Aerobic Exercise and Lipids and Lipoproteins in Patients With Cardiovascular Disease

Lifelong endurance exercise and its relation with coronary atherosclerosis

AIMS

The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial.

METHODS AND RESULTS

The Master@Heart study is a well-balanced prospective observational cohort study. Overall, 191 lifelong master endurance athletes, 191 late-onset athletes (endurance sports initiation after 30 years of age), and 176 healthy non-athletes, all male with a low cardiovascular risk profile, were included. Peak oxygen uptake quantified fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) on computed tomography coronary angiography. Analyses were corrected for multiple cardiovascular risk factors. The median age was 55 (50-60) years in all groups. Lifelong and late-onset athletes had higher peak oxygen uptake than non-athletes [159 (143-177) vs. 155 (138-169) vs. 122 (108-138) % predicted]. Lifelong endurance sports was associated with having ≥1 coronary plaque [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.17-2.94], ≥ 1 proximal plaque (OR 1.96, 95% CI 1.24-3.11), ≥ 1 calcified plaques (OR 1.58, 95% CI 1.01-2.49), ≥ 1 calcified proximal plaque (OR 2.07, 95% CI 1.28-3.35), ≥ 1 non-calcified plaque (OR 1.95, 95% CI 1.12-3.40), ≥ 1 non-calcified proximal plaque (OR 2.80, 95% CI 1.39-5.65), and ≥1 mixed plaque (OR 1.78, 95% CI 1.06-2.99) as compared to a healthy non-athletic lifestyle.

CONCLUSION

Lifelong endurance sport participation is not associated with a more favourable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile. Longitudinal research is needed to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum.

Smart Walk: A Culturally Tailored Smartphone-Delivered Physical Activity Intervention for Cardiometabolic Risk Reduction among African American Women

This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24−49 years; BMI range = 30−58 kg/m2) were randomized to the Smart Walk intervention (n = 30) or a wellness comparison intervention (n = 30). Results supported the acceptability and feasibility of the intervention, as demonstrated by participant retention (85% at 4 months and 78% at 8 months), Smart Walk app use, and intervention satisfaction (i.e., 100% of PA participants completing the intervention [n = 24] reported they would recommend it to friend). Smart Walk participants also reported greater increases in moderate-to-vigorous PA (4-month between-arm difference in change [b] = 43.3 min/week; p = 0.018; Cohen’s d = 0.69; 8-month b = 56.6 min/week; p = 0.046; d = 0.63) and demonstrated clinically relevant, although not statistically significant (p-values > 0.05), baseline to 4 months improvements in cardiorespiratory fitness (b = 1.67 mL/kg/min; d = 0.40), systolic blood pressure (b = −3.33 mmHg; d = 0.22), diastolic blood pressure (b = −4.28 mmHg; d = 0.37), and pulse wave velocity (b = −0.46 m/s; d = 0.33). Eight-month cardiometabolic outcomes followed similar trends, but had high rates of missing data (45−53%) due to COVID-19 restrictions. Collectively, findings demonstrated favorable outcomes for acceptability and feasibility, while also highlighting key areas for refinement in future research.

Evaluation of Maintained PhysicAl CaPacity 1-yr After Coronary Patient Cardiac Rehabilitation (EMAP): A FRENCH MULTICENTER STUDY

PURPOSE

Data are scarce concerning the sustainable effects of cardiac rehabilitation (CR), on cardiorespiratory fitness (CRF) of patients with coronary artery disease (CAD). This study, carried out using data from a French multicenter study, aimed to clarify the evolution of the CRF of patients with CAD 1 yr after the end of a CR stay.

METHODS

Patients were included after an acute coronary syndrome (77%) and/or coronary revascularization, occurring <3 mo beforehand. All underwent a CR program with CRF evaluation by exercise testing (ET) on a cycle ergometer at the beginning of CR (ET1), at its end (ET2), and 1 yr later (ET3)-all ETs were performed with medication.

RESULTS

Two hundred fifty-nine patients were included (age 60 ± 10 yr, 89% male) in 16 French CR centers. Left ventricular ejection fraction was 55.3 ± 9%. Revascularization was complete (82%). Maximal workloads were 110 ± 37 (ET1), 139 ± 43 (ET2), and 144 ± 46 W (ET3) (P< .001). The estimated metabolic equivalents of the task (METs) were respectively 5.3 ± 1.4, 6.4 ± 1.6 (P< .001), and 6.6 ± 1.7 (P< .002). One year later, 163 patients (63%) improved or maintained their CRF (ET3 ≥ ET2), 73 (28%) decreased (ET1 < ET3 < ET2), and 23 (9%) lost the benefit of CR (ET3 ≤ ET1).

CONCLUSION

Among completers who agreed to enroll in this study, most patients with CAD seem to maintain their CRF 1 yr after CR.

Rationale and design of the PROspective ATHletic Heart (Pro@Heart) study: long-term assessment of the determinants of cardiac remodelling and its clinical consequences in endurance athletes

Background

Exercise-induced cardiac remodelling (EICR) results from the structural, functional and electrical adaptations to exercise. Despite similar sports participation, EICR varies and some athletes develop phenotypic features that overlap with cardiomyopathies. Training load and genotype may explain some of the variation; however, exercise ‘dose’ has lacked rigorous quantification. Few have investigated the association between EICR and genotype.

Objectives

(1) To identify the impact of training load and genotype on the variance of EICR in elite endurance athletes and (2) determine how EICR and its determinants are associated with physical performance, health benefits and cardiac pathology.

Methods

The Pro@Heart study is a multicentre prospective cohort trial. Three hundred elite endurance athletes aged 14–23 years will have comprehensive cardiovascular phenotyping using echocardiography, cardiac MRI, 12-lead ECG, exercise-ECG and 24-hour-Holter monitoring. Genotype will be determined using a custom cardiomyopathy gene panel and high-density single-nucleotide polymorphism arrays. Follow-up will include online tracking of training load. Cardiac phenotyping will be repeated at 2, 5, 10 and 20 years.

Results

The primary endpoint of the Pro@Heart study is the association of EICR with both training load and genotype. The latter will include rare variants in cardiomyopathy-associated genes and polygenic risk scores for cardiovascular traits. Secondary endpoints are the incidence of atrial and ventricular arrhythmias, physical performance and health benefits and their association with training load and genotype.

Conclusion

The Pro@Heart study is the first long-term cohort study to assess the impact of training load and genotype on EICR.

Trial registration number

NCT05164328; ACTRN12618000716268.

Cardiovascular Aging and Physical Activity: Insights From Metabolomics

The purpose of this review is to explore how metabolomics can help uncover mechanisms through which physical activity may influence the progression of cardiovascular aging. Cardiovascular aging is a process of functional and structural changes in older adults which can progress to cardiovascular disease. Metabolomics profiling is an investigative tool that can track the diverse changes which occur in human biochemistry with physical activity and aging. This mini review will summarize published investigations in metabolomics and physical activity, with a specific focus on the metabolic pathways that connect physical activity with cardiovascular aging.

Endurance exercise and the risk of cardiovascular pathology in men: a comparison between lifelong and late-onset endurance training and a non-athletic lifestyle - rationale and design of the Master@Heart study, a prospective cohort trial

Introduction

Low and moderate endurance exercise is associated with better control of cardiovascular risk factors, a decreased risk of coronary artery disease and atrial fibrillation (AF). There is, however, a growing proportion of individuals regularly performing strenuous and prolonged endurance exercise in which the health benefits have been challenged. Higher doses of endurance exercise have been associated with a greater coronary atherosclerotic plaque burden, risk of AF and myocardial fibrosis (MF).

Methods and analysis

Master@Heart is a multicentre prospective cohort study aiming to assess the incidence of coronary atherosclerosis, AF and MF in lifelong endurance athletes compared to late-onset endurance athletes (initiation of regular endurance exercise after the age of 30 years) and healthy non-athletes.

The primary endpoint is the incidence of mixed coronary plaques. Secondary endpoints include coronary calcium scores, coronary stenosis >50%, the prevalence of calcified and soft plaques and AF and MF presence. Tertiary endpoints include ventricular arrhythmias, left and right ventricular function at rest and during exercise, arterial stiffness and carotid artery intima media thickness.

Two hundred male lifelong athletes, 200 late-onset athletes and 200 healthy non-athletes aged 45–70 will undergo comprehensive cardiovascular phenotyping using CT, coronary angiography, echocardiography, cardiac MRI, 12-lead ECG, exercise ECG and 24-hour Holter monitoring at baseline. Follow-up will include online tracking of sports activities, telephone calls to assess clinical events and a 7-day ECG recording after 1 year.

Ethics and dissemination

Local ethics committees approved the Master@Heart study. The trial was launched on 18 October 2018, recruitment is complete and inclusions are ongoing.

Trial registration number

NCT03711539.

Outpatient Cardiac Rehabilitation Suppresses Deterioration of Renal Function in Patients ≥75 Years of Age With Heart Disease

BACKGROUND

This study investigated the effect of outpatient cardiac rehabilitation (OCR) and physical activity on the estimated glomerular filtration rate based on serum cystatin C (eGFRcys) in patients with heart disease (HD) aged ≥75 years.Methods and Results:This non-randomized prospective intervention study involved 136 patients (non-OCR group, n=66; OCR group, n=70), 55 of whom were aged ≥75 years (non-OCR group, n=29; OCR group, n=26). Renal function (eGFRcys) was evaluated at discharge and 3 months thereafter. A linear mixed model (LMM) was used to assess changes in renal function over time. The hospital readmission rate within 3 months after discharge was also evaluated. LMM analysis showed that the change in eGFRcys was -2.27 and +0.48 mL/min/1.73 m²in the non-OCR and OCR groups, respectively (F=2.960, P=0.022). Further, among patients aged ≥75 years in the non-OCR and OCR groups, the change in eGFRcys was -3.83 and -1.08 mL/min/1.73 m², respectively (F=2.719, P=0.039). The proportion of patients aged ≥75 years who were rehospitalized due to exacerbation of HD was 16.9% (n=10) and 6.7% (n=2) in the non-OCR and OCR groups, respectively.

CONCLUSIONS

Among patients with HD aged ≥75 years, participation in OCR reduces the decline in renal function and hospital readmission rates.

Effects of green tea extract combined with brisk walking on lipid profiles and the liver function in overweight and obese men: A randomized, double-blinded, placebo-control trial

This study was aimed to investigate the effect of green tea extract (GTE) combined with brisk walking on lipid profiles and the liver function in overweight and obese men. Twenty-four participants were randomized to either the GTE group or the placebo group for 12 weeks with a 4-week follow-up. The walking program consisted of four 60-min-sessions/week and all participants were asked to consume two GTE (150mg) or placebo tablets daily. After 12-week intervention, GTE group resulted in a significant difference in the low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels when compared to placebo group (P < 0.01). There was also a significant reduction in the aspartate aminotransferase levels (P < 0.01) in the GTE group, but no change in the placebo group (P >0.05). There was no change in the triglyceride or high-density lipoprotein cholesterol (HDL-C) levels in the placebo group, but a significant reduction was noted in the HDL-C levels in the GTE group (P < 0.05). GTE combined with brisk walking resulted in a significant change in the LDL-C and TC levels, however, a significant reduce in HDL-C in the GTE group. The study has a more positive effect on the liver function than brisk walking alone.

A META-ANALYSIS OF THE EFFECTS OF GREEN TEA COMBINED WITH PHYSICAL ACTIVITY ON BLOOD LIPIDS IN HUMANS

ABSTRACT Introduction: Most studies of green tea extract (GTE) combined with physical activity have reported a preventative effect for cardiovascular disease; however, the findings regarding the effects on serum lipids are controversial. Objective: This meta-analysis aimed to examine the evidence of the effects of GTE combined with physical activity on the serum lipid content in humans. Methods: In June 2017, we conducted electronic searches of PubMed, Web of Science, and Cochrane Library to identify pertinent studies: those with an experiment period exceeding two weeks, human randomized controlled trials (RCTs), and those that only assessed GTE with physical activity were included. A random effects model meta-analysis was used in this review. Results: A total of 271 citations were retrieved in our search of the electronic literature, and 7 RCTs, which included 608 individuals, were identified. Overall, there was no significant decrease in low-density lipoprotein cholesterol (LDL-C) (SMD:-0.169; 95% confidence interval [CI]:-0.414 to 0.076; I2=22.7%; p=0.177) or total cholesterol (TC) levels between the GTE and placebo combined with the physical activity group. Similar results were also observed for high density-lipoprotein cholesterol (HDL-C) and triglycerides (TG). In the subgroup and sensitivity analyses of the five studies, the TC levels of the subjects who received a lower dose of epigallocatechin gallate (EGCG) together with performing physical activity were significantly decreased. Conclusion: Current evidence suggests that green tea combined with physical activity does not improve the lipid and lipoprotein levels in humans. Level of evidence I; Systematic review.

The Impact of Aerobic Exercise and Badminton on HDL Cholesterol Levels in Taiwanese Adults

Elevated levels of high-density lipoprotein cholesterol (HDL-C) have been associated with a decreased risk of coronary heart disease (CHD). An active lifestyle is necessary to improve HDL-C, including (but not limited to) physical exercise. Research on the association between badminton, an intermittent exercise, and HDL-C is limited. We investigated the impact of aerobic exercise and badminton on HDL-C levels in Taiwanese adults. The sociodemographic data of 7543 participants, comprising 3472 men and 4071 women aged between 30 and 70 years, were retrieved from the Taiwan Biobank. The participants were grouped into three exercise categories-no exercise, aerobic exercise, and badminton exercise. The HDL-C levels were compared using an analysis of variance (ANOVA). Multivariate linear regression models were used to determine the associations between HDL and exercise. Comparing the other two groups to the no-exercise group, the individuals who were engaged in aerobic and badminton exercise were significantly associated with higher HDL-C levels (β = 1.4077; p < 0.0001 and β = 5.6052; p = 0.0079, respectively). Aerobic exercise and badminton were also associated with higher HDL-C levels among carriers of the lipoprotein lipase (LPL) rs328 genotypes. Aerobic exercise and regular badminton were associated with higher levels of HDL-C, with the badminton group being more significant.

Management of patients with type 2 diabetes in cardiovascular rehabilitation

The clinical benefits of rehabilitation in cardiovascular disease are well established. Among cardiovascular disease patients, however, patients with type 2 diabetes mellitus require a distinct approach. Specific challenges to clinicians and healthcare professionals in patients with type 2 diabetes include the prevalence of peripheral and autonomic neuropathy, retinopathy, nephropathy, but also the intake of glucose-lowering medication. In addition, the psychosocial wellbeing, driving ability and/or occupational status can be affected by type 2 diabetes. As a result, the target parameters of cardiovascular rehabilitation and the characteristics of the cardiovascular rehabilitation programme in patients with type 2 diabetes often require significant reconsideration and a multidisciplinary approach. This review explains how to deal with diabetes-associated comorbidities in the intake screening of patients with type 2 diabetes entering a cardiovascular rehabilitation programme. Furthermore, we discuss diabetes-specific target parameters and characteristics of cardiovascular rehabilitation programmes for patients with type 2 diabetes in a multidisciplinary context, including the implementation of guideline-directed medical therapy.

How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure

OBJECTIVE

To compare the effect of exercise regimens and medications on systolic blood pressure (SBP).

DATA SOURCES

Medline (via PubMed) and the Cochrane Library.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs) and diuretics were identified from existing Cochrane reviews. A previously published meta-analysis of exercise interventions was updated to identify recent RCTs that tested the SBP-lowering effects of endurance, dynamic resistance, isometric resistance, and combined endurance and resistance exercise interventions (up to September 2018).

DESIGN

Random-effects network meta-analysis.

OUTCOME

Difference in mean change from baseline SBP between comparator treatments (change from baseline in one group minus that in the other group) and its 95% credible interval (95% CrI), measured in mmHg.

RESULTS

We included a total of 391 RCTs, 197 of which evaluated exercise interventions (10 461 participants) and 194 evaluated antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. While all medication trials included hypertensive populations, only 56 exercise trials included hypertensive participants (≥140 mmHg), corresponding to 3508 individuals. In a 10% random sample, risk of bias was higher in exercise RCTs, primarily due to lack of blinding and incomplete outcome data. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference -3.96 mmHg, 95% CrI -5.02 to -2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials.

CONCLUSIONS

The effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.

The effectiveness of aerobic exercise for hypertensive population: A systematic review and meta-analysis

The study aims to evaluate the effectiveness of different durations of aerobic exercise on hypertensive patients. Four electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) were searched from their inception until July 2018. English publications and randomized controlled trials involving aerobic exercise treatment for hypertensive population were included. Two reviewers independently extracted the data. The Cochrane's Risk of Bias tool was used to assess the quality of included studies. In this systematic review, a total of 14 articles were included, involving 860 participants. The quality of the included studies ranged from moderate to high. The results of the meta-analysis showed that compared with the control group, significant effects of aerobic exercise were observed on reducing systolic blood pressure (SBP) (mean difference [MD] = -12.26 mm Hg, 95% confidence interval [CI] = -15.17 to -9.34, P < 0.05), diastolic blood pressure (DBP; MD = -6.12 mm Hg, 95% CI = -7.76 to -4.48, P < 0.05), and heart rate (MD = -4.96 bpm, 95% CI = -6.46 to -3.43, P < 0.05). In addition, significant reductions were observed in ambulatory DBP (MD = -4.90 mm Hg, 95% CI = -8.55 to -1.25, P < 0.05) and ambulatory SBP (MD = -8.77mm Hg, 95% CI = -13.97 to -3.57, P < 0.05). Therefore, aerobic exercise might be an effective treatment for blood pressure improvement in hypertensive patients. However, the effectiveness between the duration of different treatment needs to be well-designed and rigorous studies will be required to verify the dataset.

The Impact of Supervised Exercise Training on Traditional Cardiovascular Risk Factors in Patients With Intermittent Claudication: A Systematic Review and Meta-Analysis

BACKGROUND

Patients with intermittent claudication (IC) are at increased risk of cardiovascular (CV) morbidity and mortality. Whereas extensive evidence supports the beneficial effects of supervised exercise training (SET) on walking capacity, little is known about the effect of SET on the CV risk profile of IC patients. Therefore, the aim was to evaluate the effects of SET on CV risk factors in IC patients by using meta-analysis techniques.

METHODS

A systematic search in the electronic databases MEDLINE, EMBASE, CINAHL, and CENTRAL was conducted from the earliest date available until October 2, 2018. Randomised and non-randomised controlled trials lasting ≥ four weeks and investigating the effect of SET on CV risk factors in IC patients were included. Traditional CV risk factors were studied as primary outcomes; pain free walking distance (PFWD) and maximum walking distance (MWD) were included as secondary outcomes. Data were pooled using random effects models with summary data reported as weighted means and 95% confidence interval (CIs).

RESULTS

Fifteen trials were included, involving 18 study groups (nine walking, four resistance, two aerobic training, and three combined groups), totalling 725 patients (mean age 66.3 years; mean ankle brachial index, 0.64). Exercise reduced systolic blood pressure (-5.8 mmHg; CI -9.89 to 1.67, p < .01) whereas all other CV risk factors (i.e., body weight, body mass index, diastolic blood pressure, and blood lipids) remained statistically unaltered. Exercise also improved PFWD (+132 m; CI 70-194, p < .001) and MWD (+183 m; CI 98-268, p < .001).

CONCLUSION

This meta-analysis supports the beneficial effects of SET on walking capacity. Little evidence for an improvement of the CV risk profile was found following exercise in patients with IC. However, given the scarcity of data, high quality RCTs that include an assessment of CV risk factors are urgently required to determine the effect of exercise therapy in the secondary prevention of CV disease of IC patients.

The impact of aerobic and isometric exercise on different measures of dysfunctional high-density lipoprotein in patients with hypertension

BACKGROUND

Exercise training increases high-density lipoprotein (HDL) cholesterol, but its effect on HDL function is unclear. In hypertensives, exercise improves endothelial dysfunction, which is related to HDL function. In the present study, we assess for the first time the effects of different exercise modalities on two cell-free assays of HDL function.

DESIGN

The study was conducted as a prospective randomized controlled trial in 75 hypertensive patients.

METHODS

Patients were randomized in three groups: (a) handgrip isometric training five times weekly; (b) placebo-handgrip; and (c) aerobic exercise training at least three times per week. HDL function was assessed in serum samples at baseline and after 12 weeks of training by two independent assays that determine the proinflammatory phenotype (haptoglobin content) of a specific amount of HDL (Haptoglobin-HDL [HPHDL]) and oxidized HDL (HDLox) as a measure of reduced antioxidant function of HDL. HDL function measures were normalized by the measures of a pooled control of sera from healthy participants and by HDL-C levels (normalized ratio, no units).

RESULTS

Aerobic exercise led to significant reduction of the HDLox from 0.99 ± 0.27 to 0.90 ± 0.29 (no units, p = 0.03). The HPHDL did not change in any training group. Changes of HDLox correlated with reduction of the systolic blood pressure only after aerobic exercise (R = 0.64, p = 0.03).

CONCLUSIONS

Aerobic but not isometric exercise improves the antioxidant function of HDL in patients with hypertension. This improvement correlates positively with reductions of blood pressure.

The Impact of Aerobic Exercise and Badminton on HDL Cholesterol Levels in Adult Taiwanese

Elevated levels of high-density lipoprotein cholesterol (HDL-C) have been associated with a decreased risk of coronary heart disease (CHD). An active lifestyle is necessary in order to improve lipid HDL-C, including (but not limited to) physical exercise. Research on the association between badminton, an intermittent exercise, and HDL-C is limited. We investigated the impact of aerobic exercise and badminton on HDL-C levels in Taiwanese adults. The sociodemographic data of 7797 participants comprising 3559 men and 4238 women aged between 30 to 70 years were retrieved from the Taiwan Biobank. The participants were grouped into three exercise categories—no exercise, aerobic exercise, and badminton exercise. The HDL-C levels were compared using an analysis of variance (ANOVA). The multivariate linear regression models were used to determine the associations between HDL and exercise. Comparing the other two groups to the no-exercise group, the individuals who were engaged in aerobic and badminton exercise were significantly associated with a higher HDL-C (β =1.3154; p <0.0001 and β = 6.5954; p = 0.0027, respectively). Aerobic exercise and badminton were also associated with higher HDL-C levels among carriers of the lipoprotein lipase (LPL) rs328 genotypes. Aerobic exercise and regular badminton were associated with higher levels of HDL-C, with the badminton group being more significant.

Effects of supervised structured aerobic exercise training program on high and low density lipoprotein in patients with type II diabetes mellitus

Background and Objective:

Hyperlipidemia and dyslipidemia are very common conditions among patients with Type-2 diabetes mellitus (T2DM) and associated with increased risk of coronary heart diseases. Physical activity and exercises along with medical management and dietary plan are common strategies to use for the management of deranged lipid profile in patients with T2DM. We aimed to determine the effects of supervised structured aerobic exercise training (SSAET) program on high and low density lipoprotein in patients with T2DM.

Methods:

This randomized control trial study was conducted at Riphah Rehabilitation Research Centre (RRRC), Pakistan Railway General Hospital (PRGH) Rawalpindi from 1^st January 2015 to 30^th March 2016. The inclusion criteria was Type-2 diabetes patients of both gender aged between 40 to 70 years. Patients with severe complications like coronary artery diseases (CAD), and other serious complications like diabetic foot, and severe knee and hip osteoarthritis (OA) were excluded from the study. A total of 195 patients diagnosed with T2DM were screened out and 102 were selected for the study as per the inclusion criteria. All participants were randomly assigned into two groups, experimental ‘A’ (n=51) and control ‘B’ (n=51). Patients in group A were treated with SSAET program of 25 weeks at 3 days a week in addition to routine medical management, while patients in Group-B were on their routine medications and dietary plan. Serum LDL, and HDL were tested at baseline and after 25 weeks. The data was analysed through SPSS 20.

Results:

Mean and standard deviation of LDL in group A (n=51) was 118.56±19.17 (pre) and 102.64±13.33 (post), while the mean and standard deviation for Group-B (n=51) was 116.50±18.45 (Pre) and 109.88±17.13 (post). Both groups showed improvement but, Group-A treated with SSAET along with RMM showed significantly higher (P Value ≤ 0.05) improvement as compared with group B treated with RMM alone. Mean and standard deviation of HDL in Group-A was 42.70±8.06 (pre) and 47.47±7.16 (post), while the mean and standard deviation of group B is 43.37±8.15 (Pre) and 44.41±7.91 (post). Both groups showed improvement but Group-A treated with SSAET program along with RMM showed significantly higher (P Value ≤ 0.05) improvement than group B treated with RMM alone.

Conclusion:

SSAET program along with RMM is more effective strategy for the management of deranged lipid profile in patients with T2DM.

National Lipid Association Annual Summary of Clinical Lipidology 2016

The National Lipid Association (NLA) Annual Summary of Clinical Lipidology is a yearly updated summary of principles important to the patient-centered evaluation, management, and care of patients with dyslipidemia. This summary is intended to be a "living document," with future annual updates based on emerging science, clinical considerations, and new NLA Position, Consensus, and Scientific Statements, thus providing an ongoing resource that applies the latest in medical science towards the clinical management of patients with dyslipidemia. Topics include the NLA Recommendations for Patient-Centered Management of Dyslipidemia, genetics, Familial Hypercholesterolemia, secondary causes of dyslipidemia, biomarkers and advanced lipid testing, nutrition, physical activity, obesity, adiposopathy, metabolic syndrome, diabetes mellitus, lipid pharmacotherapy, lipid-altering drug interactions, lipoprotein apheresis, dyslipidemia management and treatment based upon age (children, adolescents, and older individuals), dyslipidemia considerations based upon race, ethnicity and gender, dyslipidemia and human immune virus infection, dyslipidemia and immune disorders, adherence strategies and collaborative care, and lipid-altering drugs in development. Hyperlinks direct the reader to sentinel online tables, charts, and figures relevant to lipidology, access to online atherosclerotic cardiovascular disease risk calculators, worldwide lipid guidelines, recommendations, and position/scientific statements, as well as links to online audio files, websites, slide shows, applications, continuing medical education opportunities, and patient information.

The role of cardiorespiratory fitness on plasma lipid levels

Dyslipidemia is a treatable risk factor for cardiovascular disease. Epidemiological studies have demonstrated the importance of treatment for abnormalities in total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. Aside from pharmacotherapy, exercise and cardio-respiratory fitness have been shown to have beneficial effects on decreasing cardiovascular disease risk. Even though previous data regarding the benefits of exercise on plasma lipids have been somewhat conflicting, numerous studies have demonstrated that exercise increases HDL-cholesterol and reduces the triglyceride levels. Also, smaller, more atherogenic LDL particles seem to decrease with increases in cardio-respiratory fitness and exercise, and favorable blood lipid profiles seem to persist longer through the adult life span.

PREVENTIVE TRAINING PROGRAMME FOR PATIENTS AFTER ACUTE CORONARY EVENT-- CORRELATION BETWEEN SELECTED PARAMETERS AND AGE GROUPS

AIM

Interventional cardiovascular training programmes provide a prescription of optimal form and safe intensity. They are part of the second phase of cardiovascular rehabilitation which is a key point in the whole tertiary-preventive care for patients with coronary artery disease. The patients are hemodynamically adapted to a normal physical load, their aerobic capacity is gradually increased, and they learn principles of regular aerobic-resistance exercise. The aim of this study is to assess the impact of modified aerobic-resistance exercise on cardiorespiratory indicators in patients after acute coronary event, and evaluate the differences between monitored parameters in different age groups.

METHODS

The study was conducted on a group of 106 patients (85% of men) of an average age of 60.4 ± 10.9 years, with left ventricular ejec- tion fraction of 57.4 ± 7.2%. All subjects went through an acute coronary event. The time elapsed between the occurence of a coronary event and the beginning of the training programme was 35 ± 8 days. In patients after coronary artery bypass grafting, the time passed was 50 ± 16 days on average. All patients received a two-month aerobic-resistance training with a frequency of three times a week. The length of a training unit was set to 100 minutes (out of which 60 minutes were allocated to individual aerobic training).

RESULTS

A significant negative correlation between age and average values of monitored parameters was observed. Even though the values of all parameters are decreasing with increasing age, a shift towards higher values in all parameters occurred after completing the training programme. The study reveals that there are interindividual differences between the parameter values. Asignificant difference in individual parameters was found between different age groups. The result of the study shows that a given parameter could characterize each age group. Completing the interventional training programme also led to a significant increase of exercise tolerance (1.8 ± 0.3 vs. 2.0 ± 0.4 W/kg; p < 0.001) and of peak oxygen consumption (22.8 ± 4.5 vs. 25.9 ± 5.5 ml/kg/min, p < 0.001).

CONCLUSION

Interindividual differences between the parameter values have been identified. This could be helpful in methodological conception of preventive training programmes for patients suffering from cardiovascular disease. The mutual connection between the parameter values and age groups does not relate only to a safer training intensity determination, but also to a more precisely targeted application of different training modalities in order to achieve an optimal final training effect.

Physical activity, body composition and metabolic syndrome in young adults

OBJECTIVE

Low physical activity (PA) is a major risk factor for cardiovascular and metabolic disorders in all age groups. We measured intensity and volume of PA and examined the associations between PA and the metabolic syndrome (MS), its components and body composition among young Finnish adults.

RESEARCH DESIGN AND METHODS

The study comprises 991 men and women born 1985-86, who participated in a clinical study during the years 2009-11 which included assessments of metabolism, body composition and PA. Objectively measured (SenseWear Armband) five-day PA data was available from 737 participants and was expressed in metabolic equivalents of task (MET).

RESULTS

The prevalence of MS ranged between 8-10%. Higher total mean volume (MET-hours) or intensity (MET) were negatively associated with the risk of MS and separate components of MS, while the time spent at sedentary level of PA was positively associated with MS.

CONCLUSIONS

MS was prevalent in approximately every tenth of the young adults at the age of 24 years. Higher total mean intensity and volume rates as well as longer duration spent at moderate and vigorous PA level had a beneficial impact on the risk of MS. Longer time spent at the sedentary level of PA increased the risk of MS.

The effects of tai chi on the renal and cardiac functions of patients with chronic kidney and cardiovascular diseases

[Purpose] To assess the effects of Tai Chi on the renal and cardiac functions of patients with chronic kidney disease (CKD) and cardiovascular disease (CVD). [Subjects and Methods] Twenty-one patients with CKD and CVD were randomly divided into control and exercise groups. The exercise group performed Tai Chi training for 30 minutes three to five times a week for 12 weeks, while the control group did not. All patients’ renal and cardiac functions and blood lipid parameters were measured at baseline and after 12 weeks. [Results] The 12 weeks Tai Chi intervention improved the estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), and the high density lipoprotein (HDL) level, and decreased the serum creatintine (Scr) level, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the total cholesterol (CH), triglyceride (TG) and low density lipoprotein (LDL) levels. The change in eGFR correlated negatively with the changes in CH, TG and LDL, and positively with the change in HDL. In addition, the change in SBP correlated positively with the changes in CH, TG and LDL, and negatively with the change in HDL. [Conclusion] Tai Chi training might improve the renal and cardiac functions of CKD and CVD patients via improved regulation of lipid metabolism.

National Lipid Association Annual Summary of Clinical Lipidology 2015

The National Lipid Association (NLA) Annual Summary of Clinical Lipidology 2015 is a summary of principles important to the patient-centered evaluation, management, and care of patients with dyslipidemia. This summary is intended to be a "living document," with future annual updates based on emerging science, clinical considerations, and new NLA Position and Consensus Statements. The goal is to provide clinicians an ongoing resource that translates the latest advances in medical science toward the evaluation and treatment of patients with dyslipidemia. The 2015 NLA Annual Summary of Clinical Lipidology was founded on the principles of evidence-based medicine and is generally consistent with established national and international lipid guidelines. Topics include a general discussion of the 2014 NLA Recommendations for Patient-Centered Management of Dyslipidemia, genetics, secondary causes of dyslipidemia, biomarkers and "advanced lipid testing," medical nutrition, physical activity, obesity, pharmacotherapy, statin safety, lipid-altering drug interactions, lipoprotein apheresis, dyslipidemia in children and adolescence, dyslipidemia in older individuals, race/ethnicity, and women, health information technology and electronic medical records, as well as investigational lipid-altering drugs in development.

Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial

BACKGROUND AND AIMS

Cardiovascular co-morbidities are prevalent after stroke, with heart disease, hypertension and impaired glucose tolerance present in the majority of cases. Exercise has the potential to mediate cardiovascular risk factors commonly present in people with stroke. This single-blinded randomized controlled trial compared the effects of high versus low intensity exercise on fitness, cardiovascular risk factors, and cardiac function after stroke.

METHODS

Fifty participants (age 50-80 y, >1 y post-stroke) were randomized to a high-intensity Aerobic Exercise (AE) or low-intensity non-aerobic Balance/Flexibility (BF) program (6 months, 3 60-min sessions/week). Outcomes assessed by VO2 peak (primary outcome), arterial stiffness, ambulatory capacity, hemodynamics and cardiac function using echocardiography, and lipid, glucose and homocysteine levels. Assessors were blinded to group allocation.

RESULTS

Twenty-three (92%) of 25 AE group participants (withdrawals unrelated to the intervention) and all BF group participants completed the program. One BF group participant experienced 2 non-injurious falls during class. No other adverse events occurred. There were no changes in VO2 peak in either group (AE 16·9±7 to 17·4±7 ml●kg(-1) ●min(-1) vs. BF 16·9±6 to 16·6±5 ml●kg(-1) ●min(-1) , P=0·45), but AE group demonstrated greater improvement in right atrial emptying fraction (AE 30±22 to 37±22% vs. BF 35±20 to 31±20%, P=0·04). Both groups demonstrated improvements in lipid profiles, glucose and homocysteine levels, and ambulatory capacity (P<0·04).

CONCLUSIONS

This was the first study to examine the effects of aerobic exercise after stroke on cardiovascular hemodynamics. High-intensity exercise improved right-sided function and early myocardial relaxation. Low-intensity exercise may also benefit plasma lipid, glucose and inflammatory markers, and ambulatory capacity. This study is an important step towards understanding mechanisms by which exercise may reduce cardiovascular risk and function.

Clinical Strategies for Managing Dyslipidemias

There is substantial evidence that lipids are critical in the development and progression of atherosclerotic cardiovascular disease. In November 2013, the American College of Cardiology/American Heart Association in conjunction with the National Cholesterol Education Program IV developed new guidelines for the treatment of blood cholesterol. In this report, we review these new guidelines and emphasize the potential benefits of physical activity and exercise training on plasma lipids.

Exercise-based cardiac rehabilitation in patients with coronary heart disease: meta-analysis outcomes revisited

Cardiac rehabilitation that includes either exercise training alone or exercise training in addition to psychosocial, risk factor management and/or educational interventions is considered a Class I indication [i.e., useful and effective] for patients with coronary heart disease. This overview of six independent cardiac rehabilitation meta-analyses published since 2000 includes a total of 71 randomized clinical trials (n = 13,824 patients) and clearly demonstrates significant clinical outcomes (reduced all-cause and cardiac mortality, nonfatal reinfarction and reduced hospitalization rates) and significant positive changes in modifiable risk factors (total cholesterol, triglycerides and systolic blood pressure). Despite the observation that the elderly, females, minority ethnic groups, low socioeconomic status patients and patients with comorbidities have not been well represented in the randomized clinical trials. Recent guidelines in the UK and USA have concluded with the recommendation that cardiac rehabilitation is reasonable and necessary and should be promoted by healthcare professionals, including senior medical staff.

Physical exercise and its effects on coronary artery disease

The beneficial effects of physical exercise on stable coronary artery disease (CAD) have been shown by an increasing number of studies. Exercise training leads to an improved bioavailability of the endothelial nitric oxide and partially attenuates endothelial dysfunction. Further effects are an economization of ventricular function and a reduction of cardiovascular risk factors. In clinical studies exercise training was associated with a decreased total and cardiovascular mortality and a reduced angina pectoris threshold. Thus exercise training has developed to an evidence-based therapeutic option of stable CAD with a Class Ia recommendation in the guidelines.

Exercise effects on lipids in persons with varying dietary patterns-does diet matter if they exercise? Responses in Studies of a Targeted Risk Reduction Intervention through Defined Exercise I

BACKGROUND

The standard clinical approach for reducing cardiovascular disease risk due to dyslipidemia is to prescribe changes in diet and physical activity. The purpose of the current study was to determine if, across a range of dietary patterns, there were variable lipoprotein responses to an aerobic exercise training intervention.

METHODS

Subjects were participants in the STRRIDE I, a supervised exercise program in sedentary, overweight subjects randomized to 6 months of inactivity or 1 of 3 aerobic exercise programs. To characterize diet patterns observed during the study, we calculated a modified z-score that included intakes of total fat, saturated fat, trans fatty acids, cholesterol, omega-3 fatty acids, and fiber as compared with the 2006 American Heart Association diet recommendations. Linear models were used to evaluate relationships between diet patterns and exercise effects on lipoproteins/lipids.

RESULTS

Independent of diet, exercise had beneficial effects on low-density lipoprotein cholesterol particle number, low-density lipoprotein cholesterol size, high-density lipoprotein cholesterol, high-density lipoprotein cholesterol size, and triglycerides (P < .05 for all). However, having a diet pattern that closely adhered to American Heart Association recommendations was not related to changes in these or any other serum lipids or lipoproteins in any of the exercise groups.

CONCLUSIONS

We found that even in sedentary individuals whose habitual diets vary in the extent of adherence to AHA dietary recommendations, a rigorous, supervised exercise intervention can achieve significant beneficial lipid effects.

Evidence-based risk assessment and recommendations for physical activity clearance: established cardiovascular disease1This paper is one of a selection of papers published in this Special Issue, entitled Evidence-based risk assessment and recommendations for physical activity clearance, and has undergone the Journal’s usual peer review process

Physical activity is an effective lifestyle therapy for patients at risk for, or with, documented cardiovascular disease (CVD). Current screening tools — the Physical Activity Readiness Questionnaire (PAR-Q) and the Physical Activity Readiness Medical Evaluation (PARmed-X) — require updating to align with risk/benefit evidence. We provide evidence-based recommendations to identify individuals with CVD at lower risk, intermediate risk, or higher risk of adverse events when participating in physical activity. Forms of exercise and the settings that will appropriately manage the risks are identified. A computer-assisted search of electronic databases, using search terms for CVD and physical activity risks and benefits, was employed. The Appraisal of Guidelines for Research and Evaluation were applied to assess the evidence and assign a strength of evidence rating. A strength rating for the physical activity participation clearance recommendation was assigned on the basis of the evidence. Recommendations for physical activity clearance were made for specific CVD groups. Evidence indicates that those who are medically stable, who are involved with physical activity, and who have adequate physical ability can participate in physical activity of lower to moderate risk. Patients at higher risk can exercise in medically supervised programs. Systematic evaluation of evidence indicates that clinically stable individuals with CVD may participate in physical activity with little risk of adverse events. Therefore, changes in the PAR-Q should be undertaken and a process of assessment and consultation to replace the PARmed-X should be developed. Patients at lower risk may exercise at low to moderate intensities with minimal supervision. Those at intermediate risk should exercise with guidance from a qualified exercise professional. Patients at higher risk should exercise in medically supervised programs.

Association of high-density lipoprotein cholesterol with coronary heart disease risk across categories of low-density lipoprotein cholesterol: the atherosclerosis risk in communities study

INTRODUCTION

National cholesterol treatment guidelines include a low level of high-density lipoprotein (HDL) cholesterol (<40 mg/dL) as a major risk factor for coronary heart disease (CHD) that should be considered when making decisions on treatment of low-density lipoprotein (LDL) cholesterol.

METHODS

We investigated the association of HDL and LDL-cholesterol with incident CHD events (fatal or nonfatal CHD) over 14 years of follow-up among 13,615 adults aged 45 to 64 years in the Atherosclerosis Risk in Communities study.

RESULTS

A total of 966 (7.1%) participants had a CHD event during follow-up. After adjustment for age, race, sex, diabetes, smoking, alcohol consumption, systolic blood pressure, waist circumference, chronic kidney disease and physical activity, a graded association was present between progressively lower levels of HDL-cholesterol and higher CHD risk, overall (P < 0.001) and within each level of LDL-cholesterol (<100, 100-129, 130-159, 160-189 and ≥190 mg/dL) investigated (all P < 0.05). In addition, after multivariable adjustment including LDL-cholesterol, each standard deviation higher HDL-cholesterol (18 mg/dL) was associated with a hazard ratio of incident CHD of 0.70 (95% CI: 0.63-0.77).

CONCLUSIONS

These data suggest a graded association exists between lower levels of HDL-cholesterol and CHD across the full range of LDL-cholesterol levels. As interventions targeting HDL levels are developed, the combinatorial effects of lower HDL levels with various levels of LDL-cholesterol should be examined.

Exercise therapy correlates with improving renal function through modifying lipid metabolism in patients with cardiovascular disease and chronic kidney disease

BACKGROUND

Patients with cardiovascular disease (CVD) and chronic kidney disease (CKD) are at high risk of cardiovascular mortality, thus therapies to improve renal function should be clinically investigated.

METHODS AND RESULTS

We divided consecutive patients with CVD and CKD (n=19) into exercise (n=10) and non-exercise (n=9) therapy groups. Exercise therapy for 12 weeks significantly improved the anaerobic metabolic threshold (AT-V O₂) and high-density lipoprotein cholesterol (HDL-C) levels, and reduced triglyceride levels. Exercise therapy also improved estimated glomerular filtration rate (eGFR). Change in eGFR correlated significantly and positively with change in AT-V O₂ and HDL-C, and negatively with change in triglyceride levels.

CONCLUSIONS

Exercise therapy correlates with improving renal function in CVD patients with CKD through modifying lipid metabolism. Exercise therapy could be an effective clinical strategy to improve renal function.

Responses of blood lipids and lipoproteins to extended-release niacin and exercise in sedentary postmenopausal women

Niacin and exercise positively alter blood lipids and lipoproteins via different mechanisms. However, the effects of niacin combined with exercise on blood lipid and lipoprotein profiles have not been investigated in sedentary postmenopausal women. The current study examined the responses of blood lipids and lipoproteins to niacin and exercise in 18 sedentary postmenopausal women, who underwent four conditions: no-niacin rest, no-niacin exercise, niacin rest, and niacin exercise. Participants ingested 1,000 mg/day of extended-release niacin for 4 weeks during the niacin condition. As an exercise treatment, participants performed a single bout of exercise on a treadmill at 60% heart rate reserve until 400 kcal were expended. Extended-release niacin without the exercise intervention significantly (p < .001) increased high-density lipoprotein cholesterol and high-density lipoprotein-2 cholesterol by 12.4% and 33.3%, respectively, and decreased the total cholesterol to high-density lipoprotein cholesterol ratio by 14.8%. Thus, 4 weeks of 1,000 mg/day of extended-release niacin can improve the blood lipid and lipoprotein profiles in sedentary postmenopausal women.

Efeitos do treinamento resistido na lipoproteína de baixa densidade

Os benefícios da prática regular do exercício físico estão claramente estabelecidos na literatura. Entretanto, a escolha do tipo de exercício ideal pode ser mais salutar para indivíduos com doenças específicas e patologias associadas. O propósito desta revisão foi verificar se o treinamento resistido (TR) exerce alguma alteração no colesterol da lipoproteína de baixa densidade (LDL-C). Foram observadas grandes diferenças na literatura, dificultando uma conclusão em relação aos benefícios do TR nesta revisão. No entanto, foi visto que o TR pode ser promissor na redução dos níveis de LDL-C, principalmente em homens e mulheres adultos, em pacientes com diabetes mellitus tipo 1 e tipo 2 e em mulheres pré-menopausa, não mostrando diferenças na população idosa. Os autores concluem que o TR é uma boa opção de exercício físico para indivíduos, principalmente quando o treinamento aeróbio (TA) é contraindicado.

Effects of cardiovascular lifestyle change on lipoprotein subclass profiles defined by nuclear magnetic resonance spectroscopy

Background

Low-density lipoprotein (LDL) cholesterol lowering is a primary goal in clinical management of patients with cardiovascular disease, but traditional cholesterol levels may not accurately reflect the true atherogenicity of plasma lipid profiles. The size and concentration of lipoprotein particles, which transport cholesterol and triglycerides, may provide additional information for accurately assessing cardiovascular risk. This study evaluated changes in plasma lipoprotein profiles determined by nuclear magnetic resonance (NMR) spectroscopy in patients participating in a prospective, nonrandomized lifestyle modification program designed to reverse or stabilize progression of coronary artery disease (CAD) to improve our understanding of lipoprotein management in cardiac patients.

Results

The lifestyle intervention was effective in producing significant changes in lipoprotein subclasses that contribute to CAD risk. There was a clear beneficial effect on the total number of LDL particles (-8.3%, p < 0.05 compared to matched controls), small dense LDL particles (-9.5%, p < 0.05), and LDL particle size (+0.8%; p < 0.05). Likewise, participants showed significant improvement in traditional CAD risk factors such as body mass index (-9.9%, p < 0.01 compared to controls), total cholesterol (-5.5%, p < 0.05), physical fitness (+37.2%, p < 0.01), and future risk for CAD (-7.9%, p < 0.01). Men and women responded differently to the program for all clinically-relevant variables, with men deriving greater benefit in terms of lipoprotein atherogenicity. Plasma lipid and lipoprotein responses to the lifestyle change program were not confounded by lipid-lowering medications.

Conclusion

In at risk patients motivated to participate, an intensive lifestyle change program can effectively alter traditional CAD risk factors and plasma lipoprotein subclasses and may reduce risk for cardiovascular events. Improvements in lipoprotein subclasses are more evident in men compared to women.