Reducing effect of aerobic exercise on blood pressure of essential hypertensive patients: A meta-analysis

Lowering blood pressure by exercise: investigating the effect of sweating

High blood pressure (hypertension), is a common medical condition, affecting millions of people and is associated with significant health risks. Exercise has been suggested to manage hypertension by inducing sweating and the corresponding loss of sodium and water from the body.Thus, a variety of epidemiological and clinical studies have been conducted to investigate the relationship between sweating and exercise-induced blood pressure reduction and its impacts on hypertension. The mechanisms underlying exercise-induced blood pressure reduction are complex and still not fully understood. However, several pathways have been suggested, including the loss of sodium and water through sweat, a decrease in peripheral resistance, and an improvement in endothelial function in the blood vessels. The decrease in sodium and water content in the body associated with sweating may result in a reduction in blood volume and thus a decrease in blood pressure. Moreover, the reduction in peripheral resistance is thought to be mediated by the activation of the nitric oxide synthase pathway and the release of vasodilators such as prostacyclin and bradykinin, which lead to vasodilation and, thus, a reduction in blood pressure. In conclusion, exercise-induced sweating and consequent sodium and water loss appear to be a reliable biological link to the blood pressure-reducing effects of exercise in hypertensive individuals. Additionally, the mechanisms underlying exercise-induced blood pressure reduction are complex and involve several biological pathways in the cardiovascular system. Therefore, understanding the role of sweat production in blood pressure management is important for developing effective exercise interventions to prevent and manage hypertension.

Investigation of the involvement of platelet-activating factor in the control of hypertension by aerobic training. A randomized controlled trial

Although studies have demonstrated the effectiveness of exercise in controlling systemic arterial hypertension (SAH), the mechanisms involved in this effect are still poorly understood. Thus, this study investigated the impact of aerobic training on the relationship between platelet-activating factor (PAF) circulating levels and blood pressure in hypertensives. Seventy-seven hypertensive subjects were enrolled in this randomized controlled trial (age 66.51 ± 7.53 years, body mass 76.17 ± 14.19 kg). Participants were randomized to two groups: the intervention group (IG, n = 36), composed of hypertensive individuals submitted to an aerobic training protocol, and the control group (CG, n = 41), composed of non-exercised hypertensives. Body mass index, arterial blood pressure, quality of life, respiratory muscle strength, and functional capacity were assessed before and after 12 weeks. PAF and plasma cytokine levels were also evaluated respectively by liquid chromatography coupled with mass spectrometry and enzyme-linked immunosorbent assay. Aerobic training promoted a significant reduction in blood pressure while functional capacity, expiratory muscle strength, and quality of life, PAFC16:0 and PAFC18:1 plasma levels were increased in comparison to the CG (p < 0.05). In addition, multiple correlation analysis indicated a positive correlation [F (3.19) = 6.322; p = 0.001; R2adjusted = 0.499] between PAFC16:0 levels and expiratory muscle strength after aerobic training. Taken together, our findings indicate that PAF may be involved in the indirect mechanisms that control SAH, being mainly associated with increased respiratory muscle strength in hypertensive subjects undergoing aerobic training.

Impact of Pulsed Electromagnetic Field Therapy and Aerobic Exercise on Patients Suffering With Hypertension: A Systematic Review

Hypertension is a major preventable risk factor for cardiovascular disease. This review evaluates the effects of pulsed electromagnetic field (PEMF) therapy and aerobic exercise on blood pressure (BP) levels in hypertensive patients. This study incorporated research conducted between 2012 and 2020 that was found through a systematic literature search. The measures used to estimate the improvement in BP include the BP measurements, quality-of-life (QOL) scale, and plasma nitric oxide (NO) level. The examination of the review comprised eight studies. These encompassed studies involving individuals with a systolic BP (SBP) above 140 mmHg and a diastolic BP (DBP) above 90 mmHg; those falling within the age range of 40 to 60 years, including both genders; and patients on antihypertensive medications. The review of selected articles concluded that PEMF therapy and aerobic exercise positively impact BP among individuals with hypertension. Aerobic exercises of moderate intensity including brisk walking, jogging, and cycling type of aerobic exercises help reduce BP and maintain patients' physical fitness. PEMF therapy is a complementary approach that affects the biological system and potential health, positively impacting BP. Results indicate that PEMF therapy can be a nonpharmacological method to manage BP in clinical populations. More thorough research is necessary to understand the best dosage, long-term effects, and comparison between PEMF therapy and aerobic exercise.

Effects of aerobic exercise on blood pressure in patients with hypertension: a systematic review and dose-response meta-analysis of randomized trials

We aimed to evaluate the dose-dependent effects of aerobic exercise on systolic (SBP) and diastolic blood pressure (DBP) and haemodynamic factors in adults with hypertension. PubMed, Scopus, and Web of Science were searched to April 2022 for randomized trials of aerobic exercise in adults with hypertension. We conducted a random-effects meta-analysis to estimate mean differences (MDs) and 95%CIs for each 30 min/week increase in aerobic exercise. The certainty of evidence was rated using the GRADE approach. The analysis of 34 trials with 1787 participants indicated that each 30 min/week aerobic exercise reduced SBP by 1.78 mmHg (95%CI: -2.22 to -1.33; n = 34, GRADE=low), DBP by 1.23 mmHg (95%CI: -1.53 to -0.93; n = 34, GRADE=moderate), resting heart rate (MD = -1.08 bpm, 95%CI: -1.46 to -0.71; n = 23, GRADE=low), and mean arterial pressure (MD = -1.37 mmHg, 95%CI: -1.80 to -0.93; n = 9, GRADE = low). A nonlinear dose-dependent decrement was seen on SBP and DBP, with the greatest decrement at 150 min/week (MD150 min/week = -7.23 mmHg, 95%CI: -9.08 to -5.39 for SBP and -5.58 mmHg, 95%CI: -6.90 to -4.27 for DBP). Aerobic exercise can lead to a large and clinically important reduction in blood pressure in a dose-dependent manner, with the greatest reduction at 150 min/week. The dose-dependent effects of aerobic exercise on systolic and diastolic blood pressure and haemodynamic factors in adults with hypertension.

Screening for hypertension in adults: protocol for evidence reviews to inform a Canadian Task Force on Preventive Health Care guideline update

PURPOSE

To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening in a primary care setting for hypertension in adults aged 18 years and older. This protocol outlines the scope and methods for a series of systematic reviews and one overview of reviews.

METHODS

To evaluate the benefits and harms of screening for hypertension, the Task Force will rely on the relevant key questions from the 2021 United States Preventive Services Task Force systematic review. In addition, a series of reviews will be conducted to identify, appraise, and synthesize the evidence on (1) the association of blood pressure measurement methods and future cardiovascular (CVD)-related outcomes, (2) thresholds for discussions of treatment initiation, and (3) patient acceptability of hypertension screening methods. For the review of blood pressure measurement methods and future CVD-related outcomes, we will perform a de novo review and search MEDLINE, Embase, CENTRAL, and APA PsycInfo for randomized controlled trials, prospective or retrospective cohort studies, nested case-control studies, and within-arm analyses of intervention studies. For the thresholds for discussions of treatment initiation review, we will perform an overview of reviews and update results from a relevant 2019 UK NICE review. We will search MEDLINE, Embase, APA PsycInfo, and Epistemonikos for systematic reviews. For the acceptability review, we will perform a de novo systematic review and search MEDLINE, Embase, and APA PsycInfo for randomized controlled trials, controlled clinical trials, and observational studies with comparison groups. Websites of relevant organizations, gray literature sources, and the reference lists of included studies and reviews will be hand-searched. Title and abstract screening will be completed by two independent reviewers. Full-text screening, data extraction, risk-of-bias assessment, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers. Results from included studies will be synthesized narratively and pooled via meta-analysis when appropriate. The GRADE approach will be used to assess the certainty of evidence for outcomes.

DISCUSSION

The results of the evidence reviews will be used to inform Canadian recommendations on screening for hypertension in adults aged 18 years and older.

SYSTEMATIC REVIEW REGISTRATION

This protocol is registered on PROSPERO and is available on the Open Science Framework (osf.io/8w4tz).

Physical activity, exercise and adverse cardiovascular outcomes in individuals with pre-existing cardiovascular disease: a narrative review

INTRODUCTION

The evidence supporting the cardiovascular health benefits of physical activity and/or exercise training is well-established. While the role of physical activity in primary prevention is unequivocal, its significance in secondary prevention (among those with preexisting cardiovascular disease) is less definitive. Though guidelines universally recommend physical activity as part of the secondary preventive strategy, the empirical evidence underpinning these recommendations is not as robust as that for primary prevention.

AREAS COVERED

This review distills the body of available observational and interventional evidence on the relationship between physical activity, exercise, and adverse cardiovascular outcomes among those with preexisting cardiovascular disease. The postulated biologic mechanisms underlying the relationships, areas of prevailing uncertainty, and potential public health implications are also discussed.

EXPERT OPINION

A physical activity level of 500 MET-min/week (equivalent to 150 min of moderate-intensity physical activity or 75 min of vigorous-intensity physical activity or an equivalent combination) may be a minimum requirement for patients with preexisting CVD. However, to reap the maximum benefits of physical activity and also minimize adverse effects, physical activity and/or exercise regimens should be tailored to unique factors such as individual's baseline physical activity habits, cardiovascular health status and the specific nature of their cardiovascular disease.

Establishment of hypertension risk nomograms based on physical fitness parameters for men and women: a cross-sectional study

Objective

This study aims to establish hypertension risk nomograms for Chinese male and female adults, respectively.

Method

A series of questionnaire surveys, physical assessments, and biochemical indicator tests were performed on 18,367 adult participants in China. The optimization of variable selection was conducted by running cyclic coordinate descent with 10-fold cross-validation through the least absolute shrinkage and selection operator (LASSO) regression. The nomograms were built by including the predictors selected through multivariable logistic regression. Calibration plots, receiver operating characteristic curves (ROC), decision curve analysis (DCA), clinical impact curves (CIC), and net reduction curve plots (NRC) were used to validate the models.

Results

Out of a total of 18 variables, 5 predictors-namely age, body mass index, waistline, hipline, and resting heart rate-were identified for the hypertension risk predictive model for men with an area under the ROC of 0.693 in the training set and 0.707 in the validation set. Seven predictors-namely age, body mass index, body weight, cardiovascular disease history, waistline, resting heart rate, and daily activity level-were identified for the hypertension risk predictive model for women with an area under the ROC of 0.720 in the training set and 0.748 in the validation set. The nomograms for both men and women were externally well-validated.

Conclusion

Gender differences may induce heterogeneity in hypertension risk prediction between men and women. Besides basic demographic and anthropometric parameters, information related to the functional status of the cardiovascular system and physical activity appears to be necessary.

The Western and Chinese exercise training for blood pressure reduction among hypertensive patients: An overview of systematic reviews

Hypertension remains the world's leading cause of premature death. Interventions such as exercise, diet modification, and pharmacological therapy remain the mainstay of hypertension treatment. Numerous systematic reviews and meta-analyses demonstrated the effectiveness of western exercises, such as aerobic exercise and resistance exercise, in reducing blood pressure in hypertensive patients. There is recently emerging evidence of blood pressure reduction with Chinese exercises, such as Tai Chi, Baduanjin, and Qigong. The current overview of systematic reviews aims to evaluate the quality and descriptively summarize the evidence for the effectiveness of western and Chinese exercises for hypertension management. Thirty-nine systematic reviews were included in this overview, with 15 of those being on Chinese exercise. Evidence suggests that exercise training, regardless of Western or Chinese exercise, generally reduced both systolic and diastolic blood pressure. High-intensity intermittent training did not further reduce blood pressure when compared to moderate-intensity continuous training. Conflicting results on the effectiveness of blood pressure reduction when comparing Chinese and Western exercise training were observed. This suggests the comparable effectiveness of Chinese exercise training, in particularly Tai Chi, to general or aerobic exercise training in terms of blood pressure reduction. The Chinese exercise modality and intensity may be more suitable for the middle-aged and elderly population.

Effect of Different Types of Aerobic Exercise on Individuals With and Without Hypertension: An Updated Systematic Review

High blood pressure (BP) is one of the main modifiable risk factors for cardiovascular disease (CVD) and preventing it greatly reduces the vascular consequences of aging and, along with intensive treatment of hypertension, eliminates a large portion of the burden of CVD-related mortality. Many meta-analyses and studies proved that regular aerobic exercise (AE) reduces BP but most of these studies consider only hypertensive populations or only AE but not resistant exercise or their combination. In this review, we aimed to study the effect of different types of physical activity (PA)/AE on various populations including normotensive, prehypertensive, primary hypertensive, and resistant hypertensive with different comorbidities. We searched PubMed, Web of Science, and Google Scholar for English articles with keywords for physical activity, aerobic exercise, and blood pressure from January 2010 until September 2021. Finally, 24 studies were included. Results showed that chronic or acute AE (long-term or short-term), either alone or as combined with different sessions and programs can reduce systolic and diastolic BP in every group including normotensive, prehypertensive, primary hypertensive, resistant hypertensive individuals and diabetic patients and those with kidney problems but not in people with chronic heart failure. Isometric exercise training showed to be useful in reducing BP in all groups either as low intensity or as high intensity but the rate of reduction was different in terms of gender. AE showed to be effective in terms of BP reduction in a different age range. It can be seen that different types and duration of AE independent of the modality and programs and independent of the BP medical situation of individuals have been successful in terms of BP reduction. For those with chronic heart failure, more concern and help might be needed to decrease BP via exercise.

Association of physical activity and trajectories of physical activity with cardiovascular disease

INTRODUCTION

Prolonged sedentary life existence is associated with increased incidence of cardiovascular disease (CVD), coronary heart disease (CHD), obesity, type 2 diabetes mellitus (T2DM), hypertension, heart failure (HF), and all-cause mortality. On the contrary, regular exercise is known from antiquity to be associated with beneficial cardiovascular (CV) effects and decreased mortality.

AREAS COVERED

The cardiovascular (CV) benefits of exercise have been confirmed by many studies, but the trajectories of the different modes of PA are not well recognized. In order to examine the different modalities of exercise and its long-term trajectories, a Medline search of the English literature was conducted between 2015 and 2022 and 60 pertinent papers were selected for review.

EXPERT OPINION

Careful review of the selected papers showed that the beneficial CV effects of PA are mediated through several favorable modifications of molecular and clinical factors. Also, any type of physical activity in conjunction with lifestyle adjustments is associated with decreased incidence of CVD, CHD, obesity, T2DM, hypertension, HF, and all-cause mortality. In addition, the long-term trajectories regarding the duration and the level of exercise are associated with greater beneficial CV effects, with even the resumption of discontinued exercise can lead to beneficial CV effects.

Prescribing pattern of anti-hypertensive medications among hypertensive outpatients at selected hospitals of South Gondar Zone, Amhara, Ethiopia: a hospital based cross sectional study

BACKGROUND

Irrational prescription has a lion share for uncontrolled blood pressure. There is no study assessing prescription pattern among hypertensive patients at the study sites. Therefore, the objective of the current study was to evaluate prescription patterns for hypertension and blood pressure (BP) control at randomly selected hospitals of South Gondar Zone.

METHODS

A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021. Hypertensive patients were selected by systematic random sampling proportionally from study hospitals. Structured questionnaires were used to collect socio-demographic chacteristics and adherence. Data abstraction form was used to collect prescription patterns, BP level and other necessary information. The association of prescription patterns and other variables with blood pressure control was determined by using binary logistic regression.

RESULTS

All recruited 423 patients were included in data analysis. Among prescriptions for hypertension, on average 93.5% were found to be in line with WHO guideline. About 53% of prescriptions for hypertension were monotherapies. Patient level low medication regimen complexity, and monotherapy were associated with blood pressure control (Ajusted Odds Ratio [AOR] = 2.04, [1.07-3.91]; AOR = 3.83 [1.42-10.35], respectively). Patients with inappropriate drug selection, and non-adherence were less likely to have controlled BP (AOR = 0.47 [0.26-0.85]; AOR = 0.52 [0.34-0.85], respectively). Moreover, patients who didn't have health insurance and follow regular aerobic exercise were less likely to have controlled BP (AOR = 0.42 [0.26-0.68]; AOR = 0.53 [0.32-0.88], respectively).

CONCLUSION

Diuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Patient level low medication regimen complexity and monotherapy were positively associated with BP control whereas, non-adherence, inappropriate drug selection, having no health insurance, and didn't follow regular aerobic exercise were negatively associated with BP control. Clinicians should be adherent to treatment guidelines and focus on modifiable factors to improve BP control.

How to Unmask Hidden Cardiovascular Diseases through Preparticipation Screening in Master Athletes?

Cardiovascular disease (CVD) is the most common cause of death globally in general population. Sport activity is an effective and recommended non-pharmacological method of CVD prevention. Presently, the group of people practicing sport regularly is constantly growing due to increasing awareness of its health benefits. However, vigorous-intensity exercises can reveal previously undetected disease. Master athletes over 35 years old are particularly exposed to sudden cardiac death (SCD) mainly in the course of coronary artery disease (CAD). Another common disease in veteran athletes is hypertension. It is known that regular endurance training can lower blood pressure at rest, so arterial hypertension in athletes is usually masked by adaptation to effort. Despite of normal or high-normal blood pressure in the office, the values during exercises and in ambulatory blood pressure monitoring (ABPM) can exceed the norm. Hidden hypertension have the same negative impact on cardiovascular system. It increases the risk of (1) atherosclerosis and therefore myocardial infarction or stroke, (2) left ventricular hypertrophy with diastolic and/or systolic heart failure, myocardial fibrosis and ventricular arrhythmias, (3) left atrial enlargement increasing the risk of atrial fibrillation and stroke and (4) aortic dilation/dissection. Through these complications hypertension can lead to SCD during sport activities, therefore it is important to recognize this disease early and start a proper treatment. To enable safe participation in sports competition detailed guidelines for screening were created, but they mainly concern CAD. We propose an additional scheme of screening in master athletes including the detection of hidden hypertension to prevent its consequences.

A Pragmatic Comparison Between Aerobic Exercise and Suryanamaskar in Stress Management in Medical Professionals: A Quasi-experimental Study

Background

Stress is an episodic process in an individual’s life that depends upon the circumstances that elicit this process, later jeopardizing an individual’s mental balance and leading to depression and anxiety. Yoga is a traditional component of physical activity that contains three main domains, namely, maintaining the correct posture (asanas), control over one’s breath (pranayama) and meditation with complete concentration (dhyana), which are proven to be effective in enhancing the psychological, physical, and spiritual wellbeing of an individual along with mindfulness. The purpose of the present study was to compare aerobic exercise (AE) and Suryanamaskar (SN) in terms of the best intervention in lowering the level of stress in medical professionals (MPs).

Methods

A quasi-experimental study including a pragmatic comparison was conducted involving 30 participants who were divided into two groups A and B. The participants in group A did treadmill walking and the participants in group B were made to perform the complete cycle of SN with all the 12 asanas for four weeks.

Results

The outcomes demonstrated that both AE and SN had significant statistical values in terms of pre- and post-intervention Perceived Stress Scale (PSS) scores, resting heart rate, and systolic and diastolic blood pressure. Also, when post-intervention mean values of both the groups were compared for all the parameters, only mean PSS values were found to be statistically significant.

Conclusion

The current study concluded that both AE and SN were beneficial in decreasing the level of stress in MPs with SN being statistically more significant in reducing stress levels than AE. Both interventions are safe to perform.

The associations of job strain and leisure-time physical activity with the risk of hypertension: the population-based Midlife in the United States cohort study

OBJECTIVES

Job strain is positively associated with incident hypertension, while increasing leisure-time physical activity (LTPA) can reduce incident hypertension. However, the joint associations of job strain and LTPA with incident hypertension among United States workers have yet to be investigated. This study examined the independent and joint associations of job strain and LTPA with incident hypertension.

METHODS

This prospective cohort study (n=1,160) utilized data from the population-based Midlife in the United States study. The associations of job strain and LTPA at baseline with incident hypertension during follow-up were examined using Cox proportional hazards models. High job strain was derived from a combination of high job demands and low job control, and high LTPA was defined as engagement in moderate or vigorous LTPA at least once per week.

RESULTS

During 9,218 person-years of follow-up, the hypertension incidence rate was 30.6 (95% confidence interval [CI], 27.3 to 34.3) per 1,000 person-years. High job strain was associated with a higher risk for hypertension than low job strain (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.00 to 1.67). High LTPA was associated with lower hypertension risk than low LTPA (aHR, 0.77; 95% CI, 0.60 to 0.98). Hypertension risk was higher among workers with high job strain and low LTPA than among those with low job strain and high LTPA (aHR, 1.70; 95% CI, 1.18 to 2.43).

CONCLUSIONS

Job strain and LTPA showed positive and inverse associations, respectively, with incident hypertension. The combination of high job strain and low LTPA was associated with the highest risk for hypertension.

Effects of Exercise Training on PPARβ/δ Expression in Skeletal Muscle of Rats with Spontaneous Hypertension

PURPOSE

This study aimed to identify the relationship and mechanism between skeletal muscle peroxisome proliferator-activated receptor β/δ (PPARβ/δ) and spontaneous hypertension.

METHODS

Rats were divided into four groups ( n = 10): spontaneous hypertensive rats exercise group (SHR-E), spontaneous hypertensive rats sedentary group (SHR-S), Wistar-Kyoto control rats exercise group (WKY-E), and Wistar-Kyoto control rats sedentary group (WKY-S). Although the sedentary groups were placed on the treadmill without moving during the training sessions, the exercise groups were forced to run on a treadmill for 8 wk, 1 h·d -1 , 5 d·wk -1 . After training, the density and area of gastrocnemius microvessels were observed. PPARβ/δ, vascular endothelial growth factor A (VEGFA), superoxide dismutase 2 (SOD-2), and nitric oxide synthase in gastrocnemius were measured by real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot.

RESULTS

Except the sixth week of age, the systolic blood pressure of SHR-S was significantly higher than that of WKY-S at all time periods. Exercise significantly reduced systolic blood pressure in SHR rats. Compared with the SHR-S group, the WKY-S group had significantly higher PPARβ/δ protein level and density of skeletal muscle microvessels. Eight weeks of exercise increased the PPARβ/δ, SOD-2, VEGFA, and microvessel density and area in the skeletal muscle of SHR.

CONCLUSIONS

Exercise training promoted PPARβ/δ mRNA and protein-level expression of PPARβ/δ, SOD-2 and VEGFA in skeletal muscle, thus increasing the density and area of skeletal muscle blood vessels. These regulations contribute to the reduction of peripheral vascular resistance. This may be a potential mechanism of exercise to reduce blood pressure.

Risk of Hypertension and Use of Antihypertensive Drugs in the Physically Active Population under-70 Years Old—Spanish Health Survey

Introduction: Reducing the prevalence of hypertension is a major priority of the World Health Organization (WHO). Its high prevalence and associated risks generate high economic and social costs. Physical activity (PA) is associated with a decrease in hypertension and in the use of antihypertensive drugs. Objective: To explore the association between PA levels (PAL), prevalence of hypertension and the use of antihypertensive drugs in Spanish population. To calculate risks of hypertension and use of antihypertensive in the inactive versus physically active population. Method: This cross-sectional study used data from 17717 individuals, sampled in the 2017 National Health Survey. Interaction by sex, age groups, body mass index (BMI), hypertension prevalence, antihypertensive drugs use and PAL, using a pairwise z-test, and dependence relationships between variables, were studied using a chi square test. Odds ratios of hypertension and antihypertensive drug use were calculated among the inactive and the physically active populations. Results: The findings showed a significant inverse association between prevalence of hypertension, antihypertensive use, and PAL in both sexes and different age and BMI groups, with lower prevalence of hypertension and antihypertensive use when PAL were higher. The risks of hypertension and antihypertensive use seems to be reduced when related to higher PAL compared to inactive people. Conclusions: High PAL is associated with lower prevalence of hypertension and lower antihypertensive use. Thus, being physically active or very active may reduce the risks of suffering from hypertension and the need to use antihypertensives compared to inactive people or walkers.

Aerobic Exercise Training Improves Renal Injury in Spontaneously Hypertensive Rats by Increasing Renalase Expression in Medulla

We aimed to examine the effects of aerobic exercise training on renal function in spontaneously hypertensive rats (SHR) and elucidate their possible mechanisms. Adult male SHR and age-matched Wistar-Kyoto rats (WKY) were divided into four groups: WKY sedentary group, SHR sedentary group, low-intensity training group, and medium-intensity training group. Using molecular and biochemical approaches, we investigated the effects of 14-week training on renalase (RNLS) protein levels, renal function, and apoptosis and oxidative stress modulators in kidney tissues. In vitro, angiotensin II (Ang II)-induced human kidney proximal epithelial cells (HK-2) were treated with RNLS, and changes in apoptosis and oxidative stress levels were observed. Our results show that moderate training improved renal function decline in SHR. In addition, aerobic exercise therapy significantly increased levels of RNLS in the renal medulla of SHR. We observed in vitro that RNLS significantly inhibited the increase of Ang II-inducedapoptosis and oxidative stress levels in HK-2. In conclusion, aerobic exercise training effectively improved renal function in SHR by promoting RNLS expression in the renal medulla. These results explain the possible mechanism in which exercise improves renal injury in hypertensive patients and suggest RNLS as a novel therapy for kidney injury patients.

A Technology-Enhanced Physical Activity Intervention: A Feasibility Study

Using a single-group, pre-posttest design, we evaluated feasibility and acceptability of a technology-enhanced physical activity intervention in 43 midlife (aged 35-64) first-generation Korean American adults who were physically inactive. The intervention consisted of bi-weekly education sessions for 4 weeks, monthly small group walks for the following 8 weeks, and weekly reminder text messages during the entire intervention period. A 100% retention rate, 93% adherence, and 88.4% satisfaction supported the feasibility and acceptability of the intervention. Paired t-tests revealed the intervention was successful and effective as demonstrating a significant increase in self-efficacy and moderate physical activity and improved cardiometabolic health. This easy and motivation enhancing intervention has a wide potential applicability for other ethnic groups. Further intervention research is suggested in a large sample, multisite, for a longer-term with a randomized controlled trial design, which may lead us to narrow the gap in physical activity engagement and cardiometabolic health disparities.

Objectively Assessed Cardiorespiratory Fitness and All-Cause Mortality Risk: An Updated Meta-analysis of 37 Cohort Studies Involving 2,258,029 Participants

OBJECTIVE

To detail the magnitude and specificity of the association between cardiorespiratory fitness (CRF) and all-cause mortality risk.

METHODS

Cohort studies with at least 1 year of follow-up were sought from inception until December 2021 in MEDLINE, Embase, Web of Science, and a manual search of relevant articles. Relative risks (RRs) with 95% CIs were pooled using random-effects models. Quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool.

RESULTS

A total of 37 unique studies comprising of 2,258,029 participants with 108,613 all-cause mortality events were eligible. The pooled multivariable-adjusted RR for all-cause mortality comparing the top vs bottom tertiles of CRF levels was 0.55 (95% CI, 0.50 to 0.61). When CRF was expressed in metabolic equivalent task (MET) units, the corresponding pooled RR was 0.56 (95% CI, 0.50 to 0.62). For every 1-MET increase in CRF, the RR for all-cause mortality was 0.89 (95% CI, 0.86 to 0.92). Strength of the association did not differ by publication year, age, sex, follow-up duration, CRF assessment method, or risk of bias.

CONCLUSION

Aggregate analysis of observational cohort studies confirms a strong inverse and independent association between CRF and all-cause mortality risk. The results suggest that guideline bodies should consider the inclusion of CRF in standard risk panels for mortality risk assessment.

The Complete Health Improvement Program and Physical Activity

Background: The Complete Health Improvement Program (CHIP) has demonstrated effectiveness in improving multiple cardiovascular disease risk factors. CHIP promotes physical activity, as well as a plant-based whole-food diet. The study objective is to evaluate the effectiveness of CHIP on improving levels of physical activity. Methods: CHIP participants had biomarkers measured at baseline and after the 11th session, consisting of level of physical activity, blood pressure (BP), body mass index (BMI), fasting blood sugar (FBS), and lipid panel. Pre and post data were analyzed using paired t-tests. Results. CHIP demonstrated significant increase in level of physical activity ( P < .001) and decreased BMI, FBS, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides (all P < .001). Increased levels of physical activity correlated with decreased BMI ( P < .001), but not with other biomarkers. Conclusion: CHIP is effective in producing increased level of physical activity and improvement in multiple biomarkers. The increase in physical activity is correlated with decreased BMI.

The Systematic Analysis of Exercise Mechanism in Human Diseases

Background

As a part of a healthy lifestyle, exercise has been proven to be beneficial for the treatment of diseases and the prognosis of patients. Based on this, our research focuses on the impact of exercise on human health.

Methods

To study and analyze the samples in the GSE18966 gene expression profile, we first performed an analysis on the differential expressed genes (DEGs) through GEO2R, and then the DEGs enrichment in Gene Ontology functions and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways through the Database for Annotation, Visualization and Integrated Discovery database was conducted. Then, we delved into the gene set enrichment in KEGG through gene set enrichment analysis. After that, we achieved the construction of the protein-protein interaction (PPI) network of DEGs based on the Search Tool for the Retrieval of Interacting Genes online database, and the hub genes were screened and identified.

Results

We identified 433 upregulated DEGs and 186 downregulated DEGs from the samples before and after exercise in GSE18966. Through analysis, it was found that these DEGs-enriched pathways, such as the VEGF signaling pathway, the Wnt signaling pathway, and the insulin signaling pathway, were all involved in the regulation of various diseases. Then, GSEA analysis revealed that glycosaminoglycan biosynthesis chondroitin sulfate, type II diabetes mellitus, and basal cell carcinoma were related with exercise samples. The effects of these pathways on various diseases could be improved through exercise. Finally, 3 upregulated hub genes (VEGFA, POMC, and NRAS) and 3 downregulated hub genes (HRAS, NCOR1, and CAV1) were identified through the PPI network.

Conclusions

The bioinformatic analysis of samples before and after exercise provides key pathways and genes related to exercise to regulate various diseases, which confirms that exercise has an important influence on the treatment of many diseases.

Analysis of the Dose-Response Effects of Physical Activity on Cardiocerebrovascular and All-Cause Mortality in Hypertension

Background

Leisure-time moderate-to-vigorous physical activity (MV-PA) has been consistently regarded as a protective factor to prevent and treat hypertension. However, the effect of different levels of MV-PA against cardiocerebrovascular and all-cause mortality in hypertension is still unclear. The aim of this study was to explore the dose relationships of MV-PA on these adverse outcomes in hypertension.

Methods

In the National Health and Nutritional Examination Survey (NHANES) from 1999 to 2006, participants with hypertension were enrolled and classified into inactive (0 MET-h/week), low-active (0 < to < 7.5 MET-h/week), and high-active (≥ 7.5 MET-h/week) groups. A multivariate Cox regression analysis was conducted with a hazard ratio (HR) and corresponding 95% confidence interval (CI). To further explore the association between different levels of MV-PA and adverse outcomes, Kaplan-Meier survival curves, subgroup analysis, and restricted cubic spline curves were performed.

Results

During a median 10.93-year follow-up, 1,510 and 347 patients had died from any causes and cardiocerebrovascular, respectively. The high-active group had the highest event-free survivals of all outcomes compared with low-active and inactive groups. A multivariate Cox regression analysis demonstrated that the high-active and low-active groups were associated with reduced risks of all-cause [HR: 0.70, 95% CI: 0.60–0.82; 0.76 (0.68–0.86), respectively] and cardiocerebrovascular mortality [0.56 (0.41–0.77); 0.63 (0.50–0.81), respectively] compared with the inactive group. Subgroup analysis and restricted cubic spline curves showed that MV-PA surpassing 15 MET-h/week could decrease the risks of cardiovascular and all-cause mortality with inverse relationships, which was not the case for cerebrovascular mortality, indicating a U-shaped association.

Conclusion

Our study suggests that highly active MV-PA of 7.5 to < 15 MET-h/week was associated with the lowest risks of cardiocerebrovascular and all-cause mortality in hypertension.

Renoprotection Induced by Aerobic Training Is Dependent on Nitric Oxide Bioavailability in Obese Zucker Rats

Aerobic training (AT) promotes several health benefits that may attenuate the progression of obesity associated diabetes. Since AT is an important nitric oxide (NO⁻) inducer mediating kidney-healthy phenotype, the present study is aimed at investigating the effects of AT on metabolic parameters, morphological, redox balance, inflammatory profile, and vasoactive peptides in the kidney of obese-diabetic Zucker rats receiving L-NAME (N(omega)-nitro-L-arginine methyl ester). Forty male Zucker rats (6 wk old) were assigned into four groups (n = 10, each): sedentary lean rats (CTL-Lean), sedentary obese rats (CTL-Obese), AT trained obese rats without blocking nitric oxide synthase (NOS) (Obese+AT), and obese-trained with NOS block (Obese+AT+L-NAME). AT groups ran 60 min in the maximal lactate steady state (MLSS), five days/wk/8 wk. Obese+AT rats improved glycemic homeostasis, SBP, aerobic capacity, renal mitochondria integrity, redox balance, inflammatory profile (e.g., TNF-α, CRP, IL-10, IL-4, and IL-17a), and molecules related to renal NO⁻ metabolism (klotho/FGF23 axis, vasoactive peptides, renal histology, and reduced proteinuria). However, none of these positive outcomes were observed in CTL-Obese and Obese+AT+L-NAME (p < 0.0001) groups. Although Obese+AT+L-NAME lowered BP (compared with CTL-Obese; p < 0.0001), renal damage was observed after AT intervention. Furthermore, AT training under conditions of low NO⁻ concentration increased signaling pathways associated with ACE-2/ANG1-7/MASr. We conclude that AT represents an important nonpharmacological intervention to improve kidney function in obese Zucker rats. However, these renal and metabolic benefits promoted by AT are dependent on NO⁻ bioavailability and its underlying regulatory mechanisms.

Utilizing Machine Learning Techniques to Predict the Efficacy of Aerobic Exercise Intervention on Young Hypertensive Patients Based on Cardiopulmonary Exercise Testing

Recently, the incidence of hypertension has significantly increased among young adults. While aerobic exercise intervention (AEI) has long been recognized as an effective treatment, individual differences in response to AEI can seriously influence clinicians' decisions. In particular, only a few studies have been conducted to predict the efficacy of AEI on lowering blood pressure (BP) in young hypertensive patients. As such, this paper aims to explore the implications of various cardiopulmonary metabolic indicators in the field by mining patients' cardiopulmonary exercise testing (CPET) data before making treatment plans. CPET data are collected "breath by breath" by using an oxygenation analyzer attached to a mask and then divided into four phases: resting, warm-up, exercise, and recovery. To mitigate the effects of redundant information and noise in the CPET data, a sparse representation classifier based on analytic dictionary learning was designed to accurately predict the individual responsiveness to AEI. Importantly, the experimental results showed that the model presented herein performed better than the baseline method based on BP change and traditional machine learning models. Furthermore, the data from the exercise phase were found to produce the best predictions compared with the data from other phases. This study paves the way towards the customization of personalized aerobic exercise programs for young hypertensive patients.

Factors Related to Blood Pressure Response after Community-Based Exercise Program in the Elderly Population

Exercise has been recommended for blood pressure (BP) control, but not every individual can improve BP and reduce the risk of cardiovascular disease effectively by exercise. This study aimed to evaluate the BP response after 12-week exercise intervention and then identify the potential factors of responders on BP (R-BP) control. This was a retrospective cohort study from a project of Taipei City Government. Subjects completed the original program were included for further analysis. Sociodemographic factors, health-related behaviors, and cardiovascular risks were extracted as potential factors. The results were categorized into R-BP control, i.e., BP under optimal level (systolic BP (SBP) < 140 mmHg; and diastolic BP (DBP) < 90 mmHg) or a significant BP reduction (SBP ↓10 mmHg or DBP ↓5 mmHg) after intervention, or non-responder on BP control, i.e., subjects who failed to achieve the targets. There were 81.62% R-BP subjects. R-BP showed lower SBP and lower risk of hypertension at baseline. Active lifestyle could quadruple the number of R-BP. Higher educational level or more prescription medications were likely to be R-BP in subjects with diagnosed hypertension. Active lifestyle combined with exercise could benefit R-BP in the elderly population. Health-related factors also need to be considered for BP control.

Characteristics of Aerobic Exercise as Determinants of Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-Analysis

PURPOSE

The purpose of this study was to evaluate the effect on blood pressure (BP) and heart rate (HR) according to aerobic exercise characteristics in adults with hypertension using a systematic review and meta-analysis.

METHODS

The related researches were selected from PubMed, EMBASE, Cochrane library, CINAHL, PsycINFO, SPORTDiscus and 5 domestic databases up to September 4, 2019. To estimate the effect size, random effect models were used to derive weighted mean differences (WMD) and their 95% confidence intervals (CI) of aerobic exercise on BP and HR.

RESULTS

A total of 37 RCTs with 1,813 samples were included. Aerobic exercise was found to significantly reduce systolic BP (WMD, - 8.29 mmHg; 95% CI, - 10.12 to - 6.46), diastolic BP (WMD, - 5.19 mmHg; 95% CI, - 6.24 to - 4.14) and HR (WMD, - 4.22 beats/min; 95% CI, - 5.36 to -3.09). In detail, systolic BP and diastolic BP were significantly decreased in all groups of exercise types, frequency and duration. Systolic BP and diastolic BP were significantly decreased in the moderate and vigorous-intensity group. Exercise characteristics with the most dramatical change in systolic BP were water-based training, moderate-intensity, 3 times a week and 8 to 11 weeks of duration. In diastolic BP, the greatest effect size was over 24 weeks of exercise.

CONCLUSION

Moderate aerobic exercise, especially water-based exercise can be an important part of lifestyle modification for hypertensive patients. Also, it can be recommended in a variety of clinical settings for lowering BP and HR. However, there is insufficient evidence that low-intensity exercise is effective in lowering BP.

Efficacy of aerobic exercise on the cardiometabolic and renal outcomes in patients with chronic kidney disease: a systematic review of randomized controlled trials

BACKGROUND

Several randomized controlled trials (RCTs) have demonstrated the cardiometabolic effects of aerobic exercise in the general population and in patients with cardiovascular diseases. However, the efficacy of aerobic exercise in patients with chronic kidney disease (CKD) remains to be elucidated.

METHODS

RCTs comparing aerobic exercise with no aerobic exercise in patients with CKD not requiring kidney replacement therapy were identified through PubMed using RobotAnalyst, a web-based software system that combines text-mining and machine learning algorithms for organizing references. Cardiometabolic and renal outcomes of interest included body mass index (BMI); systolic blood pressure (SBP); hemoglobin A1c (HbA1c), total cholesterol (TCHO), low- and high- density lipoprotein cholesterol (LDLC and HDLC, respectively), and urinary protein (UP) levels/concentration; peak oxygen uptake (Vo₂peak); and glomerular filtration rate (GFR) at the end of the follow-up period. The standardized mean difference (SMD) of each outcome was estimated using the DerSimonian-Laird random-effect model with inverse-variance weighting.

RESULTS

A total of 15 trials, including 622 patients, were included. Their follow-up periods were 3-4, 6-12, and > 12-months in 7 (46.7%), 7 (46.7%), and 1 (6.7%) trial(s), respectively. Meta-analyses showed that aerobic exercise significantly decreased BMI (SMD, -0.19 [95% confidence interval, -0.38, -0.00]) and SBP (-0.75 [-1.24, -0.26]) and increased Vo₂peak (0.54 [0.29, 0.78]); however, no significant association was observed in HbA1c, TCHO, HDLC, LDLC, GFR, and UP. Meta-regression models suggested that aerobic exercise was more likely to improve Vo₂peak in patients with younger age, no diabetes, and lower BMI.

CONCLUSION

Aerobic exercise of 3-12 months' duration improved obesity, high blood pressure, and low exercise capacity in overweight/obese patients with CKD, but it had no significant effect on GFR and proteinuria. Well-designed large RCTs with a longer follow-up period are needed to evaluate the efficacy of aerobic exercise in patients with CKD.

The Effect of Different Interventions for Lifestyle Modifications on the Number of Diagnostic Criteria and Clinical Aspects of Metabolic Syndrome

Background: Lifestyle intervention programs comprise the first-choice therapy to reduce the cardiovascular risk factors in metabolic syndrome (MetS). Our aim was to compare the effects of three lifestyle modification programs on the number of diagnostic criteria and clinical parameters of MetS. Methods: Twelve-week clinical trial, including 125 adults who presented at least three of the criteria defined by the revised NCEP ATP III (National Cholesterol Education Program Adult Panel III) for MetS. Individuals were randomized into three multidisciplinary intervention groups: Standard Intervention (SI), Group Intervention (GI) and Individual Intervention (II). Results: Seventy-one individuals, aged 34-59 years, concluded the study: SI: 20, GI: 25, and II: 26. The GI and II groups presented a significant decrease of body mass index, abdominal circumference, diastolic and systolic arterial pressure after intervention. The number of diagnostic criteria for MetS decreased significantly. Within the GI and II groups, 16.0% and 15.4% of the individuals, respectively, did not meet the criteria for the clinical condition studied at the end of the interventions. In the II group, the percentage of individuals with five criteria reduced 83.5%. In the GI group, the percentage of individuals with five criteria remained the same, but the number of individuals with four criteria presented a 50.0% reduction. Conclusions: Results reinforce that nonpharmacological strategies for changing lifestyle affect the reduction of cardiovascular risk factors existing in MetS. They are also able to remove the population from this clinical condition by decreasing the diagnostic criteria. II or GI lead to a successful treatment of MetS, especially when conducted by multidisciplinary team. Brazilian Registry of Clinical Trials-ReBEC number: RBR-9wz5fc.

Computational and Pharmacogenomic Insights on Hypertension Treatment: Rational Drug Design and Optimization Strategies

Background::

Hypertension is a prevalent cardiovascular complication caused by genetic and nongenetic factors. Blood pressure (BP) management is difficult because most patients become resistant to monotherapy soon after treatment initiation. Although many antihypertensive drugs are available, some patients do not respond to multiple drugs. Identification of personalized antihypertensive treatments is a key for better BP management.

Objective::

This review aimed to elucidate aspects of rational drug design and other methods to develop better hypertension management.

Results::

Among hypertension-related signaling mechanisms, the renin-angiotensin-aldosterone system is the leading genetic target for hypertension treatment. Identifying a single drug that acts on multiple targets is an emerging strategy for hypertension treatment, and could be achieved by discovering new drug targets with less mutated and highly conserved regions. Extending pharmacogenomics research to include patients with hypertension receiving multiple antihypertensive drugs could help identify the genetic markers of hypertension. However, available evidence on the role of pharmacogenomics in hypertension is limited and primarily focused on candidate genes. Studies on hypertension pharmacogenomics aim to identify the genetic causes of response variations to antihypertensive drugs. Genetic association studies have identified single nucleotide polymorphisms affecting drug responses. To understand how genetic traits alter drug responses, computational screening of mutagenesis can be utilized to observe drug response variations at the protein level, which can help identify new inhibitors and drug targets to manage hypertension.

Conclusions::

Rational drug design facilitates the discovery and design of potent inhibitors. However, further research and clinical validation are required before novel inhibitors can be clinically used as antihypertensive therapies.

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.

Health-Associated Nutrition and Exercise Behaviors in Relation to Metabolic Risk Factors Stratified by Body Mass Index

This study aimed to investigate the relationships of nutrition and exercise behaviors on metabolic risk factors (MRF) when body mass index (BMI) was considered. Health-associated nutrition and exercise behaviors were assessed by a questionnaire, anthropometric values, blood pressure and biochemical determinations that were obtained from 4017 workers. The nutrition score was negatively associated with triglycerides in the overweight subgroup and with systolic blood pressure (SBP) in the obese subgroup. The exercise score was negatively associated with triglycerides and waist circumference (WC) and positively associated with SBP and high-density lipoprotein cholesterol (HDL-C) in the ideal weight subgroup as well as being negatively associated with WC and positively associated with HDL-C in the overweight subgroup. Similarly, the exercise score was negatively associated with WC and positively associated with SBP in the obese subgroup. However, no significant association was found between nutrition or exercise behavior and MRF in the underweight subgroup. In conclusion, the relationships of exercise and nutrition behaviors on MRF varied for different levels of BMI. Exercise showed a significant association with lower WC. Moreover, its effect showed a gradient trend in accordance with the levels of BMI. For ameliorating MRF, exercise seemed to have better effects than nutrition behavior, especially in the ideal weight subgroup.

High-intensity interval exercise promotes post-exercise hypotension of greater magnitude compared to moderate-intensity continuous exercise

PURPOSE

Physical exercise is associated with reduced blood pressure (BP). Moderate-intensity continuous exercise (MCE) promotes post-exercise hypotension (PEH), which is highly recommended to hypertensive patients. However, recent studies with high-intensity interval exercise (HIIE) have shown significant results in cardiovascular disease. Thus, this study aimed to analyze PEH in hypertensive subjects submitted to HIIE and compare it to post MCE hypotension.

METHODS

20 hypertensive adults (51 ± 8 years), treated with antihypertensive medications, were submitted to two different exercise protocols and a control session. The MCE was performed at 60-70% of VO₂ reserve, while HIIE was composed of five bouts of 3 min at 85-95% VO₂ reserve with 2 min at 50% of VO₂ reserve. The following variables were evaluated during exercise, pre- and post-session: clinical BP, heart rate (HR), double product, perception of effort, body mass, height and body mass index.

RESULTS

Systolic BP decreased after exercise in both sessions, showing greater decrease after HIIE (- 7 ± 10 and - 11 ± 12 mmHg, after MCE and HIIE, respectively, p ≤ 0.01). Diastolic BP also decreased after both sessions, but there were no significant differences between the two sessions (- 4 ± 8 and - 7 ± 8 mmHg, after MCE and HIIE, respectively).

CONCLUSION

Both exercise sessions produced PEH, but HIIE generated a greater magnitude of hypotension. The HIIE protocol performed in this study caused a greater cardiovascular stress during exercise; however, it was safe for the studied population and efficient for reducing BP after exercise.

Which type of exercise keeps you young?

PURPOSE OF REVIEW

Robust epidemiological evidence exists that lifelong regular exercise contributes to longevity. The aim of this review is to discuss recent findings regarding, which dose and type of physical activity promotes a long healthy life, free of disease.

RECENT FINDINGS

Meeting the currently recommended amounts of leisure time physical aerobic activity of moderate intensity of at least 150 min/week provides most of the longevity benefit. However, a higher duration and intensity augments the beneficial effect on cardiovascular health and metabolism. Performing three to five times the recommended physical activity minimum reaches the maximal longevity benefit, that can be achieved. Although it is not dangerous to perform even higher amounts of exercise, the benefit may decrease. A high maximal oxygen uptake in mid-life is a strong marker of longevity, whereas muscle mass is a critical prognostic factor in aging and cancer.

SUMMARY

Exercise training above the public health recommendations provides additional benefits regarding disease protection and longevity. Endurance exercise, including high-intensity training to improve cardiorespiratory fitness promotes longevity and slows down aging. Strength training should be added to slow down loss of muscle mass, associated with aging and disease.

The Physiology of Optimizing Health with a Focus on Exercise as Medicine

Physical inactivity is one of the leading health problems in the world. Strong epidemiological and clinical evidence demonstrates that exercise decreases the risk of more than 35 different disorders and that exercise should be prescribed as medicine for many chronic diseases. The physiology and molecular biology of exercise suggests that exercise activates multiple signaling pathways of major health importance. An anti-inflammatory environment is produced with each bout of exercise, and long-term anti-inflammatory effects are mediated via an effect on abdominal adiposity. There is, however, a need to close the gap between knowledge and practice and assure that basic research is translated, implemented, and anchored in society, leading to change of praxis and political statements. In order to make more people move, we need a true translational perspective on exercise as medicine, from molecular and physiological events to infrastructure and architecture, with direct implications for clinical practice and public health.

Unhealthy Behaviors Among Canadian Men Are Predictors of Comorbidities: Implications for Clinical Practice

Men's poor health behaviors are an increasingly prevalent issue with long-term consequences. This study broadly samples Canadian men to obtain information regarding health behaviors as a predictor of downstream medical comorbidities. A survey of Canadian men included questions regarding demographics, comorbidities, and health behaviors (smoking and alcohol consumption, sleep and exercise behaviors, and dietary habits). Health behaviors were classified as either healthy or unhealthy based upon previous studies and questionnaire thresholds. Multivariate regression was performed to determine predictors for medical comorbidities. The 2,000 participants were aged 19-94 (median 48, interquartile range 34-60). Approximately half (47.4%) were regular smokers, 38.7% overused alcohol, 53.9% reported unhealthy sleep, 48.9% had low levels of exercise, and 61.8% had unhealthy diets. On multivariate analysis, regular smoking predicted heart disease (OR 2.08, p < .01), elevated cholesterol (OR 1.35, p = .02), type 2 diabetes (OR 1.57, p = .02), osteoarthritis (OR 1.43, p = .04), and depression (OR 1.62, p < .01). Alcohol overuse predicted hypertension (OR 1.40, p < .01) and protected against type 2 diabetes (OR 0.61, p < .01). Unhealthy sleep predicted hypertension (OR 1.46, p < .01), erectile dysfunction (OR 1.50, p = .04), and depression (OR 1.87, p < .01). Low levels of exercise predicted hypertension (OR 1.30, p = .03) and elevated cholesterol (OR 1.27, p = .05). Finally, unhealthy diet predicted depression (OR 1.65, p < .01). This study confirms the association of poor health behaviors and comorbidities common to middle-aged and older men. The results emphasize the potential scope of targeted gender-sensitized public awareness campaigns and interventions to reduce common male disease, morbidity, and mortality.