Aerobic power and insulin action improve in response to endurance exercise training in healthy 77-87 yr olds

Physiological Adaptations to Progressive Endurance Exercise Training in Adult and Aged Rats: Insights from the Molecular Transducers of Physical Activity Consortium (MoTrPAC)

While regular physical activity is a cornerstone of health, wellness, and vitality, the impact of endurance exercise training on molecular signaling within and across tissues remains to be delineated. The Molecular Transducers of Physical Activity Consortium (MoTrPAC) was established to characterize molecular networks underlying the adaptive response to exercise. Here, we describe the endurance exercise training studies undertaken by the Preclinical Animal Sites Studies component of MoTrPAC, in which we sought to develop and implement a standardized endurance exercise protocol in a large cohort of rats. To this end, Adult (6-mo) and Aged (18-mo) female (n = 151) and male (n = 143) Fischer 344 rats were subjected to progressive treadmill training (5 d/wk, ∼70%-75% VO2max) for 1, 2, 4, or 8 wk; sedentary rats were studied as the control group. A total of 18 solid tissues, as well as blood, plasma, and feces, were collected to establish a publicly accessible biorepository and for extensive omics-based analyses by MoTrPAC. Treadmill training was highly effective, with robust improvements in skeletal muscle citrate synthase activity in as little as 1-2 wk and improvements in maximum run speed and maximal oxygen uptake by 4-8 wk. For body mass and composition, notable age- and sex-dependent responses were observed. This work in mature, treadmill-trained rats represents the most comprehensive and publicly accessible tissue biorepository, to date, and provides an unprecedented resource for studying temporal-, sex-, and age-specific responses to endurance exercise training in a preclinical rat model.

Intrinsic skeletal muscle function and contraction-stimulated glucose uptake do not vary by time-of-day in mice

A growing body of data suggests that skeletal muscle contractile function and glucose metabolism vary by time-of-day, with chronobiological effects on intrinsic skeletal muscle properties being proposed as the underlying mediator. However, no studies have directly investigated intrinsic contractile function or glucose metabolism in skeletal muscle over a 24 h circadian cycle. To address this, we assessed intrinsic contractile function and endurance, as well as contraction-stimulated glucose uptake, in isolated extensor digitorum longus and soleus from female mice at four times-of-day (Zeitgeber Times 1, 7, 13, 19). Significantly, while both muscles demonstrated circadian-related changes in gene expression, intrinsic contractile function, endurance, and contraction-stimulated glucose uptake were not different between the four time points. Overall, these results demonstrate that time-of-day variation in exercise performance and the glycemia-reducing benefits of exercise are not due to chronobiological effects on intrinsic muscle function or contraction-stimulated glucose uptake.

Impact statement

Ex vivo testing demonstrates that there is no time-of-day variation in the intrinsic contractile properties of skeletal muscle (including no effect on force production or endurance) or contraction-stimulated glucose uptake.

Intervention of muscle-building and antifrailty exercise combined with Baduanjin for frailty of different functional levels: study protocol for a randomised controlled trial

INTRODUCTION

Frailty has been currently considered as a multidimensional concept, including physical, cognitive and social frailty. Frailty has also been associated with a range of adverse events, which might increase the risks of disability, falls, fractures, delirium and death. Increasing evidence has shown that multicomponent exercise training can improve physical and cognitive function, delay or reverse frailty. However, there is still a lack of exercise intervention programmes for the frail older adults in China. This trial aims to investigate the effects of the muscle-building and antifrailty exercise combined with Baduanjin on the physical function of frail older adults, as well as the effectiveness and safety of the intervention.

METHODS AND ANALYSIS

This study is a prospective randomised controlled trial. A total of 192 patients, aged 70 years or older, who are diagnosed as prefrailty or frailty based on the Fried criteria will be included. Prior written and informed consent will be obtained from every subject. These subjects will be randomly assigned to the exercise intervention group (n=96) and the control group (n=96). The exercise intervention group will undergo different exercise programmes for different levels of physical function. They will perform the muscle-building and antifrailty exercise three times per week for 30-60 min for 24 weeks. The control group will implement health education on frailty and maintain the old lifestyle without any intervention.The primary outcomes include the change in frailty and functional capacity, assessed according to the Fried Scale and the Short Physical Performance Battery. Secondary outcomes include the changes in body composition, Activities of daily living, Mini-Mental State Examination, The Geriatric Depression Scale-15 and the haematological indicators.

ETHICS STATEMENT

The study has been approved by the Medical Ethics Committee of the PLA General Hospital (approval no.: S2022-600-02).

TRIAL REGISTRATION NUMBER

ChiCTR2300070535.

New Insights and Potential Therapeutic Interventions in Metabolic Diseases

Endocrine homeostasis and metabolic diseases have been the subject of extensive research in recent years. The development of new techniques and insights has led to a deeper understanding of the mechanisms underlying these conditions and opened up new avenues for diagnosis and treatment. In this review, we discussed the rise of metabolic diseases, especially in Western countries, the genetical, psychological, and behavioral basis of metabolic diseases, the role of nutrition and physical activity in the development of metabolic diseases, the role of single-cell transcriptomics, gut microbiota, epigenetics, advanced imaging techniques, and cell-based therapies in metabolic diseases. Finally, practical applications derived from this information are made.

Exercise and inactivity as modifiers of β cell function and type 2 diabetes risk

Exercise and regular physical activity are beneficial for the prevention and management of metabolic diseases such as obesity and type 2 diabetes, whereas exercise cessation, defined as deconditioning from regular exercise or physical activity that has lasted for a period of months to years, can lead to metabolic derangements that drive disease. Adaptations to the insulin-secreting pancreatic β-cells are an important benefit of exercise, whereas less is known about how exercise cessation affects these cells. Our aim is to review the impact that exercise and exercise cessation have on β-cell function, with a focus on the evidence from studies examining glucose-stimulated insulin secretion (GSIS) using gold-standard techniques. Potential mechanisms by which the β-cell adapts to exercise, including exerkine and incretin signaling, autonomic nervous system signaling, and changes in insulin clearance, will also be explored. We will highlight areas for future research.

Exercise and Nutritional Intervention for Physical Function of the Prefrail: A Systematic Review and Meta-Analysis

OBJECTIVES

The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function.

DESIGN

Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197).

SETTING AND PARTICIPANTS

Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions.

METHODS

Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values).

RESULTS

We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21‒1.42, I² = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70‒2.34, I² = 6%), and gait speed (n = 4, standard weighted mean difference -1.06, 95% CI -1.87 to -0.25, I² = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index.

CONCLUSIONS AND IMPLICATIONS

Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults.

Exercise in Octogenarians: How Much Is Too Little?

The global population is rapidly aging, with predictions of many more people living beyond 85 years. Age-related physiological adaptations predispose to decrements in physical function and functional capacity, the rate of which can be accelerated by chronic disease and prolonged physical inactivity. Decrements in physical function exacerbate the risk of chronic disease, disability, dependency, and frailty with advancing age. Regular exercise positively influences health status, physical function, and disease risk in adults of all ages. Herein, we review the role of structured exercise training in the oldest old on cardiorespiratory fitness and muscular strength and power, attributes critical for physical function, mobility, and independent living. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Troponin Variants as Markers of Skeletal Muscle Health and Diseases

Ca2 +-regulated contractility is a key determinant of the quality of muscles. The sarcomeric myofilament proteins are essential players in the contraction of striated muscles. The troponin complex in the actin thin filaments plays a central role in the Ca2+-regulation of muscle contraction and relaxation. Among the three subunits of troponin, the Ca2+-binding subunit troponin C (TnC) is a member of the calmodulin super family whereas troponin I (TnI, the inhibitory subunit) and troponin T (TnT, the tropomyosin-binding and thin filament anchoring subunit) are striated muscle-specific regulatory proteins. Muscle type-specific isoforms of troponin subunits are expressed in fast and slow twitch fibers and are regulated during development and aging, and in adaptation to exercise or disuse. TnT also evolved with various alternative splice forms as an added capacity of muscle functional diversity. Mutations of troponin subunits cause myopathies. Owing to their physiological and pathological importance, troponin variants can be used as specific markers to define muscle quality. In this focused review, we will explore the use of troponin variants as markers for the fiber contents, developmental and differentiation states, contractile functions, and physiological or pathophysiological adaptations of skeletal muscle. As protein structure defines function, profile of troponin variants illustrates how changes at the myofilament level confer functional qualities at the fiber level. Moreover, understanding of the role of troponin modifications and mutants in determining muscle contractility in age-related decline of muscle function and in myopathies informs an approach to improve human health.

Synergistic effects of high-intensity interval training (HIIT) and intake of nettle on serum levels of chemerin and beta cells function in type 2 diabetic rats

OBJECTIVES

This animal study aimed to demonstrate the synergistic effect of high-intensity interval training (HIIT) and alcoholic extract of nettle on serum chemerin and beta cells function in type 2 diabetic male rats.

METHODS

Thirty-two STZ-induced diabetic male Wistar rats were randomly divided into four groups including the control group, the supplemented group with 200 mg/day of nettle, the training group with five sessions per week of HIIT, and the group with combined nettle and HITT intervention. Body weight, lipid profile, beta cells function, and chemerin level were assessed after eight weeks of the intervention.

RESULTS

The values of chemerin significantly decreased in combined HIIT and nettle intervention group compared to the control group (p=0.001). The levels of glucose and insulin decreased significantly in nettle group, exercise group, and combined HIIT and nettle group (p=0.001).

CONCLUSIONS

The present study found that intense interval exercise with the consumption of alcoholic extract of nettle can affect the performance of beta cells, glucose, and insulin. Future human studies are warranted.

Modifiable Risk Factors in Alzheimer Disease and Related Dementias: A Review

PURPOSE

Although Alzheimer disease and related dementias (ADRDs) have long been considered nonpreventable and even an inevitable consequence of aging, recent findings from longitudinal studies indicate a downtrend in age-adjusted incidence and prevalence of ADRDs in Western countries. This remarkable trend might be the result of improved management of so-called modifiable risk factors. The aim of this review is to present evidence of modifiable factors of ADRDs in a life-course approach.

METHODS

A PubMed database search was conducted between November and December 2020 to identify relevant studies evaluating the role of modifiable risk factors in the development of ADRDs. Key words (Alzheimer's disease and modifiable risk factors) were used and specific inclusion and exclusion criteria applied.

FINDINGS

This review identifies modifiable factors for ADRDs divided into early-life, middle-life, and late-life risk factors, depending on the available window of preventive action. According to life course exposure, factors can be protective or deleterious for ADRDs that participate in the underlying pathophysiologic complexity of these diseases as well as the complexity for public health measures implementations.

IMPLICATIONS

The available evidence derived from epidemiologic, preclinical, interventional studies suggest that modifiable risk factors for ADRDs offer opportunities for therapeutic and preventive actions.

Type of training has a significant influence on the GH/IGF-1 axis but not on regulating miRNAs

The growth hormone (GH)/insulin-like growth factor-1 axis is responsible for glucose homeostasis. In the present study we assessed the expression levels of miRNA-124, miRNA-210 and miRNA-375 and immunoexpression of IGFBP-3 in relation to the concentrations of IGF-1 and glucose in athletes performing different types of effort. Sixty-six young male athletes (age 25.4±4.1 years) were divided into: group EN (33 male athletes; age 25.6±4.4 years) with endurance-type efforts (disciplines: triathlon, long distance running, cycling) and group ST (33 male athletes; age 25.2±3.9 years) with strength-type efforts (disciplines: weightlifting, body building, CrossFit). The control group consisted of 28 non-training men (age 29.1±4.7 years). Statistically significantly higher IGF-1 concentration and lower glucose concentration (P<0.05) in serum were observed in the group of athletes (vs. controls). Immunoexpression of IGFBP-3 was higher in athletes (vs. controls), and a higher value of immunoexpression was obtained in athlete group ST vs. group EN (P>0.05). Levels of expression of miRNA-210 and miRNA-375 were higher in athletes vs. controls (P>0.05). The obtained data confirmed the importance of the somatotropic axis in the regulation of metabolic adaptation to physical exercise. The detected variation in the concentrations and expression levels of the studied molecules involved in the somatotropic axis in athletes confirmed the role of the somatotropic axis in adaptation to physical effort. Statistically significant reduction of glucose concentration and the highest expression of IGF-1in serum in athletes suggest the anabolic effect of IGF-1 through insulin receptors on many tissues under the influence of moderate physical exercises (mainly during resistance training).

Blood biomarkers as surrogate endpoints of treatment responses to aerobic exercise and cognitive training (ACT) in amnestic mild cognitive impairment: the blood biomarkers study protocol of a randomized controlled trial (the ACT Trial)

BACKGROUND

Alzheimer's disease (AD) is an epidemic with tremendous public health impacts because there are currently no disease-modifying therapeutics. Randomized controlled trials (RCTs) for prevention of AD dementia often use clinical endpoints that take years to manifest (e.g., cognition) or surrogate endpoints that are costly or invasive (e.g., magnetic resonance imaging [MRI]). Blood biomarkers represent a clinically applicable alternative surrogate endpoint for RCTs that would be both cost-effective and minimally invasive, but little is known about their value as surrogate endpoints for treatment responses in the prevention of AD dementia.

METHODS

The objective of this study is to investigate blood neuropathological, neurodegenerative, and neurotrophic biomarkers as surrogate endpoints for treatment responses to three interventions in older adults with amnestic mild cognitive impairment (aMCI, a prodromal stage of AD): aerobic exercise, cognitive training, and combined aerobic exercise and cognitive training (ACT). We chose these three sets of biomarkers for their unique mechanistic associations with AD pathology, neurodegeneration and neurogenesis. This study is built on the ACT Trial (1R01AG055469), a single-blinded, multi-site, 2 × 2 factorial phase II RCT that examines the synergistic effects of a 6-month ACT intervention on cognition and MRI biomarkers (AD-signature cortical thickness and hippocampal volume) (n = 128). In this ACT Trial blood biomarkers study, we will enroll 120 ACT Trial participants with aMCI and measure blood biomarkers at baseline and at 3, 6, 12, and 18 months. The goals are to (1) determine the effect of interventions on blood biomarkers over 6 months, (2) evaluate blood biomarkers as surrogate endpoints for predicting cognitive responses to interventions over 18 months, and (3, exploratory) examine blood biomarkers as surrogate endpoints for predicting brain MRI biomarker responses to interventions over 18 months.

DISCUSSION

This study aims to identify new blood biomarkers that can track cognitive decline or AD-related brain atrophy among patients with aMCI subjected to a regimen of aerobic exercise and cognitive training. Findings from this study will drive the further use of blood biomarkers in developing effective prevention and treatment strategies for AD dementia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03313895. Registered on 18 October 2017.

Physical Activity and Alzheimer's Disease: A Narrative Review

Although age is a dominant risk factor for Alzheimer’s disease (AD), epidemiological studies have shown that physical activity may significantly decrease age-related risks for AD, and indeed mitigate the impact in existing diagnosis. The aim of this study was to perform a narrative review on the preventative, and mitigating, effects of physical activity on AD onset, including genetic factors, mechanism of action and physical activity typology. In this article, we conducted a narrative review of the influence physical activity and exercise have on AD, utilising key terms related to AD, physical activity, mechanism and prevention, searching the online databases; Web of Science, PubMed and Google Scholar, and, subsequently, discuss possible mechanisms of this action. On the basis of this review, it is evident that physical activity and exercise may be incorporated in AD, notwithstanding, a greater number of high-quality randomised controlled trials are needed, moreover, physical activity typology must be acutely considered, primarily due to a dearth of research on the efficacy of physical activity types other than aerobic.

Impact of Endurance and Resistance Training on Skeletal Muscle Glucose Metabolism in Older Adults

Aging is associated with insulin resistance and the development of type 2 diabetes. While this process is multifaceted, age-related changes to skeletal muscle are expected to contribute to impaired glucose metabolism. Some of these changes include sarcopenia, impaired insulin signaling, and imbalances in glucose utilization. Endurance and resistance exercise training have been endorsed as interventions to improve glucose tolerance and whole-body insulin sensitivity in the elderly. While both types of exercise generally increase insulin sensitivity in older adults, the metabolic pathways through which this occurs can differ and can be dependent on preexisting conditions including obesity and type 2 diabetes. In this review, we will first highlight age-related changes to skeletal muscle which can contribute to insulin resistance, followed by a comparison of endurance and resistance training adaptations to insulin-stimulated glucose metabolism in older adults.

The Effect of Exercise on Glucoregulatory Hormones: A Countermeasure to Human Aging: Insights from a Comprehensive Review of the Literature

Hormones are secreted in a circadian rhythm, but also follow larger-scale timetables, such as monthly (hormones of the menstrual cycle), seasonal (i.e., winter, summer), and, ultimately, lifespan-related patterns. Several contexts modulate their secretion, such as genetics, lifestyle, environment, diet, and exercise. They play significant roles in human physiology, influencing growth of muscle, bone, and regulating metabolism. Exercise training alters hormone secretion, depending on the frequency, duration, intensity, and mode of training which has an impact on the magnitude of the secretion. However, there remains ambiguity over the effects of exercise training on certain hormones such as glucoregulatory hormones in aging adults. With advancing age, there are many alterations with the endocrine system, which may ultimately alter human physiology. Some recent studies have reported an anti-aging effect of exercise training on the endocrine system and especially cortisol, growth hormone and insulin. As such, this review examines the effects of endurance, interval, resistance and combined training on hormones (i.e., at rest and after) exercise in older individuals. We summarize the influence of age on glucoregulatory hormones, the influence of exercise training, and where possible, examine masters' athletes' endocrinological profile.

Carbohydrate oxidation and glucose utilisation under hyperglycaemia in aged and young males during exercise at the same relative exercise intensity

PURPOSE

The purpose of the present study was to investigate the age-related carbohydrate oxidation and glucose utilisation rate response during exercise at the same relative intensity under hyperglycaemia in aged and young males.

METHODS

16 endurance-trained aged (n = 8; 69.1 ± 5.2 year) and young (n = 8; 22.4 ± 2.9 year) males were studied during 40 min of cycling exercise (60% [Formula: see text]) under both hyperglycaemic and euglycaemic (control) conditions. Venous blood samples were collected at baseline, post-infusion, mid- and post-exercise. Carbohydrate and fat oxidation rates were determined at both 15 and 35 min during exercise, and glucose utilisation rates were calculated.

RESULTS

The aged group displayed significantly lower rates of carbohydrate oxidation during exercise during maintained hyperglycemia (15 min = 2.3 ± 0.4 vs. 1.6 ± 0.5 g min^-1; 35 min = 2.3 ± 0.5 vs. 1.5 ± 0.5 g min^-1) and control (15 min = 2.2 ± 0.4 vs. 1.6 ± 0.7 g min^-1; 35 min = 1.9 ± 0.7 vs. 1.3 ± 0.7 g min^-1) conditions (P = 0.01). The rate of glucose utilisation during exercise was also significantly reduced (85.76 ± 23.95 vs. 56.67 ± 15.09 μM kg^-1 min^-1). There were no differences between age groups for anthropometric measures, fat oxidation, insulin, glucose, NEFA, glycerol and lactate (P > 0.05) although hyperglycemia resulted in elevated glucose and insulin, and attenuated fat metabolite levels.

CONCLUSION

Our findings highlight that ageing results in a reduction in carbohydrate oxidation and utilisation rates during exercise at the same relative exercise intensity.

Cardiorespiratory responses of a dance session designed for older women: A cross sectional study

BACKGROUND

Dancing has been increasingly used as a type of exercise intervention to improve cardiovascular fitness of older people. However, it is unclear which may be the exercise intensity of the dance sessions.

OBJECTIVE

To describe cardiorespiratory responses of a dance session for older women, and to identify intensity zones in relation to peak oxygen consumption (VO₂peak), first and second ventilatory thresholds (VT1 and VT2).

METHODS

Ten women (66 ± 5 yrs., BMI 27 ± 4) were examined on three occasions: Familiarization, maximum effort and dance sessions. Incremental treadmill test: 5 km/h, 2% slope each min, until maximum effort. Dance class (60 min): warm-up (20 min), across-the-floor (10 min), choreography (15 min), show (10 min) and cool-down (5 min). Ventilatory parameters were measured continuously (breath-by-breath).

RESULTS

VO₂ (mL·kg^-1·min^-1): Maximum effort: VO₂peak (23.3 ± 4.3), VT1 (17.2 ± 3.5) and VT2 (20.9 ± 3.4). Dancing: warm-up (12.8 ± 2.4, ~55%VO₂peak), across-the-floor (14.2 ± 2.4 ~62%VO₂peak), choreography (14.6 ± 3.2 ~63%VO₂peak) and show (16.1 ± 3.3, ~69% VO₂peak). Show was similar to VT1.

CONCLUSIONS

Cardiorespiratory demands of a dance class for older women are at low aerobic intensity. Show was similar to VT1, indicating that a dance class may be modulated to improve aerobic fitness, at least at initial stages of training.

Effects of elastic band exercises on physical ability and muscular topography of elderlyfemales

[Purpose] This study examined the effects of band exercise types on the physical ability and muscular topography for elderly females. [Subjects and Methods] Twenty-six females older than 65 years were divided into the dynamic band exercise (DBE; n=13) group and the Static band exercise (SBE; n=13) group. Each participant performed 12 weeks of elastic band exercises. Physical abilities were measured by leg extension power, sitting trunk flexion, closed eyes foot balance, and time to get up. Changes in muscle topography were evaluated with Moire measurement equipment for the chest, abdomen, and lumbar region. All results were compared before and after 12 weeks of exercise. [Results] Changes in physical ability were significantly increased in both groups. The scores for the muscular topography of the chest, abdomen, lumbar region, and all body parts was significantly improved in both groups for closed eyes foot balance. There were more improvements in the DBE group. [Conclusion] Two types of static and dynamic elastic band exercises effectively changed the physical fitness and muscle topography of elderly females. Therefore, to increase the effects of exercise, dynamic band exercises are considered useful. Because band exercises are simple, they can be used to maintain the health of elderly people.

Impact of aerobic exercise on muscle mass in patients with major depressive disorder: a randomized controlled trial

OBJECTIVE

Sarcopenia leads to physical function impairment and at least to increasing all-cause mortality. There are notes on reduced muscle mass in patients with major depressive disorder (MDD). Whether an exercise intervention counteracts low muscle mass in patients with MDD has not been studied so far. Therefore, our study aimed at examining effects of regular aerobic exercise training on muscle mass in patients with MDD.

PARTICIPANTS AND METHODS

Thirty inpatients with MDD were included in the study, of which 20 received an additional supervised exercise program. Ten patients obtained treatment as usual. Muscle mass was measured using MRI before and 6 weeks after the training period (3 times per week for 45 minutes).

RESULTS

We found a significant effect of the exercise intervention on the amount of muscle mass depending on age, body mass index, and the physical activity score (P=0.042).

CONCLUSION

Among other positive effects, regular exercise increases muscle mass in patients with MDD and, therefore, should be recommended as an additional treatment tool.

Effect of vigorous physical activity on blood lipid and glucose

The aim of the study is to investigate how the participation of vigorous physical activities in the health examination contributes to blood lipid and blood glucose. A total of 56,810 workers from the Ulsan University Hospital in Ulsan, Subjects were tested for health checkups from February to November in 2016. The subject is those who does not have medical history, current ailments, and medication histories, and selected those who conducted the study of subjects tested to research. And this study did not consider their drinking and smoking. The final selected population was 11,557 and categorized as a vigorous physical activity of the health survey items. In this study, the group participated by the vigorous physical activity activities, group 1 (n= 70) had more than 6 days of vigorous physical activity, group 2 (n= 2,960) is 3 to 5 days of vigorous physical activity, the group 3 (n= 7,389) is 1 to 2 days of vigorous physical activity. The group 4 (n= 1,138) were classified as those who did not perform vigorous physical activity. To achieve the purpose of the study, the questionnaire examined blood lipid and blood glucose, using questions related to physical activity related to health examination in the Ulsan University Hospital. We obtained the mean and standard deviation for each group and conducted the one-way analysis of variance as an independent variable. Post hoc is least significant difference test and significant level is 0.05. Vigorous physical activity more than 3 days of participation had a positive affect high-density lipoprotein cholesterol and triglyceride. But participation in vigorous physical activity did not affect blood glucose.

Health benefits of aerobic training programs in adults aged 70 and over: a systematic review

Aging is intrinsically associated with a progressive decline in muscle strength and mass, and aerobic capacity. This contributes to reduced mobility and impaired quality of life (QoL) among seniors. Regular physical activity, and more particularly aerobic training (AT), has demonstrated benefits on adults' health. The aim of this review was to assess the current level of evidence regarding the health benefits of AT in the population aged 70 years and over. A comprehensive, systematic database search for manuscripts was performed. Two reviewers independently assessed interventional studies for potential inclusion. Cardiovascular, metabolic, functional, cognitive, and QoL outcomes were targeted. Fifty-three studies were included totalling 2051 seniors aged 70 years and over. Studies selected were divided into 5 categories according to their main outcomes: cardiovascular function (34 studies), metabolic outcomes (26 studies), functional fitness (19 studies), cognitive functions (8 studies), and QoL (3 studies). With a good level of evidence but a wide heterogeneity between study designs, a significant and beneficial effect of AT was measured on the 5 outcomes. For QoL results showed a significant but slighter improvement. This systematic review highlights the benefits of AT on seniors' health outcome such as cardiovascular, functional, metabolic, cognitive, and QoL outcomes although the optimal program remains unclear. When more studies regarding this specific population are needed to determine the most favourable exercise program, clinicians should nevertheless encourage older adults over 70 to participate in AT programs to favour active and healthy ageing.

Effects of dance interventions on cardiovascular risk with ageing: Systematic review and meta-analysis

BACKGROUND

Exercising, including dancing, has been recommended to improve cardiovascular health of older people. Herein, we conducted a systematic review and meta-analysis verifying the effects of dance interventions on cardiovascular risk (CVR) in the elderly, comparing dancers to non-exercise controls and other types of exercise, in randomised (RCTs) and non-randomised control trials (nRCTs). Primary/Secondary outcomes: peak oxygen consumption (VO₂peak)/anthropometric measurements (body weight, BMI), and lipid profile.

METHODS

Data Sources: MEDLINE, Cochrane Wiley, Clinical Trials.gov, PEDRO and LILACS databases.

STUDY SELECTION

RCTs and nRCTs comparing elderly before and after dance interventions with non-exercising controls and/or practitioners of other types of exercise. Two independent reviewers extracted data and assessed the quality of included studies.

RESULTS

A total of 937 articles were retrieved, 64 full texts were assessed for eligibility, and 7 articles met the inclusion criteria. Pooled mean differences between intervention and control were calculated by random-effects model. VO₂peak improved in favour of dancers (3.4mLkg^-1min^-1, 95%CI: 1.08, 5.78, I2=71%), compared to non-exercise controls. No differences were found between dance and other exercises. Body weight and BMI were not altered by dance interventions.

CONCLUSIONS

Dance interventions may increase VO₂peak compared to non-exercising controls. Results also indicate it is as effective as other types of exercise in improving aerobic capacity of the elderly. Dancing might be a potential exercise intervention for improving cardiorespiratory fitness and consequent CVR associated with ageing. Proper reporting on adverse events is needed to base the benefits of dancing for the older on both efficacy and safety of the interventions.

Exercise Promotes Healthy Aging of Skeletal Muscle

Primary aging is the progressive and inevitable process of bodily deterioration during adulthood. In skeletal muscle, primary aging causes defective mitochondrial energetics and reduced muscle mass. Secondary aging refers to additional deleterious structural and functional age-related changes caused by diseases and lifestyle factors. Secondary aging can exacerbate deficits in mitochondrial function and muscle mass, concomitant with the development of skeletal muscle insulin resistance. Exercise opposes deleterious effects of secondary aging by preventing the decline in mitochondrial respiration, mitigating aging-related loss of muscle mass and enhancing insulin sensitivity. This review focuses on mechanisms by which exercise promotes "healthy aging" by inducing modifications in skeletal muscle.

Physical Exercise as Therapy for Frailty

Longitudinal studies demonstrate that regular physical exercise extends longevity and reduces the risk of physical disability. Decline in physical activity with aging is associated with a decrease in exercise capacity that predisposes to frailty. The frailty syndrome includes a lowered activity level, poor exercise tolerance, and loss of lean body and muscle mass. Poor exercise tolerance is related to aerobic endurance. Aerobic endurance training can significantly improve peak oxygen consumption by ∼10-15%. Resistance training is the best way to increase muscle strength and mass. Although the increase in muscle mass in response to resistance training may be attenuated in frail older adults, resistance training can significantly improve muscle strength, particularly in institutionalized patients, by ∼110%. Because both aerobic and resistance training target specific components of frailty, studies combining aerobic and resistance training provide the most promising evidence with respect to successfully treating frailty. At the molecular level, exercise reduces frailty by decreasing muscle inflammation, increasing anabolism, and increasing muscle protein synthesis. More studies are needed to determine which exercises are best suited, most effective, and safe for this population. Based on the available studies, an individualized multicomponent exercise program that includes aerobic activity, strength exercises, and flexibility is recommended to treat frailty.

Lung function profiles and aerobic capacity of adult cigarette and hookah smokers after 12 weeks intermittent training

INTRODUCTION

Pulmonary function is compromised in most smokers. Yet it is unknown whether exercise training improves pulmonary function and aerobic capacity in cigarette and hookah smokers and whether these smokers respond in a similar way as do non-smokers.

AIM

To evaluate the effects of an interval exercise training program on pulmonary function and aerobic capacity in cigarette and hookah smokers.

METHODS

Twelve cigarette smokers, 10 hookah smokers, and 11 non-smokers participated in our exercise program. All subjects performed 30 min of interval exercise (2 min of work followed by 1 min of rest) three times a week for 12 weeks at an intensity estimated at 70% of the subject's maximum aerobic capacity (VO2max). Pulmonary function was measured using spirometry, and maximum aerobic capacity was assessed by maximal exercise testing on a treadmill before the beginning and at the end of the exercise training program.

RESULTS

As expected, prior to the exercise intervention, the cigarette and hookah smokers had significantly lower pulmonary function than the non-smokers. The 12-week exercise training program did not significantly affect lung function as assessed by spirometry in the non-smoker group. However, it significantly increased both forced expiratory volume in 1 second and peak expiratory flow (PEF) in the cigarette smoker group, and PEF in the hookah smoker group. Our training program had its most notable impact on the cardiopulmonary system of smokers. In the non-smoker and cigarette smoker groups, the training program significantly improved VO2max (4.4 and 4.7%, respectively), v VO2max (6.7 and 5.6%, respectively), and the recovery index (7.9 and 10.5%, respectively).

CONCLUSIONS

After 12 weeks of interval training program, the increase of VO2max and the decrease of recovery index and resting heart rate in the smoking subjects indicated better exercise tolerance. Although the intermittent training program altered pulmonary function only partially, both aerobic capacity and life quality were improved. Intermittent training should be advised in the clinical setting for subjects with adverse health behaviors.

Exercise improves mitochondrial and redox-regulated stress responses in the elderly: better late than never!

Ageing is associated with several physiological declines to both the cardiovascular (e.g. reduced aerobic capacity) and musculoskeletal system (muscle function and mass). Ageing may also impair the adaptive response of skeletal muscle mitochondria and redox-regulated stress responses to an acute exercise bout, at least in mice and rodents. This is a functionally important phenomenon, since (1) aberrant mitochondrial and redox homeostasis are implicated in the pathophysiology of musculoskeletal ageing and (2) the response to repeated exercise bouts promotes exercise adaptations and some of these adaptations (e.g. improved aerobic capacity and exercise-induced mitochondrial remodelling) offset age-related physiological decline. Exercise-induced mitochondrial remodelling is mediated by upstream signalling events that converge on downstream transcriptional co-factors and factors that orchestrate a co-ordinated nuclear and mitochondrial transcriptional response associated with mitochondrial remodelling. Recent translational human investigations have demonstrated similar exercise-induced mitochondrial signalling responses in older compared with younger skeletal muscle, regardless of training status. This is consistent with data indicating normative mitochondrial remodelling responses to long-term exercise training in the elderly. Thus, human ageing is not accompanied by diminished mitochondrial plasticity to acute and chronic exercise stimuli, at least for the signalling pathways measured to date. Exercise-induced increases in reactive oxygen and nitrogen species promote an acute redox-regulated stress response that manifests as increased heat shock protein and antioxidant enzyme content. In accordance with previous reports in rodents and mice, it appears that sedentary ageing is associated with a severely attenuated exercise-induced redox stress response that might be related to an absent redox signal. In this regard, regular exercise training affords some protection but does not completely override age-related defects. Despite some failed redox-regulated stress responses, it seems mitochondrial responses to exercise training are intact in skeletal muscle with age and this might underpin the protective effect of exercise training on age-related musculoskeletal decline. Whilst further investigation is required, recent data suggest that it is never too late to begin exercise training and that lifelong training provides protection against several age-related declines at both the molecular (e.g. reduced mitochondrial function) and whole-body level (e.g. aerobic capacity).

Insulin Sensitivity Following Exercise Interventions: Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults

OBJECTIVE

Although exercise can improve insulin sensitivity, no adequate synthesis exists of exercise intervention studies with regard to their effect on insulin sensitivity. This comprehensive meta-analysis synthesized the insulin sensitivity outcomes of supervised exercise interventions.

METHOD

Extensive literature searching located published and unpublished intervention studies that measured insulin sensitivity outcomes. Eligible studies tested supervised exercise interventions among healthy adults. Primary study characteristics and results were coded. Random-effects meta-analyses of standardized mean differences included moderator analyses.

RESULTS

Data were synthesized across 2509 subjects (115 samples, 78 reports). The overall mean effect size for 2-group postintervention comparisons was 0.38 (95% confidence interval [CI] = 0.25-0.51, I (2) = 0%) and for 2-group pre-post comparisons was 0.43 (95% CI = 0.30-0.56, I (2) = 52%; higher mean insulin sensitivity for treatment than control subjects). The postintervention mean of 0.38 is consistent with treatment subjects ending studies with a mean fasting insulin of 6.8 mU/L if control participants' mean fasting insulin were 7.9 mU/L. Exploratory moderator analyses did not document different insulin sensitivity effect sizes across intervention characteristics or sample attributes.

CONCLUSION

This study documented that exercise is a valuable primary care and community health strategy for healthy adults to improve insulin sensitivity and lower the risk for diabetes conferred by insulin resistance.

A ~60-min brisk walk increases insulin-stimulated glucose disposal but has no effect on hepatic and adipose tissue insulin sensitivity in older women

The purpose of this study was to determine whether brisk walking improves multiorgan (liver, muscle, adipose tissue) insulin sensitivity in older women. Ten nonobese older women (age: 66.7 ± 1.5 yr, mean ± SE) completed two 2-stage hyperinsulinemic-euglycemic clamp procedures [insulin infusion rate stage 1: 10 mU/m(2) body surface area (BSA) per min; stage 2: 50 mU/m(2) BSA per min] in conjunction with stable isotope-labeled glucose and palmitate tracer infusions: one in the morning after a single, ∼1-h bout of brisk treadmill walking, the other after an equivalent period of rest in the late afternoon of the preceding day. We found that basal glucose rate of appearance (Ra) into plasma was not different after rest and after exercise (17.3 ± 0.8 and 17.1 ± 0.4 μmol/kg fat-free mass per min, respectively). The insulin-mediated decrease in glucose Ra during stage 1 of the clamp was also not different after rest and exercise (82.2% ± 3.4% and 77.7% ± 2.1%, respectively), but glucose rate of disappearance (Rd) during stage 2 of the clamp was significantly greater (P < 0.05) after exercise than rest (88.0 ± 5.9 and 78.4 ± 6.5 μmol/kg fat-free mass per min, respectively). There were no differences in palmitate Ra during basal conditions or insulin infusion after exercise and after rest. Therefore, we conclude that a single bout of brisk walking for ∼1 h improves muscle insulin sensitivity but has no effect on liver and adipose tissue insulin sensitivity in older women.

New records in aerobic power among octogenarian lifelong endurance athletes

We examined whole body aerobic capacity and myocellular markers of oxidative metabolism in lifelong endurance athletes [n = 9, 81 ± 1 yr, 68 ± 3 kg, body mass index (BMI) = 23 ± 1 kg/m(2)] and age-matched, healthy, untrained men (n = 6; 82 ± 1 y, 77 ± 5 kg, BMI = 26 ± 1 kg/m(2)). The endurance athletes were cross-country skiers, including a former Olympic champion and several national/regional champions, with a history of aerobic exercise and participation in endurance events throughout their lives. Each subject performed a maximal cycle test to assess aerobic capacity (VO(2max)). Subjects had a resting vastus lateralis muscle biopsy to assess oxidative enzymes (citrate synthase and βHAD) and molecular (mRNA) targets associated with mitochondrial biogenesis [peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and mitochondrial transcription factor A (Tfam)]. The octogenarian athletes had a higher (P < 0.05) absolute (2.6 ± 0.1 vs. 1.6 ± 0.1 l/min) and relative (38 ± 1 vs. 21 ± 1 ml·kg(-1)·min(-1)) VO(2max), ventilation (79 ± 3 vs. 64 ± 7 l/min), heart rate (160 ± 5 vs. 146 ± 8 beats per minute), and final workload (182 ± 4 vs. 131 ± 14 W). Skeletal muscle oxidative enzymes were 54% (citrate synthase) and 42% (βHAD) higher (P < 0.05) in the octogenarian athletes. Likewise, basal PGC-1α and Tfam mRNA were 135% and 80% greater (P < 0.05) in the octogenarian athletes. To our knowledge, the VO(2max) of the lifelong endurance athletes is the highest recorded in humans >80 yr of age and comparable to nonendurance trained men 40 years younger. The superior cardiovascular and skeletal muscle health profile of the octogenarian athletes provides a large functional reserve above the aerobic frailty threshold and is associated with lower risk for disability and mortality.

Detraining-induced alterations in metabolic and fitness markers after a multicomponent exercise-training program in older men

The aim of the present study was to investigate the effects of a 8-week detraining period after a 16-week multicomponent training program including strength and aerobic exercises on the main determinants of aerobic fitness, muscle strength and some metabolic markers in 24 older subjects (60.2 ± 3.0 years). The oxygen uptake at the second ventilatory threshold (VO2VT2) and at the end of exercise (VO2max), maximum voluntary contraction force (MVC) of knee extensors and some metabolic indexes, i.e., insulin sensitivity, blood lipid profile, inflammatory cytokines, and endothelial function, were evaluated at baseline and after the training and detraining periods. The training program induced significant improvements in VO2VT2 (16%, p < 0.05), VO2max (14%, p < 0.05), MVC (6.5%, p < 0.05), insulin sensitivity (16%, p < 0.05), and endothelial function (p < 0.05) but induced no significant change in lipid profile and inflammatory cytokines. Interestingly, VO2VT2 and VO2max (mL·min–1·kg–1) scores remained significantly above pretraining values after the 8-week detraining period. However, the detraining period reversed MVC values, the insulin sensitivity and endothelial function to baseline levels. To conclude, the 8-week detraining partially reversed the major components of aerobic fitness but totally abolished the gains in muscle strength and some metabolic indexes after a 16-week multicomponent training program in older men. Taken as a whole, the results of this study emphasize the importance of exercise prescriptions for older subjects and the need not to interrupt exercise-training over a prolonged period.

Physical activity: the forgotten tool for type 2 diabetes management

Individuals who are currently sedentary, unfit, or overweight can benefit metabolically from simply taking breaks from sitting. Since avoidance of sedentary behavior appears to have a large impact on glycemic management, all individuals with type 2 diabetes should be encouraged to minimally engage in greater daily movement to better manage their diabetes and body weight. In addition, engaging in physical activity of any intensity (including low-intensity ones) likely positively impacts insulin action and blood glucose control acutely. Moreover, as long as total caloric expenditure during exercise is matched (i.e., total exercise dose), daily exercise may be done every other day instead with the same glycemic results, although at least 150 min of weekly physical activity is recommended. Both aerobic and resistance training are important for individuals with diabetes, and ideally a program that combines the two types of training should be undertaken to achieve maximal glycemic and other benefits. Once individuals have successfully implemented more daily movement into their lifestyle, they will be more likely to participate in structured forms of physical activity to gain additional benefits. All clinicians working with individuals with either type 2 diabetes or prediabetes should consider incorporating these suggestions into care plans to improve their patients' glycemic management.

Steps to preventing type 2 diabetes: exercise, walk more, or sit less?

Accumulated evidence supports the promotion of structured exercise for treating prediabetes and preventing Type 2 diabetes. Unfortunately, contemporary societal changes in lifestyle behaviors (occupational, domestic, transportation, and leisure-time) have resulted in a notable widespread deficiency of non-exercise physical activity (e.g., ambulatory activity undertaken outside the context of purposeful exercise) that has been simultaneously exchanged for an excess in sedentary behaviors (e.g., desk work, labor saving devices, motor vehicle travel, and screen-based leisure-time pursuits). It is possible that the known beneficial effects of more structured forms of exercise are attenuated or otherwise undermined against this backdrop of normalized and ubiquitous slothful living. Although public health guidelines have traditionally focused on promoting a detailed exercise prescription, it is evident that the emergent need is to revise and expand the message to address this insidious and deleterious lifestyle shift. Specifically, we recommend that adults avoid averaging <5,000 steps/day and strive to average ≥7,500 steps/day, of which ≥3,000 steps (representing at least 30 min) should be taken at a cadence ≥100 steps/min. They should also practice regularly breaking up extended bouts of sitting with ambulatory activity. Simply put, we must consider advocating a whole message to "walk more, sit less, and exercise."

Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM), many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay T2DM, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower T2DM risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes, and safe and effective practices for PA with diabetes-related complications.

Prescribing exercise for individuals with type 2 diabetes: recommendations and precautions

An increasing prevalence of obesity and sedentary behavior has strongly contributed to the epidemic of type 2 diabetes mellitus. Although regular exercise improves glycemic control and is associated with reduced morbidity and mortality, many physicians fail to prescribe it. This article highlights the recommended types and quantities of physical activities that can (and should) be undertaken by individuals with type 2 diabetes, along with precautions required to maximize the safety of exercise in those using various medications and in the presence of diabetes-related complications. This article assesses the need for pre-exercise stress testing, reviews the latest exercise prescription recommendations for individuals with type 2 diabetes, and recommends strategies to assist individuals in adopting and maintaining an active lifestyle.

Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement

Although physical activity (PA) is a key element in the prevention and management of type 2 diabetes, many with this chronic disease do not become or remain regularly active. High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently, but it is now well established that participation in regular PA improves blood glucose control and can prevent or delay type 2 diabetes, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. Structured interventions combining PA and modest weight loss have been shown to lower type 2 diabetes risk by up to 58% in high-risk populations. Most benefits of PA on diabetes management are realized through acute and chronic improvements in insulin action, accomplished with both aerobic and resistance training. The benefits of physical training are discussed, along with recommendations for varying activities, PA-associated blood glucose management, diabetes prevention, gestational diabetes mellitus, and safe and effective practices for PA with diabetes-related complications.

Modification of vascular function after handgrip exercise training in 73- to 90-yr-old men

PURPOSE

To examine the influence of a unilateral exercise training protocol on brachial artery reactivity (BAR) in 12 men (aged 81 +/- 5 yr).

METHODS

Brachial artery diameters and blood flow parameters were assessed, in both arms, using high-resolution ultrasonography, before and after 5 min of forearm occlusion, before and at the end of each week of a 4-wk training program. Training consisted of a unilateral handgrip training protocol (nondominant arm) at 60% of maximal voluntary handgrip strength, performed for 4 wk, 4 d x wk(-1), 20 min per session, and a cadence of one contraction per 4 s.

RESULTS

After training, handgrip strength increased 6.2% (baseline = 32.4 +/- 7.0 kg vs week 4 = 34.4 +/- 6.7 kg) in the trained arm only but failed to reach statistical significance (P = 0.10). No statistical changes were observed for blood pressure or resting HR. In contrast, BAR increased 45% (Pre = 2.9% vs Post = 4.1%, P = 0.05) in the trained arm only. Improvements in BAR were observed after the second week of training, without significant changes in the main vasodilatory trigger, defined as the relevant shear stimulus after forearm occlusion (P > 0.05).

CONCLUSIONS

These data indicate that a localized short-term exercise program results in significant improvements in vascular function in the trained arm of elderly men compared with the control arm. Furthermore, the findings indicate a statistically significant increase in BAR at the end of the second week of training, despite a similar trigger for dilation versus before training.

Sex impacts the relation between body composition and physical function in older adults

OBJECTIVE

To determine the sex-specific relationships between physical activity, aerobic fitness, adiposity (%Fat), mineral-free lean mass (MFLM), and balance and gait performance in older adults.

METHODS

Eighty-five female and 49 male sedentary, healthy, community-dwelling older adults (mean [SD] age, 69.6 [5.4] and 70.3 [4.7] years, respectively) were evaluated on habitual physical activity via questionnaire, aerobic fitness by a maximal oxygen consumption treadmill test, whole and regional body composition by dual-energy x-ray absorptiometry, and lower extremity physical function using gait tasks and computerized dynamic posturography.

RESULTS

As expected, men had less body fat, more lean mass, and higher aerobic fitness than did women and tended to perform better on all lower extremity physical function tasks (all P <or= 0.1). Physical activity was not related to gait; however, fitness was related to gait in both sexes (r > 0.50, all P < 0.05). Body fat was related to gait in women (r = -0.38, P < 0.05) but not in men. Neither fitness nor body composition was related to balance in men, whereas in women, leg MFLM was positively associated (r = 0.27, P < 0.05). Women, but not men, with a greater ratio of body weight to leg MFLM performed worse on gait tasks (P < 0.001). There was an interaction with sex for %Fat on gait (P = 0.05) and for leg MFLM on balance (P < 0.05).

CONCLUSIONS

In sedentary healthy older adults, the relation between body composition, aerobic fitness, and balance and gait differs between sexes such that women are more strongly affected by alterations in body composition. Lower %Fat and preservation of lower body lean mass have important implications for reducing the risk of physical disability, especially in older women.

[Aging and physical activity data on which to base recommendations for exercise in older adults]

An abundance of epidemiological research confirms the benefits of physical activity in reducing risk of various age-related morbidities and all-cause mortality. Analysis of the literature focusing on key exercise variables (e.g., intensity, type, and volume) suggests that the requisite beneficial amount of activity is that which engenders improved cardiorespiratory fitness, strength, power, and, indirectly, balance. Age-related declines in these components are such that physical limitations impinge on functional activities of daily living. However, an exercise programme can minimize declines, thus preventing older adults (age 65+ years) from crossing functional thresholds of inability. Cross-sectional and longitudinal data demonstrate that cardiorespiratory fitness is associated with functional capacity and independence; strength and, importantly, power are related to performance and activities of daily living; and balance-mobility in combination with power are important factors in preventing falls. Exercise interventions have documented that older adults can adapt physiologically to exercise training, with gains in functional capacities. The few studies that have explored minimal or optimal activity requirements suggest that a threshold (intensity) within the moderately vigorous domain is needed to achieve and preserve related health benefits. Thus, physical activity and (or) exercise prescriptions should emphasize activities of the specificity and type to improve components related to the maintenance of functional capacity and independence; these will also delay morbidity and mortality. An appropriate recommendation for older adults includes moderately vigorous cardiorespiratory activities (e.g., brisk walking), strength and (or) power training for maintenance of muscle mass and specific muscle-group performance, as well as "balance-mobility practice" and flexibility (stretching) exercise as needed.

Community-based adaptive physical activity program for chronic stroke: feasibility, safety, and efficacy of the Empoli model

OBJECTIVE

To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.

METHODS

Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.

RESULTS

After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P<.00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P<.003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P=.01).

CONCLUSION

APA-stroke appears to be safe, feasible, and efficacious in a community setting.

Health benefits of physical activity in older patients: a review

As the number of elderly persons in our country increases, more attention is being given to geriatric healthcare needs and successful ageing is becoming an important topic in medical literature. Concept of successful ageing is in first line on a preventive approach of care for older people. Promotion of regular physical activity is one of the main non-pharmaceutical measures proposed to older subjects as low rate of physical activity is frequently noticed in this age group. Moderate but regular physical activity is associated with a reduction in total mortality among older people, a positive effect on primary prevention of coronary heart disease and a significant benefit on the lipid profile. Improving body composition with a reduction in fat mass, reducing blood pressure and prevention of stroke, as well as type 2 diabetes, are also well established. Prevention of some cancers (especially that of breast and colon), increasing bone density and prevention of falls are also reported. Moreover, some longitudinal studies suggest that physical activity is linked to a reduced risk of developing dementia and Alzheimer's disease in particular.

Extremely short duration high intensity interval training substantially improves insulin action in young healthy males

BACKGROUND

Traditional high volume aerobic exercise training reduces cardiovascular and metabolic disease risk but involves a substantial time commitment. Extremely low volume high-intensity interval training (HIT) has recently been demonstrated to produce improvements to aerobic function, but it is unknown whether HIT has the capacity to improve insulin action and hence glycemic control.

METHODS

Sixteen young men (age: 21 +/- 2 y; BMI: 23.7 +/- 3.1 kg x m-2; VO2peak: 48 +/- 9 ml x kg-1 x min-1) performed 2 weeks of supervised HIT comprising of a total of 15 min of exercise (6 sessions; 4-6 x 30-s cycle sprints per session). Aerobic performance (250-kJ self-paced cycling time trial), and glucose, insulin and NEFA responses to a 75-g oral glucose load (oral glucose tolerance test; OGTT) were determined before and after training.

RESULTS

Following 2 weeks of HIT, the area under the plasma glucose, insulin and NEFA concentration-time curves were all reduced (12%, 37%, 26% respectively, all P < 0.001). Fasting plasma insulin and glucose concentrations remained unchanged, but there was a tendency for reduced fasting plasma NEFA concentrations post-training (pre: 350 +/- 36 v post: 290 +/- 39 micromol x l-1, P = 0.058). Insulin sensitivity, as measured by the Cederholm index, was improved by 23% (P < 0.01), while aerobic cycling performance improved by approximately 6% (P < 0.01).

CONCLUSION

The efficacy of a high intensity exercise protocol, involving only ~250 kcal of work each week, to substantially improve insulin action in young sedentary subjects is remarkable. This novel time-efficient training paradigm can be used as a strategy to reduce metabolic risk factors in young and middle aged sedentary populations who otherwise would not adhere to time consuming traditional aerobic exercise regimes.

Exercise training impacts the myocardial metabolism of older individuals in a gender-specific manner

Aging is associated with decreases in aerobic capacity, cardiac function, and insulin sensitivity as well as alterations in myocardial substrate metabolism. Endurance exercise training (EET) improves cardiac function in a gender-specific manner, and EET has been shown to improve whole body glucose tolerance, but its effects on myocardial metabolism are unclear. Accordingly, we studied the effect of EET on myocardial substrate metabolism in older men and women. Twelve healthy older individuals (age: 60-75 yr; 6 men and 6 women) underwent PET with [(15)O]water, [(11)C]acetate, [(11)C]glucose, and [(11)C]palmitate for the assessment of myocardial blood flow (MBF), myocardial O(2) consumption (MVo(2)), myocardial glucose utilization (MGU), and myocardial fatty acid utilization (MFAU), respectively, at rest and during dobutamine infusion (10 microg.kg(-1).min(-1)). Measurements were repeated after 11 mo of EET. Maximal O(2) uptake (Vo(2max)) increased (P = 0.005) after EET. MBF was unaffected by training, as was resting MVo(2); however, posttraining dobutamine MVo(2) was significantly higher (P = 0.05), as was MGU (P < 0.04). Although overall dobutamine MFAU was unchanged, posttraining dobutamine MFAU increased in women (P = 0.01) but decreased in men (P = 0.03). Thus, EET in older individuals improves the catecholamine response of myocardial glucose metabolism. Moreover, gender differences exist in the myocardial fatty acid metabolic response to training. These findings suggest a role for altered myocardial substrate metabolism in modulating the cardiovascular benefits of EET in older individuals.