Prenatal exercise and cardiovascular health (PEACH) study: The remote effect of aerobic exercise training on conduit artery and resistance vessel function

Cardiovascular effects of exercise training in pregnant people with a high body mass index: secondary results from a randomised controlled trial (ETIP)

Objectives

We aimed to determine the effectiveness of exercise training during pregnancy on peak oxygen uptake (V̇O2peak), cardiac function and flow-mediated dilatation (FMD) of the brachial artery throughout pregnancy and post partum in individuals with a prepregnancy body mass index (BMI) ≥28 kg/m2.

Trial design

Parallel-group randomised controlled trial (RCT).

Methods

The exercise group in the Exercise Training in Pregnancy (ETIP) RCT was offered 3 weekly supervised exercise sessions comprising 35 min of moderate-intensity treadmill walking followed by 25 min of strength exercises. The intervention started in gestational weeks 12-18 and continued throughout pregnancy. We measured V̇O2peak and FMD at baseline, in gestational weeks 34-37 and 3 months post partum and offered echocardiography in gestational weeks 14, 20, and 32, and 6-8 weeks postpartum.

Results

Of the 91 participants included in ETIP, 87 participants (age: 31.3±4.2 years, BMI: 34.6±4.3 kg/m2) provided data on V̇O2peak, cardiac function and/or FMD. There was no statistically significant effect of exercise training on V̇O2peak in gestational weeks 34-37, with an estimated effect of 1.7 mL/min/kg (95% CI -0.4 to 3.7, p=0.112) or post partum (1.6 mL/min/kg, 95% CI -0.2 to 3.4, p=0.079), compared with the control group. There were no statistically significant between-group differences in either FMD or any of the echocardiographic outcomes. Only 50% of the participants in the exercise group fulfilled our prespecified adherence criteria.

Conclusion

Offering pregnant individuals with BMI ≥28 kg/m2, a supervised exercise intervention did not improve cardiorespiratory fitness, cardiac function or FMD.

Trial registration number

NCT01243554.

Exercise effects on maternal vascular health and blood pressure during pregnancy and postpartum: a systematic review and meta-analysis

AIMS

This systematic review aimed to assess the effects of exercise training during pregnancy and the postpartum period on maternal vascular health and blood pressure (BP).

METHODS AND RESULTS

The outcome of interest was pulse wave velocity (PWV), flow-mediated dilation (FMD), and BP from pregnancy to 1-year postpartum. Five databases, including Ovid MEDLINE, EMBASE, CINAHL, Web of Science, and Cochrane Library, were systematically searched from inception to August 2023. Studies of randomized controlled trials (RCTs) comparing the effects of prenatal or postpartum exercise to a non-exercise control group were included. The risk of bias and the certainty of evidence were assessed. Random-effects meta-analyses and sensitivity analyses were conducted. In total, 20 RCTs involving 1221 women were included. Exercise training, initiated from Week 8 during gestation or between 6 and 14 weeks after delivery, with the programme lasting for a minimum of 4 weeks up to 6 months, showed no significant impact on PWV and FMD. However, it resulted in a significant reduction in systolic BP (SBP) [mean difference (MD): -4.37 mmHg; 95% confidence interval (CI): -7.48 to -1.26; P = 0.006] and diastolic BP (DBP) (MD: -2.94 mmHg; 95% CI: -5.17 to -0.71; P = 0.01) with very low certainty. Subgroup analyses revealed consistent trends across different gestational stages, types of exercise, weekly exercise times, and training periods.

CONCLUSION

Exercise training during pregnancy and the postpartum period demonstrates a favourable effect on reducing maternal BP. However, further investigations with rigorous methodologies and larger sample sizes are needed to strengthen these conclusions.

Mitochondrial Dysfunction in Endothelial Progenitor Cells: Unraveling Insights from Vascular Endothelial Cells

Endothelial dysfunction is associated with several lifestyle-related diseases, including cardiovascular and neurodegenerative diseases, and it contributes significantly to the global health burden. Recent research indicates a link between cardiovascular risk factors (CVRFs), excessive production of reactive oxygen species (ROS), mitochondrial impairment, and endothelial dysfunction. Circulating endothelial progenitor cells (EPCs) are recruited into the vessel wall to maintain appropriate endothelial function, repair, and angiogenesis. After attachment, EPCs differentiate into mature endothelial cells (ECs). Like ECs, EPCs are also susceptible to CVRFs, including metabolic dysfunction and chronic inflammation. Therefore, mitochondrial dysfunction of EPCs may have long-term effects on the function of the mature ECs into which EPCs differentiate, particularly in the presence of endothelial damage. However, a link between CVRFs and impaired mitochondrial function in EPCs has hardly been investigated. In this review, we aim to consolidate existing knowledge on the development of mitochondrial and endothelial dysfunction in the vascular endothelium, place it in the context of recent studies investigating the consequences of CVRFs on EPCs, and discuss the role of mitochondrial dysfunction. Thus, we aim to gain a comprehensive understanding of mechanisms involved in EPC deterioration in relation to CVRFs and address potential therapeutic interventions targeting mitochondrial health to promote endothelial function.

IMPACTS OF AEROBIC EXERCISE ON CARDIOVASCULAR HEALTH IN COLLEGE STUDENTS

ABSTRACT Introduction Cardiovascular disease (CVD) is a major disease that seriously endangers human health. CVD in many adults begins in adolescence and even in childhood. The cardiovascular health of college students in China cannot be ignored. Objective Verify the impacts of aerobic exercise (APA) on the cardiovascular health of college students. Methods The paper uses the literature method to explore the health-promoting role of aerobic exercise in opposing and improving CVD. Also the APA exercise method of effectively improving cardiopulmonary fitness (CRF) to prevent and improve CVD. The results showed that APA can improve microcirculation by increasing microvascular reactivity. Results Coronary blood flow in healthy adults is only 8% to 9% of cardiac bleeding, while coronary blood flow increases by 40% and oxygen intake by 2-2.5 times. Aerobic exercise can improve insulin sensitivity and reduce the risk of CVD. Some risk factors related to vascular endothelial dysfunction, such as hypertension, atherosclerosis, and coronary artery disease, are often accompanied by the phenomenon of insulin resistance in the induction of CVD. At the same time, improving IR may play an effective role in preventing and treating CVD. Conclusion APA can reduce and suppress the occurrence and development of CVD risk factors such as atherosclerosis, hypertension, hyperlipidemia, hyperglycemia and obesity, intestinal microecological disorder, and reduce free radical oxidative damage and apoptosis by improving insulin sensitivity of vascular endothelial cells, inhibiting inflammatory reaction, improving mitochondrial function of cardiomyocytes, reducing body mass index and obesity, and maintaining gut micro-ecological balance, and improving vascular endothelial function and reducing CVD such as myocardial infarction. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

Research on the influence of prenatal exercises on anthropometric and vascular parameters in pregnant women

Introduction/Objective. The frequency of a sedentary lifestyle during pregnancy increases. This contributes to gestational weight gain and has a negative impact on health. This study researched the impact of prenatal exercise on gestational weight gain, blood pressure, and microcirculation in pregnant women who exercised and those who did not exercise. Methods. The study included seventy pregnant women with a normal pregnancy, who attended a psychophysical preparation program for childbirth for eight weeks. The control group (n=35) attended theoretical classes on childbirth, and the experimental group (n=35) attended prenatal exercises as well. Gestational weight gain, blood pressure, and nailfold capillary density were determined and compared between the two groups. Results. Gestational weight gain of 19.94 kg in non-exercising pregnant women was significantly greater than the gestational weight gain of 11.65 kg in pregnant women who exercised. Pregnant women who did not exercise had an increase in systolic (by 15.56 mmHg) and diastolic pressure (by 16.08 mmHg), which is significantly higher compared to pregnant women who exercised. In this group, systolic pressure increased by 2.5 mmHg, while diastolic did not change. A significant difference in the nailfold capillary density at the end of the prenatal program has not been determined. Conclusion. Prenatal exercise of moderate-intensity has a positive effect on gestational weight gain and the level of blood pressure in pregnant women. The nailfold capillary density has not differed significantly after the prenatal program in pregnant women who have exercised and in those who have not.

The Nine Month Stress Test: Pregnancy and Exercise - Similarities and Interactions

Of all physiological systems, the cardiovascular system takes on the most profound adaptation in pregnancy to support fetal growth and development. The adaptations that arise are systemic and involve structural and functional changes that can be observed at the cerebral, central, peripheral, and microvascular beds. This includes, although is not limited to increased heart rate, stroke volume and cardiac output with negligible change to blood pressure, reductions in vascular resistance and cerebral blood flow velocity, systemic artery enlargement, enhanced endothelial function. All of this takes place to accommodate blood volume expansion and ensure adequate fetal and maternal oxygen delivery. In some instances, the demand placed on the vasculature can manifest as cardiovascular maladaptation and thus, cardiovascular complications can arise. Exercise is recommended in pregnancy because of its powerful ability to reduce the incidence and severity of cardiovascular complications in pregnancy. However, the mechanism by which it acts is poorly understood. The first aim of this review is to describe the systemic adaptations that take place in pregnancy. Secondly, this review aims to describe the influence of exercise on these systemic adaptations. It is anticipated that this review can comprehensively capture the extent of knowledge in this area while identifying areas that warrant further investigation.