Acute effects of walking and combined exercise on oxidative stress and vascular function in peripheral artery disease

Oxidative stress and vascular dysfunction: Potential therapeutic targets and therapies in peripheral artery disease

Peripheral artery disease (PAD) is the manifestation of atherosclerosis characterized by the accumulation of plaques in the arteries of the lower limbs. Interestingly, growing evidence suggests that the pathology of PAD is multifaceted and encompasses both vascular and skeletal muscle dysfunctions, which contributes to blunted physical capabilities and diminished quality of life. Importantly, it has been suggested that many of these pathological impairments may stem from blunted reduction-oxidation (redox) handling. Of note, in those with PAD, excessive production of reactive oxygen species (ROS) outweighs antioxidant capabilities resulting in oxidative damage, which may have systemic consequences. It has been suggested that antioxidant supplementation may be able to assist in handling ROS. However, the activation of various ROS production sites makes it difficult to determine the efficacy of these antioxidant supplements. Therefore, this review focuses on the common cellular mechanisms that facilitate ROS production and discusses how excessive ROS may impair vascular and skeletal muscle function in PAD. Furthermore, we provide insight for current and potential antioxidant therapies, specifically highlighting activation of the Kelch-like ECH-associated protein 1 (Keap1) - Nuclear Factor Erythroid 2-related factor 2 (Nrf2) pathway as a potential pharmacological therapy to combat ROS accumulation and aid in vascular function, and physical performance in patients with PAD. Altogether, this review provides a better understanding of excessive ROS in the pathophysiology of PAD and enhances our perception of potential therapeutic targets that may improve vascular function, skeletal muscle function, walking capacity, and quality of life in patients with PAD.

Resistance exercise was safe for the pregnancy and offspring's development and partially protected rats against early life stress-induced effects

Promising evidence points to gestational physical exercise as the key to preventing various disorders that affect the offspring neurodevelopment, but there are no studies showing the impact of resistance exercise on offspring health. Thus, the aim of this study was to investigate whether resistance exercise during pregnancy is able to prevent or to alleviate the possible deleterious effects on offspring, caused by early life-stress (ELS). Pregnant rats performed resistance exercise throughout the gestational period:they climbed a sloping ladder with a weight attached to their tail, 3 times a week. Male and female pups, on the day of birth (P0), were divided into 4 experimental groups: 1) rats of sedentary mothers (SED group); 2) rats of exercised mothers (EXE group); 3) rats of sedentary mothers and submitted to maternal separation (ELS group) and 4) rats of exercised mothers and submitted to MS (EXE + ELS group). From P1 to P10, pups from groups 3 and 4 were separated from their mothers for 3 h/day. Maternal behavior was assessed. From P30, behavioral tests were performed and on P38 the animals were euthanized and prefrontal cortex samples were collected. Oxidative stress and tissue damage analysis by Nissl staining were performed. Our results demonstrate that male rats are more susceptible to ELS than females, showing impulsive and hyperactive behavior similar to that seen in children with ADHD. This behavior was attenuated by the gestational resistance exercise. Our results demonstrate, for the first time, that resistance exercise performed during pregnancy seems to be safe for the pregnancy and offspring's neurodevelopment and are effective in preventing ELS-induced damage only in male rats. Interestingly, resistance exercise during pregnancy improved maternal care and it is reasonable to propose that this finding may be related to the protective role on the animals neurodevelopment, observed in our study.

Clinical effect and biological mechanism of exercise for rheumatoid arthritis: A mini review

Rheumatoid arthritis (RA) is a common systematic, chronic inflammatory, autoimmune, and polyarticular disease, causing a range of clinical manifestations, including joint swelling, redness, pain, stiffness, fatigue, decreased quality of life, progressive disability, cardiovascular problems, and other comorbidities. Strong evidence has shown that exercise is effective for RA treatment in various clinical domains. Exercise training for relatively longer periods (e.g., ≥ 12 weeks) can decrease disease activity of RA. However, the mechanism underlying the effectiveness of exercise in reducing RA disease activity remains unclear. This review first summarizes and highlights the effectiveness of exercise in RA treatment. Then, we integrate current evidence and propose biological mechanisms responsible for the potential effects of exercise on immune cells and immunity, inflammatory response, matrix metalloproteinases, oxidative stress, and epigenetic regulation. However, a large body of evidence was obtained from the non-RA populations. Future studies are needed to further examine the proposed biological mechanisms responsible for the effectiveness of exercise in decreasing disease activity in RA populations. Such knowledge will contribute to the basic science and strengthen the scientific basis of the prescription of exercise therapy for RA in the clinical routine.

The Effect of Equipment-Based Pilates (Reformer) Exercises on Body Composition, Some Physical Parameters, and Body Blood Parameters of Medical Interns

BACKGROUND

Pilates is a type of exercise that exerts positive effects on body composition and general health. This study set out to investigate the effects of equipment-based Pilates (reformer) exercise on body composition, some physical parameters, and blood parameters of medical interns showing a tendency toward sedentary life.

MATERIALS AND METHODS

The experimental group (EG) comprising 22 healthy internship students in the medical faculty performed Pilates reformer exercises for nine weeks. The control group (CG) consisted of 18 students who did not engage in any exercise program. The baseline and final parameters of all the participants were measured.

RESULTS

The mean age of the experimental group (EG) was 23.68±1.29 years, while that of the control group (CG) was 24.78±3.44 (p=0.089). A significant difference was evident between the performance pre-test and post-test scores of the EG (p<0.05). However, a significant positive difference was noted only between the waist pre-test and post-test results in the body composition measurements (p<0.05). A significant rise in HDL and fasting blood sugar levels and a decrease in insulin levels was observed in the post-exercise biochemical parameters measured in the EG (p=0.05). When the EG and CG were compared, a significant difference was found only in HDL cholesterol values in relation to the differences between the pre-test and the post-test groups (p=0.024).

CONCLUSION

The positive data from performance tests, especially with its HDL-increasing and insulin-lowering effects in the EG, implicate that Pilates reformer exercises can produce a favorable effect on the healthy living standards of medical interns.

Recent Insights into the Nutritional Antioxidant Therapy in Prevention and Treatment of Diabetic Vascular Complications - A comprehensive Review

Diabetes mellitus (DM) and DM-induced vascular complications are a significant global healthcare problem causing a decrease in patient quality of life. The main reason for the disability and mortality of patients is rapidly progressing micro- and macroangiopathies. Currently, free radical oxidation is recognized as one of the main mechanisms in the development of DM and associated complications. Under normal physiological conditions, the level of free radicals and antioxidant defense capabilities is balanced. However, imbalance occurs between the antioxidant defense system and pro-oxidants during chronic hyperglycemia and may invoke formation of excess free radicals, leading to activation of lipid peroxidation and accumulation of highly toxic products of free radical oxidation. This is accompanied by varying degrees of insulin deficiency and insulin resistance in DM patients. Simultaneously with the activation of free radical generation, a decrease in the activity of antioxidant defense factors (superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, vitamins C and E) and an acceleration of diabetic complications is seen. Therefore, we hypothesize that antioxidants may play a positive role in the treatment of DM patients to prevent DM-induced vascular complications. However this has not been sufficiently studied. In this review, we discuss recent insights into the potential underlying mechanisms of oxidative stress induced diabetic complications, and implications of antioxidants in mitigation of DM-induced vascular complications.

Effect of Different Exercise Modalities on Oxidative Stress: A Systematic Review

Exercise-induced benefits are being increasingly recognized in promoting health and preventing diseases. However, initial adaption to exercise response can have different effects on cells, including an increase in the formation of oxidants and inflammatory mediators that ultimately leads to oxidative stress, but this scenario depends on the exercise type and intensity and training status of the individual. Therefore, we aimed to understand the effect of different types of exercise on oxidative stress. Indeed, exercise-induced minimum oxidative stress is required for regulating signaling pathways. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a search for relevant articles was carried out on PubMed/Medline, ISI Web of Science, and Google Scholar using a broad range of synonyms such as oxidants, reactive oxygen species (ROS), oxidative stress, exercise, physical training, aerobic exercise, and strength exercise until 2019. This study selected a total of 18 articles for assessing the oxidative damage using various parameters such as malondialdehyde (MDA), protein carbonyl (PCO), and F1-isoprostanes and enzymatic antioxidants. We observed that any type of exercise can increase the oxidative damage in an exercise type and intensity manner. Further, the training status of the individual and specific oxidative damage marker plays a crucial role in predicting earlier oxidative damage in the exercise condition. However, some of the studies that we included for review did not perform follow-up evaluations. Therefore, follow-up programs using larger numbers need to be performed to confirm our findings.

Effects of Exercise Mode on Arterial Stiffness in Symptomatic Peripheral Artery Disease Patients: A Randomized Crossover Clinical Trial

BACKGROUND

Exercise program has been recommended for the treatment of symptomatic peripheral artery disease (PAD) patients. However, whether exercise promotes reduction in arterial stiffness in these patients, who exhibit high arterial stiffness, is poor known.

AIM

To analyze the effects of a single session of resistance, walking, and combined exercises on arterial stiffness in symptomatic PAD patients and to describe individual responses and identify clinical predictors of arterial stiffness responses after exercises.

METHODS

Twelve patients with symptomatic PAD underwent four experimental sessions in random order: walking exercise (W - 10 bouts of 2-min walking at the speed corresponding to the onset of claudication pain with 2-min interval among sets), resistance exercise (R - 2 sets of 10 reps in eight resistance exercises), combined exercise (CO - 1 set of 10 reps in eight resistance exercises + 5 bouts of 2-min walking with 2-min interval between) and control session (C - resting in exercise room). Ambulatory arterial stiffness index (AASI) was obtained during ambulatory period after each session. Body mass index, ankle brachial index, sex and age also were evaluated.

RESULTS

AASI was lower in R compared to other sessions (R - 0.52 ± 0.05; W - 0.59 ± 0.05; CO - 0.64 ± 0.05; C - 0.60 ± 0.05, P < 0.001), with 75% of patients presenting lower AASI after R session. No difference was found between W, CO and C sessions (P> 0.05). Ankle brachial index was negatively correlated with R and W sessions net effect (r = -0.618 and -0.750, respectively; P< 0.05 for both), no correlation was found with CO.

CONCLUSION

A single bout of resistance exercise acutely reduces arterial stiffness in symptomatic PAD, while walking and combined exercise did not alter this variable. This response is more likely to occur in individuals with less severe disease.

Acute and chronic effects of combined exercise on ambulatory blood pressure and its variability in hypertensive postmenopausal women

The aim of this study was to investigate the acute and chronic effects, and their correlation, after combined aerobic and resistance exercises in blood pressure (BP) and its variability (BPV) in hypertensive postmenopausal women. Fourteen hypertensive postmenopausal women monitored BP at rest and during 24 h by ambulatory BP monitoring in a control day without exercise performance a pretraining (baseline), after an acute exercise session (acute), and after a chronic exercise training for 10 weeks (chronic). After exercise training, systolic BP (SBP, Δ = -150 mmHg.24 h), diastolic BP (DBP, Δ = -96 mmHg.24 h), and mean BP (MBP, Δ = -95 mmHg.24 h) area under the curve were smaller than baseline measurements (P < 0.05) with no difference between acute and baseline measurements. The SBP (ΔSD₂₄ = -2, ΔSD_dn = -1.7, and ΔARV₂₄ = -1.9 mmHg), DBP (ΔSD₂₄ = -0.9, ΔSD_dn = -0.8, and ΔARV₂₄ = -0.9 mmHg), and MBP (ΔSD₂₄ = -1.5, ΔSD_dn = -1.3, and ΔARV₂₄ = -1.2 mmHg) variability reduced in acute session in relation to baseline, with no chronic effects. There are moderate correlations between acute and chronic responses in wake SBP, sleep DBP, and SD₂₄. In conclusion, combined exercise reduces ambulatory BP chronically but not acutely. In contrast, BPV decreases after an acute session but not chronically. Awake SBP, sleep DBP, and SD₂₄indices are promising candidates to predict individual cardiovascular responses to exercise.

Impact of exercise in high-humidity on heart rate variability and salivary oxidative stress in obese and lightweight asthmatic children

BACKGROUND

Asthma and obesity are becoming increasingly common among children. Such conditions are known to negatively affect both cardiac autonomic function and oxidative stress. We therefore investigated the heart rate variability (HRV) and oxidative (malondialdehyde, MDA) response to exercise within a high humidity environment (~65%) in obese and lightweight asthmatic children.

METHODS

Forty-two children participated in this study and were categorized into four groups: obese asthmatic (OA, N.=10), obese non-asthmatic (ONA, N.=15), lightweight asthmatic (LA, N.=10), and lightweight non-asthmatic (LNA, N.=7). Time-domain and nonlinear indices of HRV were assessed at rest, during, and immediately after exercise. Further, saliva samples were collected immediately before and after exercise and analyzed for the determination of MDA.

RESULTS

HRV significantly decreased during and after exercise compared to baseline (P<0.05) with short-term fractal scaling exponent (α1) for the LNA group significantly smaller than the OA group after exercise (P<0.05). In contrast, the long-term fractal scaling exponent (α2) was greater after exercise compared to baseline and during exercise for all groups (P<0.05). MDA significantly decreased after exercise compared to baseline (P<0.05). We also found significant correlations after exercise between salivary levels of MDA with HRV components (i.e., RMSSD, SD1, and α2) in asthmatic groups (all P<0.05).

CONCLUSIONS

Our findings showed that exercise in high humidity environment does not significantly differentiate the autonomic response among children with various conditions (i.e., obese, asthmatic and healthy). However, a significant relationship was found between HRV and MDA in asthmatic children after exercise, highlighting the inter-relationship between oxidative stress markers and autonomic function in asthmatic children.

Combined Aerobic and Resistance Exercise in Walking Performance of Patients With Intermittent Claudication: Systematic Review

Background: The short-term benefits of aerobic and resistance exercise in subjects affected by Peripheral Arterial Disease (PAD) are scarcely examined in interaction. This study aimed to identify the effects of combined aerobic and resistance exercise programs on walking performance compared with isolated aerobic exercise or with the usual care in patients with intermittent claudication.

Methods: A systematic review was conducted following the PRISMA statement. A total of five electronic databases were searched (until October 2019) for randomized and non-randomized controlled trials. The focus comprised PAD patients with intermittent claudication who performed a combined aerobic and resistance exercise program that assessed the walking performance.

Results: Seven studies include combined aerobic and resistance exercise vs. isolated aerobic or vs. usual care. The studies represented a sample size of 337 participants. The follow-up ranged from 4 to 12 weeks, 2 to 5 times-per-week. The risk of bias in the trials was a deemed moderate-to-high risk. After the interventions, the percent change in walking performance outcomes had a large variation. In the combined and isolated aerobic programs, the walking performance always improved, while in the usual care group oscillates between the deterioration and the improvement in all outcomes. Combined exercise and isolated aerobic exercise improved the claudication onset distance from 11 to 396%, and 30 to 422%, the absolute claudication distance from 81 to 197%, and 53 to 121%, and the maximal walking distance around 23 and 10%, respectively.

Conclusions: Currently, there is insufficient evidence about the effects of combined aerobic and resistance exercise compared to isolated aerobic exercise or usual care on walking performance. However, despite the low quality of evidence, the combined aerobic and resistance exercise seems to be an effective strategy to improve walking performance in patients with intermittent claudication. These combined exercise modes or isolated aerobic exercise produce positive and significant results on walking performance. The usual care approach has a trend to deteriorate the walking performance. Thus, given the scarcity of data, new randomized controlled trial studies that include assessments of cardiovascular risk factors are urgently required to better determine the effect of this exercise combination.

The effects of isoflavone supplementation plus combined exercise on salivary markers of oxidative stress in postmenopausal women

This study tested the effect of isoflavone supplementation in addition to combined exercise training in salivary oxidative stress markers in non-obese postmenopausal women. Thirty-two postmenopausal women without hormone therapy were randomly assigned to exercise + placebo (n = 15) or exercise + isoflavone supplementation (n = 17) groups. They performed 30 sessions of combined exercises (aerobic plus resistance) over ten weeks and consumed 100 mg of isoflavone supplementation or placebo. Saliva samples were collected after an overnight fast. Superoxide dismutase, total antioxidant capacity, thiobarbituric acid reactive substances, catalase, total protein and nitrite were determined before and after ten weeks of the intervention. The ANOVA two-way analysis of variance was applied with α of 5%. Both groups increase (p<0.05) superoxide dismutase activity and decrease catalase levels. There was interaction (time × group) in both nitrite and thiobarbituric acid reactive substances results, with increase (p<0.05) in placebo group and decrease (p<0.05) in isoflavone group. No difference was found for total antioxidant capacity or total protein. The combination of isoflavone supplementation and exercise training can promote an antioxidant effect through reduction of lipid peroxidation and concentrations of salivary nitrite.