A weight reduction and weight maintenance program with long-lasting improvement in left ventricular mass and blood pressure

Effects of Lifestyle Modification on an Exaggerated Blood Pressure Response to Exercise in Normotensive Females

BACKGROUND

This study was designed to examine the effects of a lifestyle modification on the improvement in an exaggerated systolic blood pressure (SBP) response to exercise in normotensive females.

METHODS

The subjects were 78 normotensive females with (n = 25) and without (n = 53) an exaggerated SBP response to exercise who were not taking any medications. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP: ≥190 mm Hg). A lifestyle modification program consisting of aerobic exercise and diet counseling was conducted for 12 weeks. The brachial-ankle pulse wave velocity (baPWV), plasma nitrate/nitrite (NOx), plasma thiobarbituric acid-reactive substances (TBARS), high-sensitivity C-reactive protein, fibrinogen levels, and the white blood cell (WBC) counts were measured before and after 12-week intervention.

RESULTS

After 12-week intervention, the exercise-induced SBP elevation decreased in an exaggerated SBP response group (P < 0.05). In addition, the plasma NOx significantly increased, and the WBC counts and plasma TBARS decreased in an exaggerated SBP response group (P < 0.05). In an exaggerated SBP response group, a stepwise multiple regression analysis showed that the percent change in exercise-induced SBP elevation was independently associated with the percent changes in the plasma NOx level and baPWV (r2 = 0.647, P < 0.0001).

CONCLUSIONS

These results suggest that a lifestyle modification is considered to be important for reducing an exaggerated SBP response to exercise by improving the arterial stiffness and nitric oxide bioavailability.

An exaggerated blood pressure response to exercise is associated with nitric oxide bioavailability and inflammatory markers in normotensive females

This study was designed to examine the associations of an exaggerated systolic blood pressure (SBP) response to exercise with the indices of nitric oxide (NO) bioavailability, oxidative stress, inflammation and arterial stiffness in normotensive females. The subjects included 84 normotensive females without a history of cardiovascular disease or stroke who were not taking any medications. Each subject performed a multistage graded submaximal exercise stress test using an electric bicycle ergometer, and their blood pressure was measured at rest and during the last minute of each stage. The brachial-ankle pulse wave velocity, plasma nitrate/nitrite (NO_x), plasma thiobarbituric acid-reactive substances, high-sensitivity C-reactive protein (hs-CRP) and fibrinogen levels and the white blood cell count were measured. An exaggerated SBP response to exercise was defined according to the criteria of the Framingham Study (peak SBP: ⩾190 mm Hg). An exaggerated SBP response to exercise was observed in 27 subjects. A multiple logistic regression analysis revealed that the hs-CRP (odds ratio (OR): 1.05, 95% confidence interval (CI): 1.03-1.07, P=0.015) and plasma NO_x levels (OR: 0.92, 95% CI: 0.87-0.98, P=0.014) were significantly associated with an exaggerated SBP response to exercise. Furthermore, the percent change in SBP was found to be significantly associated with an increase in the hs-CRP (P for trend=0.006) and a decrease in the plasma NO_x levels (P for trend=0.001). These results suggest that an exaggerated SBP response to exercise was associated with the NO bioavailability and inflammatory status in normotensive females.

[Worksite health promotion and occupational physicians: interventional effects of exercises]

Results of annual health checkups at workplaces revealed a steady increase in the incidence of cardiovascular risk factors such as dyslipidemia and hypertension in Japan. With the aging of the workforce, the incidence is expected to increase further. These risk factors are modifiable through a lifestyle modification program including mild exercise and nutritional guidance. In 1988, the Japanese government revised the Industrial Safety and Health Law to promote health in the workplace and implemented the Total Health Promotion Plan (THP). However, only 5.0% of workplaces were implementing THP programs according to a survey conducted in 2007. Therefore, we have recommended some measures for worksite health promotion, such as collaboration between community health and occupational health for implementing health promotion activities especially in small and medium scale enterprises, environmental improvement to promote occupational health, and an approach to increase physical activity that includes walking to work and using the stairs. Worksite health promotion should be considered an important company initiative in terms of work-related outcomes such as job satisfaction, work ability, and absenteeism in addition to cardiovascular risk factors.

Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial

OBJECTIVE

To compare the lipid-lowering effects of an alternative regimen (lifestyle changes, red yeast rice, and fish oil) with a standard dose of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin).

PATIENTS AND METHODS

This randomized trial enrolled 74 patients with hypercholesterolemia who met Adult Treatment Panel III criteria for primary prevention using statin therapy. All participants were randomized to an alternative treatment group (AG) or to receive simvastatin (40 mg/d) in this open-label trial conducted between April 1, 2006, and June 30, 2006. The alternative treatment included therapeutic lifestyle changes, ingestion of red yeast rice, and fish oil supplements for 12 weeks. The simvastatin group received medication and traditional counseling. The primary outcome measure was the percentage change in low-density lipoprotein cholesterol (LDL-C). Secondary measures were changes in other lipoproteins and weight loss.

RESULTS

There was a statistically significant reduction in LDL-C levels in both the AG (-42.4%+/-15%) (P<.001) and the simvastatin group (-39.6%+/-20%) (P<.001). No significant differences were noted between groups. The AG also demonstrated significant reductions in triglycerides (-29% vs -9.3%; 95% confidence interval, -61 to -11.7; P=.003) and weight (-5.5% vs -0.4%; 95% confidence interval, -5.5 to -3.4; P<.001) compared with the simvastatin group.

CONCLUSION

Lifestyle changes combined with ingestion of red yeast rice and fish oil reduced LDL-C in proportions similar to standard therapy with simvastatin. Pending confirmation in larger trials, this multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins.

Meta-analysis of interventions to increase physical activity among cardiac subjects

BACKGROUND

Extensive primary research has tested interventions to increase physical activity (PA) among adults with cardiovascular disease. This meta-analysis integrates the extant research about how to increase PA in cardiac samples.

METHODS

Extensive literature searching located published and unpublished intervention studies that measured PA outcomes. Results were coded from primary studies. Fixed- and random-effects meta-analytic procedures included moderator analyses.

RESULTS

Data were synthesized across 11,877 subjects from 79 eligible research reports. The overall mean PA effect size for 2-group comparisons was 0.35 (higher mean for treatment than control), which is consistent with a difference of 1984 kcal/week for treatment subjects versus 1615 for control subjects. The fitness effect size for 2-group comparisons was .17. Other statistically significantly positive 2-group effect sizes were .24 for quality of life and .23 for subsequent cardiac events. Effect sizes for anthropometric measures and blood pressure did not differ significantly from 0. Exploratory moderator analyses found large effect sizes for PA among studies that had (1) an exclusive focus on PA versus diverse health behaviors, (2) more contact between interventionists and subjects, (3) supervised exercise sessions, (4) fitness testing, (5) face-to-face encounters versus mediated intervention delivery, and (6) more minutes of activity per week. Effect sizes were unrelated to funding status, dissemination vehicle, gender distribution, or attrition rate.

CONCLUSIONS

These findings document that interventions can be effective in increasing PA among patients with cardiovascular diseases. Primary research should compare interventions in randomized trials to confirm causal relationships.

Meta-analysis of patient education interventions to increase physical activity among chronically ill adults

OBJECTIVE

This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses.

METHODS

Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses.

RESULTS

Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples.

CONCLUSION

These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect.

PRACTICE IMPLICATIONS

Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.

Cardiovascular Consequences of Obesity and Targets for Treatment

Obesity is a risk factor for cardiovascular disease, including coronary artery disease and heart failure, but the mechanisms by which it may cause them are not completely clear. Currently, therapies aimed at obesity-related cardiovascular disease include weight loss strategies and reduction of the other risk factors that are associated with obesity and cardiovascular disease. Other pathways with for potential drug development for obesity-related CVD are also discussed.

Hypertensive heart disease: effects of lifestyle modifications and antihypertensive drug treatment

Target-organ protection in hypertensive patients has become increasingly important. This review will focus on hypertensive heart disease that is mainly characterized by myocardial hypertrophy and increased interstitial fibrosis. Cardiac remodeling develops as an adaptive response but actually represents a powerful independent risk factor for cardiovascular morbidity and mortality. The review will begin with a brief discussion on the complex pathophysiology of hypertensive cardiac remodeling and its clinical consequences. The effects of nonpharmacologic and pharmacologic antihypertensive treatments on the development and progression of hypertensive heart disease are presented. Finally, the impact of the regression of myocardial hypertrophy and fibrosis on cardiac function and cardiovascular risk are discussed.

Obesity and insulin resistance: Effects on cardiac structure, function, and substrate metabolism

It is widely recognized that obesity and insulin resistance can contribute to an increased risk of coronary disease, but it has also become increasingly apparent that they may contribute directly to cardiac dysfunction even in the absence of significant coronary disease. Recently, obesity, which is frequently accompanied by insulin resistance, has been independently related to clinically diagnosed heart failure. Thus, there is renewed interest in the pathophysiology of myocardial disease related to obesity and insulin resistance, as well as in the specific cellular mechanisms by which obesity may cause detrimental cardiac structural and functional changes. Alterations in hemodynamics, plasma volume, neurohormonal status, and myocardial substrate metabolism all appear to contribute to these changes. Improving our understanding of cardiac dysfunction related to obesity and insulin resistance may provide clues for new strategies to prevent and treat this alarmingly prevalent condition.

Blood Pressure-Lowering Effects of Lifestyle Modification: Possible Involvement of Nitric Oxide Bioavailability

Lifestyle modification is recommended as a non-pharmacological approach to treatment of hypertension. Many investigators have reported that exercise has antihypertensive effects, and various mechanisms have been proposed to explain this phenomenon. For example, nitric oxide (NO), which may be increased by exercise, has been reported to play a crucial role in preserving vessel homeostasis both by regulating vascular tone and by exerting anti-atherosclerotic effects. NO is known to be exquisitely sensitive to inactivation by superoxide radicals. However, the relationship between the blood pressure-lowering effect of lifestyle modification and NO bioavailability remains unknown. We investigated the effects of a 12-week lifestyle modification program consisting of mild exercise and diet on changes in blood pressure, plasma nitrate/nitrite (NOx), plasma nitrotyrosine, which is the footprint of NO interaction with reactive oxygen species, and plasma extracellular-superoxide dismutase (EC-SOD). The 12-week lifestyle modification program lowered blood pressure and increased plasma NOx. When the subjects were divided into two groups according to the change of plasma nitrotyrosine as an indicator of NO bioavailability, the subjects whose plasma nitrotyrosine decreased exhibited a significant relationship between the blood pressure-lowering effect of the lifestyle modification and the increase in EC-SOD, whereas those without a decrease in plasma nitrotyrosine exhibited a significant relationship between the blood pressure-lowering effect and the increase in maximum oxygen consumption. These results indicate that the level of NO bioavailability influences the mechanism of the blood pressure-lowering effect of aerobic exercise and diet.

What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome

Prevention of the metabolic syndrome and treatment of its main characteristics are now considered of utmost importance in order to combat the epidemic of type 2 diabetes mellitus and to reduce the increased risk of cardiovascular disease and all-cause mortality. Insulin resistance/hyperinsulinaemia are consistently linked with a clustering of multiple clinical and subclinical metabolic risk factors. It is now widely recognised that obesity (especially abdominal fat accumulation), hyperglycaemia, dyslipidaemia and hypertension are common metabolic traits that, concurrently, constitute the distinctive insulin resistance or metabolic syndrome. Cross-sectional and prospective data provide an emerging picture of associations of both physical activity habits and cardiorespiratory fitness with the metabolic syndrome. The metabolic syndrome, is a disorder that requires aggressive multi-factorial intervention. Recent treatment guidelines have emphasised the clinical utility of diagnosis and an important treatment role for 'therapeutic lifestyle change', incorporating moderate physical activity. Several previous narrative reviews have considered exercise training as an effective treatment for insulin resistance and other components of the syndrome. However, the evidence cited has been less consistent for exercise training effects on several metabolic syndrome variables, unless combined with appropriate dietary modifications to achieve weight loss. Recently published randomised controlled trial data concerning the effects of exercise training on separate metabolic syndrome traits are evaluated within this review. Novel systematic review and meta-analysis evidence is presented indicating that supervised, long-term, moderate to moderately vigorous intensity exercise training, in the absence of therapeutic weight loss, improves the dyslipidaemic profile by raising high density lipoprotein-cholesterol and lowering triglycerides in overweight and obese adults with characteristics of the metabolic syndrome. Lifestyle interventions, including exercise and dietary-induced weight loss may improve insulin resistance and glucose tolerance in obesity states and are highly effective in preventing or delaying the onset of type 2 diabetes in individuals with impaired glucose regulation. Randomised controlled trial evidence also indicates that exercise training decreases blood pressure in overweight/obese individuals with high normal blood pressure and hypertension. These evidence-based findings continue to support recommendations that supervised or partially supervised exercise training is an important initial adjunctive step in the treatment of individuals with the metabolic syndrome. Exercise training should be considered an essential part of 'therapeutic lifestyle change' and may concurrently improve insulin resistance and the entire cluster of metabolic risk factors.

Effects of a community-based lifestyle-modification program on cardiovascular risk factors in middle-aged women

We investigate the effectiveness of a community-based lifestyle-modification program for reducing blood pressure and other cardiovascular risk factors in sedentary Japanese middle-aged women. Among an initial cohort of 210 middle-aged sedentary women, 195 subjects completed a community-based 12-week lifestyle-modification program for reducing cardiovascular risk factors. Blood pressure, body weight and the serum lipid profile were measured both at baseline and at the end of the 12-week lifestyle-modification program. The program consisted of mild aerobic exercise and a mild hypocaloric diet. After the 12-week program, both systolic and diastolic blood pressure were significantly reduced, especially in subjects who were hypertensive at baseline. Desirable changes in body weight and the serum lipid profile were also found after the 12-week program. Multiple linear regression analysis revealed that, in obese subjects, the decrease in systolic blood pressure was correlated with both the initial systolic blood pressure and the change in estimated maximum oxygen consumption. In addition, the decrease in diastolic blood pressure was correlated with the initial diastolic blood pressure and the change in body weight. On the other hand, in non-obese subjects, the decrease in blood pressure was correlated with the initial blood pressure and the change in salt intake. A community-based lifestyle-modification program that consisted of mild aerobic exercise and a mild hypocaloric diet was considered to be practically effective for reducing multiple cardiovascular risk factors. Individuals who already have one or more mild cardiovascular risk factors still could be good candidates for a community-based lifestyle-modification program.

Short-term changes of cardiovascular risk factors after a non-pharmacological body weight reduction program

OBJECTIVE

To test the short-term effectiveness of a 3 week hospital-based body weight reduction (BWR) program on selected coronary heart disease (CHD) risk factors in obese subjects.

DESIGN

Intervention study to assess the modifications in CHD risk factor scores estimated according to Framingham risk factor categories (age, total cholesterol, high density lipoprotein (HDL) cholesterol, blood pressure, diabetes and smoking).

SETTING

3rd Division of Metabolic Diseases, Italian Institute for Auxology, Piancavallo (VB), Italy.

SUBJECTS

Two-hundred and sixty-eight obese patients (43 men, 225 women, age range 19-81 y; body mass index (BMI) range 30-67).

INTERVENTION

The BWR program consisted of a 3 week integrated energy-restricted diet (1200-1800 kcal/day), associated with moderate aerobic exercise, psychological counselling and educational lectures.

RESULTS

Substantial reductions of total cholesterol (16.7%), HDL cholesterol (14.8%), systolic (11.2%) and diastolic blood pressure (8.7%) were observed at the end of the intervention, even with relatively moderate decrease in weight (4.1%) and in persistence of elevated BMI (over 40 kg/m2). The mean CHD Framingham score decreased by 16.1%, from 7.8 to 6.2. The BWR-induced changes were similar in both sexes, and across strata of age and BMI.

CONCLUSIONS

The full-time participation of the patients in the hospital-based, integrated BWR program may explain the positive clinical outcome in all the subgroups considered, although the long-term results need to be quantified.

SPONSORSHIPS

Partially supported by Progetti di Ricerca Corrente, Istituto Auxologico Italiano, IRCCS, Milan, Italy.