Aerobic exercise training reduces arterial stiffness in metabolic syndrome

The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus

The significant morbidity and premature mortality of type 2 diabetes mellitus (T2DM) is largely associated with its cardiovascular consequences. Focus has long been on the arterial atheromatosis of DM giving rise to early stroke and myocardial infarctions, whereas less attention has been given to its non-ischemic cardiovascular consequences. Irrespective of ischemic changes, T2DM is associated with heart failure (HF) most commonly with preserved ejection fraction (HFpEF). Largely due to increasing population ages, hypertension, obesity and T2DM, HFpEF is becoming the most prevalent form of heart failure. Unfortunately, randomized controlled trials of HFpEF have largely been futile, and it now seems logical to address the important different phenotypes of HFpEF to understand their underlying pathophysiology. In the early phases, HFpEF is associated with a significantly impaired ability to increase cardiac output with exercise. The lowered cardiac output with exercise results from both cardiac and peripheral causes. T2DM is associated with left ventricular (LV) diastolic dysfunction based on LV hypertrophy with myocardial disperse fibrosis and significantly impaired ability for myocardial blood flow increments with exercise. T2DM is also associated with impaired ability for skeletal muscle vasodilation during exercise, and as is the case in the myocardium, such changes may be related to vascular rarefaction. The present review discusses the underlying phenotypical changes of the heart and peripheral vascular system and their importance for an adequate increase in cardiac output. Since many of the described cardiovascular changes with T2DM must be considered difficult to change if fully developed, it is suggested that patients with T2DM are early evaluated with respect to their cardiovascular compromise.

Joint associations of sleep duration and physical activity with cognitive impairment among rural elderly over 65 years old: a cross-sectional study

BACKGROUND

During the long preclinical phase of dementia, accelerated cognitive impairment is regarded as a cardinal marker. Thus, the identification of risk factors for cognitive impairment is of great significance for dementia prevention. This study aims to examine the joint associations of sleep duration and physical activity with cognitive impairment among rural elderly over 65 years old, and provide suggestions for improving the cognitive function in rural elderly over 65 years old.

METHODS

A cross-sectional study was conducted in rural Nanjing by recruiting 1147 individuals aged above 65 years. Cognitive function was assessed using the brief community screening instrument for dementia. Physical activity was assessed using the Global Physical Activity Questionnaire. Data were analyzed by multivariate logistic regression models, and a significant difference was set at P < 0.05.

RESULTS

Compared with participants with proper sleep duration and sufficient physical activity, participants with short sleep duration and insufficient physical activity (odds ratio (OR): 1.820; 95% CI: 1.265 ~ 2.618), long sleep duration and sufficient physical activity (OR: 2.428; 95% CI: 1.137 ~ 5.183) showed an increased likelihood of cognitive impairment.

CONCLUSIONS

Inappropriate sleep duration combined with insufficient physical activity was associated with a significantly higher likelihood of cognitive impairment in rural elderly over 65 years old.

Effect of aerobic exercise training on pulse wave velocity in adults with and without long-term conditions: a systematic review and meta-analysis

RATIONALE

There is conflicting evidence whether aerobic exercise training (AET) reduces pulse wave velocity (PWV) in adults with and without long-term conditions (LTCs).

OBJECTIVE

To explore whether PWV improves with AET in adults with and without LTC, to quantify the magnitude of any effect and understand the influence of the exercise prescription.

DATA SOURCES

CENTRAL, MEDLINE and EMBASE were among the databases searched.

ELIGIBILITY CRITERIA

We included studies with a PWV measurement before and after supervised AET of at least 3 weeks duration. Exclusion criteria included resistance exercise and alternative measures of arterial stiffness.

DESIGN

Controlled trials were included in a random effects meta-analysis to explore the effect of AET on PWV. Uncontrolled studies were included in a secondary meta-analysis and meta-regression exploring the effect of patient and programme factors on change in PWV. The relevant risk of bias tool was used for each study design.

RESULTS

79 studies (n=3729) were included: 35 controlled studies (21 randomised control trials (RCT) (n=1240) and 12 non-RCT (n=463)) and 44 uncontrolled (n=2026). In the controlled meta- analysis, PWV was significantly reduced following AET (mean (SD) 11 (7) weeks) in adults with and without LTC (mean difference -0.63; 95% CI -0.82 to -0.44; p<0.0001). PWV was similarly reduced between adults with and without LTC (p<0.001). Age, but not specific programme factors, was inversely associated with a reduction in PWV -0.010 (-0.020 to -0.010) m/s, p<0.001.

DISCUSSION

Short-term AET similarly reduces PWV in adults with and without LTC. Whether this effect is sustained and the clinical implications require further investigation.

The contribution of being physically active to successful aging

Growing old involves changes in physical, psychological, and cognitive functions. Promoting physical and mental health has become one of the priorities for an aging population. Studies have demonstrated the benefits of engaging in regular physical activity. Here, we aimed to understand the relationships between physical activity and working memory complaints in attention, memory storage, and executive functions. We hypothesized that physical activity was negatively associated with complaints in working memory domains after controlling for socio-demographics and distress factors, such as anxiety, stress, and depression. Two hundred and twenty-three individuals aged between 65 and 100 years (74.84; SD = 7.74; 133 males) without self-reported neurological and/or psychiatric disorders completed a questionnaire on socio-demographic, with questions on physical activity and the Italian version of the working memory questionnaire (WMQ) and the DASS-21 measuring anxiety, stress, and depression. Results from three linear regression models showed that low physical activity was associated with complaints in attention (R2 = 0.35) and executive functions (R2 = 0.37) but not in memory storage (R2 = 0.28). Notably, age, gender, and total emotional distress (DASS score) were significant in all regression models. Our results suggested regular physical activity, even just walking, is crucial for maintaining efficient cognitive function. Theoretical and practical implications for engaging in physical activity programs and social aggregation during exercise are considered. Limitations are also presented.

Effects of rope skipping exercise on physical, cardiovascular fitness and exercise tolerance in adolescent students with moderate intellectual disability

BACKGROUND

Adolescents with intellectual disabilities (ID) who live a sedentary lifestyle may lead to an increased risk of chronic cardiovascular disease in adulthood. The aim of this study is to investigate the effects of 8-week progressive rope skipping training on physical, cardiovascular fitness and exercise tolerance of high school students with moderate ID.

METHODS

Thirty-four senior high school with ID (aged 15-18 years old) were randomised into experimental group received progressive skipping rope exercise (RS, n = 17) and control group no rope skipping exercise intervention group (CON, n = 17). The RS group were received progressive rope skipping exercise for 50 min each time, three times a week, for 8 weeks. The control group was not allowed to participate in intervention activities during the study period. The physical fitness, body composition, arterial stiffness index (ASI) and blood pressure were measured before and after the 8-week intervention.

RESULTS

After the 8-week progressive skipping rope exercise intervention, the participants from the RS group increased in the 3-min step test, sit-up test, grip strength and sit and reach test, when compared to the baseline (P < 0.05). The RS group exhibited lower the area under curve of heart rate (HR) during post-exercise recovery (P < 0.05). The participants in the RS group showed significant decreases in systolic (SBP) and diastolic (DBP) blood pressure, mean arterial pressure (MAP) and HR when compared to the baseline (P < 0.05). Change SBP has moderate positive correlation with change ASI.

CONCLUSIONS

The results of this experiment suggest that progressive rope skipping exercise might improve physical fitness and promote cardiovascular health, as well as enhance exercise tolerance for adolescent students with moderate ID.

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.

Effects of traditional Chinese exercise on vascular function in patients with Alzheimer's disease: A protocol for systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Alzheimer's disease (AD) is a progressive neurodegenerative disorder with an insidious onset, usually characterized by memory impairment, visual-spatial skill impairment, executive dysfunction and personality behavioral changes. Studies have confirmed that vascular dysfunction may precede AD pathological changes and can present as vascular malformations, atherosclerosis, and impaired self-regulation, and can affect oxidative stress and amyloidosis. Therefore, it is important to improve or prevent vascular dysfunction in AD patients. Regular exercise can effectively inhibit the production of reactive oxygen species during the occurrence of AD and can improve the reduction of cerebral blood flow due to AD. Previous studies have shown that exercise can achieve superior clinical results in improving vascular function in AD patients. Therefore, we hypothesize that traditional Chinese exercises (TCEs) may have a good clinical effect in improving vascular function in patients with AD.

METHODS

We will search "PubMed," "the Cochrane Library," "Embase," "Web of Science," "CINAHL," "ProQuest Dissertations and Theses," and "ProQuest-Health & Medical Collection," "CNKI," "SinoMed," "VIP," and "Wanfang Data" to find randomized controlled trials of the effects of TCEs on AD vascular function from the creation of the database to the present, including at least 1 indicator in carotid intima-media thickness (cIMT), middle cerebral artery mean flow velocity (MFV), blood indicators [Heme Oxidase-1 (HO-1), angiopoietin I (Ang I), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor, matrix metalloproteinase-9 (MMP-9)], and arterial stiffness [(Ankle Brachial Index (ABI), pulse wave velocity (PWV)]. For the included literature, Excel 2019 will be used for data extraction and collection. For the indicators that can be netted for network meta-analysis, Surface Under the Cumulative Ranking for each exercise modality will be calculated with the help of Stata 16.0 and rank, where the higher the SUCRA score, the higher the ranking. For the indicators that cannot be netted, Review Manager 5.4 will be used for meta-analysis will be performed to evaluate the improvement effect of TCEs on AD patients.

RESULTS

This meta-analysis will further determine the efficacy and safety of TCEs on vascular function in AD patients.

CONCLUSION

In this study, randomized controlled trials of the effects of TCEs on vascular function in AD patients will be selected to provide evidence-based medical evidence for promoting the application of TCEs by observing the order of advantages and disadvantages of various exercise modalities through network meta-analysis.

Effect of Exercise on Arterial Stiffness in Healthy Young, Middle-Aged and Older Women: A Systematic Review

Arterial stiffness, an age-dependent phenomenon, is improved with exercise, which in turn may prevent cardiovascular diseases in women. However, there is a lack of consolidated information on the impact of exercise on arterial stiffness among healthy women. The aim of this review was to (i) analyse the effect of exercise on arterial stiffness in healthy young, middle-aged, and older women, and (ii) recommend types, intensity, and frequency for each age group. Database searches on PubMed, ScienceDirect, Web of Science, and Scopus were conducted using PRISMA guidelines until September 2022. The keywords were: exercise, women/female, and arterial stiffness. The inclusion criteria were: healthy women, supervised exercise, and arterial stiffness measures. Study quality and bias were assessed using the PEDro scale. Fifty-one papers were classified into young (n = 15), middle-aged (n = 14), and older (n = 22) women. Improvements in arterial stiffness were observed among: young women (Pulse Wave Velocity, PWV: 4.9-6.6 m/s), following an 8-week high-intensity aerobic (3 days/week) or hypoxic high-intensity interval training; middle-aged women (PWV: 5.1-7.9 m/s), aerobic exercise with moderate intensity or stretching exercise at "moderate to heavy" (Borg Scale), 20-30 s per site, 10 s of rest interval for 30 min; and for older women (PWV: 7.9-15.6 m/s), resistance training at light intensity, aerobic exercise at any intensity, or a combination of the two exercises. This review shows that arterial stiffness increases with age in healthy women and has an inverse relationship with exercise intensity. Therefore, when prescribing exercise to improve arterial stiffness, age and arterial stiffness measures should be accounted for.

Ambulatory and successive home-based heart rate targeted aerobic training improves arterial parameters: a follow-up study in people with metabolic syndrome

BACKGROUND

Studies demonstrated that outpatient aerobic exercise programs (aEP) can significantly decrease aortic stiffness in people with metabolic syndrome (MetS). There is some limited data that remotely supervised home-based aEP can also improve arterial stiffness in this population. We aimed to evaluate the changes in the arterial wall parameters after the 2-month ambulatory supervised aEP followed by the 6-month home-based aEP with and without targeting of heart rate (HR) by electrocardiogram (ECG) in people with MetS.

METHODS

In this prospective study (ClinicalTrials.gov identifier: NCT05592704) 132 MetS subjects (mean age 52.44 ± 6.26 years, 54.55% female) were evaluated. At first, all subjects participated in the 2-month ambulatory supervised aEP, which consisted of 40 individual aerobic training sessions on a cycle ergometer 5 times/week for 40 min and received the recommendations for home-based training. Then the study (n = 66) and the control (n = 66) groups participated in the 6-month home-based aEP, but only the study group subjects targeted their HR using ECG monitor connected to the smartphone during workouts. Arterial stiffness parameters and carotid artery intima-media thickness (cIMT) were evaluated in all participants at baseline and after 8 months.

RESULTS

After 8 months, carotid-femoral pulse wave velocity (c-f PWV) significantly reduced in both groups (-12.22% in the study group vs. -7.85% in the control group, all p < .001) without a significant between-group difference (p = 0.144). A significant improvement of carotid-radial pulse wave velocity (c-r PWV) was observed only in the study group (-11.37%, p < .001, d = -0.671) with significant between-group difference (p < .001). The reduction of c-r PWV after 8 months of aEP occurred when c-r PWV at baseline was in the 2nd quartile (>7.90 m/s). A significant decrease of 3.32% in cIMT was present only in the study group (p = .032, d = -0.288).

CONCLUSIONS

The combination of 2-month ambulatory supervised aEP and successive 6-month home-based aEP targeted by HR monitoring using ECG improved arterial properties in MetS subjects more than the same combination without HR targeting, leading to the greater reduction of c-r PWV and cIMT.

A bench to bedside perspective on anthracycline chemotherapy-mediated cardiovascular dysfunction: challenges and opportunities. A symposium review

Cardiovascular diseases (CVD) are the leading cause of death worldwide and the risk of developing CVD is markedly increased following anthracycline chemotherapy treatment. Anthracyclines are an essential component of the cancer treatment regimen used for common forms of cancer in male and female children, adolescents, young adults, and older adults. Increased CVD risk with anthracyclines occurs, in part, due to vascular dysfunction-impaired endothelial function and arterial stiffening. These features of vascular dysfunction also play a major role in other common disorders observed following anthracycline treatment, including chronic kidney disease, dementia, and exercise intolerance. However, the mechanisms by which anthracycline chemotherapy induces and sustains vascular dysfunction are incompletely understood. This budding area of biomedical research is termed cardio-oncology, which presents the unique opportunity for collaboration between physicians and basic scientists. This symposium, presented at Experimental Biology 2022, provided a timely update on this important biomedical research topic. The speakers presented observations made at levels from cells to mice to humans treated with anthracycline chemotherapeutic agents using an array of translational research approaches. The speaker panel included a diverse mix of female and male investigators and unique insight from a cardio-oncology physician-scientist. Particular emphasis was placed on challenges and opportunities in this field as well as mechanisms that could be viewed as therapeutic targets leading to novel treatment strategies.

Effect of Exercise on Carotid Artery Intima-Media Thickness in Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Carotid intima-media thickness (cIMT) is a validated surrogate marker of atherosclerosis that is independently associated with the risk for cardiovascular disease. Recent studies on the effect of exercise on cIMT have yielded conflicting results.

METHODS

Studies that were available up until October 30, 2021 from the PubMed, Cochrane Library, Embase, and Web of Science databases were included in the analysis. Subgroup analyses were performed to determine the effects of the type, intensity, and duration of exercise on cIMT.

RESULTS

This review included 26 studies with 1370 participants. Compared with control participants, those who engaged in exercise showed a decline in cIMT (weighted mean difference [WMD] -0.02; 95% confidence interval [CI], -0.03 to -0.01; I2 = 90.1%). Participants who engaged in aerobic (WMD -0.02; 95% CI, -0.04 to -0.01; I2 = 52.7%) or resistance (WMD -0.01; 95% CI, -0.02 to -0.00; I2 = 38.5%) exercise showed lower cIMT compared with control participants. An exercise duration of >6 months was associated with a 0.02 mm reduction in cIMT. In participants with low cIMT at baseline (<0.7 mm), exercise alone was not associated with a change in cIMT (WMD -0.01; 95% CI, -0.03 to 0.00; I2 = 93.9%).

CONCLUSIONS

Exercise was associated with reduced cIMT in adults. Aerobic exercise is associated with a greater decline in cIMT than other forms of exercise. Large, multicenter, randomized controlled trials are required to establish optimal exercise protocols for improving the pathological process of atherosclerosis.

Effects of Different Long-Term Exercise Modalities on Tissue Stiffness

Stiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.

Arterial Stiffness following Endurance and Resistance Exercise Sessions in Older Patients with Coronary Artery Disease

Arterial stiffness (AS) is associated with coronary artery disease (CAD). Acute endurance training decreases AS, whereas acute resistance training increases it. However, these results are from studies in apparently healthy adults, and there is no information on the effects of such afterload AS in elderly patients with CAD. We aimed to investigate the effect of acute endurance or resistance training on the time course of changes in the indices of AS in elderly patients with CAD in order to understand how stiffness responds after training. We tested 18 trained men with CAD. AS was measured using central and peripheral pulse wave velocity (PWV) after 15 min of rest and after 5, 15, and 30 min of endurance and resistance training sessions. The endurance session consisted of high-intensity interval walking at 85-90% of maximum heart rate, and the resistance session consisted of 70% of the maximum of one repetition. An interaction effect was found for central and peripheral PWV (p ≤ 0.001; carotid, η² = 0.72; aortic, η² = 0.90; femoral, η² = 0.74), which was due to an increase in PWV after resistance and a decrease in central and peripheral PWV after endurance. This study demonstrates that training mode influences the time course of AS responses to acute exercise in these patients. Acute endurance training decreased AS, whereas resistance training significantly increased it.

Impact of acute and chronic regular exercise on arterial stiffness and reflection measures in coronary artery disease patients: A Protocol for Randomized Clinical Trial

Vascular stiffness due to arteriosclerosis reduces arterial elasticity which is as an independent and non-invasive predictor of future incidence of coronary heart disease and stroke. There is limited evidence of the benefits of regular exercise on arterial stiffness in populations suffering from cardiovascular diseases (CVD) especially coronary artery disease (CAD).

Aim. To determine the acute and chronic effects of aerobic, resistance and combined exercise on arterial and hemodynamic function in patients with CAD.

Material and methods. This study will be a prospective, single-blind, randomized study examining the effects of exercise on arterial stiffness. The study will be conducted at a tertiary care hospital for a continuous period of one year. Patients with CAD (n=105) will be selected using systematic sampling techniques and allocated randomly to one of the four treatment groups using computer-generated, random number sequence for age, sex and health status of CAD (Group-I: aerobic exercise, Group-II: resistance exercise, Group-III: combined aerobic and resistance exercise, and Group-IV: control) as per the inclusion and exclusion criteria. All recruited subjects will be informed about the assessment and intervention procedure before getting the consent form filled. This project followed the guidelines of standard protocol for randomized clinical trials (spirit).

Perspective. It is expected that this study protocol shall through light and be helpful in better quality of life along with decline in drug dependency for the people suffering from CAD. Further this study will be valuable is designing exercise protocol for the people suffering from CAD.

Aortic waveform responses to insulin in late versus early chronotype with metabolic syndrome

Late chronotype (LC) correlates with reduced metabolic insulin sensitivity and cardiovascular disease. It is unclear if insulin action on aortic waveforms and inflammation is altered in LC versus early chronotype (EC). Adults with metabolic syndrome (n = 39, MetS) were classified as either EC (Morning-Eveningness Questionnaire [MEQ] = 63.5 ± 1.2) or LC (MEQ = 45.5 ± 1.3). A 120 min euglycemic clamp (40 mU/m² /min, 90 mg/dL) with indirect calorimetry was used to determine metabolic insulin sensitivity (glucose infusion rate [GIR]) and nonoxidative glucose disposal (NOGD). Aortic waveforms via applanation tonometry and inflammation by blood biochemistries were assessed at 0 and 120 min of the clamp. LC had higher fat-free mass and lower VO₂ max, GIR, and NOGD (between groups, all p ≤ 0.05) than EC. Despite no difference in 0 min waveforms, both groups had insulin-stimulated elevations in pulse pressure amplification with reduced AIx75 and augmentation pressure (AP; time effect, p ≤ 0.05). However, EC had decreased forward pressure (Pf; interaction effect, p = 0.007) with insulin versus rises in LC. Although LC had higher tumor necrosis factor-α (TNF-α; group effect, p ≤ 0.01) than EC, both LC and EC had insulin-stimulated increases in TNF-α and decreases in hs-CRP (time effect, both p ≤ 0.01). Higher MEQ scores related to greater insulin-stimulated reductions in AP (r = -0.42, p = 0.016) and Pf (r = -0.41, p = 0.02). VO₂ max correlated with insulin-mediated reductions in AIx75 (r = -0.56, p &lt; 0.01) and AP (r = -0.49, p &lt; 0.01). NOGD related to decreased AP (r = -0.44, p = 0.03) and Pf (r = -0.43, p = 0.04) during insulin infusion. LC was depicted by blunted forward pressure waveform responses to insulin and higher TNF-α in MetS. More work is needed to assess endothelial function across chronotypes.

Preventing the adverse cardiovascular consequences of allogeneic stem cell transplantation with a multi-faceted exercise intervention: the ALLO-Active trial protocol

BACKGROUND

Allogeneic stem cell transplantation (allo-SCT) is a potentially lifesaving treatment for high-risk hematological malignancy, but survivors experience markedly elevated rates of cardiovascular disease and associated functional impairment. Mounting evidence suggests regular exercise, combined with a reduction in sedentary time through replacement with light exercise may be a useful therapeutic strategy for the prevention of cardiovascular comorbidities. However, this type of intervention has yet to be evaluated in patients undergoing allo-SCT. The ALLO-Active study will evaluate the efficacy of a ~ 4 month multi-faceted exercise intervention, commenced upon admission for allo-SCT, to preserve peak oxygen uptake (VO2peak) and peak cardiac output, compared with usual care. The study will also evaluate the effect of the intervention on functional independence, quality of life, and symptoms of fatigue.

METHODS

Sixty adults with hematological malignancy scheduled for allo-SCT will be randomly assigned to usual care (n = 30) or the exercise and sedentary behaviour intervention (n = 30). Participants assigned to the intervention will complete a thrice weekly aerobic and progressive resistance training program and concomitantly aim to reduce daily sedentary time by 30 min with short, frequent, light-intensity exercise bouts. Participants will undergo testing prior to, immediately after inpatient discharge, and 12 weeks after discharge. To address aim 1, VO2peak and peak cardiac output (multiple primary outcomes, p < 0.025) will be assessed via cardiopulmonary exercise testing and exercise cardiac magnetic resonance imaging, respectively. Secondary outcomes include functional independence (defined as VO2peak ≥ 18.mL.kg-1.min-1), quality of life, and fatigue (assessed via validated questionnaire). Exploratory outcomes will include indices of resting cardiac, vascular, and skeletal muscle structure and function, cardiovascular biomarkers, anxiety and depression, transplant outcomes (e.g., engraftment, graft-versus-host disease), and habitual physical activity, sedentary time, and sleep.

DISCUSSION

Multi-faceted exercise programs are a promising approach for ameliorating the cardiovascular consequences of allo-SCT. If this intervention proves to be effective, it will contribute to the development of evidence-based exercise guidelines for patients undergoing allo-SCT and assist with optimising the balance between acute cancer management and long-term health.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), ID: 12619000741189 . Registered 17 May 2019.

Aerobic exercise training improves not only brachial artery flow-mediated vasodilatation but also carotid artery reactivity: A randomized controlled, cross-over trial in older men

It is well-known that aerobic exercise training beneficially affects endothelial function as measured by brachial artery flow-mediated vasodilation (FMD). This trial with older sedentary overweight and obese men, therefore, examined the effects of aerobic training on other non-invasive markers of the vasculature, which have been studied in less detail. Seventeen men (67 ± 2 years, BMI: 30.3 ± 2.8 kg/m² ) participated in this controlled cross-over study. Study participants followed in random order a fully supervised, progressive, aerobic exercise training (three 50-min sessions each week at 70% maximal power) and a no-exercise control period for 8 weeks, separated by a 12-week wash-out period. At the end of each period, endothelial function was assessed by the carotid artery reactivity (CAR) response to a cold pressor test and FMD, and local carotid and regional aortic stiffness by the carotid-to-femoral pulse wave velocity (PWV_c-f ). The retinal microvasculature, the serum lipid profile, 24-h ambulatory blood pressure, and 96-h continuous glucose concentrations were also determined. Aerobic training increased CAR from 1.78% to 4.01% (Δ2.23 percentage point [pp]; 95% CI: 0.58, 3.89 pp; p = 0.012) and FMD from 3.88% to 6.87% (Δ2.99 pp; 95% CI: 0.58, 5.41 pp; p = 0.019). The stiffness index β₀ increased by 1.1 (95% CI: 0.3, 1.9; p = 0.012), while PWV_c-f did not change. Retinal arteriolar width increased by 4 μm (95% CI: 0, 7 μm; p = 0.041). Office blood pressure decreased, but ambulatory blood pressure, and serum lipid and continuous glucose concentrations did not change. Aerobic exercise training improved endothelial function and retinal arteriolar width in older sedentary overweight and obese men, which may reduce cardiovascular risk.

Exercise, Physical Activity, and Cardiometabolic Health: Pathophysiologic Insights

Physical activity and its sustained and purposeful performance-exercise-promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one's global cardiovascular, pulmonary and metabolic health, and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity; beneficial changes in body composition and adiposity; and improved cardiac mechanics and vascular health. We subsequently identify knowledge gaps that remain in exercise science, including heterogeneity in exercise responsiveness. While the application of molecular profiling technologies in exercise science has begun to illuminate the biochemical pathways that govern exercise-induced health promotion, much of this work has focused on individual organ systems and applied single platforms. New insights into exercise-induced secreted small molecules and proteins that impart their effects in distant organs ("exerkines") highlight the need for an integrated approach towards the study of exercise and its global effects; efforts that are ongoing.

Impact of a Novel Training Approach on Hemodynamic and Vascular Profiles in Older Adults

Exercise training beneficially moderates the effects of vascular aging. This study compared the efficacy of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME), a novel training regimen, versus aerobic training on hemodynamic profiles in participants ≥70 years at risk for losing functional independence. Seventy-five participants (52 females, age: 76 ± 5 years) were assessed for hemodynamic and vascular function at baseline, after 4 weeks of either PRIME or aerobic training (Phase 1) and again after a further 8 weeks of aerobic and resistance training (Phase 2). Data were analyzed using 2 × 2 repeated-measures analysis of variance models on the change in each dependent variable. PRIME demonstrated reductions in brachial and aortic mean arterial pressure and diastolic blood pressure (p < .05) from baseline after Phase 1, which were sustained throughout Phase 2. Earlier and greater reductions in blood pressure following PRIME support the proposal that peripheral muscular training could beneficial for older individuals commencing an exercise program.

Joint effects of self-reported sleep and modifiable physical activity on risk of dyslipidaemia in women aged 45-55 years: a cross-sectional study

OBJECTIVES

Modifiable physical activity (PA) plays an important role in dyslipidaemia risk in middle-aged women with sleep problems, especially perimenopausal women. We aimed to explore the joint effects of sleep and PA on the risk of dyslipidaemia in women aged 45-55 years, and the extent to which PA moderated the effect of sleep on the risk of dyslipidaemia.

DESIGN

A cross-sectional study.

SETTING

This study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015.

PARTICIPANTS

721 women aged 45-55 years were included.

OUTCOME MEASUREMENT

PA was measured by the Global Physical Activity Questionnaire. Sleep was measured by questionnaire formulated by the Chinese Center for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the joint effects of sleep and PA on dyslipidaemia risk. OR and 95% CI were reported.

RESULTS

Among all participants, 60.6% had sleep problems, 29.0% had low PA and 41.1% had dyslipidaemia. Women with sleep problems had higher dyslipidaemia risk than women without sleep problems, irrespective of low, moderate or high PA, with OR (95% CI) of 4.24 (2.40 to 7.49), 3.14 (1.80 to 5.49) and 2.04 (1.20 to 3.48), respectively. PA could not completely attenuate the negative association between sleep and dyslipidaemia risk. With PA increased from low to high, the OR of dyslipidaemia decreased by 2.20. Women with sleep problems and low PA had higher risks of high total cholesterol, high triglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol than women without sleep problems and high PA, with OR (95% CI) of 2.51 (1.18 to 5.35), 2.42 (1.23 to 4.74), 2.88 (1.44 to 5.74) and 2.52 (1.12 to 5.70), respectively.

CONCLUSIONS

Among women aged 45-55 years, the joint effects of self-reported sleep and PA on dyslipidaemia risk were more marked for sleep than for PA. Modifiable PA is a widely accessible and effective intervention to reduce the dyslipidaemia risk in women with sleep problems, particularly among perimenopausal women.

Interpreting 'anti-inflammatory' cytokine responses to exercise: focus on interleukin-10

Circulating concentrations of canonically pro- and anti-inflammatory cytokines are commonly measured when evaluating the anti-inflammatory effects of exercise. An important caveat to interpreting systemic cytokine concentrations as evidence for the anti-inflammatory effects of exercise is the observed dissociation between circulating cytokine concentrations and cytokine function at the tissue/cellular level. The dichotomization of cytokines as pro- or anti-inflammatory also overlooks the context dependence of cytokine function, which can vary depending on the physiological state being studied, the cytokine's cellular source/target, and magnitude of cytokine responses. We re-evaluate our current understanding of anti-inflammatory cytokine responses to exercise by highlighting nuances surrounding the interpretation of altered systemic cytokine concentrations as evidence for changes in inflammatory processes occurring at the tissue/cellular level. We highlight the lesser known pro-inflammatory and immunostimulatory actions of the prototypical anti-inflammatory cytokine, interleukin (IL)-10, including the potentiation of interferon gamma production during endotoxaemia, CD8⁺ T cell activation in tumour bearing rodents and cancer patients in vivo, and CD8⁺ T lymphocyte and natural killer cell activation in vitro. IL-10's more well-established anti-inflammatory actions can also be blunted following exercise training and under chronic inflammatory states such as type 2 diabetes (T2D) independently of circulating IL-10 concentrations. The resistance to IL-10's anti-inflammatory action in T2D coincides with blunted STAT3 phosphorylation and can be restored with small-molecule activators of IL-10 signalling, highlighting potential therapeutic avenues for restoring IL-10 action. We posit that inferences based on altered circulating cytokine concentrations alone can miss important functional changes in cytokine action occurring at the tissue/cellular level.

Vascular Ageing and Aerobic Exercise

Impairment of vascular function, in particular endothelial dysfunction and large elastic artery stiffening, represents a major link between ageing and cardiovascular risk. Clinical and experimental studies identified numerous mechanisms responsible for age-related decline of endothelial function and arterial compliance. Since most of these mechanisms are related to oxidative stress or low-grade inflammation, strategies that suppress oxidative stress and inflammation could be effective for preventing age-related changes in arterial function. Indeed, aerobic physical activity, which has been shown to improve intracellular redox balance and mitochondrial health and reduce levels of systemic inflammatory markers, also improves endothelial function and arterial distensibility and reduces risk of cardiovascular diseases. The present paper provides a brief overview of processes underlying age-related changes in arterial function, as well as the mechanisms through which aerobic exercise might prevent or interrupt these processes, and thus attenuate vascular ageing.

Domains of Physical Activity in Relation to Stiffness Index in the General Population

Background

Regular exercise training represents an important modifier of arterial stiffness (AS). Therefore, sex‐specific relations between domains of physical activity (PA; commuting, domestic, and leisure‐time PA, including active sport and occupational PA) with AS were investigated.

Methods and Results

Stiffness index by digital photoplethysmography was investigated in 12 650 subjects from the GHS (Gutenberg Health Study). Self‐reported PA was evaluated by the “Short Questionnaire to Assess Health‐Enhancing Physical Activity” and reported as activity score peer week, being a combined measure of duration, frequency, and intensity of PA. Multivariable linear regression analysis demonstrated strong beneficial effects of repetitive activities, such as active commuting or leisure‐time PA–related walking on AS in men, but not in women. Lower AS associated with endurance training was also found among men and premenopausal women. In contrast, intense occupational PA was related to stiffer vessels in men (P<0.0001) and women (P=0.0021) in a fully adjusted model. Combination of both, performing endurance training and having stiffness index values below median, resulted in the best survival. In contrast, subjects with elevated stiffness index at baseline without any endurance activities demonstrated the worst survival.

Conclusions

In this population representative sample, a differential impact of domains of self‐reported PA on AS was demonstrated. Our data strengthen the importance of regular endurance PA to induce a reduction of AS, which, in turn, may improve cardiovascular prognosis. We also report deleterious effects of intense occupational PA on stiffness index, a finding that needs further confirmation by larger prospective trials.

Advances in Non-Invasive Blood Pressure Monitoring

This paper reviews recent advances in non-invasive blood pressure monitoring and highlights the added value of a novel algorithm-based blood pressure sensor which uses machine-learning techniques to extract blood pressure values from the shape of the pulse waveform. We report results from preliminary studies on a range of patient populations and discuss the accuracy and limitations of this capacitive-based technology and its potential application in hospitals and communities.

Chronic stress induced perivascular adipose tissue impairment of aortic function and the therapeutic effect of exercise

NEW FINDINGS

What is the central question of this study? Thoracic perivascular adipose tissue (tPVAT) is known to, in part, regulate aortic function: what are the effects of unpredictable chronic mild stress (UCMS) on the tPVAT regulation of aortic function and what is the role of exercise training in alleviating the potential negative actions of UCMS on tPVAT? What is the main finding and its importance? UCMS causes tPVAT to disrupt endothelium-dependent dilatation, increases inflammatory cytokine production and diminishes tPVAT-adiponectin. Exercise training proved efficacious in preventing tPVAT-mediated disruption of aortic function. The data support a tPVAT mechanism through which chronic stress negatively impacts vascular health, which adds to our knowledge of how psychological disorders might increase the risk of cardiovascular disease.

ABSTRACT

Chronic stress is a major risk for cardiovascular disease. Perivascular adipose tissue (PVAT) has been shown to regulate vascular function; however, the impact of chronic stress and the comorbidity of metabolic syndrome (MetS) on thoracic (t)PVAT is unknown. Additionally, aerobic exercise training (AET) is known to combat the pathology of MetS and chronic stress, but the role of tPVAT in these actions is also unknown. Therefore, the purpose of this study was to examine the effects of unpredictable chronic mild stress (UCMS) on the tPVAT regulation of aortic function and the preventative effect of AET. Lean (LZR) and obese (OZR) Zucker rats (16-17 weeks old) were exposed to 8 weeks of UCMS with and without treadmill exercise (AET). In LZR, UCMS impaired aortic endothelium-dependent dilatation (EDD) (assessed ex vivo by wire myography) and aortic stiffness (assessed by elastic modulus) with no change in OZR subject to UCMS. However, both LZR and OZR UCMS tPVAT impaired EDD compared to respective controls. LZR and OZR subject to UCMS had higher oxidative stress production, diminished adiponectin and impaired aortic nitric oxide levels. Divergently, UCMS induced greater inflammatory cytokine production in LZR UCMS tPVAT, but not in OZR UCMS tPVAT. AET prevented the tPVAT impairment of aortic relaxation with UCMS in LZR and OZR. Additionally, AET reduced aortic stiffness in both LZR and OZR. These beneficial effects on tPVAT regulation of the aorta are likely due to AET preservation of adiponectin, reduced oxidative stress and inflammation, and enhanced nitric oxide. UCMS impaired tPVAT-regulated aortic function in LZR, and augmented MetS-induced EDD in OZR. Conversely, AET in combination with UCMS largely preserved aortic function and the tPVAT environment, in both groups.

Comparative effect of physical exercise versus statins on improving arterial stiffness in patients with high cardiometabolic risk: A network meta-analysis

BACKGROUND

The comparative analysis of the effect of several doses of statins against different intensities of physical exercise on arterial stiffness (a measure of cardiovascular risk) could shed light for clinicians on which method is most effective in preventing cardiovascular disease (CVD) and be used to inform shared decision-making between doctors and patients. This study was aimed at analyzing the effect, in high cardiometabolic risk patients, of different statins doses and exercise intensities on arterial stiffness (a measure of cardiovascular risk) by integrating all available direct and indirect evidence in network meta-analyses.

METHODS AND FINDINGS

We systematically searched MEDLINE, Embase, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception to February 28, 2020; for unpublished trials, we also searched ClinicalTrials.gov. We searched for studies concerning the effect of statins or physical exercise on arterial stiffness, measured by pulse wave velocity (PWV). For methodological quality assessment, Cochrane Collaboration's tool for assessing risk of bias (RoB2) was used. A network geometry graph was used to assess the strength of the evidence. Comparative evaluation of the interventions effect was performed by conducting a standard pairwise meta-analysis and a network meta-analysis (NMA) for direct and indirect comparisons between interventions and control/nonintervention. A total of 22 studies were included in the analyses (18 randomized controlled trials (RCTs) and 4 nonrandomized experimental studies), including 1,307 patients with high cardiometabolic risk from Asia (3 studies), Oceania (2 studies), Europe (10 studies), North America (5 studies), and South America (2 studies). The overall risk of bias assessed with RoB2 was high in all included studies. For standard pairwise meta-analysis and NMA, high-intensity exercise versus control (mean difference (MD) -0.56; 95% CI: -1.01, -0.11; p = 0.015 and -0.62; 95% CI: -1.20, -0.04; p = 0.038, respectively) and moderate statin dose versus control (MD -0.80, 95% CI: -1.59, -0.01; p = 0.048 and -0.73, 95% CI: -1.30, -0.15; p = 0.014, respectively) showed significant MDs. When nonrandomized experimental studies were excluded, the effect on high-intensity exercise versus control and moderate statin dose versus was slightly modified. The main limitation of this study was that the magnitude of the effect of the exercise interventions could be underestimated due to regression toward the mean bias because the baseline cardiometabolic risk profile of patients in the physical exercise intervention trials was healthier than those in the statins ones; consequently, more modest improvements in physical exercise interventions compared to statins interventions can be expected. Additionally, we might consider as limitations the small study sizes, the heterogeneous patient groups, the focus on a proxy endpoint (PWV), and the high risk of bias.

CONCLUSIONS

In this NMA, we found that although many patients could benefit from statins for reducing CVD risk, our results support that, considering the beneficial effects of high-intensity exercise on arterial stiffness, it would be worthwhile to refocus our attention on this type of exercise as an effective tool for the prevention of CVD.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019123120.

Different degree of intervention in 6-month weight-loss support and arterial stiffness: Secondary analysis of a randomized controlled trial

BACKGROUND AND AIMS

Weight reduction by lifestyle modification (i.e., low-calorie diet and/or exercise) decreases arterial stiffness in overweight or obese individuals. We previously demonstrated that weight loss differs depending on the degree of intervention in weight-loss support in a randomized controlled trial (UMIN000001259). However, the effect of different degrees of intervention on arterial stiffness remains unclear.

METHODS AND RESULTS

A total of 188 middle-aged men and women with overweight or obesity (51 ± 7 years, BMI: 29.0 ± 3.2 kg/m²) participated in the 6-month trial wherein they were assigned to a low (LI, n = 63), moderate (MI, n = 62), or high intensive intervention (HI, n = 63) group. Initially, one motivational lecture on weight loss was provided to all three groups, whereas educational materials (textbooks, notebooks, and a pedometer) were provided to groups MI and HI. Additionally, the HI group participated in a series of group-based sessions. Body weight and arterial stiffness assessed by brachial-ankle pulse wave velocity (baPWV) were measured at 0, 3, and 6 months. Six-month weight loss was greater in the order of HI, MI, and LI groups. The interventions reduced baPWV in all groups, and the reduction was not significantly different among the groups (114.3 ± 16.3, 82.6 ± 15.2, and 98.8 ± 90.4 cm/s, respectively).

CONCLUSION

In overweight or obese individuals, different degrees of intervention in weight-loss support affect body weight; however, the extent to which arterial stiffness improves does not differ among support programs.

Anti-Inflammatory Effects of Exercise on Metabolic Syndrome Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Increments in inflammatory indicators and low levels of physical activity are correlated to the expansion of the metabolic syndrome (MetS).

OBJECTIVE

The purpose of this study was to establish if exercise training ameliorates inflammatory status in MetS patients.

DATA SOURCES

PubMed, CINAHL, and Medline, Google Scholar, and Scopus databases and reference lists of included studies were searched.

STUDY SELECTION

Twenty randomized controlled trials (RCTs) of exercise-training impact on inflammatory markers (tumor necrosis factor (TNF) α, C-reactive protein (CRP), interleukin (IL) 6, IL-8, IL-10, and IL-18) with concurrent control groups were included in this analysis.

RESULTS

Results demonstrated an overall significant decrease in serum levels of TNF-α (mean difference (MD): -1.21 pg/ml; 95% confidence interval (CI): -1.77, -0.66), CRP (MD: -0.52 mg/l; 95% CI: -0.79, -0.25), IL-8 (MD: -1.31 pg/ml; 95% CI: -2.57, -0.06), and a significant increase in IL-10 (MD: 0.48 pg/ml; 95% CI: 0.10, 0.86). But exercise training did not change the level of IL-6 (MD: -0.69 pg/ml; 95% CI: -1.53, 0.14) and IL-18 (MD: -53.01 pg/ml; 95% CI: -166.64, 60.62).

CONCLUSION

Exercise training improves TNF-α, CRP, IL-8, and IL-10 levels in patients with MetS. For some variables, isolated aerobic exercise, and combined aerobic and resistance exercise appears to be optimal. Future research is needed to clarify the mechanisms underlying exercise training's effect on this population's inflammatory markers. More studies are required to confirm these findings.

Effect of High Intensity Interval Training on Matrix Metalloproteinases in Women with Breast Cancer Receiving Anthracycline-Based Chemotherapy

Anthracycline chemotherapy is commonly used to treat breast cancer yet may increase the level of matrix metalloproteinases (MMP) -2 and -9, which increase the risk of atherosclerosis. While exercise has been shown to reduce the level of MMP in patients with diabetes, high intensity interval training (HIIT) has not been utilized to improve level of MMP in women with breast cancer receiving anthracycline chemotherapy. Thirty women were randomized to either 8-week HIIT or control (CON) group. The CON group was offered the HIIT intervention after 8 weeks. MMP-1, -2 -7, -9, tissue inhibitor of MMP (TIMP) -1, and-2 were measured at baseline and post-intervention. Repeated measures ANCOVA and paired t-test were performed to assess changes in MMP and TIMP. Post-intervention, no significant between-group differences were observed for MMP and TIMP. However, within-group decrease in MMP-9 was observed in the HIIT group [104.3(51.9) to 65.2(69.1); P = 0.01]. MMP-9 in the CON group was not significantly changed [115.5(47.2) to 90.4(67.9);]. MMP-2 significantly increased in both the HIIT group [76.6(11.2) to 83.2(13.1); P = 0.007) and the CON group [69.0(8.9) to 77.6(11.1) P = 0.003). It is unclear whether an 8-week HIIT intervention influences MMP-9 in breast cancer patients undergoing anthracycline chemotherapy. Additional investigations are required to understand the exercise-induced changes in MMP-2 and -9 in women undergoing anthracycline chemotherapy.

Vascular improvements in individuals with type 2 diabetes following a 1 year randomised controlled exercise intervention, irrespective of changes in cardiorespiratory fitness

AIMS/HYPOTHESIS

Vascular changes in individuals with type 2 diabetes mellitus majorly contribute to the development of cardiovascular disease. Increased cardiorespiratory fitness (CRF) has been associated with improvements in vascular health. Although CRF tends to improve with exercise training, there remains a portion of participants with little or no improvement. Given the importance of vascular function in individuals with type 2 diabetes, we assessed whether individuals who failed to improve CRF following a 1 year exercise intervention also failed to improve arterial stiffness and structural indices.

METHODS

Individuals with type 2 diabetes with no major micro- and macrovascular complications and aged between 30 and 75 years old (n = 63) participated in a three-arm, 1 year, randomised controlled exercise intervention in Lisbon, Portugal. The study involved a non-exercise control group, a moderate continuous training combined with resistance training (RT) group and a high-intensity interval training with RT group. Allocation of participants into the intervention and control groups was done using a computer-generated list of random numbers. An improvement in CRF was defined as a change in [Formula: see text] ≥5%. Vascular stiffness and structural indices were measured using ultrasound imaging and applanation tonometry. Generalised estimating equations were used to compare changes in vascular measures across individuals in the control group (n = 22) and those in the exercise groups who either had improved CRF (CRF responders; n = 14) or whose CRF did not improve (CRF non-responders; n = 27) following 1 year of exercise training.

RESULTS

Compared with the control group, exercisers, with and without improvements in CRF, had decreased carotid intima-media thickness (IMT) (CRF responders: β = -2.84 [95% CI -5.63, -0.04]; CRF non-responders: β = -5.89 [95% CI -9.38, -2.40]) and lower-limb pulse wave velocity (PWV) (CRF responders: β = -0.14 [95% CI -0.25, -0.03]; CRF non-responders: β = -0.14 [95% CI -0.25, -0.03]), the latter being an indicator of peripheral arterial stiffness. Only CRF responders had decreased PWV of the upper limb compared with control participants (β = -0.12 [95% CI -0.23, -0.01]). As for central stiffness, CRF non-responders had increased aortic PWV compared with CRF responders (β = 0.19 [95% CI 0.07, 0.31]), whereas only the CRF non-responders had altered carotid distensibility coefficient compared with the control group (β = 0.00 [95% CI 3.01 × 10^-5, 0.00]). No interaction effects between the CRF responders and non-responders vs control group were found for the remaining stiffness or haemodynamic indices (p>0.05).

CONCLUSIONS/INTERPRETATION

Regardless of improvements in CRF, individuals with type 2 diabetes had significant improvements in carotid IMT and lower-limb arterial stiffness following a 1 year exercise intervention. Thus, a lack of improvement in CRF following exercise in people with type 2 diabetes does not necessarily entail a lack of improvement in vascular health.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03144505 FUNDING: This work was supported by fellowships from the Portuguese Foundation for Science and Technology. This work is also financed by a national grant through the Fundação para a Ciência e Tecnologia (FCT), within the unit I&D 472.

Pulse Wave Velocity Is Associated with Increased Plasma oxLDL in Ageing but Not with FGF21 and Habitual Exercise

Fibroblast growth factor 21 (FGF21) and adiponectin increase the expression of genes involved in antioxidant pathways, but their roles in mediating oxidative stress and arterial stiffness with ageing and habitual exercise remain unknown. We explored the role of the FGF21-adiponectin axis in mediating oxidative stress and arterial stiffness with ageing and habitual exercise. Eighty age- and sex-matched healthy individuals were assigned to younger sedentary or active (18-36 years old, n = 20 each) and older sedentary or active (45-80 years old, n = 20 each) groups. Arterial stiffness was measured indirectly using pulse wave velocity (PWV). Fasted plasma concentrations of FGF21, adiponectin and oxidized low-density lipoprotein (oxLDL) were measured. PWV was 0.2-fold higher and oxLDL concentration was 25.6% higher (both p < 0.001) in older than younger adults, despite no difference in FGF21 concentration (p = 0.097) between age groups. PWV (p = 0.09) and oxLDL concentration (p = 0.275) did not differ between activity groups but FGF21 concentration was 9% lower in active than sedentary individuals (p = 0.011). Adiponectin concentration did not differ by age (p = 0.642) or exercise habits (p = 0.821). In conclusion, age, but not habitual exercise, was associated with higher oxidative stress and arterial stiffness. FGF21 and adiponectin did not differ between younger and older adults, meaning that it is unlikely that they mediate oxidative stress and arterial stiffness in healthy adults.

Chronic Standing Desk Use and Arterial Stiffness

Background: Sedentary activity and sitting for at least 10 hours per day can increase the risk for cardiovascular disease by more than 60%. Use of standing desks may decrease sedentary time and improve cardiovascular health. Acute standing lowers pulse wave velocity (PWV), but chronic effects remain unknown. The purpose of this study was to determine the effect of chronic standing desk use on arterial stiffness versus seated controls. Methods: A total of 48 adults participated in this study. Twenty-four participants qualified as seated desk users (age 41 [10] y, body mass index 25 [4] kg/m2) and 24 as standing desk users (age 45 [12] y, body mass index 25 [5] kg/m2). Arterial stiffness was assessed as PWV within the aorta, arm, and leg. Results: Carotid–femoral PWV (cfPWV) was not different between seated (6.6 [1.3] m/s) and standing (6.9 [1.3] m/s) groups (P = .47). Similarly, there were no differences in arm or leg PWV between groups (P = .13 and P = .66, respectively). A secondary analysis of traditional factors of age and aerobic fitness revealed significant differences in cfPWV in seated and standing desk participants. Age also significantly influenced cfPWV across conditions. Conclusions: Standing for >50% of a workday did not affect PWV. Consistent with previous research, fitness and age are important modulators of arterial stiffness.

Exercise training prevents the perivascular adipose tissue-induced aortic dysfunction with metabolic syndrome

The aim of the study was to determine the effects of exercise training on improving the thoracic perivascular adipose tissue (tPVAT) phenotype (inflammation, oxidative stress, and proteasome function) in metabolic syndrome and its subsequent actions on aortic function.

Methods

Lean and obese (model of metabolic syndrome) Zucker rats (n=8/group) underwent 8-weeks of control conditions or treadmill exercise (70% of max speed, 1 h/day, 5 days/week). At the end of the intervention, the tPVAT was removed and conditioned media was made. The cleaned aorta was attached to a force transducer to assess endothelium-dependent and independent dilation in the presence or absence of tPVAT-conditioned media. tPVAT gene expression, inflammatory /oxidative phenotype, and proteasome function were assessed.

Results

The main findings were that Ex induced: (1) a beige-like, anti-inflammatory tPVAT phenotype; (2) a greater abundance of ^•NO in tPVAT; (3) a reduction in tPVAT oxidant production; and (4) an improved tPVAT proteasome function. Regarding aortic function, endothelium-dependent dilation was greater in exercised lean and obese groups vs. controls (p < 0.05). Lean control tPVAT improved aortic relaxation, whereas obese control tPVAT decreased aortic relaxation. In contrast, the obese Ex-tPVAT increased aortic dilation, whereas the lean Ex-tPVAT did not affect aortic dilation.

Conclusion

Overall, exercise had the most dramatic impact on the obese tPVAT reflecting a change towards an environment with less oxidant load, less inflammation and improved proteasome function. Such beneficial changes to the tPVAT micro-environment with exercise likely played a significant role in mediating the improvement in aortic function in metabolic syndrome following 8 weeks of exercise.

Plasma matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs and aging and lifelong exercise adaptations in ventricular and arterial stiffness

The age-associated increase in cardiac and central arterial stiffness is attenuated with lifelong (>25 years) endurance exercise in a dose-dependent manner. Remodelling of the extracellular matrix of cardiovascular structures may underpin these lifelong exercise adaptations in structural stiffness. The primary aim was to examine whether matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) levels are associated with aging and lifelong exercise-related changes in cardiac and central arterial stiffness. Plasma MMPs and TIMPs, left ventricular (LV) (LV stiffness constant) and central arterial stiffness (pulse wave velocity) were examined in healthy adults stratified into five groups based on age and lifelong weekly exercise frequency: (1) young sedentary adults (28-50 years), and older adults (>60 years) who had performed either: (a) sedentary (0-1 sessions/week), (b) casual (2-3 sessions/week), (c) committed (4-5 sessions/week) or (d) athletic (≥6 sessions/week) frequency of exercise. MMP-1 was significantly lower in young compared to older sedentary (p = 0.049). Except for TIMP-2 (p = 0.018 versus committed) and the ratio of MMP-2/TIMP-4 (p = 0.047 versus committed), MMP and TIMP expression was not significantly different in lifelong exercise groups (≥casual) compared to the older sedentary group. MMP-1, -3 had a weak positive relationship with central PWV (r = 0.17-0.25, p ≤ 0.050) but there were no significant relationships between MMPs or TIMPs and LV stiffness constant (p ≥ 0.148). In conclusion, there was not a clear or consistent difference in plasma MMPs and TIMPs with lifelong exercise dose despite exhibiting lower cardiovascular stiffness at the highest exercise levels.

Role of Chronic Stress and Exercise on Microvascular Function in Metabolic Syndrome

PURPOSE

The present study examined the effect of unpredictable chronic mild stress (UCMS) on peripheral microvessel function in healthy and metabolic syndrome (MetS) rodents and whether exercise training could prevent the vascular dysfunction associated with UCMS.

METHODS

Lean and obese (model of MetS) Zucker rats (LZR and OZR) were exposed to 8 wk of UCMS, exercise (Ex), UCMS + Ex, or control conditions. At the end of the intervention, gracilis arterioles (GA) were isolated and hung in a pressurized myobath to assess endothelium-dependent (EDD) and endothelium-independent (EID) dilation. Levels of nitric oxide (NO) and reactive oxygen species (ROS) were measured through 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate and dihydroethidium staining, respectively.

RESULTS

Compared with LZR controls, EDD and EID were lower (P = 0.0001) in LZR-UCMS. The OZR-Ex group had a higher EDD (P = 0.0001) and EID (P = 0.003) compared with OZR controls, whereas only a difference in EDD (P = 0.01) was noted between the LZR-control and LZR-Ex groups. Importantly, EDD and EID were higher in the LZR (P = 0.0001; P = 0.02) and OZR (P = 0.0001; P = 0.02) UCMS + Ex groups compared with UCMS alone. Lower NO bioavailability and higher ROS were noted in the LZR-UCMS group (P = 0.0001), but not OZR-UCMS, compared with controls. The Ex and UCMS-Ex groups had higher NO bioavailability (P = 0.0001) compared with the control and UCMS groups, but ROS levels remained high.

CONCLUSIONS

The comorbidity between UCMS and MetS does not exacerbate the effects of one another on GA EDD responses, but does lead to the development of other vasculopathy adaptations, which can be partially explained by alterations in NO and ROS production. Importantly, exercise training alleviates most of the negative effects of UCMS on GA function.

Effects of a moderate-intensity aerobic exercise programme on the cognitive function and quality of life of community-dwelling elderly people with mild cognitive impairment: A randomised controlled trial

BACKGROUND

Individuals with mild cognitive impairment have a heightened risk of developing dementia. Physical exercise, especially moderate-intensity aerobic exercise, is a promising lifestyle intervention to improve the cognitive function of this patient group. However, the mechanisms underlying the exercise-cognition relationship are not fully understood. Whether the cognitive benefits of physical exercise can improve the overall well-being of this group remains unknown. This study aims to address these research gaps in the under-researched Chinese population.

OBJECTIVES

This study aimed to evaluate the effects of a moderate-intensity aerobic exercise programme on the cognitive function and health-related quality of life of Chinese elderly with mild cognitive impairment and to explore the mediating roles of depressive mood and sleep quality in the exercise-cognition relationship.

DESIGN

A single-blinded randomised controlled trial.

SETTINGS AND PARTICIPANTS

This study was conducted in two urban community healthcare centres in Hangzhou City, China. Elderly people aged over 60 years screened with mild cognitive impairment were included.

METHODS

A total of 120 eligible participants were randomly assigned to receive either the group-based moderate-intensity aerobic exercise programme or the health education programme (as attention-placebo control). Montreal Cognitive Assessment, Quality of Life-Alzheimer's Disease, Geriatric Depression Scale and Pittsburgh Sleep Quality Index were administered at baseline before randomisation and immediately after the completion of the interventions. Analysis followed the intention-to-treat principle. Generalised estimating equation was used to compare the changes in the cognitive function and health-related quality of life over the pre-test and post-test periods between the groups. The mediating roles of depressive mood and sleep quality in the exercise-cognition relationship were examined with the PROCESS macro.

RESULTS

Participants in the intervention group had a significantly greater improvement in terms of cognitive function (β = 1.895; 95% confidential interval [CI] = 1.421, 2.368; p <  0.001) and health-related quality of life (β= 0.605; 95% CI= 0.295, 0.914; p <  0.001) compared with the control group over the pre-test and post-test periods. The exercise-cognition relationship was significantly mediated by reduced depressive symptoms (indirect effect: β= -0.705; 95% CI: -1.028, -0.382) and improved sleep quality (indirect effect: β=-0.205; 95% CI: -0.122, 0.831).

CONCLUSIONS

This study revealed the benefits and outlined the underlying mediating mechanism of an aerobic exercise programme to the cognitive function and health-related quality of life of Chinese elderly people with mild cognitive impairment. The findings provided insights into the development of public health initiatives to promote brain health amongst the elderly with mild cognitive impairment.

The relationship between arterial stiffness and maximal oxygen consumption in healthy young adults

Objective

Arterial stiffness is associated with an increased risk of cardiovascular diseases in various populations. There was little research on the relationship between arterial stiffness and maximal aerobic capacity (VO_2max) in healthy young adults. The aim of this study was to investigate the relationship between VO_2max and arterial stiffness in young adults.

Methods

The subjects were 13 men and 10 women with mean age of 22.9 ± 0.7, 23.6 ± 0.4 years, respectively. Height, weight, body mass index, body fat (%), waist to hip ratio, total/high density lipoprotein (HDL)/low density lipoprotein (LDL) cholesterol, triglycerides, fasting glucose, blood pressure, heart rate, glycated hemoglobin and blood lactate were measured. In addition, peripheral arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV) and VO_2max was determined using graded exercise test.

Results

VO_2max had no significant correlation with baPWV (r = 0.2, p = 0.2). Total cholesterol correlated significantly to variables such as HDL (r = 0.6, p = 0.0015) and LDL cholesterol (r = -0.6, p = 0.0018). VO_2max had a significant association with triglyceride (r = -0.5, p = 0.0033).

Conclusions

This study suggests that there is no relationship between arterial stiffness and aerobic capacity in healthy young adults.

Precision in Promoting Physical Activity and Exercise With the Overarching Goal of Moving More

Physical inactivity is strongly associated with an unfavorable health profile, increasing an individual's risk for developing cardiovascular disease. Initiating a regular exercise routine contributes to improvements in cardiorespiratory fitness, body composition, resting blood pressure, blood glucose, and circulating lipoproteins. However, the extent to which positive changes occur come with significant inter-individual variability within intervention groups; non-responders and responders have been commonly identified across populations, highlighting that not all exercise regimens are universally effective in all individuals and should therefore not be treated as a "one-size fits all" prescription. Recent studies have therefore emphasized reporting the quantity of participants favorably and meaningfully "responding" to varying amounts and intensities of exercise, thereby presenting the opportunity to view exercise prescription in the context of precision medicine. This review will address the impact of varying amounts and intensities of physical activity and exercise, highlighting their impact on key health metrics.

Effects of exercise modalities on central hemodynamics, arterial stiffness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Exercise is accepted as an important contribution to the rehabilitation of patients with cardiovascular disease (CVD). This study aims to better understand the possible causes for lack of consensus and reviews the effects of three exercise modalities (aerobic, resistance and combined exercise) on central hemodynamics, arterial stiffness and cardiac function for better rehabilitation strategies in CVD.

METHODS

The electronic data sources, Cochrane Library, MEDLINE, Web of Science, EBSCO (CINAHL), and ScienceDirect from inception to July 2017 were searched for randomized controlled trials (RCTs) investigating the effect of exercise modalities in adult patients with CVD. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis and meta-regression were used to study potential moderating factors.

RESULTS

Thirty-eight articles describing RCTs with a total of 2089 patients with CVD were included. The pooling revealed that aerobic exercise [MD(95%CI) = -5.87 (-8.85, -2.88), P = 0.0001] and resistance exercise [MD(95%CI) = -7.62 (-10.69, -4.54), P<0.00001] significantly decreased aortic systolic pressure (ASP). Resistance exercise significantly decreased aortic diastolic pressure [MD(95%CI) = -4(-5.63, -2.37), P<0.00001]. Aerobic exercise significantly decreased augmentation index (AIx) based on 24-week exercise duration and patients aged 50-60 years. Meanwhile, aerobic exercise significantly improved carotid-femoral pulse wave velocity (cf-PWV) [MD(95%CI) = -0.42 (-0.83, -0.01), P = 0.04], cardiac output (CO) [MD(95% CI) = 0.36(0.08, 0.64), P = 0.01] and left ventricular ejection fraction (LVEF) [MD(95%CI) = 3.02 (2.11, 3.93), P<0.00001]. Combined exercise significantly improved cf-PWV [MD(95%CI) = -1.15 (-1.95, -0.36), P = 0.004] and CO [MD(95% CI) = 0.9 (0.39, 1.41), P = 0.0006].

CONCLUSIONS

Aerobic and resistance exercise significantly decreased ASP, and long-term aerobic exercise reduced AIx. Meanwhile, aerobic and combined exercise significantly improved central arterial stiffness and cardiac function in patients with CVD. These findings suggest that a well-planned regime could optimize the beneficial effects of exercise and can provide some evidence-based guidance for those involved in cardiovascular rehabilitation of patients with CVD.

Effects of high-intensity interval training on vascular function in breast cancer survivors undergoing anthracycline chemotherapy: design of a pilot study

INTRODUCTION

Cardiovascular disease (CVD) mortality is higher among breast cancer survivors (BCS) who receive chemotherapy compared with those not receiving chemotherapy. Anthracycline chemotherapy is of particular concern due to anthracycline-related impairment of vascular endothelial cells and dysregulation of the extracellular matrix. One strategy proven to offset these impairments is a form of exercise known as high-intensity interval training (HIIT). HIIT improves endothelial function in non-cancer populations by decreasing oxidative stress, the main contributor to anthracycline-induced vascular dysfunction. The purpose of this pilot study is to assess the feasibility of an 8-week HIIT, as well as the HIIT effects on endothelial function and extracellular matrix remodelling, in BCS undergoing anthracycline chemotherapy.

METHODS AND ANALYSIS

Thirty BCS are randomised to either HIIT, an 8-week HIIT intervention occurring three times per week (seven alternating bouts of 90% of peak power output followed by 10% peak power output), or delayed group (DEL). Feasibility of HIIT is assessed by (1) the percentage of completed exercise sessions and (2) the number of minutes of exercise completed over the course of the study. Vascular function is assessed using brachial artery flow-mediated dilation and carotid intima media thickness. Extracellular matrix remodelling is assessed by the level of matrix metalloproteinases in the plasma. A repeated-measures analysis of covariance model will be performed with group (HIIT and DEL group) and time (pre/post assessment) as independent factors. We hypothesise that HIIT will be feasible in BCS undergoing anthracycline chemotherapy, and that HIIT will improve endothelial function and extracellular matrix remodelling, compared with the DEL group. Success of this study will provide evidence of feasibility and efficacy to support a larger definitive trial which will impact cancer survivorship by decreasing anthracycline-induced vascular dysfunction, thereby benefiting cardiovascular markers that are related to CVD risk.

ETHICS AND DISSEMINATION

This trial was approved by the University of Southern California Institutional Review Board (HS-15-00227).

TRIAL REGISTRATION NUMBER

NCT02454777; Pre-results.

Nonpharmacologic management of hypertension: a multidisciplinary approach

PURPOSE OF REVIEW

Nonpharmacologic lifestyle modification interventions (LMIs), such as increasing physical activity, dietary modification, weight-loss, reducing alcohol consumption and smoking cessation, are effective strategies to lower resting blood pressures (BPs) in prehypertensive or hypertensive patients. However, the limited time shared between a physician and a patient is not adequate to instill an adoption of LMI. The purpose of this review is to therefore highlight evidence-based BP lowering, LMI strategies that can feasibly be implemented in clinical practices.

RECENT FINDINGS

Interventions focusing on modifying physical activity, diet, weight-loss, drinking and smoking habits have established greater efficacy in reducing elevated BP compared with providing guideline recommendations based on national guidelines. Alone greater reductions in BP can be achieved through programmes that provide frequent contact time with exercise, nutrition and/or wellness professionals. Programmes that educate individuals to lead peer support groups can be an efficient method of ensuring compliance to LMI.

SUMMARY

Evidence of a multidisciplinary approach to LMI is an effective and attractive model in managing elevated BP. This strategy is an attractive model that provides the necessary patient attention to confer lifestyle maintenance.

Intense aerobic exercise lowers blood pressure in individuals with metabolic syndrome taking antihypertensive medicine

OBJECTIVE

There is a growing tendency for physicians to prescribe exercise in accordance with the 'exercise is medicine' global health initiative. However, the exercise-pharmacologic interactions for controlling blood pressure are not well described. Our purpose was to study whether angiotensin II receptor type 1 blocker (ARB) antihypertensive medicine enhances the blood pressure-lowering effects of intense exercise.

PARTICIPANTS AND METHODS

Fifteen hypertensive individuals with metabolic syndrome chronically medicated with ARB underwent two exercise trials in a blind randomized order. One trial was conducted after taking their habitual dose of ARB (ARB MED trial) and another after 48 h of placebo medicine (i.e. dextrose; PLAC trial).

RESULTS

After placebo medication, brachial systolic blood pressure increased by 5.5 mmHg [P=0.009; effect size (ES)=0.476] and diastolic by 2.5 mmHg (P=0.030; ES=0.373). Exercise reduced systolic and diastolic blood pressures to the same extent in ARB MED and PLAC trials (7 and 8 mmHg, respectively, for systolic and 5 and 4 mmHg, respectively, for diastolic, all P<0.05). Pulsatile measures of arterial stiffness did not reveal an interaction effect between exercise and medication. However, postocclusion reactive hyperemia increased after exercise only in the ARB MED trial (361±169 to 449±240% from baseline; P=0.033; ES=0.429).

CONCLUSION

ARBs and a bout of intense exercise each have an independent effect on lowering blood pressure in hypertensive individuals, and these effects are additive.

Psychological stress-induced cerebrovascular dysfunction: the role of metabolic syndrome and exercise

NEW FINDINGS

What is the central question of this study? How does chronic stress impact cerebrovascular function and does metabolic syndrome accelerate the cerebrovascular adaptations to stress? What role does exercise training have in preventing cerebrovascular changes to stress and metabolic syndrome? What is the main finding and its importance? Stressful conditions lead to pathological adaptations of the cerebrovasculature via an oxidative nitric oxide pathway, and the presence of metabolic syndrome produces a greater susceptibility to stress-induced cerebrovascular dysfunction. The results also provide insight into the mechanisms that may contribute to the influence of stress and the role of exercise in preventing the negative actions of stress on cerebrovascular function and structure.

ABSTRACT

Chronic unresolvable stress leads to the development of depression and cardiovascular disease. There is a high prevalence of depression with the metabolic syndrome (MetS), but to what extent the MetS concurrent with psychological stress affects cerebrovascular function is unknown. We investigated the differential effect of MetS on cerebrovascular structure/function in rats (16-17 weeks old) following 8 weeks of unpredictable chronic mild stress (UCMS) and whether exercise training could limit any cerebrovascular dysfunction. In healthy lean Zucker rats (LZR), UCMS decreased (28%, P < 0.05) ex vivo middle cerebral artery (MCA) endothelium-dependent dilatation (EDD), but changes in MCA remodelling and stiffness were not evident, though cerebral microvessel density (MVD) decreased (30%, P < 0.05). The presence of UCMS and MetS (obese Zucker rats; OZR) decreased MCA EDD (35%, P < 0.05) and dilatation to sodium nitroprusside (20%, P < 0.05), while MCA stiffness increased and cerebral MVD decreased (31%, P < 0.05), which were linked to reduced nitric oxide and increased oxidative levels. Aerobic exercise prevented UCMS impairments in MCA function and MVD in LZR, and partly restored MCA function, stiffness and MVD in OZR. Our data suggest that the benefits of exercise with UCMS were due to a reduction in oxidative stress and increased production of nitric oxide in the cerebral vessels. In conclusion, UCMS significantly impaired MCA structure and function, but the effects of UCMS were more substantial in OZR vs. LZR. Importantly, aerobic exercise when combined with UCMS prevented the MCA dysfunction through subtle shifts in nitric oxide and oxidative stress in the cerebral microvasculature.

Pulse wave velocity is lower in trained than in untrained sickle cell trait carriers

BACKGROUND

Sickle cell trait (SCT) is a benign condition of sickle cell disease. Nevertheless, previous reports showed that SCT carriers have increased blood viscosity and decreased vascular reactivity compared to non-SCT carrier. The benefit of regular exercise on vascular function has been well documented in the general population but no study focused on the SCT population.

PURPOSE

The aim of our study was to compare arterial stiffness and blood viscosity between trained and untrained SCT carriers, as well as a group of untrained non-SCT.

METHODS

Arterial stiffness (finger-toe pulse wave velocity) and blood viscosity were evaluated in untrained non-SCT carriers (n = 10), untrained SCT carriers (n = 23) and trained SCT carriers (n = 17) who reported at least 10 hours of physical exercise per week.

RESULTS

Untrained SCT carriers had higher pulse wave velocity (p = 0.032) and blood viscosity (p < 0.001) than their trained counterparts. In addition, untrained SCT carriers had higher blood viscosity (p < 0.001) than the untrained non-SCT group. A positive association was noted between blood viscosity and pulse wave velocity in the whole study population.

CONCLUSION

Our study suggests that regular exercise may be beneficial for the vascular function of SCT carriers.