Long-term effects of exercise on blood pressure and lipids in healthy women aged 40-65 years: The Sedentary Women Exercise Adherence Trial (SWEAT)

A pilot study of the effects of supervised exercise training on body composition, cardiometabolic risk factors, muscle strength and functional capacity in individuals with bariatric surgery

The main objective of this pilot study was to evaluate the effects of functional exercise training (FET) and home exercise training (HET) on body composition, cardiometabolic risk factors, muscle strength, and functional capacity in individuals with bariatric surgery. The sample of the study included 30 individuals who underwent bariatric surgery. The FET group had functional exercise training consisting of stretching, aerobic, strengthening, and balance exercises assigned by a physiotherapist (n = 15), and the HET group had the same exercises under supervision (n = 15). The training sessions were planned as × 3 per week for a period of 8 weeks. Body composition, cardiometabolic risk factors, cardiometabolic risk status, muscle strength, and functional capacity of all individuals were evaluated before and after training. According to the measurements, body weight (BW), body mass index (BMI), body fat mass (BFM), C-reactive protein, glycated hemoglobin, insulin resistance, cardiovascular risk total score, and ten-year cardiovascular percentage risk decreased significantly (p < 0.05), while HDL-C, leg, back, and hand grip strength (right-left), and walking distance increased significantly (p < 0.05) in the FET group. In the HET group, there were significant increases in body fat percentage (BFM %), BFM, and body muscle mass percentage (BMM %) (p < 0.05), while body muscle mass (BMM), right hand grip strength, leg and back muscle strength, and walking distance scores significantly decreased (p < 0.05). It was concluded that personalized and supervised FET has a positive effect on body composition, cardiometabolic risk factors, muscle strength, and functional capacity, and it can be recommended as a safe exercise model for bariatric surgery patients.

Walking for hypertension

BACKGROUND

Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. Walking is a low-cost form of physical activity and one which most people can do. Studies testing the effect of walking on blood pressure have revealed inconsistent findings.

OBJECTIVES

To determine the effect of walking as a physical activity intervention on blood pressure and heart rate.

SEARCH METHODS

We searched the following databases up to March 2020: the Cochrane Hypertension Specialised Register, CENTRAL (2020, Issue 2), Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO, SPORTDiscus, PEDro, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the following Chinese databases up to May 2020: Index to Taiwan Periodical Literature System; National Digital Library of Theses and Dissertation in Taiwan; China National Knowledge Infrastructure (CNKI) Journals, Theses & Dissertations; and Wanfang Medical Online. We contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials of participants, aged 16 years and over, which evaluated the effects of a walking intervention compared to non-intervention control on blood pressure and heart rate were included.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Where data were not available in the published reports, we contacted authors. Pooled results for blood pressure and heart rate were presented as mean differences (MDs) between groups with 95% confidence intervals (CIs). We undertook subgroup analyses for age and sex. We undertook sensitivity analyses to assess the effect of sample size on our findings.

MAIN RESULTS

A total of 73 trials met our inclusion criteria. These 73 trials included 5763 participants and were undertaken in 22 countries. Participants were aged from 16 to 84 years and there were approximately 1.5 times as many females as males. The characteristics of walking interventions in the included studies were as follows: the majority of walking interventions was at home/community (n = 50) but supervised (n = 36 out of 47 reported the information of supervision); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate. Many studies were at risk of selection bias and performance bias. Primary outcome We found moderate-certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD -4.11 mmHg, 95% CI -5.22 to -3.01; 73 studies, n = 5060). We found moderate-certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD -4.41 mmHg, 95% CI -6.17 to -2.65; 14 studies, n = 491), and low-certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD -3.79 mmHg, 95% CI -5.64 to -1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD -4.30 mmHg, 95% CI -6.17 to -2.44, 24 studies, n = 2610). We also found low certainty-evidence suggesting that walking reduces SBP in both females (MD -5.65 mmHg, 95% CI -7.89 to -3.41; 22 studies, n = 1149) and males (MD -4.64 mmHg, 95% CI -8.69 to -0.59; 6 studies, n = 203). Secondary outcomes We found low-certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD -1.79 mmHg, 95% CI -2.51 to -1.07; 69 studies, n = 4711) and heart rate (MD -2.76 beats per minute (bpm), 95% CI -4.57 to -0.95; 26 studies, n = 1747). We found moderate-certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD -3.01 mmHg, 95% CI -4.44 to -1.58; 14 studies, n = 491) and low-certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD -1.74 mmHg, 95% CI -2.95 to -0.52; 32 studies, n = 1730) and those aged 60 years and over (MD -1.33 mmHg, 95% CI -2.40 to -0.26; 23 studies, n = 2490). We found moderate-certainty evidence that suggests walking reduces DBP for males (MD -2.54 mmHg, 95% CI -4.84 to -0.24; 6 studies, n = 203) and low-certainty evidence that walking reduces DBP for females (MD -2.69 mmHg, 95% CI -4.16 to -1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence suggests that walking probably reduces SBP. Moderate- or low-certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low-certainty evidence suggests that walking may reduce DBP and heart rate. Moderate- and low-certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes.

Exercise Reduces Ambulatory Blood Pressure in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Although exercise training reduces office blood pressure (BP), scarcer evidence is available on whether these benefits also apply to ambulatory blood pressure (ABP), which is a stronger predictor of cardiovascular disease and mortality. The present study aims to assess the effects of exercise training on ABP in patients with hypertension based on evidence from randomized controlled trials. Methods and Results A systematic search of randomized controlled trials on the aforementioned topic was conducted in PubMed and Scopus (since inception to April 1, 2020). The mean difference between interventions (along with 95% CI) for systolic BP and diastolic BP was assessed using a random-effects model. Sub-analyses were performed attending to (1) whether participants were taking antihypertensive drugs and (2) exercise modalities. Fifteen studies (including 910 participants with hypertension) met the inclusion criteria. Interventions lasted 8 to 24 weeks (3-5 sessions/week). Exercise significantly reduced 24-hour (systolic BP, -5.4 mm Hg; [95% CI, -9.2 to -1.6]; diastolic BP, -3.0 mm Hg [-5.4 to -0.6]), daytime (systolic BP, -4.5 mm Hg [-6.6 to -2.3]; diastolic BP, -3.2 mm Hg [-4.8 to -1.5]), and nighttime ABP (systolic BP, -4.7 mm Hg [-8.4 to -1.0]; diastolic BP, -3.1 mm Hg [-5.3 to -0.9]). In separate analyses, exercise benefits on all ABP measures were significant for patients taking medication (all P<0.05) but not for untreated patients (although differences between medicated and non-medicated patients were not significant), and only aerobic exercise provided significant benefits (P<0.05). Conclusions Aerobic exercise is an effective coadjuvant treatment for reducing ABP in medicated patients with hypertension.

Lifestyle interventions for the prevention and treatment of hypertension

Hypertension affects approximately one third of the world's adult population and is a major cause of premature death despite considerable advances in pharmacological treatments. Growing evidence supports the use of lifestyle interventions for the prevention and adjuvant treatment of hypertension. In this Review, we provide a summary of the epidemiological research supporting the preventive and antihypertensive effects of major lifestyle interventions (regular physical exercise, body weight management and healthy dietary patterns), as well as other less traditional recommendations such as stress management and the promotion of adequate sleep patterns coupled with circadian entrainment. We also discuss the physiological mechanisms underlying the beneficial effects of these lifestyle interventions on hypertension, which include not only the prevention of traditional risk factors (such as obesity and insulin resistance) and improvements in vascular health through an improved redox and inflammatory status, but also reduced sympathetic overactivation and non-traditional mechanisms such as increased secretion of myokines.

Effects of endurance training on serum lipids

BACKGROUND AND AIMS

Physical activity is recommended as part of the lifestyle modification for the treatment of hyperlipidemia, however, the literature reports heterogeneous quantitative effects of exercise on serum lipids. We therefore reviewed the effects of aerobic exercise on serum lipids with special focus on the training effectiveness.

METHODS

Data regarding effects of endurance training (ET) on total Cholesterol (TC), LDL-Cholesterol (LDL-C), HDL-Cholesterol (HDL-C) and triglycerides (TG) were evaluated in a selective literature search. To account for the observed heterogeneity of the training interventions, studies were analyzed according to effectiveness (duration, intensity, frequency) of training.

RESULTS

Unselected training intervention studies did not exert significant effects on serum LDL-C but showed minor positive effects on HDL-C and TG. Effective endurance training - defined as endurance training performed by an intensity of 65-75% of the heart rate reserve (corresponding to 75-85% maximum heart rate or 65-80% VO_2max) for a duration of 40-50min per training unit on 3-4days/week over a period of 26-40weeks showed improvement of serum lipids. Effective training lowered TC by -3.75% (p=0.0006), LDL-C by -4.76% (p=0.0015), TG by -8.24% (p=0.0004) and increased HDL-C by +4.43% (p=0.0061).

CONCLUSION

The analysis suggests that a minimum exercise threshold is necessary to produce effects on serum lipids. Overall, the quantitative effect of physical activity on serum lipids is small.

Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial

QUESTION

What is the effectiveness of gym-based exercise versus home-based exercise with telephone follow-up amongst adults with chronic conditions who have completed a short-term exercise program supervised by a health professional?

DESIGN

A randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded outcome assessment at baseline and 3, 6, 9 and 12 months.

PARTICIPANTS

The participants were recruited following a 6-week exercise program at a community health service.

INTERVENTION

One group of participants received a gym-based exercise program for 12 months (gym group). The other group received a home-based exercise program for 12 months with telephone follow-up for the first 10 weeks (home group).

OUTCOME MEASURES

Outcome measures included European Quality of Life Instrument (EQ-5D), the Friendship Scale, the Hospital and Anxiety and Depression Scale, Phone-FITT, 6-minute walk test, body mass index and 15-second sit-to-stand test.

RESULTS

There was no significant difference between study groups in the primary outcome (EQ-5D visual analogue scale, 0 to 100) across the 12-month intervention period, with an estimate (adjusted regression coefficient) of the difference in effects of 0 (95% CI -5 to 4). The gym group demonstrated slightly fewer symptoms of depression over the 12-month period compared to the home group (mean difference 0.8 points on a 21-point scale, 95% CI 0.1 to 1.6).

CONCLUSION

Similar long-term clinical outcomes and long-term exercise adherence are achieved with the two approaches examined in this study. Participation in gym-based group exercise may improve mental health outcomes slightly more, although the mechanisms for this are unclear because there was no change in the selected measure of social isolation or other measures of health and wellbeing. This finding may also be a Type 1 error. Further research to reproduce these results and that investigates the economic efficiency of these models of care is indicated.

TRIAL REGISTRATION

ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2017) Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial. Journal of Physiotherapy 63: 154-160].

Poststroke depression: risk factors and potential effects on functional recovery

The factors that may cause poststroke depression were investigated in the literature focusing on lesion localization, age, stroke severity, and impairments in physical and cognitive function. The aim of this study was to examine the risk factors influencing the development of poststroke depression and to determine the effect of depression on the patients' functional improvement after rehabilitation. Patients in the first 6-month period after stroke who were hospitalized in the Physical Medicine and Rehabilitation Clinic were included in this study. Patients who were admitted to the hospital within 0-30 and 30-120 days from the date of stroke were considered early and late rehabilitation entrants, respectively. The sample of this study included 93 patients. Patients' demographic and clinical characteristics, complications, and medical history were recorded. Upper extremity motor function, ambulation, and mood were evaluated according to the Frenchay Arm Test, the Functional Ambulation Scale, and the Beck Depression Inventory, respectively. The Functional Independence Measure (FIM) was applied to patients at admission to the hospital, at discharge, and 1 month after discharge (follow-up). The mean age of the patients was 58 years and the mean disease duration was 53 days. Depression was diagnosed in 49 (53%) patients. Except for age and disease duration, none of the factors of sex, hemiplegic side, stroke severity, stroke etiology, neglect, spasticity, sedentary lifestyle, poststroke immobility, and early-onset or late-onset to rehabilitation was found to induce statistically significant differences in the development of depression. Statistically significant changes occurred in total FIM levels between the groups with and without depression between admission and discharge, admission and follow-up, and discharge and follow-up. The levels were significantly higher in patients without depression than in patients with depression. Depression was found in a high frequency in stroke patients. Younger age and long disease duration were found to be factors affecting the development of depression. FIM scores were observed to be lower in stroke patients with depression.

Effectiveness of a Community-Based Physical Activity and Nutrition Behavior Intervention on Features of the Metabolic Syndrome: A Cluster-Randomized Controlled Trial

BACKGROUND

Metabolic syndrome (MetS) and its subclinical diseases are now public health problems in Vietnam. This study aimed at determining the effectiveness of a physical activity and nutrition program for reducing MetS proportion and its components among adults with MetS in Hanam province, Vietnam.

METHODS

A total of 417 volunteers aged 50-65 years with MetS were recruited from 10 communes. The communes were randomly allocated to an intervention group (five communes, n = 214) and a control group (five communes, n = 203). The participants in the intervention group received a nutrition and physical activity program for 6 months, whereas participants in the control group received standard diet and physical activity advice on only one occasion. Anthropometry, lipid profiles, glycemic status, and blood pressure were measured at baseline and at 6 months to evaluate program effectiveness.

RESULTS

In total, 175 intervention (81.8%) and 162 control (79.8%) participants completed the post-program evaluation. After controlling for the effects of clustering and confounding factors, the intervention group showed significant improvements in high-density lipoprotein cholesterol (+0.42 mM, P < 0.001), waist circumference (-1.63 cm, P < 0.001), waist-to-hip ratio (-0.024, P < 0.001), weight (-1.44 kg, P < 0.001), and body mass index (-0.59 kg/m², P < 0.001) when compared with the control group. A reduction in the MetS proportion was found in both intervention and control groups (P < 0.001), decreasing to 56.0% and 75.9%, respectively, but the post-program proportion was significantly lower among the intervention participants (P < 0.001). Furthermore, the mean number of MetS components exhibited by individuals decreased significantly in the intervention group (P < 0.001).

CONCLUSIONS

The community-based physical activity and nutrition program reduced MetS proportion, with significant improvements in several metabolic and anthropometric parameters for Vietnamese adults with MetS.

Effect of exercise intensity on lipid profile in sedentary obese adults

BACKGROUND

Exercise is a lifestyle change that has been recommended for lowering atherogenic index in adults. The intensity and duration of exercise to bring about a change in the lipid parameters are yet to be determined. Previous studies examining the effects of exercise intensity on lipid and lipoprotein levels have reported conflicting findings. Thus we aimed at determining the changes in lipid profile in sedentary obese adults influenced by different intensity of exercise.

METHODOLOGY

Study included 51 obese adults with sedentary lifestyle. Participants performed exercise of moderate intensity (n=22) and high intermittent intensity (n=29) for a duration of 40min/day for 5 days/week and 20 min/day for 3 days/week respectively on bicycle ergometer for a period of 15 weeks.

OUTCOME MEASURES

Pretesting and post testing included measurement of height, weight, blood pressure and lipid profile.

STATISTICAL ANALYSIS

RESULTS were analysed using the Paired and Unpaired samples t-test.

RESULTS

Postexercise revealed significant reduction in the LDL-C and diastolic blood pressure (p<0.05) with the high intensity exercise group.There was a significant difference in BMI, lipid profile and blood pressure in both the moderate and high intensity exercise group.

CONCLUSION

This study suggests that exercise is "elixir" for a healthy life. High intermittent intensity can be considered for individuals who have time constraints and lead a sedentary life style and moderate intensity exercise advised for individuals who are willing to create time for their health benefits. A programmed protocol of exercise will help in reduction of lipid parameters.

Protocol for a randomized controlled trial evaluating the effect of physical activity on delaying the progression of white matter changes on MRI in older adults with memory complaints and mild cognitive impairment: the AIBL Active trial

BACKGROUND

Older adults free of dementia but with subjective memory complaints (SMC) or mild cognitive impairment (MCI) are considered at increased risk of cognitive decline. Vascular risk factors (VRF), including hypertension, heart disease, smoking, hypercholesterolemia and lack of physical activity (PA) have been identified as modifiable risk factors contributing to cognitive decline, and white matter hyperintensities (WMH) are associated with VRF, SMC and cognitive impairment. Findings from a growing number of clinical trials with older adults are providing strong evidence for the benefits of physical activity for maintaining cognitive function, but few studies are investigating these benefits in high-risk populations. The aim of AIBL Active is to determine whether a 24-month physical activity program can delay the progression of white matter changes on magnetic resonance imaging (MRI).

METHODS/DESIGN

This single-blind randomized controlled trial (RCT) is offered to 156 participants, aged 60 and older, in the Melbourne arm of the Australian Imaging Biomarkers and Lifestyle Flagship Study of Aging (AIBL). Participants must have SMC with or without MCI and at least one VRF. The PA intervention is a modification of the intervention previously trialed in older adults with SMC and MCI (Fitness for the Ageing Brain Study). It comprises 24 months of moderate, home-based PA (150 minutes per week) and a behavioral intervention package. The primary outcome measure will be change in WMH after 24 months on MRI. Cognition, quality of life, functional fitness, level of physical activity, plasma biomarkers for cerebrovascular disease and amyloid positron emission tomography (PET) imaging comprise secondary measures.

DISCUSSION

Currently, there is no effective pharmacological treatment available to delay cognitive decline and dementia in older adults at risk. Should our findings show that physical activity can slow down the progression of WMH, this RCT would provide an important proof of concept. Since imbedded in AIBL this RCT will also be able to investigate the interaction between vascular and Alzheimer's disease pathologies.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry ACTRN12611000612910.

A comparison of the effects of swimming and walking on body weight, fat distribution, lipids, glucose, and insulin in older women--the Sedentary Women Exercise Adherence Trial 2

All types of aerobic exercise are assumed to affect cardiovascular risk similarly. There are few studies of swimming, but complex responses to water-based exercise suggest its potential for differential effects. The aim of the study was to compare the effects of swimming and walking on fitness, body weight, lipids, glucose, and insulin in older women. Sedentary women aged 50 to 70 years (N = 116), randomly assigned to swimming or walking plus usual care or a behavioral intervention, completed 3 sessions per week of moderate-intensity exercise, supervised for 6 months then unsupervised for 6 months. After 6 months, 1.6-km walk time decreased in walkers and swimmers, with greater improvement in walkers (1.0 vs 0.6 minute, P = .001). In swimmers, but not walkers, distance swum in 12 minutes increased (78.1 vs -2.2 m, P = .021). Waist and hip circumferences (80.8 vs 83.1 cm and 101.8 vs 102.4 cm; P = .023 and P = .042, respectively) and insulin area under the curve (oral glucose tolerance test) (5128 vs 5623 μU/[L 120 min], P < .05) were lower with swimming. Lipids did not differ between groups. At 12 months, fitness was maintained. Relative to walking, swimming reduced body weight by (1.1 kg, P = .039) and resulted in lower total and low-density lipoprotein cholesterol (0.3 and 0.2 mmol/L; P = .040 and P = .049, respectively). The magnitude of the difference in the reduction of insulin area under the curve between swimming and walking was greater at 12 months; however, the significance was attenuated (4677 vs 5240 μU/[L 120 min], P = .052). Compared with walking, swimming improved body weight, body fat distribution, and insulin in the short term and, in the longer term, body weight and lipid measures. These findings suggest that the type of exercise can influence health benefits.

The effect of walking intervention on blood pressure control: a systematic review

BACKGROUND

Hypertension is a major public health problem and a key risk factor of cardiovascular diseases. Increased physical activity has been recommended as an important lifestyle modification for the prevention and control of hypertension. However the optimal characteristics for a physical activity programme remain open to debate. Walking is recommended by healthcare professionals as a form of exercise for controlling hypertension and nurses find it difficult to provide advice about this form of physical activity. Studies testing the effect of walking on blood pressure have produced inconsistent findings.

OBJECTIVES

To systematically review the evidence for the effectiveness of walking intervention on blood pressure.

METHODS

A systematic search of the literature was conducted using a range of electronic and evidence-based databases to identify studies. Criteria for study inclusion were a randomised controlled trial design with a non-intervention control group; study samples were aged 16 years and over; the intervention was predominantly focused on walking and blood pressure was an outcome. Data extraction and quality appraisal were carried out independently by two reviewers; a third reviewer was consulted when needed.

RESULTS

A total of 27 randomised controlled trials were included and nine of the 27 trials found an effect of walking intervention on blood pressure control. Walking intervention tends to be effective from studies with larger sample size. A beneficial effect of walking on blood pressure tended to employ moderate to high-intensity walking and a longer intervention period than those trials not showing the effect.

CONCLUSIONS

The results of this review provide evidence of the beneficial effects of walking on lowering blood pressure. Recommendations on lowering blood pressure with a walking activity should address the issue of walking intensity to achieve a beneficial effect on lowering blood pressure. Future research investigating the effect of walking intensity on blood pressure levels and rigorous design of walking interventions to achieve better adherence and methodological quality is required.

Effects of aerobic and strength-based training on metabolic health indicators in older adults

BACKGROUND

The weakening of the cardiovascular system associated with aging could be countered by increasing levels of physical activity and functional fitness. However, inconsistent findings have been found, and the variety of characteristics of exercise used in previous studies may partly explain that inconsistent results.

OBJECTIVE

To investigate the training effect of sixteen weeks of moderate intensity, progressive aerobic and strength-based training on metabolic health of older women and men.

METHODS

Sixty three sedentary individuals (mean (SD) age 76 (8) years) were randomly assigned to control (n = 31) or exercising (n = 32) groups. The training group was separated to aerobic (n = 18) or strength-based (n = 14). Training took place three times a week. Subjects agreed not to change their diet or lifestyle over the experimental period.

RESULTS

Exercising group attained after treatment significant differences on body weight, waist circumference, body mass index, diastolic blood pressure, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, total cholesterol/HDL-cholesterol relationship, high sensitivity C-reactive protein, and 6-minute walk distance. The control group only had significant differences on waist circumference.

CONCLUSION

The training programs produced significant benefits on metabolic health indicators of sedentary older women and men.

Relationship of health behavior theories with self-efficacy among insufficiently active hypertensive African-American women

OBJECTIVE

While self-efficacy plays an important role in physical activity, relatively little research has examined this construct in minorities. This study identified theoretical correlates associated with self-efficacy among insufficiently active, hypertensive Black women.

METHODS

Correlates of self-efficacy to: (1) overcoming barriers to physical activity; (2) making time for activity; and (3) "sticking with" physical activity were studied.

RESULTS

Sixty-one women (M=50.48+/-4.2 years) participated. We accounted for 32% of the variance in confidence in overcoming barriers. Women confident in overcoming barriers reported less worry about physical activity. The TTM processes of change were also in the model: consciousness raising, environmental reevaluation, counter conditioning, and self-liberation. We accounted for 16% of the variance in "making time" self-efficacy. An aversiveness barrier (e.g., physical activity is boring, physical activity is hard work) was the dominant variable in the model. Confidence to 'stick with' physical activity was associated with self-reevaluation (i.e., reflection on how personal values correspond to behavior). Social support and competing demands were not associated with self-efficacy.

CONCLUSIONS

Consistent with Social Cognitive Theory, results suggest that self-efficacy is behavior specific and each measure likely provides unique information.

PRACTICE IMPLICATIONS

Interventions should be tailored to address specific self-efficacy types.

Twelve-month effects of the Groningen active living model (GALM) on physical activity, health and fitness outcomes in sedentary and underactive older adults aged 55-65

OBJECTIVE

To determine the effects on energy expenditure, health and fitness outcomes after 12 months of GALM.

METHODS

Subjects from matched neighbourhoods were assigned to an intervention (IG) (n=79) or a waiting-list control group (CG) (n=102). During the 12 months the IG attended two series of 15 moderately intensive GALM sessions once a week and the CG attended one series after a 6-month waiting-list period.

RESULTS

Significant time effects were found for energy expenditure for recreational sports activities (EE(RECSPORT)), other leisure-time physical activity (EE(LTPA)) and total physical activity (EE(TOTAL)). EE(RECSPORT) increased over 12 months for both groups while the significant time x group interaction for EE(LTPA) revealed that the CG continuously increased over 12 months and the IG improved in the first 6 months but decreased from 6 to 12 months. Further significant time effects were found for performance-based fitness but no group effects.

CONCLUSION

Participation in GALM improved EE(RECSPORT) after 12 months, which was reflected in increases in performance-based fitness. The increase in EE(LTPA) seemed to be a short-term effect (6 months), which may explain the lack of improvement in other health indicators.

PRACTICE IMPLICATIONS

To further increase EE(LTPA), more attention should be paid to behavioural skill-building during the GALM program.

Definitions of sedentary in physical-activity-intervention trials: a summary of the literature

This review describes the definitions of sedentary used to screen community-dwelling adults in physical-activity-intervention trials published from 2000 to 2005. Results of 42 trials showed that definitions of sedentary varied from <20 to <150 min/week of physical activity, and few reported the type (work, household, or leisure) or intensity of activity that was used to screen participants. The range of "sedentary" samples makes it difficult to compare trial results or generalize findings. Published reports of exercise trials would be more useful to practitioners and researchers if they included an explicit description of the cut point used to define sedentary adults in the sample, in terms of maximum minutes or days per week of activity and the wording of the screening measure in terms of type and intensity of activity.

Evaluating a community-based walking intervention for hypertensive older people in Taiwan: a randomized controlled trial

OBJECTIVE

To study the effect of a community-based walking intervention on blood pressure among older people.

METHOD

The study design was a randomized controlled trial conducted in a rural area of Taiwan between October 2002 and June 2003. A total of 202 participants aged 60 years and over with mild to moderate hypertension was recruited. Participants randomized to the intervention group (n=102) received a six-month community-based walking intervention based on self-efficacy theory. A public health nurse provided both face-to-face and telephone support designed to assist participants to increase their walking. Control group participants (n=100) received usual primary health care. Primary outcome was change in systolic blood pressure and secondary outcomes were exercise self-efficacy, self-reported walking and diastolic blood pressure.

RESULTS

At six-month follow-up the mean change in systolic blood pressure was a decrease of 15.4 mmHg and 8.4 mmHg in the intervention and control group, respectively. The difference in mean change between the two groups was -7.0 mmHg (95% CI, -11.5 to -2.5 mmHg, p=0.002). Improvement in exercise self-efficacy scores was greater among intervention group participants (mean difference 1.23, 95% CI, 0.5 to 2.0, p=0.001). Intervention group participants were more likely to report walking more (p<0.0005) but no differences were observed in diastolic blood pressure (p=0.19).

CONCLUSIONS

Among hypertensive older people, a six-month community-based walking intervention was effective in increasing their exercise self-efficacy and reducing systolic blood pressure.

EXERCISE AND BLOOD PRESSURE: APPLYING FINDINGS FROM THE LABORATORY TO THE COMMUNITY SETTING

1. During the 1980s, there was growing epidemiological evidence that aerobic training lowered blood pressure (BP). Early intervention studies had not always supported this conclusion. Such studies were limited by methodological shortcomings. Few studies had used normotensive individuals or women alone. 2. Exercise training is an attractive lifestyle strategy in the prevention of hypertension. In our studies in men, vigorous intensity cycling did not lower resting BP. 3. Vigorous exercise reduces day time ambulatory BP and, in combination with calorie restriction, had a synergist effect to reduce night-time and 24 h BP. 4. Exercise is a positive and effective adjunct to other lifestyle measures in the prevention of hypertension. Adherence to either supervised or unsupervised moderate-intensity exercise is sufficient to reduce BP in the short and long term. 5. Further studies need to be performed to evaluate the clinical significance and mechanisms for the increase in resting BP observed in older women. 6. Older individuals with hypertension should be monitored when taking up a swimming programme. 7. Exercise induced changes in BP seen in the laboratory are also observed in the community setting.

Blood pressure rise with swimming versus walking in older women: the Sedentary Women Exercise Adherence Trial 2 (SWEAT 2)

OBJECTIVE

Swimming is often recommended in the prevention and treatment of hypertension. Few studies have investigated the effect of swimming training on blood pressure (BP). Our objective was to evaluate 6 months of supervised moderate swimming or walking on BP in previously sedentary, normotensive, older women.

DESIGN

Women aged 50-70 years (n = 116) were randomly assigned to a supervised 6-month swimming or walking programme. They were further randomized to receive usual care or a behavioural intervention package.

METHODS

Exercise comprised 3 sessions/week with a warm-up, cool down, and 30-min of moderate intensity walking or swimming. BP was recorded for 20 min supine, and 5 min standing. Assessments were made at 0 and 6 months.

RESULTS

At baseline, mean supine BP (+/- SD) was 115.7 +/- 1.3/66.8 +/- 0.7 mmHg. Swimming improved swim distance by 78.1 m (29.3%) [95% confidence interval (CI); 66.7, 89.4] and walk time by 0.58 min (3.8%) (0.41, 0.74). Walking decreased walk time by 1.0 min (6.5%) (0.81, 1.19). After adjustment for initial BP, age, hypertension treatment status and change in weight, swimming increased supine and standing systolic BP relative to walking by 4.4 mmHg (1.2, 7.5) (P = 0.008) and 6.0 mmHg (2.6, 9.5) (P = 0.001), respectively. Supine and standing diastolic BP increased by 1.4 mmHg (-0.14, 3.0) (P = 0.07) and 1.8 mmHg (-0.02, 3.5) (P = 0.05), respectively.

CONCLUSION

Relative to moderately paced walking, regular swimming significantly elevates BP in previously sedentary, normotensive, older women. This finding may have important implications for exercise prescription in older subjects.

Home versus center based physical activity programs in older adults

BACKGROUND

Physical inactivity is a leading cause of preventable death and morbidity in developed countries. In addition physical activity can potentially be an effective treatment for various medical conditions (e.g. cardiovascular disease, osteoarthritis). Many types of physical activity programs exist ranging from simple home exercise programs to intense highly supervised hospital (center) based programs.

OBJECTIVES

To assess the effectiveness of 'home based' versus 'center based' physical activity programs on the health of older adults.

SEARCH STRATEGY

The reviewers searched the Cochrane Central Register of Controlled Trials (CENTRAL) (1991-present), MEDLINE (1966-Sept 2002), EMBASE (1988 to Sept 2002), CINAHL (1982-Sept 2002), Health Star (1975-Sept 2002), Dissertation Abstracts (1980 to Sept 2002), Sport Discus (1975-Sept 2002) and Science Citation Index (1975-Sept 2002), reference lists of relevant articles and contacted principal authors where possible.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials of different physical activity interventions in older adults (50 years or older) comparing a 'home based' to a 'center based' exercise program. Study participants had to have either a recognised cardiovascular risk factor, or existing cardiovascular disease, or chronic obstructive airways disease (COPD) or osteoarthritis. Cardiac and post-operative programs within one year of the event were excluded.

DATA COLLECTION AND ANALYSIS

Three reviewers selected and appraised the identified studies independently. Data from studies that then met the inclusion/exclusion criteria were extracted by two additional reviewers.

MAIN RESULTS

Six trials including 224 participants who received a 'home based' exercise program and 148 who received a 'center based' exercise program were included in this review. Five studies were of medium quality and one poor. A meta-analysis was not undertaken given the heterogeneity of these studies. CARDIOVASCULAR. The largest trial (accounting for approximately 60% of the participants) looked at sedentary older adults. Three trials looked at patients with peripheral vascular disease (intermittent claudication). In patients with peripheral vascular disease center based programs were superior to home at improving distance walked and time to claudication pain at up to 6 months. However the risk of a training effect may be high. There are no longer term studies in this population. Notably home based programs appeared to have a significantly higher adherence rate than center based programs. However this was based primarily on the one study (with the highest quality rating of the studies found) of sedentary older adults. This showed an adherence rate of 68% in the home based program at two year follow-up compared with a 36% adherence in the center based group. There was essentially no difference in terms of treadmill performance or cardiovascular risk factors between groups. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). Two trials looked at older adults with COPD. In patients with COPD the evidence is conflicting. One study showed similar changes in various physiological measures at 3 months that persisted in the home based group up to 18 months but not in the center based group. The other study showed significantly better improvements in physiological measures in the center based group after 8 weeks but again the possibility of a training effect is high. OSTEOARTHRITIS. No studies were found. None of the studies dealt with measures of cost, or health service utilization.

AUTHORS' CONCLUSIONS

In the short-term, center based programs are superior to home based programs in patients with PVD. There is a high possibility of a training effect however as the center based groups were trained primarily on treadmills (and the home based were not) and the outcome measures were treadmill based. There is conflicting evidence which is better in patients with COPD. Home based programs appear to be superior to center based programs in terms of the adherence to exercise (especially in the long-term).

Physical conditioning modulates rat cardiac vascular endothelial growth factor gene expression in nitric oxide-deficient hypertension

Many individuals with cardiac diseases undergo periodic physical conditioning with or without medication to improve cardiovascular health. Therefore, this study investigated the interaction of physical training and chronic nitric oxide synthase (NOS) inhibitor (nitro-L-arginine methyl ester, L-NAME) treatment on blood pressure (BP), cardiac vascular endothelial factor (VEGF) gene expression, and nitric oxide (NO) systems in rats. Fisher 344 rats were divided into four groups and treated as follows: (1) sedentary control, (2) exercise training (ET) for 8 weeks, (3) L-NAME (10mg/kg, s.c. for 8 weeks), and (4) ET+L-NAME. BP was monitored with tail-cuff method. The animals were sacrificed 24h after last treatments and hearts were isolated and analyzed. Physical conditioning significantly increased respiratory exchange ratio, cardiac NO levels, NOS activity, endothelial eNOS, and inducible iNOS protein expression as well as VEGF gene expression. Training also caused depletion of cardiac malondialdehyde (MDA) levels indicating the beneficial effects of the training. Chronic L-NAME administration resulted in a depletion of cardiac NO level, NOS activity, and eNOS, nNOS, and iNOS protein expressions, as well as VEGF gene expression (2-fold increase in VEGF mRNA). Chronic L-NAME administration also enhanced cardiac MDA levels indicating cardiac oxidative injury. These biochemical changes were accompanied by increases in BP after L-NAME administration. Interaction of training and NOS inhibitor treatment resulted in normalization of BP and up-regulation of cardiac VEGF gene expression. The data suggest that physical conditioning attenuated the oxidative injury caused by chronic NOS inhibition by up-regulating the cardiac VEGF and NO levels and lowering the BP in rats.

Regular Exercise as an Effective Approach in Antihypertensive Therapy

PURPOSE

Exercise has been well documented to exert a beneficial effect on cardiovascular health. The effective control of arterial pressure (BP) is essential from the standpoint of cardiovascular prevention. So far, no study has determined the long-term effect of regular training as a monotherapy on both BP at rest and during exercise.

METHODS

Therefore, 10 subjects with hypertension (aged 43 +/- 3 yr) were studied in order to define BP response to long-term aerobic training. BP measurements were obtained at rest and during ergometry (50-100 W). Patients were instructed to exercise weekly (2 x 60 min aerobic exercise).

RESULTS

BP during exercise (100 W) did fall already after 6 months of regular training from 184 +/- 10/107 +/- 6 to 170 +/- 10/100 +/- 7, and this was associated with a 14% decrease in the rate-pressure product (at 100 W). After 18 months of training, there were further reductions in BP, at rest from 139 +/- 9/96 +/- 6 to 133 +/- 14/91 +/- 7 (P < 0.05) and during ergometry (100 W) from 184 +/- 10/107 +/- 6 to 172 +/- 8/96 +/- 6 mm Hg (P < 0.001). During a 3-yr follow-up, BP continued to decrease significantly to 130 +/- 13/87 +/- 7 mm Hg at rest and 167 +/- 9/92 +/- 6 mm Hg during exercise. No significant changes in body weight were documented during the training period.

CONCLUSION

The data demonstrate that long-term aerobic exercise is associated with a decrease in BP at rest and during exercise, which is comparable to that of drug therapies. This antihypertensive effect of regular training can be maintained as long as 3 yr.

Medical choices available for management of menopause

The indications for hormone therapy (HT) have changed markedly since the 1980s; they now include the treatment of menopausal symptoms and the prevention and treatment of osteoporosis in the short term. Long-term therapy is discouraged because of the small increase in risk of breast cancer after 5 years of therapy. Careful assessment of the midlife woman allows for individualized risk-benefit analysis with the formulation of a specific health management plan. Lifestyle advice and modification form the cornerstone of management-followed by therapeutic options if appropriate indications exist. In some industrialized countries alternative therapies are preferred despite little scientific evidence of their efficacy. The choices of hormonal products have increased, with the introduction of new formulations and routes of administration allowing for more optimal treatment of the menopause, especially in the presence of concurrent medical conditions, for example, diabetes, breast cancer or fibroids.

Controlled comparison of retention and adherence in home- vs center-initiated exercise interventions in women ages 40-65 years: The S.W.E.A.T. Study (Sedentary Women Exercise Adherence Trial)

BACKGROUND

In an 18-month exercise intervention in previously sedentary older women (40-65 years), we examined whether an initial 6 months of supervised exercise leads to greater long-term retention and adherence to regular physical activity than an unsupervised home-based program and whether these outcomes are influenced by the exercise intensity.

METHODS

Women (N = 126) were recruited from the community and randomly assigned to either center-based or home-based exercise three times/week. The center-based group attended supervised sessions for 6 months, while after 10 initial sessions the home-based group exercised at home. After 6 months both groups were home-based for a further 12 months. Within each arm, subjects were further randomized to exercise at either moderate or vigorous intensity.

RESULTS

The center-based group had higher retention than the home-based (97, 94, 81 versus 87, 76, and 61%) at 6, 12, and 18 months, respectively (P < 0.05). At 6 months, adherence was higher in the center-based group (84 versus 63%, P < 0.001) and energy expenditure was higher at 6 (P < 0.05) and 12 (P < 0.01) months. At 18 months, retention was higher with moderate exercise (P < 0.05), while adherence was similar with both intensities.

CONCLUSION

An initial 6 months of center-based exercise enhanced retention in both the short and the long term and promoted short-term adherence and energy expenditure. Long-term, moderate exercise retained more subjects, but had little influence on adherence.

Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials

OBJECTIVE

To determine the effectiveness of exercise training (aerobic and resistance) in modifying blood lipids, and to determine the most effective training programme with regard to duration, intensity and frequency for optimizing the blood lipid profile.

DESIGN

Trials were identified by a systematic search of Medline, Embase, Science Citation Index (SCI), published reviews and the references of relevant trials. The inclusion criteria were limited to randomized, controlled trials of aerobic and resistance exercise training which were conducted over a minimum of four weeks and involved measurement of one or more of the following: total cholesterol (TC), high density lipoprotein (HIDL-C), low density lipoprotein (LDL-C) and triglycerides (TG).

SUBJECTS

A total of 31 trials ( 1833 hyperlipidemic and normolipidemic participants) were included.

RESULTS

Aerobic exercise training resulted in small but statistically significant decreases of 0.10 mmol/L (95% CI: 0.02, 0.18). 0.10 (95% CI: 0.02, 0.19), 0.08 mmol/L (95% CI: 0.02, 0.14), for TC, LDL-C, and TG, respectively, with an increase in HDL-C of 0.05 mmol/L (95% CI: 0.02, 0.08). Comparisons between the intensities of the aerobic exercise programmes produced inconsistent results; but more frequent exercise did not appear to result in greater improvements to the lipid profile than exercise three times per week. The evidence for the effect of resistance exercise training was inconclusive.

CONCLUSIONS

Caution is required when drawing firm conclusions from this study given the significant heterogeneity with comparisons. However, the results appear to indicate that aerobic exercise training produced small but favourable modifications to blood lipids in previously sedentary adults.