Resistance training improves cardiovascular risk factors in obese women despite a significative decrease in serum adiponectin levels

Effects of L-Leucine Supplementation and Resistance Training on Adipokine Markers in Untrained Perimenopausal and Postmenopausal Women

ABSTRACT

Chapman-Lopez, TJ, Funderburk, LK, Heileson, JL, Wilburn, DT, Koutakis, P, Gallucci, AR, and Forsse, JS. Effects of L-leucine supplementation and resistance training on adipokine markers in untrained perimenopausal and postmenopausal women. J Strength Cond Res 38(3): 526-532, 2024-This study examined the effects of supplementing 5 g of leucine compared with a placebo during a 10-week resistance training program on body composition parameters and adipokine concentrations in untrained, perimenopausal and postmenopausal women. Thirty-five women were randomly assigned to 2 groups-leucine (LEU, n = 17) and placebo (PLC, n = 18)-in a double-blind, placebo-controlled trial. Each group consumed the supplement or placebo every day and completed a resistance training program for 10 weeks. Using 3-day food records, a diet was assessed before the intervention and after its cessation. Body composition was assessed preintervention and postintervention using dual-energy x-ray absorptiometry. Moreover, the concentrations of adipokines, such as adiponectin, visfatin, leptin, and monocyte chemoattractant protein-1 (MCP-1), were assessed preintervention and postintervention. Both groups showed an increase in visceral adipose tissue (VAT) area ( p = 0.030) and fat-free mass (FFM; p = 0.023). There were significant group differences in concentrations of visfatin ( p = 0.020) and leptin ( p = 0.038) between the PLC and LEU groups. Visfatin displayed higher concentrations in the PLC group and leptin displayed higher concentrations in the LEU group. In addition, there were significant decreases in adiponectin concentrations for both groups (LEU: 652 ± 513 to 292 ± 447 pg·ml -1 ; PLC: 584 ± 572 to 245 ± 356 pg·ml -1 , p = 0.002) and MCP-1 only decreased in the PLC group (253 ± 119 to 206 ± 106 pg·ml -1 , p = 0.004). There were significant decreases in adiponectin concentrations in both groups and a decrease in MCP-1 concentrations in the PLC group. These decreases may be due to both adipokines possible relationship with VAT area. However, it is not known whether leucine has underlying properties that hinder changes in MCP-1 concentrations.

Acute and Chronic Effects of Strength Training on Plasma Levels of Adipokines in Man

Adipose tissue is specialized cells that produce and release adipokines. Exercise may modulate adipokine production in adipocytes. The aim of this longitudinal study was to evaluate the acute and chronic effects of strength training (ST) on plasma levels of adiponectin, leptin, and resistin. Twelve untrained young male participants (23.42±2.67 years) were selected. The training protocol consisted of 3 exercises, with 3 sets of 65% of 1RM (one-repetition maximum) with pause of 90 s between sets with duration of 5 s/repetition (2 s conc/3 s ecc), 3 times a week for 10 weeks. Blood was collected at four time points: before and after the first ST session and before and after the last ST session. The comparisons between adipokine levels before and after the same training session showed acute changes, while the comparisons between levels before or after the first session versus before or after the last session revealed chronic alterations. ST increased adiponectin levels after the first exercise session in comparison to levels before this session [50 952 (46 568-51 894) pg/mL vs. 52 981 (49 901-54 467) pg/mL, p=0.019]. Similar differences were observed for resistin levels, which were higher after the last session compared to before [4 214.4 (±829) pg/mL vs. pre-S30 2 251.3 (±462.2) pg/mL, p=0.0008] and in the comparison between after the last and after the first ST sessions [4 214.4 (±829.0) pg/mL vs. 1 563.7 (±284.8) pg/mL, p=0.004]. Leptin levels acutely changed in the last training session. ST produced acute and chronic changes in plasma adipokines.

Dose-response effects of exercise and caloric restriction on visceral adiposity in overweight and obese adults: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To determine and compare the dose-response effects of exercise and caloric restriction on visceral adipose tissue in overweight and obese adults, while controlling for the weekly energy deficit induced by the interventions.

METHODS

PubMed, Embase, CINAHL and Web of Science were searched for randomised controlled trials comparing exercise or caloric restriction against eucaloric controls in overweight or obese adults. The primary outcome was the change in visceral fat measured by CT or MRI. Meta-analyses and meta-regressions were performed to determine the overall effect size (ES) and the dose-dependent relationship of exercise and caloric restriction on visceral fat. Heterogeneity, risk of bias and the certainty of evidence were also assessed.

RESULTS

Forty randomised controlled trials involving 2190 participants were included. Overall, exercise (ES -0.28 (-0.37 to -0.19); p<0.001; I2=25%) and caloric restriction (ES -0.53 (-0.71 to -0.35); p<0.001; I2=33%) reduced visceral fat compared with the controls. Exercise demonstrated a dose-response effect of -0.15 ((-0.23 to -0.07); p<0.001) per 1000 calories deficit per week, whereas the effect of caloric restriction was not dose-dependent (ES 0.03 (-0.12 to 0.18); p=0.64). Most of the studies showed a moderate risk of bias.

CONCLUSIONS

These findings support the dose-dependent effects of exercise to reduce visceral fat in overweight and obese adults. Caloric restriction did not demonstrate a dose-response relationship, although this may be attributed to the smaller number of studies available for analysis, compared with exercise studies.

PROSPERO REGISTRATION NUMBER

CRD42020210096.

Long-term effects of different exercise training modes on cytokines and adipokines in individuals with overweight/obesity and cardiometabolic diseases: A systematic review, meta-analysis, and meta-regression of randomized controlled trials

The present study aimed to investigate the evidence on the effects of different long-term training interventions (aerobic [AeT], resistance [RT], and combined [COMB]) and spontaneous physical activity (PA) in modifying cytokines and adipokines in individuals with overweight or obesity with or without cardiometabolic diseases while considering potential confounders. Although exercise interventions have become a potentially effective tool for preventing and treating metabolic diseases, the evidence provided by previous systematic reviews is inconclusive since several potential confounders have yet to be addressed. Therefore, we conducted a systematic literature search in Medline, Cochrane, and Embase databases from January 2000 to July 2022 and performed a meta-analysis. Inclusion criteria retrieved 106 full texts comprising 8,642 individuals with a range BMI of 25.1-43.8 kg m^-2 . We found that independently of the training mode, exercise had a beneficial effect on diminishing Adiponectin, C-reactive protein (CRP), IL-6, IL-18, IL-20, Leptin, sICAM, and TNF-α levels circulating levels. Furthermore, by subsequent analysis, we detected differential effects of AeT, RT, and COMB, with sex, age, body composition, and trial length acting as moderators. The comparison of training modes revealed a difference favoring COMB over AeT for regulating the increase in CRP with no differences in the remaining biomarkers. Meta-regression analysis revealed an effect of change in maximal oxygen uptake (VO_2max ) on CRP, IL-6, and TNF-α, while IL-10 was influenced by the change in body fat. The results suggest that all interventions, except PA, are effective in lessening this population's inflammatory status, provided that exercise results in an increase of VO_2max .

Effects of Exercise Training on Inflammatory and Cardiometabolic Risk Biomarkers in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

The interaction between type 2 diabetes mellitus (T2DM) and cardiometabolic morbidity and mortality stems from the progressive nature of inflammation underpinning both diseases. Exercise training is considered an effective treatment strategy for T2DM and cardiometabolic diseases.

OBJECTIVE

The current systematic review and meta-analysis investigated the effects of exercise training on inflammatory and cardiometabolic risk biomarkers in patients with T2DM.

DATA SOURCES

Electronic databases (PubMed/Medline, Embase, Cochrane Library, CINAHL, Google Scholar, Scopus, and Web of Science) were searched for randomized controlled trials (RCTs) from inception to January 2022. We used random effects models to estimate weighted mean differences with 95% confidence intervals.

STUDY SELECTION

Twenty-five RCTs were included (N = 1257 participants; mean age = 52 years). Included studies had moderate to good overall methodological quality (TESTEX = 9 (range 7-13).

RESULTS

Meta-analysis indicated that exercise training significantly increased adiponectin and decreased fasting insulin, homeostatic model assessment for insulin resistance, tumor necrosis factor-α, interleukin-6, and C-reactive protein (ps ≤ 0.05). Subgroup analysis by type of training indicated that aerobic exercise had the most consistent beneficial effects as compared to other types of exercise training; however, there was high heterogeneity among studies.

CONCLUSION

Different types of exercise training increase adiponectin levels and decrease pro-inflammatory cytokines such as TNF-α, IL-6, and CRP, as well as fasting insulin and insulin resistance markers in patients with T2DM. However, these effects were not beneficial for more commonly measured cardiometabolic risk factors (i.e., lipid profiles). Additional relevant clinical trials are required to confirm these results.

TRIAL REGISTRATION

This systematic review and meta-analysis was prospectively registered in the PROSPERO database (CRD42022307396).

The impact of exercise and dietary interventions on circulating leptin and adiponectin in individuals who are overweight and those with obesity: A systematic review and meta-analysis

The effects of exercise training (Ex), dietary interventions (DIs), and a combination of Ex and DI (Ex + DI) on leptin and adiponectin have been established. However, less is known regarding the comparisons of Ex with DI and of Ex + DI with either Ex or DI alone. The aim of the present meta-analysis is to compare the effects of Ex with those of DI and those of Ex + DI with those of either Ex or DI alone on circulating leptin and adiponectin in individuals who are overweight and those with obesity. PubMed, Web of Science, and MEDLINE were searched to identify original articles, published through June 2022, that compared the effects of Ex with those of DI and/or the effects of Ex + DI with those of Ex and/or DI on leptin and adiponectin in individuals with BMIs (in kg/m²) of ≥25 and aged 7-70 y. Standardized mean differences (SMDs), weighted mean differences, and 95% CIs were calculated using random-effect models for outcomes. Forty-seven studies, comprising 3872 participants who were overweight and those with obesity, were included in the current meta-analysis. DI reduced the concentration of leptin (SMD: -0.30; P = 0.001) and increased the concentration of adiponectin (SMD: 0.23; P = 0.001) compared with Ex, as did Ex + DI (leptin: SMD: -0.34; P = 0.001; adiponectin: SMD: 0.37; P = 0.004) compared with Ex alone. However, Ex + DI did not affect the concentration of adiponectin (SMD: 0.10; P = 0.11) and led to inconsistent and nonsignificant changes in the concentration of leptin (SMD: -0.13; P = 0.06) compared with DI alone. Subgroup analyses showed that age, BMI, duration of intervention, type of supervision, quality of the study, and magnitude of energy restriction are sources of heterogeneity. Our results suggest that Ex alone was not as effective as DI or Ex + DI for decreasing leptin and increasing adiponectin in individuals with overweight and obesity. However, Ex + DI was not more effective than DI alone, suggesting that diet plays a critical role in beneficially altering the concentrations of leptin and adiponectin. This review was registered at PROSPERO as CRD42021283532.

Physical activity on cardiorespiratory fitness and cardiovascular risk in premenopausal and postmenopausal women: a systematic review of randomized controlled trials

IMPORTANCE

The apparent cardioprotective effects of endogenous estrogens to prevent cardiovascular disease in premenopausal women are reduced with the loss of estrogen post-menopause. Cardiorespiratory fitness and cardiovascular risk factors are closely related to physical activity levels.

OBJECTIVE

This study conducted a critical assessment of studies for health prevention that analyze the effects of physical activity programs on cardiorespiratory fitness and cardiovascular risk factors in women, comparing premenopausal and postmenopausal states, through a systematic review of randomized controlled trials.

EVIDENCE REVIEW

A computerized literature search was performed to include articles up until December 2021 in the following online databases: PubMed, Cochrane, Scopus, SportDiscus, and Web of Science. Regarding physical activity intervention, women of all ages were engaged. The PEDro scale and Oxford's evidence levels were used for the assessment of the risk of bias in the included articles.

FINDINGS

Fourteen scientific articles met the inclusion criteria. Great variability was found in physical activity variables. All the studies found an improvement in at least one variable. The risk of bias was high, with all the articles obtaining a low methodological quality, except two with high methodological quality. Only one article considered the differences in the menopausal state observing the effects of physical activity intervention and highlighting the importance of physical activity in both states.

CONCLUSIONS AND RELEVANCE

To strengthen the evidence for the benefits of physical activity programs in women and to observe the effects depending on their menopausal state, there is an ongoing need for more rigorous randomized controlled trials of appropriate length and dose, with individualized exercise intensity.

A comparison of the impact of exercise training with dietary intervention versus dietary intervention alone on insulin resistance and glucose regulation in individual with overweight or obesity: a systemic review and meta-analysis

PURPOSE

Obesity is associated with the development of insulin resistance (IR) and type 2 diabetes for which exercise training (Ex) and dietary interventions (DI) are effective interventions that can improve IR. We therefore performed a systematic meta-analysis to compare the effect of Ex + DI compared with DI on IR and glucose homeostasis.

METHODS

PubMed and Cochrane Library were conducted up to May 2021. Meta-analyses were conducted to compare the effect of Ex + DI compared with DI on fasting glucose and insulin, IR and body weight. Standardized mean differences (SMDs), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were computed using random or fixed effect models.

RESULTS

Fifty studies involving 2864 participants with overweight or obesity were included in the meta-analysis. Ex + DI caused a larger decrease in fasting glucose (p = 0.001, 62 trials) and IR (p = 0.01, 29 trials) when compared with DI alone. There was no significant evidence, however, for a greater effect of Ex + DI on fasting insulin (p = 0.07, 48 trials) and body weight (p = 0.12, 58 trials), compared with DI alone.

CONCLUSION

Our results suggest that a combination of Ex and DI may be more effective than DI alone at improving IR and fasting glucose in individuals with overweight and obesity.

The effects of exercise and low-calorie diets compared with low-calorie diets alone on health: a protocol for systematic reviews and meta-analyses of controlled clinical trials

BACKGROUND

Exercise and weight loss diets are two independent non-pharmaceutical strategies used to improve several aspects of body composition and health. We plan to systematically review controlled clinical trials investigating weight loss diets alone compared to weight loss diets in conjunction with exercise on energy intake, body weight, body composition, cardiometabolic risk factors, sex hormones, and mental health.

METHODS AND ANALYSIS

PubMed/MEDLINE, EMBASE, ISI (Web of Science), Scopus, and Google Scholar will be searched to retrieve potential controlled clinical trials investigating the effects of exercise in conjunction with weight loss diets compared with weight loss diets alone on energy intake, body weight and composition (fat mass, fat-free mass), anthropometrics (waist circumference), cardiometabolic markers, sex hormones [testosterone, estradiol, and sex hormone binding globulin (SHBG)], liver and kidney enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), uric acid, blood urea nitrogen (BUN), glomerular filtration rate (GFR), quality of life, and depression in adults. The weighted mean difference (WMD) and its corresponding 95% confidence intervals (CIs) will be derived using random effects model. Several subgroup analyses based on follow-up duration, the health status of the participants, the diet used for weight loss, the exercise protocol, participants' sex, and other possible variables will be conducted to explore possible sources of heterogeneity. Publication bias will be explored by inspecting funnel plots and by conducting asymmetry tests. Overall quality of the evidence will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.

DISCUSSION

We envisage that this systematic review and meta-analysis will provide valuable information regarding the effectiveness of adding exercise to weight loss diets. No primary data is going to be collected; therefore, ethical approval is not required. The resulting manuscripts will be disseminated in peer-reviewed journals and at international and national conferences.

SYSTEMATIC REVIEW REGISTRATION

The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO, Registration ID: CRD42020173434 ).

Effects of Chair-Based, Low-Load Elastic Band Resistance Training on Functional Fitness and Metabolic Biomarkers in Older Women

Strength training can improve myriad health parameters in elderly cohorts. Although potentially more appropriate for the elderly, low-load resistance training protocols have been less investigated. We aimed to examine the effects of 12 weeks of chair-based, low-load resistance training with elastic band (EBT) on functional fitness and metabolic biomarkers in older women. One hundred sixty-eight women were allocated randomly to an elastic band resistance training (EBT, n = 86, 75.7 ± 8.9 years, 71.3 ± 12.2 kg) or a control group (CON, n = 82, 74.5 ± 8.2years, 70.6 ± 12.0 kg). RT protocol consisted of periodized chair-based, low-load whole-body resistance exercises (2 sets, 12-15 repetitions, 40-60% of one repetition maximum-1RM) using an elastic band, twice weekly for 12 weeks. The resistance training program was generally designed to maintain internal load over time, provided with increasing intensity using various elastic bands (Thera-Band). Functional fitness (30-s Chair Stand,30-s Arm Curl, 2-min Step Test, Chair Sit-and-Reach, Back Scratch, 8-Foot Up-and-Go, Handgrip Strength) and metabolic markers (Fasting blood glucose, triglycerides, total cholesterol, high (HDL) and low (LDL) density lipoprotein) were measured before and after the training period. To detect pre/post intervention changes and between group- differences 2x2 repeated measures ANOVA was applied. Significant improvements over time for all fitness variables for EBT comparing to CON were obtained (F = 12.78, p < 0.05 for 30-s Chair Stand; F = 14.04, p < 0.05 for 30-s Arm Curl; F = 5.18, p < 0.05 for 2-min Step Test; F = 10.90, p < 0.05 for Chair Sit-and-Reach; F = 16.57, p < 0.05 for Back Scratch; F = 11.79, p < 0.05 for 8-foot Up-and-Go; and F = 29.25, p < 0.05 for Handgrip Strength). In addition, significant improvements over time for all but one (triglycerides) biomarkers for EBT comparing to CON were obtained (F = 7.30, p < 0.05 for blood sugar levels; F = 13.36, p < 0.05 for total cholesterol; F = 8.61, p < 0.05 for HDL; and F = 11.53, p < 0.05 for LDL). Furthermore, the participants' adherence to training sessions of over 90% was reported. In conclusion, 12 weeks of EBT is safe and beneficial for improving health-related fitness and metabolic biomarkers in older women and seems to be viable model to ensure a high training adherence rate.

Resistance training decreases plasma levels of adipokines in postmenopausal women

Physical inactivity and the onset of menopause increase the risk of cardiovascular disease amongst postmenopausal women. We aim to investigate the effect of resistance training (RT) on plasma levels of selected cytokines, adipokines, myokines, and sex hormones in postmenopausal women with vasomotor symptoms. This was a sub-study of a randomised controlled trial investigating the effects of RT on vasomotor symptoms in postmenopausal women. Women were randomised to join a 15-week RT program (n = 26) or remain sedentary as control (n = 29). Venous blood samples were taken at week-0 and week-15 for all participants. Enzyme-linked immunosorbent assays and multiple bead assays were used to measure cytokines, adipokines, myokines, and sex hormones in plasma. Plasma measurements of 16 of 33 analytes were within detectable limits. After adjusting for good compliance in the RT group (58% of RT participants), after 15 weeks, significantly lower plasma levels of adiponectin (p < 0.001), lipocalin-2 (p < 0.01) and resistin (p = 0.04) were found. Comparing control and RT women, using change-over-time values, significant increases in median testosterone and sex hormone binding globulin levels were seen in RT women. RT intervention lowers the levels of adipokines, particularly adiponectin, in postmenopausal women with vasomotor symptoms. These results were secondary outcomes of a clinical trial, and further investigations in a larger cohort are essential with the additional control of diet control and body composition analyses. Nevertheless, our study shows RT may be a beneficial intervention in reducing inflammation amongst postmenopausal women.

Changes in Lipoinflammation Markers in People with Obesity after a Concurrent Training Program: A Comparison between Men and Women

Obesity is related to low-grade systemic inflammation. This state of inflammation is characterized by the alteration in adipokine regulation, which may lead to a situation of cardiometabolic risk. The aim of this study was to evaluate the effects of a concurrent training program on markers of lipoinflammation in adult people with obesity, comparing the response to the training between men and women. A quasi-experimental, quantitative, and longitudinal study with a pre–post intervention was conducted. An 8-week concurrent training program was carried out, in which 26 individuals with obesity participated (mean ± SD; age = 46.38 ± 4.66) (BMI = 36.05 ± 4.99) (12 men and 14 women). Before and after the intervention period, blood samples were taken by percutaneous puncture. The blood levels of adiponectin and leptin were evaluated. Significant differences were obtained in the adiponectin–leptin ratio (A/L ratio) of the entire sample (p = 0.009, ES = 0.53), which indicates a decrease in the risk of cardiovascular diseases and lipoinflammation. There were no significant differences in the improvements observed after the training in A/L ratio between women (A/L change = +63.5%) and men (A/L change= +59.2%). It can be concluded that the combination of aerobic exercise and resistance training induced an improvement in markers of lipoinflammation and cardiometabolic risk in the individuals with obesity evaluated in this study.

The Effect of Aerobic and Resistance Training and Combined Exercise Modalities on Subcutaneous Abdominal Fat: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Subcutaneous abdominal adipose tissue (SAT), is the largest fat depot and major provider of free fatty acids to the liver. Abdominal fat is indirectly (via increased levels of low-grade inflammation) correlated with many of the adverse health effects of obesity. Although exercise is one of the most prominent components of obesity management, its effects on SAT are still unclear. The aim of this study was to investigate the independent effects of aerobic training (AT) and resistance training (RT) modalities and combined exercise modalities on SAT in adults. PubMed, SCOPUS, and Google Scholar were searched to find relevant publications up to November 2018. The effect sizes were represented as weighted mean difference (WMD) and 95% CIs. Between-study heterogeneity was examined using the I2 test. Overall, 43 identified trials that enrolled 3552 subjects (2684 women) were included. After removal of outliers, combining effect sizes indicated a significant effect of AT (WMD: -13.05 cm2; 95% CI: -18.52, -7.57; P < 0.001), RT (WMD: -5.39 cm2; 95% CI: -9.66, -1.12; P = 0.01), and combined exercise training (CExT; WMD: -28.82 cm2; 95% CI: -30.83, -26.81; P < 0.001) on SAT relative to control groups. Pooled effect sizes demonstrated a significant effect of AT on SAT compared with a CExT group (WMD: 11.07 cm2; 95% CI: 1.81, 20.33; P = 0.01). However, when comparing the AT and RT groups, no significant difference was seen in SAT (WMD: -0.73 cm2; 95% CI: -4.50, 3.04; P = 0.70). Meta-analysis of relevant trials indicated that AT, RT, and CExT lead to SAT reduction. Aerobic exercise was shown to produce greater efficacy in decreasing SAT.

Effects of Exercise on the Body Composition and Lipid Profile of Individuals with Obesity: A Systematic Review and Meta-Analysis

Background

Numerous researchers have worked to develop treatments for obesity; however, the prevalence of obesity continues to increase in many countries. Moreover, the effects of physical activity and exercise on obesity remain unclear. Therefore, it is necessary to perform a systematic review and meta-analysis to assess the relationship between exercise and obesity using mediator variables such as the mode of exercise.

Methods

Our review focuses on research tracking the effects of exercise on obesity conducted from 2007 to 2016 and available in any of three databases: Embase, PubMed, and EBSCO Academic Search Premier. The keywords used in the search were “exercise and obesity” and “exercise and obese.”

Results

The average size of the effects that exercise interventions have on body mass index (standardized mean difference [SMD], 0.533), waist circumference (SMD, 0.666), total cholesterol (SMD, 0.721), and triglyceride (TG; SMD, 0.603) were medium or larger. Exercise had greater effects on the outward appearance of obesity (body mass index, waist circumference) than on its practical factors (weight, % body fat). The effect of exercise on TG (SMD, 0.603) was larger than that on low-density lipoprotein (SMD, 0.406) and high-density lipoprotein (SMD, −0.222). Exercise duration (weeks of exercise) and intensity correlate better than exercise time (minutes per week) with a large and consistent improvement in adult obesity.

Conclusion

We suggest that individuals with obesity should exercise consistently to achieve significant improvements in their health.

Strength Training Improves Metabolic Health Markers in Older Individual Regardless of Training Frequency

The main purpose of the present study was to investigate the effect of frequency, thereby increasing training volume, of resistance training on body composition, inflammation markers, lipid and glycemic profile in healthy older individuals (age range 65–75 year). Ninety-two healthy participants were randomly assigned to one of four groups; performing strength training one- (EX1), two- (EX2), or three- (EX3) times-per-week and a non-training control (CON) group. Whole-body strength training was performed using 2–5 sets and 4–12 repetitions per exercise and 7–9 exercises per session. All training groups attended supervised resistance training for 6 months. Body composition was measured by dual X-ray absorptiometry and fasting blood samples were taken pre- and post-training. There were significant main effects of time for total fat mass (F = 28.12, P < 0.001) and abdominal fat mass (F = 20.72, P < 0.001). Pre- to post-study, statistically significant reductions in fat mass (Δ = -1.3 ± 1.4 kg, P < 0.001, n = 26) were observed in EX3. Pre- to post-study reductions in low density lipoprotein (LDL) concentration (Δ = -0.38 ± 0.44 mmol⋅L^-1, P = 0.003, n = 19) were observed only in EX3, whereas a significant pre- to post-study increases in high density lipoprotein (HDL) concentration (0.14–0.19 mmol⋅L^-1) were observed in all training groups. Most variables at baseline demonstrated a significant (negative) relationship when correlating baseline values with their change during the study including: Interleukin-6 (IL-6) (r = -0.583, P < 0.001), high-sensitivity c-reactive protein (hs-CRP) (r = -0.471, P < 0.001, and systolic blood pressure (r = -0.402, P = 0.003). The present study suggests that having more than two resistance training sessions in a week could be of benefit in the management of body composition and lipid profile. Nevertheless, interestingly, and importantly, those individuals with a higher baseline in systolic blood pressure, IL-6 and hs-CRP derived greatest benefit from the resistance training intervention, regardless of how many times-a-week they trained. Finally, the present study found no evidence that higher training frequency would induce greater benefit regarding inflammation markers or glycemic profile in healthy older adults.

May the force be with you: why resistance training is essential for subjects with type 2 diabetes mellitus without complications

Physical activity, together with diet and pharmacological therapy, represents one of the three cornerstones in type 2 diabetes mellitus treatment and care. The therapeutic appeal of regular physical activity stems from: (i) its non-pharmacological nature; (ii) its beneficial effects on the metabolic risk factors associated with diabetes complications; (iii) its low costs. Evidence accumulated in the last years suggests that aerobic training-endurance training-constitutes a safe modality of intervention, achievable, and effective in diabetes treatment, whenever it is not limited by comorbidities. Aerobic training exerts insulin-mimetic effects and has been shown to lower mortality risk too. Anaerobic, intense physical activity, such as that of strength or power sports disciplines, is not univocally recognized as safe and simple to realize, however, it is important in stimulating energy and glucose metabolism. According to recent evidence, high-intensity training may be prescribed even in the face of cardiovascular diseases, peripheral vascular disease, or osteoarthritis. Some studies have shown resistance training to be more efficient than aerobic exercise in improving glycemic control. This review explores the most up-to-date indications emerging from literature in support of the beneficial effects of strength stimulation and resistance training in patients with type 2 diabetes without complications.

The impact of duration on effectiveness of exercise, the implication for periodization of training and goal setting for individuals who are overfat, a meta-analysis

Given the assumption that all methods of exercise, e.g., endurance (ET), resistance (RT), or combination of both (E+R), can induce a beneficial effect size (ES) for changes in body composition and health status of individuals who are overfat. Thus the aim and purpose of this study is to evaluate the current body of knowledge to address the question as to the impact that the duration of exercise has on its relative effectiveness for inducing health and body compositional changes in individuals who are overfat to assist with developing periodized exercise protocols and establishing short and long term goals. A tiered meta-analysis of 92-studies and 200-exercise groupings were used for establishing pooled ES within and between groupings based on the increments of 4-week of duration and study designs of ≤8, 9-16, 17-23, 24-36, and ≥36 weeks. Analysis based on random-effect of response indicates a continuum of effectiveness within and between ET, RT and E+R based on duration. Where beneficial effectiveness is not indicated for any measures until after 8-weeks of continuous training with progressive effectiveness being noted in changes to cardiorespiratory fitness, inflammatory cytokines, and alteration of metabolic status from 12-weeks through 32-weeks of continuous training. Results indicate a greater ES for RT and E+R versus ET early in intervention that equalizes with longer durations. Supporting the use of RT and E+R within a periodized program. And secondarily, goals should be established first on performance gains and second body composition or health status modifications for the individual who is overfat.

A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue

Exercise training ('exercise') and hypocaloric diet ('diet') are frequently prescribed for weight loss in obesity. Whilst body weight changes are commonly used to evaluate lifestyle interventions, visceral adiposity (VAT) is a more relevant and stronger predictor for morbidity and mortality. A meta-analysis was performed to assess the effects of exercise or diet on VAT (quantified by radiographic imaging). Relevant databases were searched through May 2014. One hundred seventeen studies (n = 4,815) were included. We found that both exercise and diet cause VAT loss (P < 0.0001). When comparing diet versus training, diet caused a larger weight loss (P = 0.04). In contrast, a trend was observed towards a larger VAT decrease in exercise (P = 0.08). Changes in weight and VAT showed a strong correlation after diet (R(2)  = 0.737, P < 0.001), and a modest correlation after exercise (R(2)  = 0.451, P < 0.001). In the absence of weight loss, exercise is related to 6.1% decrease in VAT, whilst diet showed virtually no change (1.1%). In conclusion, both exercise and diet reduce VAT. Despite a larger effect of diet on total body weight loss, exercise tends to have superior effects in reducing VAT. Finally, total body weight loss does not necessarily reflect changes in VAT and may represent a poor marker when evaluating benefits of lifestyle-interventions.

Promotion of healthy nutrition in clinical practice: A cross-sectional survey of practices and barriers among physiotherapists in southeast Nigeria

Background:

Healthy diet counselling is an important concept in health promotion. Physiotherapists are well positioned to initiate or support healthy nutrition in addition to physical activity counselling, in routine patient consultation.

Objective:

To determine the practices about and barriers to diet counselling practices among physiotherapists in Southeast Nigeria.

Methods:

In this cross-sectional survey, a total of 140 questionnaires were distributed among physiotherapists.

Results:

Overall, 103 physiotherapists responded. Physiotherapists are confident and consider the incorporation of dietary counselling very important and of high priority in their daily clinical work. They, however, assessed and counselled on dietary status opportunistically in patients. Notwithstanding, physiotherapists believed that the diet counselling they give could be effective in helping patients change their unhealthy dieting practices. Patients were also amenable to physiotherapists advocating on diet issues as part of their consultation. Several barriers to incorporating diet counselling into physiotherapy practice were identified, including lack of access to a dietician/health promotion staff/counsellors, lack of proper patient education materials, lack of expertise in relation to dietary risk factors’ assessment and management, and uncertainty about what dietary services to provide.

Conclusion:

Although physiotherapists consider it important to incorporate diet counselling in their daily clinical practice, development and implementation of strategies to improve physiotherapists’ diet counselling knowledge, competence, skills, and practice are warranted.

High Intensity Interval- vs Resistance or Combined- Training for Improving Cardiometabolic Health in Overweight Adults (Cardiometabolic HIIT-RT Study): study protocol for a randomised controlled trial

BACKGROUND

Although evidence shows the positive health effects of physical activity, most of the adult population in Colombia are sedentary. It is, therefore, important to implement strategies that generate changes in lifestyle behaviours. This protocol describes a study in which we will compare the effects of 12 weeks of high-intensity interval training (HIIT), resistance training (RT) or combined training (HIIT + RT) on the improvement of body composition, endothelial function, blood pressure, blood lipids, and cardiorespiratory fitness in a cohort of sedentary, overweight adults (aged 30-50 years).

METHODS/DESIGN

Sixty sedentary, overweight adults attending primary care in Bogotá, Colombia will be included in a factorial randomised controlled trial. Participants will be randomly assigned to the following intervention groups: (1) non-exercise group: usual care with dietary support, (2) HIIT group: 4 × 4-min intervals at 85-95 % maximum heart rate (HRmax) (with the target zone maintained for at least 2 minutes), interspersed with a 4-min recovery period, at 65 % HRmax, (3) RT group: completing a resistance circuit (including upper and lower muscle groups) as many times as needed according to subject's weight until an expenditure of 500 kcal at 40-80 % of one-rep max (1RM) has been achieved, and (4) combined group: HIIT + RT. The primary end point for effectiveness is vascular function as measured by flow-mediated vasodilatation 1 week after the end of exercise training.

DISCUSSION

The results of this study will provide new information about the possible effect of the programme in improving the cardiometabolic health of overweight adults, making a more efficient use of an adult's resources over time.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02715063 . Registered on 8 March 2016.

Role of physical activity in the management and assessment of rheumatoid arthritis patients

OBJECTIVES

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients.

METHODS

A literature search of EMBASE and MEDLINE databases from January 2000 to January 2015.

RESULTS

The evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry.

CONCLUSIONS

The regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.

Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18-65 years old) who are overfat, or obese; systematic review and meta-analysis

There are number of means of methods to alter body composition, and metabolic issues, available for the adult who is overfat. The following is a systematic review and meta-analysis focused on comparing changes from treatment program for adults who are overfat based on analysis of aggregated effect size (ES) of inducing changes. So as to determine the relative effectiveness of such protocols and intervention plans of choice. This tiered meta-analysis of 66-population based studies, and 162-studywise groups, a clear pattern of ES being established across and within treatments. First, hypocaloric balance is necessary for changing body composition, but the effectiveness for establishing imbalance does not equate with the effectiveness for body compositional changes, or any biomarkers associated with metabolic issues. With analysis showing that there is a necessity to include exercise in combination with diet effectively elicit changes in body composition and biomarkers of metabolic issues. More importantly, the combination, resistance training (RT) was more effective than endurance training (ET) or combination of RT and ET, particularly when progressive training volume of 2-to-3 sets for 6-to-10 reps at an intensity of ≥75% 1RM, utilizing whole body and free-weight exercises, at altering body compositional measures (ES of 0.47, 0.30, and 0.40 for loss of BM, FM, and retention of FFM respectively) and reducing total cholesterol (ES = 0.85), triglycerides (ES = 0.86) and low-density lipoproteins (ES = 0.60). Additionally RT was more effective at reducing fasting insulin levels (ES = 3.5) than ET or ET and RT. Even though generally lower ES than RT, the inclusion of ET was more effective when performed at high intensity (e.g. ≥70% VO2max or HRmax for 30-minutes 3-4x's/wk), or in an interval training style than when utilizing the relatively common prescribed method of low-to-moderate (e.g., 50-70% VO2max or HRmax for at least equal time) steady state method, ES of 0.35, 0.39, and 0.13 for BM, FM, and FFM respectively. Thus indicating that focus of treatment should be on producing a large metabolic stress (as induced by RT or high levels of ET) rather than an energetic imbalance for adults who are overfat.

Weight training, aerobic physical activities, and long-term waist circumference change in men

OBJECTIVE

Findings on weight training and waist circumference (WC) change are controversial. This study examined prospectively whether weight training, moderate to vigorous aerobic activity (MVAA), and replacement of one activity for another were associated with favorable changes in WC and body weight (BW).

METHODS

Physical activity, WC, and BW were reported in 1996 and 2008 in a cohort of 10,500 healthy U.S. men in the Health Professionals Follow-up Study. Multiple linear regression models (partition/substitution) to assess these associations were used.

RESULTS

After adjusting for potential confounders, a significant inverse dose-response relationship between weight training and WC change (P-trend <0.001) was observed. Less age-associated WC increase was seen with a 20-min/day activity increase; this benefit was significantly stronger for weight training (-0.67 cm, 95% CI -0.93, -0.41) than for MVAA (-0.33 cm, 95% CI -0.40, -0.27), other activities (-0.16 cm, 95% CI -0.28, -0.03), or TV watching (0.08 cm, 95% CI 0.05, 0.12). Substituting 20 min/day of weight training for any other discretionary activity had the strongest inverse association with WC change. MVAA had the strongest inverse association with BW change (-0.23 kg, 95% CI -0.29, -0.17).

CONCLUSIONS

Among various activities, weight training had the strongest association with less WC increase. Studies on frequency/volume of weight training and WC change are warranted.

Effects of diet and exercise interventions on diabetes risk factors in adults without diabetes: meta-analyses of controlled trials

BACKGROUND AND AIMS

Fasting insulin (FI), fasting glucose (FG), systolic blood pressure (SBP), high density lipoproteins (HDL), triacylglycerides (TAG), and body mass index (BMI) are well-known risk factors for type 2 diabetes. Reliable estimates of lifestyle intervention effects on these factors allow diabetes risk to be predicted accurately. The present meta-analyses were conducted to quantitatively summarize effects of diet and exercise intervention programs on FI, FG, SBP, HDL, TAG and BMI in adults without diabetes.

MATERIALS AND METHODS

MEDLINE and EMBASE were searched to find studies involving diet plus exercise interventions. Studies were required to use adults not diagnosed with type 2 diabetes, involve both dietary and exercise counseling, and include changes in diabetes risk factors as outcome measures. Data from 18, 24, 23, 30, 29 and 29 studies were used for the analyses of FI, FG, SBP, HDL, TAG and BMI, respectively. About 60% of the studies included exclusively overweight or obese adults. Mean age and BMI of participants at baseline were 48 years and 30.1 kg/m(2). Heterogeneity of intervention effects was first estimated using random-effect models and explained further with mixed-effects models.

RESULTS

Adults receiving diet and exercise education for approximately one year experienced significant (P <0.001) reductions in FI (-2.56 ± 0.58 mU/L), FG (-0.18 ± 0.04 mmol/L), SBP (-2.77 ± 0.56 mm Hg), TAG (-0.258 ± 0.037 mmol/L) and BMI (-1.61 ± 0.13 kg/m(2)). These risk factor changes were related to a mean calorie intake reduction of 273 kcal/d, a mean total fat intake reduction of 6.3%, and 40 minutes of moderate intensity aerobic exercise four times a week. Lifestyle intervention did not have an impact on HDL. More than 99% of total variability in the intervention effects was due to heterogeneity. Variability in calorie and fat intake restrictions, exercise type and duration, length of the intervention period, and the presence or absence of glucose, insulin, or lipid abnormalities explained 23-63% of the heterogeneity.

CONCLUSIONS

Calorie and total fat intake restrictions coupled with moderate intensity aerobic exercises significantly improved diabetes risk factors in healthy normoglycemic adults although normoglycemic adults with glucose, insulin, and lipid abnormalities appear to benefit more.

Randomized controlled trial to evaluate the effects of combined progressive exercise on metabolic syndrome in breast cancer survivors: rationale, design, and methods

Background

Metabolic syndrome (MetS) is increasingly present in breast cancer survivors, possibly worsened by cancer-related treatments, such as chemotherapy. MetS greatly increases risk of cardiovascular disease and diabetes, co-morbidities that could impair the survivorship experience, and possibly lead to cancer recurrence. Exercise has been shown to positively influence quality of life (QOL), physical function, muscular strength and endurance, reduce fatigue, and improve emotional well-being; however, the impact on MetS components (visceral adiposity, hyperglycemia, low serum high-density lipoprotein cholesterol, hypertriglyceridemia, and hypertension) remains largely unknown. In this trial, we aim to assess the effects of combined (aerobic and resistance) exercise on components of MetS, as well as on physical fitness and QOL, in breast cancer survivors soon after completing cancer-related treatments.

Methods/Design

This study is a prospective randomized controlled trial (RCT) investigating the effects of a 16-week supervised progressive aerobic and resistance exercise training intervention on MetS in 100 breast cancer survivors. Main inclusion criteria are histologically-confirmed breast cancer stage I-III, completion of chemotherapy and/or radiation within 6 months prior to initiation of the study, sedentary, and free from musculoskeletal disorders. The primary endpoint is MetS; secondary endpoints include: muscle strength, shoulder function, cardiorespiratory fitness, body composition, bone mineral density, and QOL. Participants randomized to the Exercise group participate in 3 supervised weekly exercise sessions for 16 weeks. Participants randomized to the Control group are offered the same intervention after the 16-week period of observation.

Discussion

This is the one of few RCTs examining the effects of exercise on MetS in breast cancer survivors. Results will contribute a better understanding of metabolic disease-related effects of resistance and aerobic exercise training and inform intervention programs that will optimally improve physiological and psychosocial health during cancer survivorship, and that are ultimately aimed at improving prognosis.

Trial registration

NCT01140282; Registration: June 10, 2010

Short term resistance training enhanced plasma apoA-I and FABP4 levels in Streptozotocin-induced diabetic rats

BACKGROUND

Type 1 diabetes mellitus is associated with a high risk for early atherosclerotic complications. Altered lipids and lipoprotein metabolism in chronic diabetes mellitus is associated with pathogenesis of atherosclerosis and other cardiovascular diseases. The aim of this study was to investigate the effects of 4 weeks resistance training on plasma lipid profile, fatty acid binding protein (FABP) 4 and apolipoprotein (apo) A-I levels in type 1 diabetic rats.

METHODS

Thirty two male Wister rats (12-14 weeks old) were randomly divided into four groups: non-diabetic control; non-diabetic trained; diabetic control; diabetic trained. The rats in training groups were subjected to a resistance training program (3 days/wk, for 4 wk) consisted of climbing a ladder carrying a load suspended from the tail.

RESULTS

Diabetic inducing increased plasma apoA-I and decreased FABP4 levels compared with non-diabetic control group (respectively, P = 0.001 & P = 0.041). After 4 weeks' resistance training, plasma levels of apoA-I and FABP4 in the diabetic trained rats were significantly higher compared with the diabetic control group (respectively, P = 0.003 & P = 0.017). Plasma HDL-C level in diabetic trained group was higher than diabetic control group (P = 0.048). Liver triglycerides concentrations were significantly lower in both trained (non-diabetic and diabetic) groups compared with their control groups (respectively, P = 0.041 and P = 0.002).

CONCLUSION

These data indicated that resistance training may be an efficient intervention strategy to increase plasma apoA-I, HDL-C and FABP4 concentrations, along with decreases liver triglycerides in streptozotocin induced diabetic rats. Further research is needed to elucidate physiological significance of circulating FABP4 levels.

Lift weights to fight overweight

Although resistance training (RT) has long been accepted as a means for developing and maintaining muscular strength, endurance, power and muscle mass, its beneficial relationship with health factors and chronic disease has only recently been recognized in the scientific literature. Prior to 1990, resistance training was not a part of the recommended guidelines for exercise training and rehabilitation for either the American Heart Association or the American College of Sports Medicine (ACSM). In 1990, the ACSM recognized resistance training as a significant component of a comprehensive fitness programme for healthy adults of all ages, a position subsequently confirmed few years after. At present, even though interest in clinical applications of RT is increasing, there are still some concerns, among physicians, about the use of this exercise methodology in weight control programmes. This review aims to explore the metabolic effects of RT and its efficacy and feasibility in overweight subjects.

Resistance training for diabetes prevention and therapy: experimental findings and molecular mechanisms

Type 2 diabetes mellitus (T2D) is characterized by insulin resistance, impaired glycogen synthesis, lipid accumulation, and impaired mitochondrial function. Exercise training has received increasing recognition as a cornerstone in the prevention and treatment of T2D. Emerging research suggests that resistance training (RT) has the power to combat metabolic dysfunction in patients with T2D and seems to be an effective measure to improve overall metabolic health and reduce metabolic risk factors in diabetic patients. However, there is limited mechanistic insight into how these adaptations occur. This review provides an overview of the intervention data on the impact of RT on glucose metabolism. In addition, the molecular mechanisms that lead to adaptation in skeletal muscle in response to RT and that are associated with possible beneficial metabolic responses are discussed. Some of the beneficial adaptations exerted by RT include increased GLUT4 translocation in skeletal muscle, increased insulin sensitivity and hence restored metabolic flexibility. Increased energy expenditure and excess postexercise oxygen consumption in response to RT may be other beneficial effects. RT is increasingly establishing itself as an effective measure to improve overall metabolic health and reduce metabolic risk factors in diabetic patients.

Whole-body cryostimulation as an effective method of reducing low-grade inflammation in obese men

This study was aimed to evaluate anti-inflammatory effect of the whole body cryostimulation in obese men. Fourteen subjects (BMI >30 kg m⁻²), divided into two subgroups according to cardiorespiratory fitness: higher (HCF) or lower (LCF), have been exposed to 10 sessions in a cryogenic chamber (−110 °C). Blood samples were collected before, 30 min and 24 h after the first, fifth and last cryostimulation. Coldness exposures affected blood cytokine profile; however, the response depended on subjects’ fitness capacity. Concentrations of pro-inflammatory cytokines in the LCF decreased by 19, 6.8, and 7.4 % in IL-6, resistin, and visfatin, respectively. TNFα in the LCF dropped 4.3-fold compared to baseline, while in the HCF, changes were smaller, yet significant. Anti-inflammatory cytokine IL-10 increased in both groups. No changes in adiponectin and leptin were observed in either group. Obtained results suggest that whole body cryostimulation can be a supplementary method for obese in reducing systemic inflammation.

The role of exercise in the treatment of obesity

The United States is in the midst of a significant public health problem that relates to obesity and inactivity. This epidemic has far-ranging consequences for our workforce and our children and shows no signs of slowing in the near future. Significant research has been performed on the effects of exercise for the reduction of body weight; results of most studies indicate that exercise alone has a small effect on body-weight reduction independent of caloric restriction. However, when combined with dietary restriction, exercise has a synergistic effect and enhances weight loss beyond the effect of diet alone. In addition, exercise has been shown to have significant beneficial effects on cardiovascular and metabolic risk factors independent of actual weight loss, and losing just a small amount of weight can have a significant beneficial effect on these parameters. Genetic factors related to obesity have been found to be positively modified when persons incorporate physical activity into their lifestyle. Sitting time appears to be an independent risk factor for the development of metabolic risk factors; persons who spend more time sitting and watching television have worse metabolic profiles, even if they achieve the recommended amount of physical activity per week, than do those who move about throughout the day. Exercise also is essential for the prevention of weight gain over a life span, although the amount required to prevent weight gain may be closer to twice the amount of exercise recommended by the current Physical Activity Guidelines for Americans (www.health.gov/paguidelines). In many ways, the physiatrist is the most well prepared of all the specialists to address the complex, multidimensional problems of obesity and inactivity.

Weight-loss diet alone or combined with progressive resistance training induces changes in association between the cardiometabolic risk profile and abdominal fat depots

BACKGROUND/AIMS

A weight-loss diet alone or combined with a progressive resistance training program induced different adaptations on cardiometabolic risk, i.e. regional changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volume distribution patterns. We hypothesized that a heterogeneous adipose tissue metabolism may exist between visceral fat at different discal levels.

METHODS

Thirty-four obese women, aged 40-60 years, were randomized to three groups: a control group (n = 9), a diet group (WL; n = 12) with a caloric restriction of 500 kcal/day during 16 weeks, or a diet-plus-resistance-training group (WL+RT; n = 13) with the same caloric restriction and a 16-week resistance training of 2 sessions per week.

RESULTS

The association pattern between abdominal fat depots and glucose metabolism variables showed a change from the L4-L5 region (preintervention) to VAT L2-L3 and SAT L2-L3 in the WL and WL+RT groups, respectively. It is noteworthy that accumulation of fat in the midthigh was not characterized by a more favorable lipid profile or glucose metabolism.

CONCLUSION

Our results reinforce the importance of considering L2-L3 images to predict insulin resistance after a weight-loss diet, alone or combined with resistance training.

Prognostic significance of adipocytokines in systolic heart failure patients

OBJECTIVES

The goal of this study was designed to assess prognostic values of simultaneous measurement of adipocytokines in systolic heart failure (HF) patients.

METHODS

Patients with HF manifestations and left ventricular ejection fraction (LVEF) ≤ 50% were selected in this study. Gender, age, medications and serum biochemical data were recorded upon admissions. Adipocytokines including adiponectin, leptin, resistin, visfatin and retinol binding protein-4 were measured.

RESULTS

A total of 108 (83 males and 25 females) patients were enroled. The age was 62±15 years and mean LVEF was 35%. Twenty patients died during 776±323 days follow-up. In univariate analysis, mortality was found to be associated with the log-transformed values of serum resistin (β=5·616, P=0·04), log-transformed values of serum adiponectin (β=4·377, P=0·038), age (β=1·071, P<0·001), NTHA functional status (β=3·752, P=0·001) and body mass index (β=0·858, P=0·012). Patients with higher level of serum resistin were associated with higher mortality (P=0·012). In multivariate analysis, mortality is associated with log-transformed values of serum resistin (β=3·666, P=0·045), age (β=1·044, P=0·017) and NTHA functional status (β=2·541, P=0·025).

CONCLUSIONS

Serum resistin level was associated with higher mortality in systolic HF patients even after adjusting clinical parameters. Resistin may be an informative risk marker for systolic HF patients.

Weight change in control group participants in behavioural weight loss interventions: a systematic review and meta-regression study

Background

Unanticipated control group improvements have been observed in intervention trials targeting various health behaviours. This phenomenon has not been studied in the context of behavioural weight loss intervention trials. The purpose of this study is to conduct a systematic review and meta-regression of behavioural weight loss interventions to quantify control group weight change, and relate the size of this effect to specific trial and sample characteristics.

Methods

Database searches identified reports of intervention trials meeting the inclusion criteria. Data on control group weight change and possible explanatory factors were abstracted and analysed descriptively and quantitatively.

Results

85 trials were reviewed and 72 were included in the meta-regression. While there was no change in control group weight, control groups receiving usual care lost 1 kg more than control groups that received no intervention, beyond measurement.

Conclusions

There are several possible explanations why control group changes occur in intervention trials targeting other behaviours, but not for weight loss. Control group participation may prevent weight gain, although more research is needed to confirm this hypothesis.

Melanocortin receptor expression is associated with reduced CRP in response to resistance training

The existing paradigm of exercise-induced decreases in chronic inflammation focuses on the expression of inflammatory receptors on systemic monocytes in response to exercise training, with the role of anti-inflammatory receptors largely ignored. Our recent preliminary studies indicate that the anti-inflammatory melanocortin receptors (MCRs) may play a role in modulating exercise-induced decreases in chronic inflammation. Here, we present a study designed to determine the effect of intense, resistance exercise training on systemic monocyte MCR expression. Because low-grade chronic inflammation is associated with elevated cardiometabolic risk in healthy populations and exercise decreases chronic inflammation, we investigated the associations between systemic monocyte cell surface expression of MCRs and inflammatory markers as a possible mechanism for the beneficial anti-inflammatory effects of resistance training. To this end, the present study includes 40 adults (aged 19-27 yr) and implements a 12-wk periodized, intensive resistance training intervention. Melanocortin 1 and 3 receptor expression on systemic monocytes and inflammatory markers, including C-reactive protein (CRP), interleukin (IL)-6, IL-1β, and IL-10, were measured before and after the intervention. Resistance training significantly altered MCR systemic monocyte cell surface expression, had no chronic effects on IL-6, IL-1β, or IL-10 expression, but significantly decreased CRP levels from a moderate to a low cardiovascular disease risk category. More specifically, decreased melanocortin 3 receptor expression significantly correlated with decreased CRP, independent of changes in adiposity. These data suggest that the observed responses in MCR expression and decreases in cardiovascular disease risk in response to resistance training represent an important anti-inflammatory mechanism in regulating exercise-induced decreases in chronic inflammation that occur independent of chronic changes in systemic cytokines.

Resistance training, visceral obesity and inflammatory response: a review of the evidence

Intra-abdominal obesity is an important risk factor for low-grade inflammation, which is associated with increased risk for diabetes mellitus and cardiovascular disease. For the most part, recommendations to treat or prevent overweight and obesity via physical activity have focused on aerobic endurance training as it is clear that aerobic training is associated with much greater energy expenditure during the exercise session than resistance training. However, due to the metabolic consequences of reduced muscle mass, it is understood that normal ageing and/or decreased physical activity may lead to a higher prevalence of metabolic disorders. Whether resistance training alters visceral fat and the levels of several pro-inflammatory cytokines produced in adipose tissue has not been addressed in earlier reviews. Because evidence suggests that resistance training may promote a negative energy balance and may change body fat distribution, it is possible that an increase in muscle mass after resistance training may be a key mediator leading to a better metabolic control. Considering the benefits of resistance training on visceral fat and inflammatory response, an important question is: how much resistance training is needed to confer such benefits? Therefore, the purpose of this review was to address the importance of resistance training on abdominal obesity, visceral fat and inflammatory response.

A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat

It is increasingly recognized that the location of excess adiposity, particularly increased deposition of visceral adipose tissue (VAT), is important when determining the adverse health effects of overweight and obesity. Exercise therapy is an integral component of obesity management, but the most potent exercise prescription for VAT benefit is unclear. We aimed to evaluate the independent and synergistic effects of aerobic exercise (AEx) and progressive resistance training (PRT) and to directly compare the efficacy of AEx and PRT for beneficial VAT modulation. A systematic review and meta-analysis was performed to assess the efficacy of exercise interventions on VAT content/volume in overweight and obese adults. Relevant databases were searched to November 2010. Included studies were randomized controlled designs in which AEx or PRT in isolation or combination were employed for 4 weeks or more in adult humans, where computed tomography (CT) or magnetic resonance imaging (MRI) was used for quantification of VAT pre- and post-intervention. Of the 12196 studies from the initial search, 35 were included. After removal of outliers, there was a significant pooled effect size (ES) for the comparison between AEx therapy and control (-0.33, 95% CI: -0.52 to -0.14; P < 0.01) but not for the comparison between PRT therapy and control (0.09, 95% CI: -0.17 to -0.36; P = 0.49). Of the available nine studies which directly compared AEx with PRT, the pooled ES did not reach statistical significance (ES = 0.23, 95% CI: -0.02 to 0.50; P = 0.07 favouring AEx). The pooled ES did not reach statistical significance for interventions that combined AEx and PRT therapy vs. control (-0.28, 95% CI: -0.69 to 0.14; P = 0.19), for which only seven studies were available. These data suggest that aerobic exercise is central for exercise programmes aimed at reducing VAT, and that aerobic exercise below current recommendations for overweight/obesity management may be sufficient for beneficial VAT modification. Further investigation is needed regarding the efficacy and feasibility of multi-modal training as a means of reducing VAT.

Efficacy of resistance exercises in rheumatoid arthritis: meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the efficacy of resistance exercises in RA patients.

METHODS

A systematic literature search was done using Pubmed, Embase and Cochrane databases through November 2009 and in abstracts presented at rheumatology scientific meetings over the past 3 years. Randomized controlled trials (RCTs) comparing resistance exercise based therapy with interventions without resistance exercise for the treatment of RA patients were included. Outcomes studied were post-intervention disability on the HAQ, functional capacity assessed by walking speed, pain on the visual analogue scale (VAS), joint count, isometric, isokinetic and grip strength. Efficacy was assessed by weighted mean differences (WMDs) and tolerance was assessed by relative risk (RR). Data were pooled using the inverse of variance model, and heterogeneity was tested.

RESULTS

Ten RCTs, including 547 patients, met the study inclusion criteria. The mean (S.D.) Jadad score was 2.3 (0.6). Resistance exercises significantly improved isokinetic strength (WMD = 23.7%, P < 0.001), isometric strength (WMD = 35.8%, P < 0.001), grip strength (WMD = 26.4%, P < 0.001) and HAQ (WMD = -0.22, P < 0.001). Exercise also had a positive impact on the 50-foot walking test (WMD = -1.90 s, P < 0.001) and ESR (WMD = -5.17, P = 0.005). Withdrawals [RR = 0.95, 95% confidence interval (CI) 0.61, 1.48] and adverse events (RR = 1.08, 95% CI 0.72, 1.63) were well balanced in both groups. Patient and exercise characteristics did not influence the results. Subgroup analysis revealed a trend towards higher efficacy associated with high-intensity programmes.

CONCLUSION

Resistance exercise in RA is safe, and the improvement in most outcomes was statistically significant and possibly clinically relevant for RA disability.

Effects of exercise on inflammation markers in type 2 diabetic subjects

Endothelial dysfunction and plasma markers of inflammation are significantly increased in type 2 diabetics. Several proinflammatory cytokines, acute-phase proteins, and cell adhesion molecules, such as C-reactive protein (CRP), interleukines (IL), and tumor necrosis factor alpha (TNF-α), seem to play a role in the low-grade systemic inflammation observed in these subjects. Lifestyle changes are necessary to prevent atherosclerosis and cardiovascular events. Physical exercise is known to reduce markers of inflammation by decreasing adipocytokine production and cytokine release from skeletal muscles, endothelial cells, and immune system and also improving antioxidant status. In type 2 diabetics, aerobic and resistance training have different effects on cytokine levels, and the differences in the modalities of exercise (type, duration, and intensity) and especially in the examined population could produce different results. Recent research showed that combined exercise has greater anti-inflammatory effects than aerobic or resistance exercise alone causing a deepest decrease in CRP, IL-6, IL-1β, TNF-α, leptin, and resistin and a higher increase in anti-inflammatory cytokines such as IL-4, IL-10, and adiponectin.

Aging, resistance training, and diabetes prevention

With the aging of the baby-boom generation and increases in life expectancy, the American population is growing older. Aging is associated with adverse changes in glucose tolerance and increased risk of diabetes; the increasing prevalence of diabetes among older adults suggests a clear need for effective diabetes prevention approaches for this population. The purpose of paper is to review what is known about changes in glucose tolerance with advancing age and the potential utility of resistance training (RT) as an intervention to prevent diabetes among middle-aged and older adults. Age-related factors contributing to glucose intolerance, which may be improved with RT, include improvements in insulin signaling defects, reductions in tumor necrosis factor-α, increases in adiponectin and insulin-like growth factor-1 concentrations, and reductions in total and abdominal visceral fat. Current RT recommendations and future areas for investigation are presented.

Weight-loss diet alone or combined with resistance training induces different regional visceral fat changes in obese women

BACKGROUND

Quantification of abdominal fat and its regional distribution has become increasingly important in assessing the cardiovascular risk.

OBJECTIVE

To examine the effects of 16 weeks of a hypocaloric diet with a caloric restriction of 500 Kcal per day (WL) or the same dietary intervention plus resistance training (WL+RT) on regional variation of abdominal visceral (visceral adipose tissue (VAT)) and subcutaneous (subcutaneous adipose tissue (SAT)) fat loss. Second, to identify the single-image that best represents total magnetic resonance imaging measurements of total VAT and SAT volume before and after WL or WL+RT intervention.

DESIGN

A total of 34 obese (body mass index: 30-40 kg m(-2)) women, aged 40-60 years, were randomized to three groups: a control group (C; n = 9), a diet group (WL; n = 12) and a diet plus resistance training group (WL+RT; n = 13) with the same caloric restriction as group WL and a 16-week supervised whole-body RT of two sessions per week.

RESULTS

WL+RT programs lead to significant changes in the location of highest mean VAT area from L3-L4 to L2-L3 discal level from pre- to post- intervention, whereas after WL the greatest relative VAT losses were located at L5-S1. Similar decreases in the SAT areas at all discal levels were observed after WL and WL+RT.

CONCLUSION

Different weight loss regimes may lead to different distribution of VAT. Sites located significantly above (cranial to) L4-L5 (that is, ∼ 5-6 cm above L4-L5 or at L2-L3 discal level) provided superior prediction of total abdominal VAT volume, whereas more caudal slices provide better prediction of subcutaneous fat, not only before but also after either WL or WL+RT.