), mechanical efficiency (r=-0.16, P=0.39), or the change in ejection fraction (r=-0.07; P=0.68).

CONCLUSIONS

CR is associated with an improvement in VAC and LV mechanical efficiency in heart failure patients. Further studies are needed to determine the incremental value of VAC and mechanical efficiency over CPX-derived data in predicting clinical outcomes.

Effects of endurance, circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients

Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake ([Formula: see text]), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (-18 %), [Formula: see text] (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (-11 %), [Formula: see text] (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in [Formula: see text], mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.

Lifestyle Patterns Are Associated with Elevated Blood Pressure among Qatari Women of Reproductive Age: A Cross-Sectional National Study

Women of childbearing age are particularly vulnerable to the adverse effects of elevated blood pressure (BP), with dietary and lifestyle habits being increasingly recognized as important modifiable environmental risk factors for this condition. Using data from the National STEPwise survey conducted in Qatar in year 2012, we aimed to examine lifestyle patterns and their association with elevated BP among Qatari women of childbearing age (18–45 years). Socio-demographic, lifestyle, dietary, anthropometric and BP data were used (n = 747). Principal component factor analysis was applied to identify the patterns using the frequency of consumption of 13 foods/food groups, physical activity level, and smoking status. Multivariate logistic regression analyses were used to evaluate the association of the identified lifestyle patterns with elevated BP and to examine the socio-demographic correlates of these patterns. Three lifestyle patterns were identified: a “healthy” pattern characterized by intake of fruits, natural juices, and vegetables; a “fast food & smoking” pattern characterized by fast foods, sweetened beverages, and sweets, in addition to smoking; and a “traditional sedentary” pattern which consisted of refined grains, dairy products, and meat in addition to low physical activity. The fast food & smoking and the traditional & sedentary patterns were associated with an approximately 2-fold increase in the risk of elevated BP in the study population. The findings of this study highlight the synergistic effect that diet, smoking and physical inactivity may have on the risk of elevated BP among Qatari women.

Exercise modalities and endothelial function: a systematic review and dose-response meta-analysis of randomized controlled trials

BACKGROUND

Regular exercise is associated with enhanced nitric oxide (NO) bioavailability. Flow-mediated dilation (FMD) is used widely to assess endothelial function (EF) and NO release.

OBJECTIVES

The aims of this systematic review and meta-analysis were to (i) investigate the effect of exercise modalities (aerobic, resistance or combined) on FMD; and (ii) determine which exercise and participant characteristics are most effective in improving FMD.

METHODS

We searched the MEDLINE, Embase, Cochrane Library, and Scopus databases for studies that met the following criteria: (i) randomized controlled trials of exercise with comparative non-exercise, usual care or sedentary groups; (ii) duration of exercise intervention ≥4 weeks; (iii) age ≥18 years; and (iv) EF measured by FMD before and after the intervention. Weighted mean differences (WMDs) with 95% confidence interval were entered into a random effect model to estimate the pooled effect of the exercise interventions.

RESULTS

All exercise modalities enhanced EF significantly: aerobic (WMD 2.79, 95% CI 2.12-3.45, p = 0.0001), resistance (WMD 2.52, 95% CI 1.11-3.93, p = 0.0001) and combined (WMD 2.07, 95% CI 0.70-3.44, p = 0.003). A dose-response relationship was observed between aerobic exercise intensity and improvement in EF. A 2 metabolic equivalents (MET) increase in absolute exercise intensity or a 10% increase in relative exercise intensity resulted in a 1% unit improvement in FMD. There was a positive relationship between frequency of resistance exercise sessions and improvement in EF (β 1.14, CI 0.16-2.12, p = 0.027).

CONCLUSIONS

All exercise modalities improve EF significantly and there was a significant, positive relationship between aerobic exercise intensity and EF. Greater frequency, rather than intensity, of resistance exercise training enhanced EF.

Physical activity and better medication compliance improve mini-mental state examination scores in the elderly

In addition to hypertension, dyslipidemia, atherosclerosis, and diabetes, a sedentary lifestyle plays a pivotal role in cerebro- and cardiovascular disease and progressive cognitive decline, including vascular dementia and Alzheimer's disease. The present study investigated whether controlling the key risks and participating in physical activity have a beneficial impact on these disorders. Elderly volunteers were enrolled in a 3-month program that consisted of structured exercise three times per week. The daily routine, medical treatment, and vital parameters were evaluated and correlated with the subjects' neuropsychiatric status. High blood pressure was found in 40% of the participants, with no significant differences between the sexes. A higher proportion of females (55%) than males (18%) forgot to take their medication during the observation period. Significant negative correlations were found between Mini-Mental State Examination (MMSE) scores and age, lack of a caregiver, and increased pulse rate before or after exercise. These results suggest that the presence of home assistance and subsequent improvement in medication compliance, vital parameter optimization, and regular physical activity may yield better MMSE results and a lower risk for cerebro- and cardiovascular disease.