Effects of exercise training on cardiovascular function and plasma lipid, lipoprotein, and apolipoprotein concentrations in premenopausal and postmenopausal women

Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases

Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation (AF), respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and nontraditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise, and AF. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and AF. Recent advances in molecular profiling technologies (ie, genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on interindividual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.

The effects of exercise training on lipid metabolism and coronary heart disease

Blood lipoproteins are formed by various amounts of cholesterol (C), triglycerides (TGs), phospholipids, and apolipoproteins (Apos). ApoA1 is the major structural protein of high-density lipoprotein (HDL), accounting for ~70% of HDL protein, and mediates many of the antiatherogenic functions of HDL. Conversely, ApoB is the predominant low-density lipoprotein (LDL) Apo and is an indicator of circulating LDL, associated with higher coronary heart disease (CHD) risk. Thus, the ratio of ApoB to ApoA1 (ApoB/ApoA1) is used as a surrogate marker of the risk of CHD related to lipoproteins. Elevated or abnormal levels of lipids and/or lipoproteins in the blood are a significant CHD risk factor, and several studies support the idea that aerobic exercise decreases CHD risk by partially lowering serum TG and LDL-cholesterol (LDL-C) levels and increasing HDL-C levels. Exercise also exerts an effect on HDL-C maturation and composition and on reverse C transport from peripheral cells to the liver to favor its catabolism and excretion. This process prevents atherosclerosis, and several studies showed that exercise training increases heart lipid metabolism and protects against cardiovascular disease. In these and other ways, it more and more appears that regular exercise, nutrition, and strategies to modulate lipid profile should be viewed as an integrated whole. The purpose of this review is to assess the effects of endurance training on the nontraditional lipid biomarkers, including ApoB, ApoA1, and ApoB/ApoA1, in CHD risk.

Menopausal Status and Physical Activity Are Independently Associated With Cardiovascular Risk Factors of Healthy Middle-Aged Women: Cross-Sectional and Longitudinal Evidence

Cardiovascular disease (CVD) is the primary cause of mortality in women in developed countries. CVD risk rises with age, yet for women there is a rapid increase in CVD risk that occurs after the onset of menopause. This observation suggests the presence of factors in the middle-aged women that accelerate the progression of CVD independent of chronological aging. Leisure time physical activity (LTPA) is a well-established protective factor against CVD. However, its role in attenuating atherogenic lipid profile changes and CVD risk in post-menopausal women has not been well-established. The present study is part of the Estrogenic Regulation of Muscle Apoptosis (ERMA) study, a population-based cohort study in which middle-aged Caucasian women (47-55) were classified into pre-menopausal, peri-menopausal, and post-menopausal groups based on follicle stimulating hormone levels and bleeding patterns. Comprehensive questionnaires, laboratory visits, anthropometric measurements, and physical activity monitoring by accelerometers were used to characterize the menopausal groups and serum lipid profiles were analyzed to quantify CV (cardiovascular) risk factors. Based on our findings, LTPA may attenuate menopause-associated atherogenic changes in the serum CV risk factors of healthy middle-aged women. However, LTPA does not seem to entirely offset the lipid profile changes associated with the menopausal transition.

Metabolic syndrome in menopause and associated factors: a meta-analysis

OBJECTIVE

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes. Menopause is associated with an increased risk for MetS. The purpose of this meta-analysis is to better understand the relationship between MetS and menopause.

METHODS

MEDLINE and EMBASE were searched for all the associated articles on (1) MetS components in postmenopausal women vs. premenopausal women, (2) comparison of MetS incidence between surgical menopause and natural menopause, (3) the effect of hormone therapy (HT) with 17β-estradiol (E2) compared to conjugated equine estrogen (CEE) on MetS components among postmenopausal women. A meta-analysis was applied by Review Manager 5.3 software.

RESULTS

All comparable indicators were significantly unfavorably changed in postmenopausal women compared to premenopausal women except for high density lipoprotein cholesterol. Women who underwent surgical menopause suffered a 1.51-fold higher risk for MetS compared to those with natural menopause. HT with E2 provided more benefits for levels of triglyceride and diastolic blood, while CEE showed a better effect on both high and low density lipoprotein cholesterol levels.

CONCLUSIONS

Menopause nearly adversely affects all components of MetS, and surgical menopause may lead to a higher incidence of MetS compared to natural menopause. HT with various preparations may have different effects on MetS components. These results may clarify the management of menopause-related MetS in clinical practice.

A standardized exercise intervention differentially affects premenopausal and postmenopausal African-American women

OBJECTIVE

African-American women represent an understudied population in menopause research yet face greater postmenopausal challenges associated with mortality than their white peers. We investigated the effects of a mild-intensity aerobic exercise training program on markers of mortality risk in both premenopausal and postmenopausal African-American women.

METHODS

Sixteen premenopausal women and 19 postmenopausal women underwent 6 months of mild-intensity aerobic exercise training. Measurements included markers of blood lipid and glucose profile, inflammation, kidney function, vascular health, and aerobic fitness before and after the exercise intervention.

RESULTS

Before the exercise intervention, the premenopausal and postmenopausal groups only differed in age, low-density lipoprotein, and total cholesterol levels, with the latter two being higher in the postmenopausal group. Both triglycerides and markers of early-stage endothelial dysfunction (CD62E endothelial microparticles) improved in both groups with aerobic exercise training. Aerobic fitness, glomerular filtration rate, body mass index, plasma glucose levels, and markers of late-stage endothelial dysfunction (CD31/CD42b endothelial microparticles) only improved in the premenopausal group.

CONCLUSIONS

Mild-intensity aerobic exercise training succeeds in improving some markers of cardiovascular disease and mortality in postmenopausal women. Higher levels of exercise intensity or perhaps additional interventions may need to be considered to further decrease mortality risk in this population.

Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans

OBJECTIVE

This study examined whether the combination of alternate day fasting (ADF) plus exercise produces superior changes in body composition and plasma lipid levels when compared to each intervention alone.

DESIGN AND METHODS

Obese subjects (n = 64) were randomized to 1 of 4 groups for 12 weeks: 1) combination (ADF plus endurance exercise), 2) ADF, 3) exercise, or 4) control.

RESULTS

Body weight was reduced (P < 0.05) by 6 ± 4 kg, 3 ± 1 kg, and 1 ± 0 kg in the combination, ADF, and exercise groups, respectively. Fat mass and waist circumference decreased (P < 0.001), while lean mass was retained in the combination group. Low-density lipoprotein (LDL) cholesterol decreased (12 ± 5%, P < 0.05) and high-density lipoprotein (HDL) cholesterol increased (18 ± 9%, P < 0.05) in the combination group only. LDL particle size increased (P < 0.001) by 4 ± 1 Å and 5 ± 1 Å in the combination and ADF groups, respectively. The proportion of small HDL particles decreased (P < 0.01) in the combination group only.

CONCLUSIONS

These findings suggest that the combination produces superior changes in body weight, body composition, and lipid indicators of heart disease risk, when compared to individual treatments.

Neuroprotection and neurodegeneration in Alzheimer's disease: role of cardiovascular disease risk factors, implications for dementia rates, and prevention with aerobic exercise in african americans

Prevalence of Alzheimer's disease (AD) will reach epidemic proportions in the United States and worldwide in the coming decades, and with substantially higher rates in African Americans (AAs) than in Whites. Older age, family history, low levels of education, and ɛ4 allele of the apolipoprotein E (APOE) gene are recognized risk factors for the neurodegeneration in AD and related disorders. In AAs, the contributions of APOE gene to AD risk continue to engender a considerable debate. In addition to the established role of cardiovascular disease (CVD) risk in vascular dementia, it is now believed that CVD risk and its endophenotype may directly comediate AD phenotype. Given the pleiotropic effects of APOE on CVD and AD risks, the higher rates of CVD risks in AAs than in Whites, it is likely that CVD risks contribute to the disproportionately higher rates of AD in AAs. Though the advantageous effects of aerobic exercise on cognition is increasingly recognized, this evidence is hardly definitive, and data on AAs is lacking. In this paper, we will discuss the roles of CVD risk factors in the development of AD and related dementias, the susceptibility of these risk factors to physiologic adaptation, and fitness-related improvements in cognitive function. Its relevance to AD prevention in AAs is emphasized.

Responses of blood lipids and lipoproteins to extended-release niacin and exercise in sedentary postmenopausal women

Niacin and exercise positively alter blood lipids and lipoproteins via different mechanisms. However, the effects of niacin combined with exercise on blood lipid and lipoprotein profiles have not been investigated in sedentary postmenopausal women. The current study examined the responses of blood lipids and lipoproteins to niacin and exercise in 18 sedentary postmenopausal women, who underwent four conditions: no-niacin rest, no-niacin exercise, niacin rest, and niacin exercise. Participants ingested 1,000 mg/day of extended-release niacin for 4 weeks during the niacin condition. As an exercise treatment, participants performed a single bout of exercise on a treadmill at 60% heart rate reserve until 400 kcal were expended. Extended-release niacin without the exercise intervention significantly (p < .001) increased high-density lipoprotein cholesterol and high-density lipoprotein-2 cholesterol by 12.4% and 33.3%, respectively, and decreased the total cholesterol to high-density lipoprotein cholesterol ratio by 14.8%. Thus, 4 weeks of 1,000 mg/day of extended-release niacin can improve the blood lipid and lipoprotein profiles in sedentary postmenopausal women.

Resistance training improves cardiovascular risk factors in obese women despite a significative decrease in serum adiponectin levels

Increased circulating adiponectin and insulin sensitivity are usually observed after body fat loss induced by a weight-loss diet. Progressive resistance training (PRT) without a concomitant weight-loss diet significantly decreases visceral fat, thus improving insulin sensitivity. Therefore, the purpose of this study was to ascertain the effects of combined 16-week PRT and weight-loss diet on circulating adiponectin and insulin sensitivity index. Thirty-four obese (BMI: 30-40 kg/m(2)) women, aged 40-60 year, were randomized to three groups: a control group (C; n = 9); a diet group (WL; n = 12) with a caloric restriction of 500 kcal/d; and a diet plus resistance training group (WL+RT; n = 13) with the same caloric restriction as group WL and a 16-week supervised whole body PRT of two sessions/week. Both WL and WL+RT groups showed similar decreases in body mass (-6.3% and -7.7%) and visceral fat (-19.9% and -20.5%). WL resulted in an expected increase in circulating levels of adiponectin (P = 0.07) and insulin sensitivity. However, circulating total adiponectin decreased (P < 0.05) in WL+RT group, whereas an improvement in different cardiovascular risk factors (insulin sensitivity, low-density lipoprotein cholesterol (LDL-C), etc.) was observed. In conclusion, in obese women a 16-week combined PRT and weight-loss diet is accompanied by significant improvements in different cardiovascular risk factors in spite of a significant decrease of circulating adiponectin.

Exercise training, lipid regulation, and insulin action: a tangled web of cause and effect

Lipids are a strong mediator of coronary artery disease and cardiovascular risk. Although the effects of exercise to improve high-density lipoprotein (HDL) cholesterol and serum triglycerides (TGs) have been known for some time, the effects of different amounts and intensities of exercise on fasting and postprandial serum lipids are little understood. Normal lipid physiology is perturbed in insulin resistant states, where inhibition of lipolysis is impaired, particularly in the postprandial period when excursions in insulin and serum TGs are particularly high. In our STRRIDE (Studies of a Targeted Risk Reduction Intervention through Defined Exercise) study, three important metabolic cardiovascular risk-related variables were improved more by moderate intensity than vigorous-intensity exercise. Moderate-intensity exercise was significantly more effective at lowering TGs and improving insulin sensitivity than was vigorous exercise. Additionally, a composite score for metabolic syndrome improved significantly with low-amount/moderate, but did not with low-amount/vigorous-intensity exercise. That all three of these strong, independent, cardiovascular risk factors were significantly affected by moderate-intensity exercise suggests that regular walking exercise might be as effective, if not more so, than more vigorous exercise in favorably modifying cardiovascular risk. Despite the impressive effects of regular exercise on fasting lipids and atherogenic dyslipidemia, they are more impressive when compared with the trajectory of changes that occur in individuals that remain inactive, without regular exposure to regular exercise. A scientific priority for future investigations should be to study the independent and combined effects of exercise intensity and amount on exercise responses through a direct comparison between two groups matched on amount but differing in intensity.

Effect of resistance training on risk of coronary artery disease in women with multiple sclerosis

The effects of a lower-extremity progressive resistance-training program (PRT) on risk factors for coronary artery disease (CAD) were determined in patients with multiple sclerosis (MS). Twelve ambulatory women with MS (47.3+/-4.7 years; Expanded Disability Status Score (EDSS), 4.00+/-1.37) completed twice weekly lower-body PRT for 8 weeks. Knee extensor and ankle flexor strength improved significantly (p<0.05) after training, and self-reported fatigue decreased (p<0.05). Serum triglyceride concentrations decreased (p<0.05) but body-weight and fatness, blood pressure, and serum glucose, total cholesterol and high-density lipoprotein cholesterol were unchanged. However, the number of CAD risk factors that reached the clinical threshold for each subject declined after PRT, suggesting that resistance training can promote CAD risk reduction in ambulatory female MS subjects.

Effects of aquatic resistance training on health and fitness in postmenopausal women

To investigate effects of 24 weeks of resistance training with aquatic resistance devices or elastic bands (EB) on markers of cardiovascular health and physical capacity. Forty-six healthy, sedentary postmenopausal women participated. The groups were aquatic exercise (AE; n = 15), EB (n = 21), and control (n = 10). Venous blood chemistry included cholesterol, triglycerides, glucose, and apolipoprotein B. Physical capacity was assessed by the sit-and-reach, knee push-up, 60-s squat, and abdominal crunch tests. Both AE and EB, respectively, showed a significant (P <or= 0.05) decrease in body fat (14.56, 11.97%) and diastolic blood pressure (8.03, 5.88%), and a significant increase in fat-free mass (2.88, 1.22%), sit-and-reach (27.94, 44.2%), knee push-ups (84.74, 51.59%), and 60-s squats (65.76, 46.04%). AE also showed a significant increase in abdominal crunches (28.11%). Aquatic resistance training can offer significant physiological benefits in health and performance that are comparable to those obtained from EB in this population.

Habitual consumption of eggs does not alter the beneficial effects of endurance training on plasma lipids and lipoprotein metabolism in untrained men and women

Changes in plasma lipid and apolipoprotein profiles were evaluated in 12 healthy, unfit subjects (VO(2peak) 39.1+/-2.8 ml.kg(-1).min(-1); 5 women, 7 men) at baseline and following endurance exercise training. The exercise protocol consisted of a 6-week endurance exercise training program (4-5 days week(-1); 60 min.session(-1); > or =65% HR(max)). Subjects were randomly assigned to consume an egg- (n=6; 12 eggs.week(-1)) or no-egg (n=6; 0 eggs.week(-1))-based, eucaloric, standardized diet for 8 weeks. Both diets were macronutrient balanced [60% carbohydrate, 30% fat, 10% protein (0.8 g.kg(-1).day(-1))] and individually designed for weight maintenance. Plasma lipids were measured twice within the same week at baseline and following exercise training. At baseline, subjects were normolipidemic with values of 163.9+/-41.8, 84.8+/-36.7, 60.6+/-15.4 and 93.1+/-52 mg dl(-1) for total cholesterol, LDL cholesterol and HDL cholesterol and triglyceride concentrations, respectively. A two-way ANOVA was used to analyze diet and exercise effects and interactions. In both groups, endurance exercise training resulted in a significant 10% increase in HDL-C (P<.05), a 19% decrease in Apo B concentrations (P<.05) and reductions in plasma CETP activity (P<.05). Plasma LDL-C decreased by 21% (P=.06). No main effects of diet or interactions with plasma lipids or Apo B concentrations were observed. These data demonstrate that endurance training improved the plasma lipid profiles of previously unfit, normolipidemic subjects independent of dietary cholesterol intake from eggs.

Do age and baseline LDL cholesterol levels determine the effect of regular exercise on plasma lipoprotein cholesterol and apolipoprotein B levels?

Apolipoprotein B (apoB) concentration and age are independently associated with an increased risk for cardiovascular disease. Age is also associated with increased apoB concentration. The purpose of this study was to determine the effects of exercise on apoB and examine the association between age and lipoproteins. Forty-one sedentary individuals exercised for 6 months, four times/week for 40 min between 60 and 85% of their maximal heart rate. Lipids were determined three times: before training, 24 and 72 h after the last training session. Exercise did not alter apoB (1.2+/-0.05 g/l vs. 1.2+/-0.05 g/l; P>0.05), or other lipids or lipoproteins. When participants were sequestered by baseline low density lipoprotein cholesterol (LDLc), total cholesterol (TC) was decreased at 24 h post (6.3+/-0.2 mmol/l vs. 6.0+/-0.2 mmol/l, P<0.05) and LDLc after 24 and 48 h post (4.3+/-0.1 mg/dl vs. 3.9+/-0.1 and 4.1+/-0.2 mg/dl, P<0.05) in the high LDLc group. In the low LDLc group both TC (4.4+/-0.2 mmol/l vs. 4.6+/-0.2 and 4.6+/-0.2 mmol/l, P>0.05) and LDLc (2.6+/-0.1 mmol/l vs. 2.8+/-0.1 and 2.8+/-0.2 mmol/l, P<0.05) were elevated at 24 h and remained elevated at 72 h post compared to baseline. Age does not affect apoB or lipoproteins in response to exercise. Individuals with high baseline LDLc experienced acute reduction in TC and LDLc produced by each exercise session.

Acute changes in blood lipids and enzymes in postmenopausal women after exercise

The effectiveness of lifestyle intervention strategies to improve blood lipids in women may be dependent on preexisting cholesterol concentrations. We characterized the effects of cholesterol status on blood lipid, lipoprotein lipid, and lipid regulatory enzyme responses to a single session of aerobic exercise in physically active, postmenopausal women. In this study, blood samples were obtained from 12 women with high cholesterol (HC; ≥200 mg/dl) and 13 women with normal cholesterol (NC; <200 mg/dl), 24 h before (Pre), immediately after (IPE), and 24 and 48 h after an exercise session (treadmill walking at 70% peak oxygen consumption, 400 kcal). We found that repeated-measures analysis revealed the following: 1) preexercise cholesterol differences did not influence the lipid or lipoprotein lipid responses to exercise; 2) for both groups, triglyceride was significantly reduced (−8.5%) after exercise; 3) the concentration profile over time for high-density lipoprotein cholesterol was significant for both groups, first falling at IPE then rising back to Pre levels by 24 h after exercise; 4) the lecithin-cholesterol acyltransferase activity (LCATA) exercise response was group dependent, increasing modestly in the NC group at 24 and 48 h; 5) lipoprotein lipase activity (LPLA) increased at IPE (by 17%) in the HC group only and then fell at 24 and 48 h (by 21%) compared with Pre; and 6) cholesterol ester transfer protein activity was unchanged by exercise. From these findings, we conclude that in postmenopausal women, a single session of endurance exercise elicited a short-term, favorable decrease in triglycerides independent of initial blood cholesterol concentrations. However, LCATA and LPLA postexercise changes were influenced by preexercise cholesterol status.

Fitness and physical activity in children with asthma

Asthma remains the most common chronic disease in childhood, reportedly affecting up to 25% of children in Western urban environmental settings. There seems to be a common perception that asthmatic children have a reduced capacity for exercise. Surprisingly, there is conflicting evidence in the literature in relation to this position. In this review, we present an overview of the literature in which habitual physical activity and fitness levels, including aerobic fitness, of asthmatic and non-asthmatic children are compared. There is contradictory evidence regarding the aerobic fitness levels of asthmatic children and adolescents, and it remains unclear whether significant differences exist between asthmatic children and their non-asthmatic counterparts. There is limited information concerning the relative anaerobic fitness of asthmatic children and adolescents; however, this is also conflicting. During childhood and adolescence, asthmatic individuals seem to have physical activity levels comparable with those of the normal paediatric population. However, differences in physical activity levels may develop during the time of maturation from adolescence into adulthood. Accordingly, it is not possible to establish a definitive conclusion about the issue in either children or adults. Further research with well designed methodologies is needed in order to determine whether asthmatic children and adolescents have different aerobic fitness, anaerobic fitness and physical activity levels when compared with the normal paediatric population.

Reducing cardiovascular risk factors in postmenopausal women through a lifestyle change intervention

BACKGROUND

The impact of a 6-month lifestyle change intervention on cardiovascular risk factors in obese, sedentary, postmenopausal women was examined. A secondary aim of this investigation was to determine whether the addition of self-control skills training to an empirically supported lifestyle change intervention would result in greater cardiovascular risk reduction.

METHODS

Forty-four women were randomly assigned to receive either a lifestyle change or a lifestyle change with self-control skills intervention. Pretreatment and posttreatment weight loss, body composition, physical activity, cardiorespiratory fitness, diet, blood pressure (BP), blood lipids, and psychosocial functioning were assessed. Also, at 1-year posttreatment, weight loss, body composition, self-reported physical activity, and psychosocial functioning were assessed.

RESULTS

The women significantly increased their physical activity (+39.6%) and cardiorespiratory fitness (+13.5%) and reduced their body weight (-6.5%), fat mass (-7.4%), body fat (-2.4%), BP (SBP -6.2%, DBP -9.2%), total cholesterol (-7.4%), triglycerides (-16.5%), and low-density lipoprotein (LDL) cholesterol (9.1%) and improved their diet (p < 0.05). At the 1-year follow-up, women had regained approximately 63% of their posttreatment weight loss (p < 0.05), but had maintained their previous increases in physical activity. Additionally, there were no significant changes in fat free mass, body fat, anxiety, or depression between the end of treatment and 1-year posttreatment. The addition of self-control skills training did not significantly improve cardiovascular risk reduction.

CONCLUSIONS

Lifestyle change interventions may be an effective means for reducing cardiovascular risk in obese, sedentary, postmenopausal women. However, greater attention should be devoted to the maintenance of these positive lifestyle changes.

Relative influence of diet and physical activity on cardiovascular risk factors in urban Chinese adults

OBJECTIVE

The relative influence of dietary factors vs physical activity on cardiovascular risk factors are poorly understood. We investigated these factors in a population whose traditional diet may have both positive (high plant-based) and negative (high refined carbohydrate) aspects, and whose physical activity levels (PALs) vary widely.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 130 weight stable adults aged 35-49 y (BMI 18-35 kg/m(2)) living in urban Beijing, China.

MEASUREMENTS

Dietary intake (by food frequency questionnaire), PAL as the ratio of predicted total to resting energy expenditure), percent body fat (by deuterium oxide dilution), and central adiposity (waist circumference and waist to hip ratio) were assessed. Biochemical parameters (total cholesterol, low- and high-density lipoprotein cholesterol (LDL-C; HDL-C), triglyceride (TG), apolipoproteins A-I and B, glucose, insulin, and homocysteine and its related vitamins), blood pressure and presence of the metabolic syndrome (having >/=3 risk factors of central adiposity, HDL-C, TG, glucose, blood pressure) were also examined.

RESULTS

Mean values for cardiovascular risk factors were relatively low, but 19% of subjects had the metabolic syndrome. Using validated methods for measuring food intake and energy expenditure, we found that an adverse cardiovascular risk profile was associated with a diet high in carbohydrate, low in polyunsaturated fat, and low in fruit and vegetables, independent of body fatness and its distribution. While dietary factors predicted individual cardiovascular risk factors more consistently than PAL, avoidance of low PAL reduced the risk of having the metabolic syndrome.

CONCLUSION

These results suggest that, regardless of total body fatness and fat distribution, multiple unfavorable dietary factors and low physical activity independently increase the risk for cardiovascular disease. Avoidance of a sedentary lifestyle additionally reduces the risk of developing the metabolic syndrome.

Effects of an off-site walking program on energy expenditure, serum lipids, and glucose metabolism in middle-aged women

The present study aims to identify the effects of systematic walking on exercise energy expenditure (EEE) and blood profiles in middle-aged women. Fifty-two female nurse managers, aged 32 to 57 years (42.0 +/- 6.2), were randomly assigned to an intervention group (IG) and a control group (CG) for a 12-week study of the walking program. EEE was measured using a microelectronic device. Blood profiles were assessed before and after the walking program. The mean EEE (kcal/kg/d) in the IG and CG was 4.73 +/- 1.02 and 3.88 +/- 0.81 (P = 0.01), indicating an increase of 1.17 +/- 0.98 and 0.46 +/- 0.68 from baseline (P = 0.01), respectively. The mean change in high-density lipoprotein cholesterol in the IG and CG was 1.8 +/- 8.3 mg/dL and -2.9 +/- 7.0 mg/dL (P = 0.051); that in insulin was -4.5 +/- 7.5 microU/dL and -0.6 +/- 4.3 microU/dL (P = 0.046), respectively. These results show that systematic walking increases EEE and improves blood profiles.

Controlled comparison of retention and adherence in home- vs center-initiated exercise interventions in women ages 40-65 years: The S.W.E.A.T. Study (Sedentary Women Exercise Adherence Trial)

BACKGROUND

In an 18-month exercise intervention in previously sedentary older women (40-65 years), we examined whether an initial 6 months of supervised exercise leads to greater long-term retention and adherence to regular physical activity than an unsupervised home-based program and whether these outcomes are influenced by the exercise intensity.

METHODS

Women (N = 126) were recruited from the community and randomly assigned to either center-based or home-based exercise three times/week. The center-based group attended supervised sessions for 6 months, while after 10 initial sessions the home-based group exercised at home. After 6 months both groups were home-based for a further 12 months. Within each arm, subjects were further randomized to exercise at either moderate or vigorous intensity.

RESULTS

The center-based group had higher retention than the home-based (97, 94, 81 versus 87, 76, and 61%) at 6, 12, and 18 months, respectively (P < 0.05). At 6 months, adherence was higher in the center-based group (84 versus 63%, P < 0.001) and energy expenditure was higher at 6 (P < 0.05) and 12 (P < 0.01) months. At 18 months, retention was higher with moderate exercise (P < 0.05), while adherence was similar with both intensities.

CONCLUSION

An initial 6 months of center-based exercise enhanced retention in both the short and the long term and promoted short-term adherence and energy expenditure. Long-term, moderate exercise retained more subjects, but had little influence on adherence.

Blood lipid and lipoprotein adaptations to exercise: a quantitative analysis

Dose-response relationships between exercise training volume and blood lipid changes suggest that exercise can favourably alter blood lipids at low training volumes, although the effects may not be observable until certain exercise thresholds are met. The thresholds established from cross-sectional literature occur at training volumes of 24 to 32 km (15 to 20 miles) per week of brisk walking or jogging and elicit between 1200 to 2200 kcal/wk. This range of weekly energy expenditure is associated with 2 to 3 mg/dl increases in high-density lipoprotein-cholesterol (HDL-C) and triglyceride (TG) reductions of 8 to 20 mg/dl. Evidence from cross-sectional studies indicates that greater changes in HDL-C levels can be expected with additional increases in exercise training volume. HDL-C and TG changes are often observed after training regimens requiring energy expenditures similar to those characterised from cross-sectional data. Training programmes that elicit 1200 to 2200 kcal/wk in exercise are often effective at elevating HDL-C levels from 2 to 8 mg/dl, and lowering TG levels by 5 to 38 mg/dl. Exercise training seldom alters total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C). However, this range of weekly exercise energy expenditure is also associated with TC and LDL-C reductions when they are reported. The frequency and extent to which most of these lipid changes are reported are similar in both genders, with the exception of TG. Thus, for most individuals, the positive effects of regular exercise are exerted on blood lipids at low training volumes and accrue so that noticeable differences frequently occur with weekly energy expenditures of 1200 to 2200 kcal/wk. It appears that weekly exercise caloric expenditures that meet or exceed the higher end of this range are more likely to produce the desired lipid changes. This amount of physical activity, performed at moderate intensities, is reasonable and attainable for most individuals and is within the American College of Sports Medicine's currently recommended range for healthy adults.

Effects of long-term moderate exercise and increase in number of daily steps on serum lipids in women: randomised controlled trial [ISRCTN21921919]

BACKGROUND: This study was designed to evaluate the effects of a 24-month period of moderate exercise on serum lipids in menopausal women. METHODS: The subjects (40--60 y) were randomly divided into an exercise group (n = 14) and a control group (n = 13). The women in the exercise group were asked to participate in a 90-minute physical education class once a week and to record their daily steps as measured by a pedometer for 24 months. RESULTS: Mean of daily steps was significantly higher in the exercise group from about 6,800 to over 8,500 steps (P < 0.01). In the control group, the number of daily steps ranged from 5,700 to 6,800 steps throughout the follow-up period. A significant interaction between the exercise group and the control group in the changes og total cholesterol (TC), high-density lipoprotein cholesterol (HDLC) and TC : HDLC ratio could be observed (P < 0.05). By multiple regression analysis, the number of daily steps was related to HDLC and TC : HDLC levels after 24 months, and the changes in TC and HDLC concentrations. CONCLUSIONS: These results suggest that daily exercise as well as increasing the number of daily steps can improve the profile of serum lipids.

Long-term effects of exercise on blood pressure and lipids in healthy women aged 40-65 years: The Sedentary Women Exercise Adherence Trial (SWEAT)

OBJECTIVES

To evaluate the long-term effects of regular moderate or vigorous intensity exercise on blood pressure and blood lipids in previously sedentary older women.

DESIGN

Subjects were randomly assigned to either a supervised centre-based (CB) or a minimally supervised home-based (HB) exercise program, initially for 6 months. Within each program, subjects were further randomized to exercise either at moderate (40-55% heart rate reserve, HRres) or vigorous intensity (65-80% HRres). After 6 months, all groups continued a HB moderate or vigorous exercise program for another 12 months.

METHODS

Healthy, sedentary women (aged 40-65 years) (n = 126) were recruited from the community. Subjects exercised three times per week for 30 min. They were evaluated at baseline, 6, 12 and 18 months.

RESULTS

There was a significant fall of 2.81 mmHg in systolic blood pressure (P = 0.049) and 2.70 mmHg in diastolic blood pressure (P = 0.004) after correction for age and baseline values with moderate exercise, but not with vigorous-intensity exercise. When this analysis was repeated with the change in body mass included, the results were unchanged. After correction for potential confounding factors, there was a significant fall in total cholesterol and low density lipoprotein cholesterol with vigorous but not moderate exercise at 6 months (P < 0.05) but not at 18 months.

CONCLUSIONS

In this largely normotensive population of older women, a moderate, but not vigorous exercise program, achieved sustained falls in resting systolic and diastolic blood pressure over 18 months. The study demonstrates that, in older women, moderate intensity exercise is well accepted, sustainable long-term and has the health benefit of reduced blood pressure.

Dose-response: variation with age, sex, and health status

PURPOSE

The purpose of this study was to summarize the literature on the influence of age, sex, and health status on the changes in systolic (SBP) and diastolic blood pressure (DBP), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) consequent to exercise training.

METHODS

A MEDLINE search was performed from January 1966 through August 2000 to identify studies that have investigated the effects of age, sex, and health status on the changes in the outcome variables with exercise training. References from these studies and from review and meta-analysis studies were also reviewed.

RESULTS AND CONCLUSIONS

The results indicate that age has little or no influence on the changes in SBP, DBP, TG, and HDL-C in response to exercise training. When looking at sex, females appear to have an attenuated response to exercise training compared with males with respect to SBP, DBP, and HDL-C, but the data for TG are equivocal. Finally, there appears to be more favorable changes in resting SBP and DBP, TG, and HDL-C in unhealthy subjects (hypertensive and post-MI patients) when compared with healthy subjects.

Strength training in the elderly: effects on risk factors for age-related diseases

Strength training (ST) is considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure that is associated with advanced age. This reversal is thought to result in improvements in functional abilities and health status in the elderly by increasing muscle mass, strength and power and by increasing bone mineral density (BMD). In the past couple of decades, many studies have examined the effects of ST on risk factors for age-related diseases or disabilities. Collectively, these studies indicate that ST in the elderly: (i) is an effective intervention against sarcopenia because it produces substantial increases in the strength, mass, power and quality of skeletal muscle; (ii) can increase endurance performance; (iii) normalises blood pressure in those with high normal values; (iv) reduces insulin resistance; (v) decreases both total and intra-abdominal fat; (vi) increases resting metabolic rate in older men; (vii) prevents the loss of BMD with age; (viii) reduces risk factors for falls; and (ix) may reduce pain and improve function in those with osteoarthritis in the knee region. However, contrary to popular belief, ST does not increase maximal oxygen uptake beyond normal variations, improve lipoprotein or lipid profiles, or improve flexibility in the elderly.

Effects of exercise rehabilitation on cardiovascular risk factors in older patients with peripheral arterial occlusive disease

OBJECTIVE

The purpose of this study was to determine whether a 6-month exercise rehabilitation program can improve cardiovascular risk factors in patients with peripheral arterial occlusive disease (PAOD).

METHODS

Thirty-four patients (mean age, 68 +/- 8 years; range 54-84 years) with PAOD with intermittent claudication (Fontaine stage II) and 14 longitudinal controls of comparable age with stage II PAOD enrolled in an exercise intervention at the University Medical Center and Veterans Affairs Medical Center at Baltimore, Maryland. The main outcome measures were lipid profile (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol [LDL-C]), fasting glucose, blood pressure, body mass index, treadmill times to onset and maximal claudication pain, cardiopulmonary function (peak oxygen uptake), and ankle/brachial index.

RESULTS

With exercise rehabilitation, treadmill times to onset and maximal claudication pain increased by 106% and 64% (P <.0001), whereas peak oxygen uptake increased 7% (P <.05). Exercise rehabilitation lowered total cholesterol and LDL-C levels by 5.2% (P <.005) and 8% (P <.01), respectively. Systolic blood pressure declined by 5.7% (P <.05) with no change in diastolic blood pressure. These changes in cholesterol and LDL-C concentrations were related to their initial values. All other cardiovascular risk factors measured did not change. There was no correlation between improvement of cardiovascular risk factors and functional performance measurements. None of the variables measured changed significantly in the control group.

CONCLUSIONS

Exercise rehabilitation not only improves functional performance, but also results in favorable alterations in cardiovascular risk factor profile, which is an important element in the management of PAOD.

Exercise training and blood lipids in hyperlipidemic and normolipidemic adults: a meta-analysis of randomized, controlled trials

OBJECTIVE

To determine the effectiveness of exercise training (aerobic and resistance) in modifying blood lipids, and to determine the most effective training programme with regard to duration, intensity and frequency for optimizing the blood lipid profile.

DESIGN

Trials were identified by a systematic search of Medline, Embase, Science Citation Index (SCI), published reviews and the references of relevant trials. The inclusion criteria were limited to randomized, controlled trials of aerobic and resistance exercise training which were conducted over a minimum of four weeks and involved measurement of one or more of the following: total cholesterol (TC), high density lipoprotein (HIDL-C), low density lipoprotein (LDL-C) and triglycerides (TG).

SUBJECTS

A total of 31 trials ( 1833 hyperlipidemic and normolipidemic participants) were included.

RESULTS

Aerobic exercise training resulted in small but statistically significant decreases of 0.10 mmol/L (95% CI: 0.02, 0.18). 0.10 (95% CI: 0.02, 0.19), 0.08 mmol/L (95% CI: 0.02, 0.14), for TC, LDL-C, and TG, respectively, with an increase in HDL-C of 0.05 mmol/L (95% CI: 0.02, 0.08). Comparisons between the intensities of the aerobic exercise programmes produced inconsistent results; but more frequent exercise did not appear to result in greater improvements to the lipid profile than exercise three times per week. The evidence for the effect of resistance exercise training was inconclusive.

CONCLUSIONS

Caution is required when drawing firm conclusions from this study given the significant heterogeneity with comparisons. However, the results appear to indicate that aerobic exercise training produced small but favourable modifications to blood lipids in previously sedentary adults.

Effect of 14 weeks of resistance training on lipid profile and body fat percentage in premenopausal women

OBJECTIVES

To study the effects of a supervised, intensive (85% of one repetition maximum (1-RM)) 14 week resistance training programme on lipid profile and body fat percentage in healthy, sedentary, premenopausal women.

SUBJECTS

Twenty four women (mean (SD) age 27 (7) years) took part in the study. Subjects were randomly assigned to either a non-exercising control group or a resistance exercise training group. The resistance exercise training group took part in supervised 45-50 minute resistance training sessions (85% of 1-RM), three days a week on non-consecutive days for 14 weeks. The control group did not take part in any structured physical activity.

RESULTS

Two way analysis of variance with repeated measures showed significant (p < 0.05) increases in strength (1-RM) in the exercising group. There were significant (p < 0.05) decreases in total cholesterol (mean (SE) 4.68 (0.31) v 4.26 (0.23) mmol/1 (180 (12) v 164 (9) mg/dl)), low density lipoprotein (LDL) cholesterol (2.99 (0.29) v 2.57 (0.21) mmol/l (115 (11) v 99 (8) mg/dl), the total to high density lipoprotein (HDL) cholesterol ratio (4.2 (0.42) v 3.6 (0.42)), and body fat percentage (27.9 (2.09) v 26.5 (2.15)), as well as a strong trend towards a significant decrease in the LDL to HDL cholesterol ratio (p = 0.057) in the resistance exercise training group compared with their baseline values. No differences were seen in triglycerides and HDL cholesterol. No changes were found in any of the measured variables in the control group.

CONCLUSIONS

These findings suggest that resistance training has a favourable effect on lipid profile and body fat percentage in healthy, sedentary, premenopausal women.

Coronary heart disease risk factors in middle-aged former top-level athletes

A cross-sectional study was conducted to determine the impact of previous athleticism on coronary heart disease (CHD) risk factors in 168 middle-aged men and 147 middle-aged women in Estonia. Participants were divided into four groups: physically active ex-athletes (AA), sedentary ex-athletes (SA), recreational exercisers (RE), and non-exercisers (NE). The Sharkey's questionnaire was applied to determine the CHD risk factors, health habits, medical, safety, personal, psychological and women's risk factors scores. Anthropometric characteristics, resting systolic and diastolic blood pressure values (SBP, DBP), and physical working capacity (PWC170) were measured. Concentrations of total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), triacylglycerols (TG), and glucose were determined. Low-density lipoprotein cholesterol (LDL-C) and HDL-C/CHOL ratio were computed. From the questionnaire results, significant differences in CHD risk scores in both sex groups in favour of AA and RE were found. DBP in men was significantly higher in SA, and SBP in women was significantly higher in NE in comparison with other groups. PWC170 and PWC170/kg was highest in AA and lowest in NE in both sex groups. There were no significant differences for blood biochemical parameters between women's groups. In men, AA had a lower CHOL level in comparison with SA and NE, and lower concentrations of TG and LDL-C than other groups. AA and RE had a higher HDL-C concentration and HDL-C/CHOL ratio in comparison with the other groups. In conclusion, differences in CHD risk factors were related to current physical activity, and were more expressed in men than in women.

The effects of menopausal status and exercise training on serum lipids and the activities of intravascular enzymes related to lipid transport

The study purpose was to compare the effect of exercise training on serum lipid and apolipoprotein concentrations and the activities of intravascular enzymes related to lipid transport in previously untrained eumenorrheic, premenopausal (PRM) women (n = 21; mean age, 36 +/- 3 years) and estrogen-free postmenopausal (POM) women (n = 16; mean age, 68 +/- 8 years). Subjects trained at a progressive intensity and duration (50% to 75% maximal O2 consumption [VO2max], 200 to 300 kcal/session) 4 d/wk for 12 weeks. Before and after training, VO2max, body weight, relative body fat, and fasting blood samples were obtained following 2 weeks on a standardized diet designed to maintain body weight and during the early follicular stage for the PRM group. Blood samples were analyzed for serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), the cholesterol content of the HDL3 subfraction, apolipoprotein (apo)A-I and apoB, lipoprotein(a), and the activity of lecithin:cholesterol acyltransferase (LCAT). Total and hepatic triglyceride lipase activity (HTGLA) were determined from plasma samples obtained after heparin administration. The cholesterol content of the low-density lipoprotein (LDL) and HDL2 subfractions and endothelial-bound lipoprotein lipase activity (LPLA) were calculated. A two (group) x two (time) multivariate ANOVA (MANOVA), with repeated measures for time indicated that the exercise-induced changes in physiological measurements, serum lipid or apolipoprotein concentrations, or enzyme activities did not differ between groups. Serum concentrations of TC, LDL-C, and HDL3 cholesterol, TG, and apo A-I and apoB were higher in POM women compared with the PRM group (P < .05 for all). For the combined groups, body weight and relative body fat did not change with training, but VO2max increased an average of 18.5% (P < .05). LPLA, HTGLA, and LCAT activity were unaltered with exercise training. Except for a small but significant decrease in HDL-C (-5.5%) and an elevation in apoB (4.3%; P < .05 for both), the concentrations of serum lipids and apolipoproteins did not change over the training period. We conclude that in previously untrained women, menopausal status does not influence the exercise training response of serum lipids or apolipoproteins or activities of intravascular enzymes related to lipid transport.

Sequential effects of aerobic exercise training and weight loss on risk factors for coronary disease in healthy, obese middle-aged and older men

The relative benefits of weight loss (WL) versus aerobic exercise training (AEX) on cardiac risk factors in obese individuals remain controversial. In this study, we examined the effects of the sequential interventions of 9 months of AEX followed by weight loss with continued AEX (AEX + WL) on cardiac risk factors in 21 obese (body fat, 29.5% +/- 0.8%, mean +/- SEM) middle-aged and older men. AEX increased the maximal aerobic capacity ([VO2max] in liters per minute) of these men by 14% (P < .001), with no significant change in weight. AEX did not improve blood pressure (BP) or oral glucose tolerance, and had no significant effect on lipid concentrations. During the AEX + WL intervention, the 21 men lost 8.1 +/- 0.6 kg. Despite continued training, there was no further increase in VO2max during this intervention. Compared with AEX, AEX + WL decreased glucose and insulin responses during the oral glucose tolerance test (OGTT) by 8% (P < .05) and 30% (P < .01), respectively. AEX + WL reduced plasma triglyceride (TG) by 17% (P < .05) and low-density lipoprotein cholesterol (LDL-C) by 8% (P < .01) and increased high-density lipoprotein cholesterol (HDL-C) by 11% (3.7 mg/dL, P < .01). The sequential interventions resulted in a 20% decrease in the LDL-C/HDL-C ratio. The results demonstrate that AEX + WL had a more substantial impact than AEX alone on glucose tolerance and lipoprotein concentrations. Physicians should encourage obese patients to become physically active and lose weight to improve their cardiac risk factor profile.

High-density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners

BACKGROUND

Official guidelines from the Centers for Disease Control and Prevention assert that the majority of health benefits from physical activity are obtained by walking 2 miles (3.2 km) briskly most days of the week (the energy equivalent of running 8 to 12 km per week). The objective of our study was to examine the dose-response relation in women between risk factors for coronary heart disease, particularly the concentration of high-density lipoprotein (HDL) cholesterol, and vigorous exercise at levels that exceed the official guidelines.

METHODS

The number of kilometers run per week reported by 1837 female recreational runners in a national cross-sectional survey was compared with medical data provided by the women's physicians.

RESULTS

In these cross-sectional data, plasma HDL cholesterol concentrations were higher by an average (+/- SE) of 0.133 +/- 0.020 mg per deciliter (0.003 +/- 0.0005 mmol per liter) for every additional kilometer run per week, an amount nearly identical with that previously reported for men (0.136 +/- 0.006 mg per deciliter [0.004 +/- 0.0002 mmol per liter] per kilometer per week). Among women who ran less than 48 km per week, mean plasma HDL concentrations were significantly higher with each 16-km increment in distance. Women who ran more than 64 km per week had significantly higher mean concentrations of HDL cholesterol than did women who ran less than 48 km per week. They were also significantly more likely to have HDL cholesterol concentrations greater than 100, 90, or 80 mg per deciliter (2.6, 2.3, or 2.1 mmol per liter) than were women running less than 64 km per week. HDL cholesterol concentrations increased significantly in relation to the number of kilometers run per week in premenopausal women who were not using oral contraceptives and in postmenopausal women, whether they were receiving estrogen-replacement therapy or not.

CONCLUSIONS

Substantial increases in HDL cholesterol concentrations were found in women who exercised at levels exceeding current guidelines; higher HDL cholesterol concentrations could provide added health benefits to these women.

Effects of endurance exercise and hormone replacement therapy on serum lipids in older women

OBJECTIVE

To determine the effects of 11 months of exercise training and hormone replacement therapy (HRT), alone or in combination, on serum lipids and lipoproteins, in postmenopausal women.

DESIGN

Controlled, prospective, 11-month clinical trial. Healthy postmenopausal women (n = 71, age range 60-72 yrs) were assigned to four groups in a 2 X 2 design (control, exercise, HRT, exercise + HRT).

SETTING

Large, midwestern urban community; subjects were recruited from the community-at-large. The exercise program was conducted at a university exercise facility.

INTERVENTIONS

HRT consisted of conjugated estrogens at 0.625 mg/day and trimonthly medroxyprogesterone acetate 5 mg/day for 13 days. Exercise consisted of 2 months of low intensity exercise followed by 9 months of vigorous exercise for 45 min/day, 3 or more days/week, at 65-85% of maximal heart rate.

MEASUREMENTS

Maximal aerobic power (VO2max), resting blood pressure, body composition, serum lipids and lipoproteins, and dietary intake at baseline and after 11 months.

MAIN RESULTS

At the end of 11 months, subjects in the exercise group had decrease total cholesterol (TC; P < .01) and LDL-cholesterol (LDL-C; P < .05), but there was no change in HDL-cholesterol (HDL-C) or triglycerides. Women in the HRT group had decreased LDL-C (P < .001) and increased HDL-C (P < .01) and triglycerides (P < .01), but there was no change in TC. Exercise + HRT subjects had decreased TC (P < .05) and LDL-C (P < .001), and increased HDL-C (P < .001); exercise prevented the HRT-related increase in triglycerides.

CONCLUSIONS

Endurance exercise training and HRT have independent and complimentary effects on serum lipids profiles in healthy postmenopausal women. Such effects are likely to reduce the risk of cardiovascular morbidity in this population.

Failure of 40 weeks of brisk walking to alter blood lipids in normolipemic women

Sedentary, eumenorrheic women (N = 27) 22 to 40 years of age, with high baseline levels of plasma high-density lipoprotein cholesterol, were randomly assigned to a walking (n = 16) or a control group (n = 11). The training program involved treadmill walking 4.8 km (3.0 miles) four times a week for 40 weeks at a mean intensity of 72% maximal heart rate. Aerobic power (VO2max) was improved by 22%, but no training effect was observed in body composition variables or blood lipid/lipoprotein levels. Despite additional increments in exercise intensity over the final 20 weeks of training, most of the improvement in VO2max was observed over the first 20 weeks of the study. Exercising subjects' baseline levels of plasma HDL-C were found to be inversely associated with the change (delta) scores in the lipoprotein (r = -0.51, p < or = .05).

Effects of long-term exercise of moderate intensity on anthropometric values and serum lipids and lipoproteins

The influence of endurance training on serum lipids and lipoproteins was investigated in 20 sedentary males and 14 sedentary females. The total group was trained 3 to 4 times a week for 9 months. After 24 weeks all subjects ran a 15 km-race and after 36 weeks a half-marathon (21 km) race. Anthropometric values were determined before and after the training programme. Blood samples were drawn before the start of the training programme and, in order to avoid the measurement of acute effects, 5 days before both races. In the male group, median body weight and body mass were significantly decreased (p < 0.01) after nine months of training, while in the female group body weight and body mass index remained essentially unchanged. Percentage body fat, measured by skinfold thickness was significantly decreased in both groups at the end of the training programme. During the training period, median serum total cholesterol, low density lipid cholesterol and triacylglycerol concentrations decreased significantly (p < 0.01) in the male group, while in the female population the median serum lipid- and lipoprotein concentrations did not differ from pre-training values. The changes in serum lipids or lipoproteins did not correlate significantly with changes in body weight, body mass index or percentage body fat. Stepwise multiple regression showed that these changes were mostly dependent on initial concentrations in serum. Finally, no significant increase in median high density lipid cholesterol was observed in either the male or female group.(ABSTRACT TRUNCATED AT 250 WORDS)

Dyslipidemias and the secondary prevention of coronary heart disease

Dyslipidemias in patients with coronary heart disease confer a greater risk of ischemic cardiac events than comparable dyslipidemias in people free of disease. A major dyslipidemia can be diagnosed in more than 80% of patients with established premature coronary heart disease. These dyslipidemias constitute not only elevations of low-density lipoprotein cholesterol (hypercholesterolemia) but also indicate abnormalities in the metabolism of triglyceride-rich lipoproteins, high-density lipoproteins, and lipoprotein(a). Clinical trials have demonstrated that therapy to lower low-density lipoprotein levels can delay angiographic progression of coronary stenoses and reduce recurrent cardiac event rates. These clinical benefits from low-density lipoprotein cholesterol lowering may occur as early as 6 to 12 months after initiation of therapy. Intervention strategies for dyslipidemias are directed toward lowering the low-density lipoprotein cholesterol fraction to 90 to 100 mg/dl. This approach begins with dietary modification, weight loss, smoking cessation, and aerobic exercise. Patients with hypercholesterolemia refractory to nonpharmacologic intervention require lipid-lowering agents. The choice of lipid-lowering medications is influenced by concomitant abnormalities of lipoprotein metabolism, such as hypertriglyceridemia or hypoalphalipoproteinemia. Treatment of primary dyslipidemias other than hypercholesterolemia may be warranted in the presence of other cardiac risk factors; however, a broader spectrum of clinical trial data is needed to support or refute this contention.

Serum lipids, neuroendocrine, and cardiovascular responses to stress in men and women with mild hypertension

In this study, we examined the relation between serum lipid levels, gender, and cardiovascular and neuroendocrine stress reactivity in patients with mild hypertension. Ninety-nine individuals (62 men, 37 women) with mild hypertension performed four mental stress tasks: mental arithmetic, public speaking, cold stress, and a computer videogame. Cardiovascular reactivity scores were computed by subtracting the minimum resting blood pressure (BP) and heart rate (HR) values from the maximum values obtained during each task. Neuroendocrine reactivity was calculated as the change from epinephrine and norepinephrine values from mean rest to mean task. High and low reactors were identified on the basis of median splits of reactivity scores, averaged across all four stressors. High systolic blood pressure reactors had higher levels of total (TC), low-density lipoprotein cholesterol (LDL-C), and apo-B than did low reactors. High diastolic blood pressure reactors had lower levels of high-density lipoprotein cholesterol (HDL-C) and higher levels of LDL-C and apo-B than did low reactors. High HR reactors had higher apo-AI:apo-AII ratios than low reactors. Lipid levels were not different for high and low epinephrine and norepinephrine reactors. Although women were noted to have more favorable lipid profiles than men, both male and female hypertensive patients who were high reactors had less favorable lipid profiles than low reactors.

Physical activity and serum lipids and lipoproteins in elderly women

OBJECTIVE

The relationship between cardiorespiratory exercise and serum lipid and lipoprotein levels was studied in elderly women.

DESIGN

Randomized controlled experimental design with a follow up of 12 weeks; cross-sectional comparison at baseline.

SETTING

Community-living elders in university exercise facilities.

PARTICIPANTS

Thirty-two apparently healthy, sedentary elderly Caucasian women, 67 to 85 years of age. Ten highly conditioned elderly women, 65 to 84 years of age, who were active in endurance competitions and had been training for 11.2 +/- 1.2 years, were recruited at baseline for cross-sectional comparisons.

INTERVENTIONS

Sedentary subjects were randomized to either a walking or calisthenic group. Intervention groups exercised 30 to 40 minutes, 5 days a week for 12 weeks, with the walking group training at 60% heart rate reserve and the calisthenic group engaging in mild range-of-motion and flexibility movements that kept their heart rates close to resting levels.

MEASUREMENTS

Serum lipids and lipoproteins, maximal aerobic capacity (VO2 max), four skinfolds, and dietary intake at baseline and after 5 and 12 weeks.

RESULTS

When the highly conditioned group and combined group of sedentary subjects were compared at baseline, serum high-density lipoprotein cholesterol (HDL-C; 1.61 +/- 0.14 vs 1.27 +/- 0.05 mmol/L, respectively; P = 0.048) and triglycerides (1.29 +/- 0.15 vs 2.00 +/- 0.15, respectively; P = 0.002), but not total serum cholesterol (5.72 +/- 0.36 vs 5.72 +/- 0.19 mmol/L, respectively) and low-density lipoprotein cholesterol (LDL-C; 3.62 +/- 0.36 vs 3.72 +/- 0.18 mmol/L, respectively), were significantly different. Twelve weeks of moderate cardiorespiratory exercise improved the VO2max of the sedentary subjects 12.6% but did not result in any change in body weight, energy intake, dietary quality, or any of the serum lipids or lipoproteins.

CONCLUSION

Highly conditioned and lean elderly women, when compared with their sedentary counterparts, had higher HDL-C and lower triglycerides, but similar total serum cholesterol and LDL-C values. However, twelve weeks of moderate cardiorespiratory exercise were not associated with an improvement in serum lipid or lipoprotein profiles in previously sedentary elderly women.

Physical activity and its association with plasma lipids and lipoproteins in elderly women

The association of physical activity to plasma lipid and lipoprotein levels was examined cross-sectionally in 634 elderly, postmenopausal women whose mean age was 70.7 years. Leisure-time physical activity in kilocalories per week was assessed by the Paffenbarger Questionnaire, a composite index of sports/recreation, stair climbing, and walking. Subjects were categorized by tertile of kilocalories per week from total physical activity, number of flights of stairs climbed, and number of blocks walked. After adjustment for age, body mass index, education, and oral estrogen use, no significant differences were noted in total cholesterol, high-density-lipoprotein cholesterol (HDL-C), HDL2-C, HDL3-C, low-density-lipoprotein cholesterol (LDL-C), or triglycerides across tertile of total activity or number blocks walked. Total cholesterol was significantly different across tertile of number of flights of stairs climbed (P < 0.05), and only a borderline association was noted with LDL-C (P < 0.08). The study suggests that leisure-time physical activity, as measured by the Paffenbarger Questionnaire, is not associated with a favorable lipid profile in elderly, postmenopausal women. Failure to find an association may reflect the relatively small number of women who engaged in moderate- or high-intensity activity.

The effects of aerobic exercise on premenstrual symptoms in middle-aged women: a preliminary study

The effects of aerobic exercise and strength training on premenstrual symptoms were evaluated in 23 healthy premenopausal women. Premenstrual symptoms were assessed at baseline and following 3 months of exercise participation. Women who engaged in aerobic exercise significantly increased their aerobic capacity, while the women who participated in non-aerobic exercise did not. Results showed that while participation in both exercise conditions was associated with general improvement in many premenstrual symptoms, subjects in the aerobic exercise group improved on more symptoms, especially premenstrual depression.