Long-term vigorous training in young adulthood and later physical activity as predictors of hypertension in middle-aged and older men

Physical activity and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies

Background

Physical activity has been associated with a significant reduction in risk of sudden cardiac death in epidemiological studies, however, the strength of the association needs clarification. We conducted a systematic review and meta-analysis to summarize the available data from population-based prospective studies.

Methods

PubMed and Embase databases were searched for studies of physical activity and sudden cardiac death from inception to March 26th 2019. Prospective studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of sudden cardiac death associated with physical activity were included. A random effects model was used to estimate summary RRs (95% CIs).

Results

Thirteen prospective studies were included in the systematic review. Eight prospective studies with 1193 sudden cardiac deaths among 136,298 participants were included in the meta-analysis of physical activity and sudden cardiac death and the summary RR for highest vs. lowest level of physical activity was 0.52 (95% CI: 0.45–0.60, I² = 0%, p_{heterogeneity} = 0.72). The association was similar in men and women and among American and European studies. In the dose-response analysis the summary RR was 0.68 (95% CI: 0.55–0.86, I² = 44%, n = 3) per 20 MET-hours/week. Although the test for nonlinearity was not significant, p_nonlinearity = 0.18, there was no further reduction in risk beyond 20–25 MET-hours/week. The summary RR was 0.58 (95% CI: 0.41–0.81, I² = 0%, p_{heterogeneity} = 0.65, n = 2) for the highest vs. the lowest level of cardiorespiratory fitness.

Conclusion

This meta-analysis suggest that a high compared to a low level of physical activity may reduce the risk of sudden cardiac death in the general population. Further studies are needed to clarify the dose-response relationship between specific subtypes and intensities of physical activity in relation to sudden cardiac death.

Changes in Patient-Reported Outcome Measures From the Time of Injury to Return to Play in Adolescent Athletes at Secondary Schools With an Athletic Trainer

CONTEXT

Typically, athletic trainers rely on clinician-centered measures to evaluate athletes' return-to-play status. However, clinician-centered measures do not provide information regarding patients' perceptions.

OBJECTIVE

To determine whether clinically important changes in patient-reported outcomes were observed from the time of lower extremity injury to the time of return to play in adolescent athletes.

DESIGN

Cross-sectional study.

SETTING

The National Athletic Treatment, Injury and Outcomes Network (NATION) program has captured injury and treatment data in 31 sports from 147 secondary schools across 26 states. A subsample of 24 schools participated in the outcomes study arm during the 2012-2013 and 2013-2014 academic years.

PATIENTS OR OTHER PARTICIPANTS

To be included in this report, student-athletes must have sustained a knee, lower leg, ankle, or foot injury that restricted participation from sport for at least 3 days. A total of 76 initial assessments were started by athletes; for 69 of those, return-to-play surveys were completed and analyzed.

MAIN OUTCOME MEASURE(S)

All student-athletes completed generic patient-reported outcome measures (Patient-Reported Outcomes Measurement Information System [PROMIS] survey, Global Rating of Change scale, and Numeric Pain Rating Scale) and, depending on body region, completed an additional region-specific measure (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure). All applicable surveys were completed at both the initial and return-to-play time points. Means and standard deviations for the total scores of each patient-reported outcome measure at each time point were calculated. Change scores that reflected the difference from the initial to the return-to-play time points were calculated for each participant and compared with established benchmarks for change.

RESULTS

The greatest improvement in patient-reported outcomes was in the region-specific forms, with scores ranging from 9.92 to 37.73 on the different region-specific subscales (Knee Injury and Osteoarthritis Outcome Score or Foot and Ankle Ability Measure; scores range from 0-100). The region-specific subscales on average still showed a 21.8- to 37.5-point deficit in reported health at return to play. The PROMIS Lower Extremity score increased on average by 13 points; all other PROMIS scales were within normative values after injury.

CONCLUSIONS

Adolescent athletes who were injured at a high school with an athletic trainer may have shown improvement in patient-reported outcomes over time, but when they returned to play, their outcome scores remained lower than norms from comparable athlete groups.

The Impact of Previous Athletic Experience on Current Physical Fitness in Former Collegiate Athletes and Noncollegiate Athletes

Background:

Physical activity performed at moderate intensity is associated with reduced risk of mortality, cardiovascular disease, hypertension, and some types of cancers. However, vigorous physical activity during participation in college athletics may increase the risk of injury, which might limit future physical activity levels.

Purpose:

To evaluate differences in current physical fitness levels between former Division I athletes and noncollegiate athletes.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

The sample was recruited from a large midwestern university alumni database and consisted of 2 cohorts: (1) former Division I athletes (n = 100; mean age, 53.1 ± 7.4 years) and (2) nonathletes who were active in college (n = 100; age, 51.4 ± 7.3 years). Individuals answered a demographics questionnaire and completed a physical fitness assessment consisting of 7 measures: percent body fat, 1-mile walk, sit-to-stand test, push-up, half sit-up test, sit and reach test, and back scratch test.

Results:

Performance was significantly worse for former Division I athletes compared with nonathletes for percent body fat (mean difference, 7.58%; F_{(1, 198)} = 59.91; P < 0.01), mile time (mean difference, 2.42 minutes; F_{(1, 198)} = 1.74; P = 0.03), sit-to-stand test (mean difference, 4.3 repetitions; F_{(1, 198)} = 6.59; P = 0.01), and push-up test (mean difference, 8.9 repetitions; F_{(1, 198)} = 7.35; P = 0.01).

Conclusion:

Former Division I athletes may be limited because of previous injury, inhibiting their ability to stay active later in life.

Clinical Relevance:

It is imperative that clinicians, coaches, and strength and conditioning specialists understand the possible future repercussions from competing at the Division I level.

Effect of concurrent resistance and sprint training on body composition and cardiometabolic health indicators in masters cyclists

In older previously sedentary individuals endurance training imposes a more effective stimulus to enhance cardiometabolic health compared with resistance or sprint training. We examined the effect of replacing a portion of endurance training with combined resistance and/or sprint training and how this influences cardiometabolic health indicators in masters endurance cyclists. Twenty-seven well-trained male road cyclists (53.7±8.2 years) were allocated to a resistance and track sprint-cycling training group (RTC, n=10), an endurance and track sprint-cycling group (ETC, n=7) or a control endurance group (CTRL, n=10). Both the RTC and ETC groups completed a 12-week intervention of specific training while the CTRL group maintained their endurance training load. Lower limb lean mass (LLM), trunk fat mass (TFM), fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before and after the intervention period. TFM decreased for all groups (P<0.05) while LLM significantly increased for RTC and ETC groups (P<0.05). No significant between group or time effects were observed for FBG, TC, TG, SBP, or DBP. The results suggest that replacing a portion of endurance training with 12 weeks of ETC or RTC training favourably affects body composition by lowering TFM and increasing LLM without negatively affecting cardiometabolic health indicators in well-trained masters endurance cyclists.

Former male elite athletes and risk of hypertension in later life

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults

This systematic review examines critically the scientific basis for Canada's Physical Activity Guide for Healthy Active Living for adults. Particular reference is given to the dose-response relationship between physical activity and premature all-cause mortality and seven chronic diseases (cardiovascular disease, stroke, hypertension, colon cancer, breast cancer, type 2 diabetes (diabetes mellitus) and osteoporosis). The strength of the relationship between physical activity and specific health outcomes is evaluated critically. Literature was obtained through searching electronic databases (e.g., MEDLINE, EMBASE), cross-referencing, and through the authors' knowledge of the area. For inclusion in our systematic review articles must have at least 3 levels of physical activity and the concomitant risk for each chronic disease. The quality of included studies was appraised using a modified Downs and Black tool. Through this search we identified a total of 254 articles that met the eligibility criteria related to premature all-cause mortality (N = 70), cardiovascular disease (N = 49), stroke (N = 25), hypertension (N = 12), colon cancer (N = 33), breast cancer (N = 43), type 2 diabetes (N = 20), and osteoporosis (N = 2). Overall, the current literature supports clearly the dose-response relationship between physical activity and the seven chronic conditions identified. Moreover, higher levels of physical activity reduce the risk for premature all-cause mortality. The current Canadian guidelines appear to be appropriate to reduce the risk for the seven chronic conditions identified above and all-cause mortality.

Discipline-specific insulin sensitivity in athletes

OBJECTIVE

Weight status and abnormal liver function are the two factors that influence whole-body insulin sensitivity. The main goal of the study was to compare insulin sensitivity in athletes (n=757) and physically active controls (n=670) in relation to the two factors.

METHODS

Homeostatic metabolic assessment for insulin resistance (HOMA-IR), weight status, and abnormal liver function (alanine aminotransferase and aspartate aminotransferase) were determined from 33 sports disciplines under morning fasted condition. This study was initiated in autumn 2006 and repeated in autumn 2007 (n=1508) to ensure consistency of all observations.

RESULTS

In general, HOMA-IR and blood pressure levels in athletes were significantly greater than those in physically active controls but varied widely with sport disciplines. Rowing and short-distance track athletes had significantly lower HOMA-IR values and archery and field-throwing athletes had significantly higher values than the control group. Intriguingly, athletes from 22 sports disciplines displayed significantly greater body mass index values above control values. Multiple regression analysis showed that, for non-athlete controls, body mass index was the only factor that contributed to the variations in HOMA-IR. For athletes, body mass index and alanine aminotransferase independently contributed to the variation of HOMA-IR.

CONCLUSION

This is the first report documenting HOMA-IR values in athletes from a broad range of sport disciplines. Weight status and abnormal liver function levels appear to be the major contributors predicting insulin sensitivity for the physically active population.

Biological characteristics and ageing in former elite volleyball players

To date, there is very little information about the effects of ageing and sport selection on the characteristics of former athletes. The aim of this study was to analyse anthropometric and physiological characteristics of 146 former elite volleyball players in Italy. The possible effect of an active or inactive lifestyle on ageing was assessed by comparing the biological profiles of subsamples of former athletes with and without regular sport activity. All the former athletes underwent measurements of standard anthropometry (height, sitting height and body mass; skinfold thicknesses; bi-acromial and bi-cristal breadths; upper limb length; upper arm, calf and chest girths), cardio-respiratory function (vital capacity, forced vital capacity, forced expiratory volume in 1s; systolic and diastolic blood pressures and heart rate), muscle strength (handgrip strength), and cognitive function (visual and auditory simple reaction times; Digit-Symbol subtest). Body composition parameters were estimated from anthropometric measurements. Data on lifestyle were collected by questionnaires. The results show that the former players differ from current players in several anthropometric and physiological traits. Selection pressure seems to be more responsible for these differences than ageing. This study underlines the particular performance of former players in cognitive functions. Moreover, it confirms that an active lifestyle has beneficial effects on the biological age profiles of former athletes.

Characteristics of glycemic control in elite power and endurance athletes

A previous study has shown that former elite power athletes exhibited significantly greater relative risk in diabetes than that of former elite endurance athletes. It is unknown whether insulin sensitivity in elite young healthy power athletes is lower than that in elite young endurance athletes. This study includes two parts, part I and part II. In the part I of this study, an oral glucose tolerance test was performed in all of the elite juvenile track athlete subjects, specializing either in short-distance racing (jSD, N = 13, aged 12.5 +/- 0.37 years) or in long-distance racing (jLD, N = 13, aged 12.6 +/- 0.42 years). In the part II of this study, we recruited elite adult swimmers and divided them into two groups according to their specialty in swimming race distance: long-distance (aLD, N = 10, age 20.3 +/- 1.32) and short-distance groups (aSD, N = 10, age 20.2 +/- 1.31). Insulin sensitivity was significantly lower in the jSD group than that in the jLD group, as indicated by the area under the curves of insulin and glucose following a 75-g oral glucose load. Fasting plasma LDL-C and total cholesterol levels in the jSD group were significantly greater than those in the jLD group. The result of the part II of this study, similar to the result of the part I, shows that insulin sensitivity in aSD swimmers was significantly lower than that in aLD swimmers. LDL-C, total cholesterol, and triglyceride levels were also found higher in aSD swimmers than in those of aLD swimmers. These new findings implicate that the genetic makeup associated with exceptional power or endurance performance of elite athletes could also reflect on their metabolic characteristics; elite power athletes appear to be more insulin resistant than elite endurance athletes.

Muscle fiber-type distribution as a predictor of blood pressure: a 19-year follow-up study

The known association between physical activity and low blood pressure may be influenced by inherited characteristics. Skeletal muscle consists of type I (slow-twitch) and type II (fast-twitch) muscle fibers, with proportions highly variable between individuals and mostly determined by genetic factors. A high percentage of type I fibers (type I%) has been associated with low blood pressure in cross-sectional studies. We investigated whether type I percentage predicts future blood pressure levels and explains part of the association between physical activity and blood pressure. At baseline, in 1984, muscle fiber-type distribution, physical activity, and body mass index (BMI) were determined in 64 healthy men (age, 32 to 58 years). At follow-up, in 2003, blood pressure, physical activity, and BMI were determined in these men. In subjects without antihypertensive medication (n=43), type I percentage accounted for 5%/18% of the variation in systolic/diastolic blood pressure. A high type I percentage predicted, independent of both baseline (in 1984) and follow-up (in 2003), physical activity, BMI, and low systolic and diastolic blood pressure. Adjusted for all baseline covariates, a 20-unit higher type I percentage predicted a 11.6-mm Hg lower systolic blood pressure (P=0.018) and a 5.0-mm Hg lower diastolic blood pressure (P=0.018). High levels of physical activity in 1984 predicted low diastolic blood pressure, but this association was lost when type I percentage was included into the model. A high proportion of type I fibers in skeletal muscle is an independent predictor of low blood pressure and explains part of the known association between high levels of physical activity and low blood pressure.

Relative roles of heredity and physical activity in adolescence and adulthood on blood pressure

Part of the association between physical activity and low blood pressure (BP) may be a consequence of genetic selection. We investigated the association of genetic factors and physical activity in adolescence and adulthood with BP. BP was measured with a Finapres device in 71 monozygotic and 104 dizygotic male twin pairs using no antihypertensive medication. Subjects' mean age was 50.4 yr (range 40–72 yr). Subjects were interviewed about their lifetime exercise and other health habits. Exercise was classified as aerobic, power, or other, and these were further divided into adolescence (12–20 yr of age), the previous year, and lifetime. Genetic modeling was conducted to estimate genetic and environmental components of variance of systolic and diastolic BP. Aerobic exercise in adolescence and high-intensity aerobic exercise throughout the lifetime were associated with low diastolic BP in adulthood. Of the variance in diastolic BP, genetic factors accounted for 35% and aerobic exercise in adolescence for 5%. For systolic BP, genetic factors accounted for 39% of the variance. In turn, genetic factors accounted for 44% of the variance in aerobic exercise in adolescence. The genetic factors in part accounting for the variance in diastolic BP and those in part accounting for variance in aerobic exercise in adolescence were correlated. The association between aerobic exercise in adolescence and low diastolic BP in adulthood is a new finding, as is the observation that the factors partly share the same genes.

Occurrence of chronic disease in former top-level athletes. Predominance of benefits, risks or selection effects?

Former elite athletes from most sports disciplines have lower overall morbidity risk and enjoy better self-rated health in later years compared with the general population and matched controls who were healthy at young age. This is seen particularly among former endurance athletes who have a lower incidence of coronary heart disease and type 2 diabetes mellitus. Most often data are available only for men. Based on the available data, participation in elite sports cannot be regarded as an overall health hazard. However, aside from a high risk of acute injury in specific sports, possible negative effects of long-standing athletic activity on the development of osteoarthritis should not be neglected. It should also be remembered that elite athletes are a biologically and genetically select group who are not representative of the population at large. Given the nature of the available data, the possible health consequences of recent changes in different characteristics of sports, such as training practices, professionalism and use of doping, cannot be properly predicted.

Prevention of hypertension

Hypertension is a major risk factor for many cardiovascular diseases including stroke, coronary heart disease, cardiac failure, and endstage renal disease. Therefore, prevention of hypertension becomes an important goal in overall efforts to control blood pressure and reduce the incidence of hypertension-related cardiovascular and renal complications and outcomes. Many risk factors underlying hypertension have been identified including nonmodifiable factors such as age, gender, genetic factors, and race, as well as modifiable factors including overweight, high sodium intake, low potassium intake, alcohol consumption, and reduced physical activity. A number of studies have demonstrated that interventions aimed at changing these modifiable factors might decrease blood pressure and even prevent the development of hypertension. Thus, present national recommendations and guidelines include lifestyle modifications ranging from weight loss in case of obesity, engagement in regular isotonic physical activity, reduced sodium diet (<100 mmol/d), supplementation of potassium, and alcohol moderation (<1 ounce of ethanol or its equivalent per day).