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Integrating Regular Exergaming Sessions in the ExerCube into a School Setting Increases Physical Fitness in Elementary School Children: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11061570. [PMID: 35329896 PMCID: PMC8948983 DOI: 10.3390/jcm11061570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to investigate the effects of a school-based exergame intervention on anthropometric parameters and physical fitness. Fifty-eight students (10.4 ± 0.8 years; 48% girls) were randomized into an intervention (IG) and a control (CG) group. Both groups participated in regular physical education classes during the three-month intervention period. The IG additionally received a 20-minute exergame intervention twice per week. At baseline and following the intervention period, body mass index (BMI) and waist-to-height ratio (WHtR) were assessed. Furthermore, a sprint test (ST), a countermovement jump test (CMJ), and a shuttle run test (SRT) were performed. Due to prescribed quarantine measures, only 34 students (18 IG; 16 CG) were included in the final analysis. A significant group−time interaction was determined in CMJ performance (p < 0.001; η2 = 0.403), with a significant increase (+2.6 ± 2.4 cm; p < 0.001; η2 = 0.315) in the IG and a significant decrease (−2.0 ± 3.1 cm; p = 0.009; η2 = 0.190) in the CG. Furthermore, ST performance significantly improved in the IG (−0.03 ± 0.08 s; p = 0.012; η2 = 0.180) but not in the CG (0.13 ± 0.16 s; p = 0.460; η2 = 0.017), revealing significant interaction effects (p = 0.02; η2 = 0.157). Significant group−time interaction was observed for the SRT (p = 0.046; η2 = 0.122), with a significant increase (+87.8 ± 98.9 m; p = 0.028; η2 = 0.147) in the IG and no changes (−29.4 ± 219.7 m; p = 0.485; η2 = 0.016) in the CG. Concerning BMI (p = 0.157; η2 = 0.063) and WHtR (p = 0.063; η2 = 0.114), no significant interaction effects were detected. School-based exergaming is a suitable tool to influence students’ physical fitness positively.
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Königstein K, Büschges JC, Sarganas G, Krug S, Neuhauser H, Schmidt-Trucksäss A. Exercise and Carotid Properties in the Young-The KiGGS-2 Study. Front Cardiovasc Med 2022; 8:767025. [PMID: 35071349 PMCID: PMC8766972 DOI: 10.3389/fcvm.2021.767025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Carotid intima-media thickness (cIMT) and stiffness (cS) are predictive markers of early vascular aging and atherosclerotic risk. This study assessed, whether exercise has protective effects on carotid structure and function or on vascular risk in the young. Methods: Volume and change of exercise (recreational and organized sports participation) of German adolescents and young adults was assessed within the prospective population-study KiGGS at KiGGS-Wave-1 (2009-2012) and KiGGS-Wave-2 (2014-2017) using standardized self-reporting questionnaires. CIMT and cS were measured by real-time B-mode ultrasound sequences with semi-automated edge-detection and automatic electrocardiogram-gated quality control in 2,893 participants (14-28 years, 49.6% female). A cumulative index for atherosclerotic risk (CV-R) included z-scores of mean arterial pressure, triglycerides, total/HDL-cholesterol-ratio, body mass index, and HbA1c. Results: At KiGGS-Wave-2 cross-sectional CV-R but not cS and cIMT was lower in all exercise-groups compared to "no exercise" (B = -0.73, 95%-CI = -1.26 to 0.19, p = 0.008). Longitudinal volume of exercise was negatively associated with CV-R (B = -0.37, 95%-CI = -0.74 to 0.00, p = 0.048) but not with cS and cIMT. Cross-sectional relative risk of elevated CV-R but not cS and cIMT was lower in all exercise-groups compared to "no exercise" (RR = 0.80, 95%-CI = 0.66 to 0.98, p = 0.033). High exercise volumes were associated with lower relative risk of elevated CV-R (RR = 0.80, 95%-CI = 0.65-0.97, p = 0.021) and cS in tendency but not with cIMT. Conclusions: Increased levels of exercise are associated with a better cardiovascular risk profile in young individuals, but not with cS and cIMT. Our study confirms previous recommendations on exercise in this age group without demonstrating a clear benefit on surrogate markers of vascular health.
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Affiliation(s)
- Karsten Königstein
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Division Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Julia Charlotte Büschges
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Giselle Sarganas
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Susanne Krug
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Arno Schmidt-Trucksäss
- Division Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Ketelhut S, Röglin L, Kircher E, Martin-Niedecken A, Ketelhut R, Hottenrott K, Ketelhut K. The New Way to Exercise? Evaluating an Innovative Heart-rate-controlled Exergame. Int J Sports Med 2021; 43:77-82. [PMID: 34255326 DOI: 10.1055/a-1520-4742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exergames may offer novel opportunities to expand physical activity. Most games, however, only result in low to moderate-intensity activities that are too low to allow relevant physical adjustments. In the present study, the exercise intensity of a new, heart rate controlled, functional fitness game was assessed. 28 subjects (aged 24.8±3.8 yrs; 46% female; BMI 23.2±2.3 kg/m2) were enrolled in this study. VO2max and maximal heart rate (HRmax) were assessed during a maximal graded exercise test on a treadmill and compared with the oxygen consumption (VO2) and heart rate (HR) during a game in the ExerCube.In the ExerCube, the subjects reached a peak HR of 187.43±9.22 bpm, which corresponds to 96.57±3.64% of their HRmax. The mean HR throughout the game was 167.11±10.94 bpm, corresponding to 86.07±4.33% of HRmax. VO2peak reached 41.57±5.09 ml/kg/min during the game in the ExerCube, which corresponds to 84.75±7.52% of VO2max. The mean VO2 consumption during the game reached 32.39±4.04 ml/kg/min, which corresponds to 66.01±5.09% of VO2max. The ExerCube provides a form of vigorous physical exercise. Due to its playful, immersive, and motivating nature, the ExerCube seems to be a promising tool to facilitate physical activity.
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Affiliation(s)
- Sascha Ketelhut
- Institute of Sport Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lisa Röglin
- Institute of Sport Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva Kircher
- Internal Medicine, Charité Medical Faculty Berlin, Berlin, Germany
| | | | - Reinhard Ketelhut
- Internal Medicine, Charité Medical Faculty Berlin, Berlin, Germany.,Cardiology - Sports Medicine, Medical Center Berlin, Berlin, Germany
| | - Kuno Hottenrott
- Institute of Sport Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Kerstin Ketelhut
- Natural Sciences, MSB Medical School Berlin GmbH, Berlin, Germany
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Fernberg U, Fernström M, Hurtig-Wennlöf A. Higher Total Physical Activity is Associated with Lower Arterial Stiffness in Swedish, Young Adults: The Cross-Sectional Lifestyle, Biomarkers, and Atherosclerosis Study. Vasc Health Risk Manag 2021; 17:175-185. [PMID: 33953561 PMCID: PMC8092620 DOI: 10.2147/vhrm.s283211] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose Arterial stiffness describes the rigidity of the arterial walls and is associated with risk factors for cardiovascular disease (CVD). Arterial stiffness predicts future events and mortality, and the predictive value is stronger in younger versus older subjects. The aims of the present study were, firstly, to present data on physical activity (PA) and time spent sedentary, in the population of Swedish, young adults. Secondly, to explore the association between PA and arterial stiffness. Material and Methods Self-reported healthy, non-smoking, Swedish, young adults, 18–25 years old, participated in the cross-sectional Lifestyle, Biomarkers and Atherosclerosis (LBA) study. The daily PA was objectively measured with an accelerometer for 1 week. Of the 834 participants, 658 individuals had valid registrations. The arterial stiffness measures, pulse wave velocity (PWV) and augmentation index (AIx) were measured with applanation tonometry. Results Women were on overall more physically active than men, they spent 214 min/day in light PA (LPA) compared to men who spent 202 min/day. Women took significantly more steps per day than men, 7796 vs 7336 steps/day, and spent less time sedentary, 523 min/day, compared to men who spent 547 min/day sedentary. In total, 76% of the individuals spent on average at least 30 minutes per day in the recommended moderate and vigorous PA (MVPA). Lower arterial stiffness was associated with more MVPA and total PA in the total population. Conclusion We conclude that in this age group of young, self-reported healthy adults 18–25 years, it is important to highlight the health-enhancing possibilities of time spent in physical activity on the vascular function, measured as PWV and AIx. It is of high relevance in a public health perspective to expand preventive efforts beyond the high-risk groups and encourage young adults to be physically active.
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Affiliation(s)
- Ulrika Fernberg
- Cardiovascular Research Center, Faculty of Medicine and Health, Örebro University, Örebro, 70182, Sweden
| | - Maria Fernström
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, GIH, Stockholm, 11433, Sweden
| | - Anita Hurtig-Wennlöf
- Cardiovascular Research Center, Faculty of Medicine and Health, Örebro University, Örebro, 70182, Sweden.,The Biomedical Platform, Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, 55111, Sweden
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Morioka T, Mori K, Emoto M. Is Stiffness Parameter β Useful for the Evaluation of Atherosclerosis?~ Its Clinical Implications, Limitations, and Future Perspectives ~. J Atheroscler Thromb 2021; 28:435-453. [PMID: 33583910 PMCID: PMC8193788 DOI: 10.5551/jat.rv17047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis comprises two components, atherosis and sclerosis, characterized by morphological wall thickening and functional stiffening, respectively, of the arterial wall. In recent years, much interest has been directed to the role of functional changes in large arteries, i.e., increased stiffness or decreased elasticity, on the development of cardiovascular diseases. In fact, the clinical evaluation of arterial stiffness is increasingly performed in patients with cardiovascular risk factors. Local arterial stiffness is measured using an ultrasound technique implemented with an echo-tracking system at the common carotid and femoral arteries. Several indices of local arterial stiffness are obtained by ultrasound, among which stiffness parameter β is unique because it is the least affected by blood pressure at the time of measurement. Evidence from cross-sectional studies indicates that increased stiffness parameter β is associated with a number of cardiovascular risk factors, such as older age, smoking, insufficient physical activity, hypertension, obesity, metabolic syndrome, insulin resistance, type 2 diabetes, chronic kidney disease, and comorbid cardiovascular disease. Results from several prospective observational studies also suggest that carotid stiffness parameter β is a useful surrogate marker of cardiovascular events and/or mortality, although the results differ depending on the characteristics of the study subjects. Furthermore, several interventional studies have shown that carotid stiffness parameter β improved after lifestyle modification or drug treatment. In this review, we summarize the current evidence of stiffness parameter β of the carotid artery and discuss its clinical implications as a marker of vascular health or as a predictor of cardiovascular outcomes.
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Affiliation(s)
- Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
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7
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Chao HH, Liao YH, Chou CC. Influences of Recreational Tennis-Playing Exercise Time on Cardiometabolic Health Parameters in Healthy Elderly: The ExAMIN AGE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031255. [PMID: 33573269 PMCID: PMC7908508 DOI: 10.3390/ijerph18031255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Aging and chronic degeneration are the primary threats to cardiometabolic health in elderly populations. Regular appropriate exercise would benefit the advanced aging population. PURPOSE This study investigates whether the degree of weekly tennis participation exhibits differences in primary cardiometabolic parameters, including arterial stiffness, inflammation, and metabolic biomarkers in elderly tennis players. METHODS One hundred thirty-five long-term participants in elder tennis (>50 years old) were initially screened. Twenty-six eligible and voluntary subjects were divided into high tennis time group (HT) (14 ± 1.3 h/week) and low tennis time group (LT) (4.5 ± 0.7 h/week) by stratification analysis based on the amount of tennis playing activity time. The brachial-ankle pulse wave velocity (baPWV), blood pressure, ankle-brachial index (ABI), blood metabolic biomarkers, and insulin resistance were measured to compare the difference between HT and LT groups. RESULTS The baPWV was significantly lower in the HT group than that in the LT group (1283.92 ± 37.01 vs. 1403.69 ± 53.71 cm/s, p < 0.05). We also found that the HT insulin-resistant homeostasis model assessment (HOMA-IR) was significantly lower than that of LT (1.41 ± 0.11 vs. 2.27 ± 0.48 μIU/mL, p < 0.05). However, the blood lipid biomarkers (glucose, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride) were not statistical different between HT and LT groups (p > 0.05). CONCLUSION We demonstrated that under the condition of similar daily physical activity level, elderly with a higher time of tennis-playing (HT group) exhibited relatively lower arterial stiffness (lower PWV) and lower insulin resistance compared to those with lower time tennis-playing (LT).
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Affiliation(s)
- Hsiao-Han Chao
- Department of Athletics, National Taiwan University, Taipei 10617, Taiwan;
| | - Yi-Hung Liao
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
| | - Chun-Chung Chou
- Physical Education Office, National Taipei University of Technology, Taipei 10608, Taiwan
- Correspondence: ; Tel.: +886-2-27712171 (ext. 3332)
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Lona G, Hauser C, Köchli S, Infanger D, Endes K, Faude O, Hanssen H. Blood Pressure Increase and Microvascular Dysfunction Accelerate Arterial Stiffening in Children: Modulation by Physical Activity. Front Physiol 2020; 11:613003. [PMID: 33391029 PMCID: PMC7773656 DOI: 10.3389/fphys.2020.613003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background Atherosclerotic remodeling starts early in life and can accelerate in the presence of cardiovascular risk (CV) factors. Regular physical activity (PA) can mitigate development of large and small artery disease during lifespan. We aimed to investigate the association of changes in body mass index (BMI), blood pressure (BP), PA behavior and retinal microvascular diameters with large artery pulse wave velocity (PWV) in prepubertal children over 4 years. Methods The school-based prospective cohort study included 262 children initially aged 6–8 years, assessing the above CV risk factors and retinal vessels by standardized procedures at baseline (2014) and follow-up (2018). PWV was assessed by an oscillometric device at follow-up. Results Children with increased systolic BP over 4 years showed higher PWV at follow-up (β [95% CI] 0.006 [0.002 to 0.011] mmHg per unit, P = 0.002). In contrast, increased vigorous PA corresponded to a lower PWV at follow-up (β [95% CI] −0.009 [−0.018 to <0−0.001] 10 min/day per unit, P = 0.047). Progression of retinal arteriolar narrowing and venular widening were linked to a higher PWV after 4 years (β [95% CI] −0.014 [−0.023 to −0.004] 0.01 changes per unit, P = 0.003). Conclusion Increase in systolic BP and progression of microvascular dysfunction were associated with higher PWV after 4 years. Children with increasing levels of vigorous PA were found to have lower PWV at follow-up. Habitual vigorous PA has the potential to decelerate the process of early vascular aging in children and may thus help counteract CV disease development later in life. Clinical Trial Registration ClinicalTrials.gov, Identifier: NCT03085498.
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Affiliation(s)
- Giulia Lona
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Christoph Hauser
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabrina Köchli
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Denis Infanger
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Katharina Endes
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Oliver Faude
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
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9
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Ketelhut S, Kirchenberger T, Ketelhut RG. Hemodynamics in young athletes following high-intensity interval or moderate-intensity continuous training. J Sports Med Phys Fitness 2020; 60:1202-1208. [PMID: 32536111 DOI: 10.23736/s0022-4707.20.10814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The present study aimed to investigate the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on blood pressure (BP) and parameters of arterial stiffness in young athletes. METHODS Seventeen rowers (aged 15±1.3 years) were randomized into an intervention group (IG, N.=10) and the control group (CG, N.=7). During an 8-week intervention period, the IG completed a HIIT on the rowing ergometer twice-weekly (2×4×2 min at ≈95% of maximum heart rate [HR<inf>max</inf>], 60 s rest) in addition to the regular rowing training (3×/week MICT 70-90 min, ≈70% HR<inf>max</inf>). The CG completed the regular normal rowing training and, instead of the HIIT units, two additional MICT units (70-90 min, ≈70% HR<inf>max</inf>). Before and after the intervention period, hemodynamic parameters were recorded non-invasively in both groups. RESULTS After the intervention period, there was a significant decrease in peripheral systolic (P=0.01) and diastolic (P=0.05) BP, as well as in central systolic (P=0.05) and diastolic BP (P=0.03) in the IG. Furthermore, pulse wave velocity (PWV) (P=0.05) was significantly reduced. Analysis of intervention effects revealed significant between-group differences in central diastolic BP (P=0.05), in augmentation pressure (P=0.02), and in augmentation index (P=0.006) favoring IG. The CG showed no significant changes in the respected parameters throughout the intervention. CONCLUSIONS Already in adolescent athletes, a HIIT intervention has beneficial effects on peripheral and central BP as well as on PWV, augmentation pressure, and augmentation index.
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Affiliation(s)
- Sascha Ketelhut
- Institute of Sports Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany - .,Medical Center Berlin, Berlin, Germany -
| | - Timo Kirchenberger
- Medical Center Berlin, Berlin, Germany.,Charité-University Berlin, Berlin, Germany
| | - Reinhard G Ketelhut
- Medical Center Berlin, Berlin, Germany.,Charité-University Berlin, Berlin, Germany
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10
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Pulse Wave Velocity Is Associated with Increased Plasma oxLDL in Ageing but Not with FGF21 and Habitual Exercise. Antioxidants (Basel) 2020; 9:antiox9030221. [PMID: 32156043 PMCID: PMC7139299 DOI: 10.3390/antiox9030221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022] Open
Abstract
Fibroblast growth factor 21 (FGF21) and adiponectin increase the expression of genes involved in antioxidant pathways, but their roles in mediating oxidative stress and arterial stiffness with ageing and habitual exercise remain unknown. We explored the role of the FGF21-adiponectin axis in mediating oxidative stress and arterial stiffness with ageing and habitual exercise. Eighty age- and sex-matched healthy individuals were assigned to younger sedentary or active (18-36 years old, n = 20 each) and older sedentary or active (45-80 years old, n = 20 each) groups. Arterial stiffness was measured indirectly using pulse wave velocity (PWV). Fasted plasma concentrations of FGF21, adiponectin and oxidized low-density lipoprotein (oxLDL) were measured. PWV was 0.2-fold higher and oxLDL concentration was 25.6% higher (both p < 0.001) in older than younger adults, despite no difference in FGF21 concentration (p = 0.097) between age groups. PWV (p = 0.09) and oxLDL concentration (p = 0.275) did not differ between activity groups but FGF21 concentration was 9% lower in active than sedentary individuals (p = 0.011). Adiponectin concentration did not differ by age (p = 0.642) or exercise habits (p = 0.821). In conclusion, age, but not habitual exercise, was associated with higher oxidative stress and arterial stiffness. FGF21 and adiponectin did not differ between younger and older adults, meaning that it is unlikely that they mediate oxidative stress and arterial stiffness in healthy adults.
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11
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Chronic Standing Desk Use and Arterial Stiffness. J Phys Act Health 2019; 16:1022-1028. [DOI: 10.1123/jpah.2018-0668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/03/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022]
Abstract
Background: Sedentary activity and sitting for at least 10 hours per day can increase the risk for cardiovascular disease by more than 60%. Use of standing desks may decrease sedentary time and improve cardiovascular health. Acute standing lowers pulse wave velocity (PWV), but chronic effects remain unknown. The purpose of this study was to determine the effect of chronic standing desk use on arterial stiffness versus seated controls. Methods: A total of 48 adults participated in this study. Twenty-four participants qualified as seated desk users (age 41 [10] y, body mass index 25 [4] kg/m2) and 24 as standing desk users (age 45 [12] y, body mass index 25 [5] kg/m2). Arterial stiffness was assessed as PWV within the aorta, arm, and leg. Results: Carotid–femoral PWV (cfPWV) was not different between seated (6.6 [1.3] m/s) and standing (6.9 [1.3] m/s) groups (P = .47). Similarly, there were no differences in arm or leg PWV between groups (P = .13 and P = .66, respectively). A secondary analysis of traditional factors of age and aerobic fitness revealed significant differences in cfPWV in seated and standing desk participants. Age also significantly influenced cfPWV across conditions. Conclusions: Standing for >50% of a workday did not affect PWV. Consistent with previous research, fitness and age are important modulators of arterial stiffness.
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12
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Goeder D, Böhm B, Oberhoffer R, Müller J. Postexercise changes in peripheral and central blood pressure during a 24-hour ambulatory blood pressure monitoring in healthy young men. J Sports Med Phys Fitness 2019; 59:1593-1598. [PMID: 31610642 DOI: 10.23736/s0022-4707.19.09448-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Central systolic blood pressure (cSBP), a measure of arterial stiffness, determines the afterload of the heart and provides greater prognostic significance regarding cardiovascular outcomes than peripheral systolic blood pressure (pSBP). Physical exercise is associated with an acute hypotensive effect on pSBP, but the significance of exercise on cSBP is missing. This study investigates the effect of a single exercise bout on pSBP and cSBP during a 24-hour ambulatory blood pressure monitoring (ABPM). METHODS In 25 healthy male individuals (27.5±5.5 years) baseline pSBP and cSBP values were determined in a supine position using the oscillometric Mobil-O-Graph device. Afterward, they performed a maximum cardiopulmonary exercise test (CPET) on a bicycle ergometer. The 24-hour ABPM was launched 15 minutes after terminating CPET. RESULTS Significant dipping of cSBP was found compared to baseline values in the first (-6.8 [-9.9 to -3.7] mmHg; P<0.001) second (-7.4 [-10.6 to -4.2] mmHg; P<0.001) and third hour (-6.4 [-11.5 to -1.3]; P=0.016) after exercise. Afterwards, cSBP continuously increases but remains significant reduced to baseline in the third (-6.4 [-11.5 to -1.3] mmHg; P=0.016), and fifth hour (-4.3 [-8.2 to -0.4] mmHg; P=0.033). There were only significant changes in pSBP compared to baseline values after 10 hours till the night period. The dipping pattern in the night period was similar in pSBP and cSBP. CONCLUSIONS 24-h postexercise responses of pSBP and cSBP differs significantly. This suggests a different regulatory mechanism of exercise on the peripheral and central arteries that have further be elucidated.
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Affiliation(s)
- Daniel Goeder
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany -
| | - Birgit Böhm
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Renate Oberhoffer
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Jan Müller
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
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13
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Effect of Tai Chi on Cardiac and Static Pulmonary Function in Older Community-Dwelling Adults at Risk of Ischemic Stroke: A Randomized Controlled Trial. Chin J Integr Med 2018; 25:582-589. [DOI: 10.1007/s11655-018-3056-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 10/27/2022]
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14
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Hidalgo-Santamaria M, Bes-Rastrollo M, Martinez-Gonzalez MA, Moreno-Galarraga L, Ruiz-Canela M, Fernandez-Montero A. Physical Activity Intensity and Cardiovascular Disease Prevention-From the Seguimiento Universidad de Navarra Study. Am J Cardiol 2018; 122:1871-1878. [PMID: 30297266 DOI: 10.1016/j.amjcard.2018.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
The association between the intensity of physical activity and the incidence of cardiovascular diseases (CVD), irrespective of energy expenditure (EE), requires further study. Our objective is to examine this relationship using data from a large Spanish cohort. The Seguimiento Universidad de Navarra cohort is formed of university graduates recruited from March 1999 to October 2015. We included 18,737 adults free of CVD (mean age 38 years, 61% women), with a median follow-up of 10.3 years. We estimated the average intensity of leisure time physical activity (LTPA) using a validated questionnaire. We classified respondents into 3 groups: Inactive, <6 average metabolic equivalents (METs) and ≥6 average METs. We used Cox proportional hazards models adjusted by the EE in LTPA (MET-h/week) and other confounding factors, to examine this association. During 1,72,299 person-years of follow-up, we registered 127 cases of CVD (myocardial infarction, stroke, and death due to cardiovascular causes). The adjusted hazard ratio for CVD was 0.76 (95% CI 0.48 to 1.21) in the lower intensity group, and 0.31 (95% CI 0.12 to 0.79) in the higher intensity group, compared with the inactive, with a linear trend (p = 0.03). In conclusion, given the same level of EE, those respondents engaged in higher intensity LTPA, had a lower risk of CVD.
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15
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Association between Sports Participation in Early Life and Arterial Intima-Media Thickness among Adults. ACTA ACUST UNITED AC 2018; 54:medicina54050085. [PMID: 30428573 PMCID: PMC6262615 DOI: 10.3390/medicina54050085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 01/04/2023]
Abstract
Background: Early sports practice is associated with several health benefits during childhood and adolescence, moreover, recent evidence also suggests that sports during childhood and adolescence can produce some benefits during adulthood. However, the association between early sports practice and arterial thickness is not clear. Thus, our aim was analyze the association between sports participation in childhood and adolescence, carotid/femoral intima–media thickness, and blood flow index in adulthood. Material and Methods: Sample was composed of 107 adults (64 males) between 30 years and 50 years, which were recruited from different gyms and university staff from São Paulo State University. Participants were divided according to sports participation in early life (engaged in sports during childhood and adolescence (n = 52) and no engagement in sports during childhood and adolescence (n = 55)). Carotid and femoral intima–media thickness were measured through Doppler ultrasonography method. Carotid and femoral index were estimated from ultrasonography measures. As covariates, the following were adopted: chronological age, sex, body fat (through dual-energy x-ray absorptiometry), c-reactive protein, HOMA, alcohol consumption, tobacco smoking, mean arterial pressure and current physical activity (pedometer). General estimating equations were used, adopting p < 0.05. Results: In the adjusted analyses, early sports participation was associated with lower carotid intima–media index (early sports participation: 0.64 mm ± 0.14 mm vs. no early sports participation: 0.71 mm ± 0.21 mm; p = 0.011), but not associated with femoral intima–media thickness, carotid resistive index and femoral resistive index after the adjustment by potential confounders. Conclusions: Sports participation in childhood and adolescence was associated with a reduced carotid intima–media thickness, independently of relevant confounders.
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16
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Ahmadi-Abhari S, Sabia S, Shipley MJ, Kivimäki M, Singh-Manoux A, Tabak A, McEniery C, Wilkinson IB, Brunner EJ. Physical Activity, Sedentary Behavior, and Long-Term Changes in Aortic Stiffness: The Whitehall II Study. J Am Heart Assoc 2017; 6:JAHA.117.005974. [PMID: 28784651 PMCID: PMC5586440 DOI: 10.1161/jaha.117.005974] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical activity is associated with reduced cardiovascular disease risk, mainly through effects on atherosclerosis. Aortic stiffness may be an alternative mechanism. We examined whether patterns of physical activity and sedentary behavior are associated with rate of aortic stiffening. METHODS AND RESULTS Carotid-femoral pulse wave velocity (PWV) was measured twice using applanation tonometry at mean ages 65 (in 2008/2009) and 70 (in 2012/2013) years in the Whitehall-II study (N=5196). Physical activity was self-reported at PWV baseline (2008/2009) and twice before (in 1997/1999 and 2002/2003). Sedentary time was defined as sitting time watching television or at work/commute. Linear mixed models adjusted for metabolic and lifestyle risk factors were used to analyze PWV change. Mean (SD) PWV (m/s) was 8.4 (2.4) at baseline and 9.2 (2.7) at follow-up, representing a 5-year increase of 0.76 m/s (95% CI 0.69, 0.83). A smaller 5-year increase in PWV was observed for each additional hour/week spent in sports activity (-0.02 m/s [95% CI -0.03, -0.001]) or cycling (-0.02 m/s [-0.03, -0.008]). Walking, housework, gardening, or do-it-yourself activities were not significantly associated with aortic stiffening. Each additional hour/week spent sitting was associated with faster PWV progression in models adjusted for physical activity (0.007 m/s [95% CI 0.001, 0.013]). Increasing physical activity over time was associated with a smaller subsequent increase in PWV (-0.16 m/s [-0.32, -0.002]) compared with not changing activity levels. CONCLUSIONS Higher levels of moderate-to-vigorous physical activity and avoidance of sedentary behavior were each associated with a slower age-related progression of aortic stiffness independent of conventional vascular risk factors.
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Affiliation(s)
- Sara Ahmadi-Abhari
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Severine Sabia
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.,INSERM, Centre for Research in Epidemiology & Public Health, Hôpital Paul Brousse, Bâtiment, France
| | - Martin J Shipley
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mika Kivimäki
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Archana Singh-Manoux
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.,INSERM, Centre for Research in Epidemiology & Public Health, Hôpital Paul Brousse, Bâtiment, France
| | - Adam Tabak
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.,Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Carmel McEniery
- Clinical Pharmacology Unit, University of Cambridge, United Kingdom
| | - Ian B Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, United Kingdom
| | - Eric J Brunner
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Gerber M, Ludyga S, Mücke M, Colledge F, Brand S, Pühse U. Low vigorous physical activity is associated with increased adrenocortical reactivity to psychosocial stress in students with high stress perceptions. Psychoneuroendocrinology 2017; 80:104-113. [PMID: 28324699 DOI: 10.1016/j.psyneuen.2017.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/03/2017] [Accepted: 03/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The pathways by which physical activity impacts on participants' health are still not fully understood. The purpose of the present study was to go beyond existing research by combining methods from survey-based and experimental stress research, and by examining whether the potential of vigorous physical activity (VPA) to attenuate physiological and psychological stress responses is moderated by participants' subjective stress perception. METHODS The sample consisted of 42 undergraduate students (M=21.2±2.2 years, 52% women). Participants self-reported their stress and wore an accelerometer device for seven consecutive days. To examine differences in the adrenocortical, autonomic and psychological stress reactivity, salivary free cortisol, heart rate, state anxiety, mood and calmness were assessed prior to, during and after the Trier Social Stress Test (TSST). The cut-offs of the American College of Sports Medicine (ACSM) were used to distinguish between students below/above current VPA recommendations. RESULTS High levels of perceived stress combined with VPA levels below the ACSM's standards (<3×20min/week) were associated with an increased salivary cortisol response to the TSST (p<.05). No significant group differences existed for heart rate. However, students with high stress/low VPA experienced less favourable affect throughout the entire testing session (p<.05). CONCLUSIONS Our study suggests that VPA has a high stress-protective potential among undergraduate students with high stress levels. Our findings highlight that promoting VPA in young adults seems to be a promising strategy to increase physiological and psychological stress resilience.
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Affiliation(s)
- Markus Gerber
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland.
| | - Sebastian Ludyga
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Manuel Mücke
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Flora Colledge
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
| | - Serge Brand
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland; Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics of the University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, Sport Science Section, University of Basel, Basel, Switzerland
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Haapala EA, Lankhorst K, de Groot J, Zwinkels M, Verschuren O, Wittink H, Backx FJ, Visser-Meily A, Takken T. The associations of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness in youth with chronic diseases or physical disabilities. Eur J Prev Cardiol 2017; 24:1102-1111. [PMID: 28374647 PMCID: PMC5495431 DOI: 10.1177/2047487317702792] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The evidence on the associations of cardiorespiratory fitness, body adiposity and sports participation with arterial stiffness in children and adolescents with chronic diseases or physical disabilities is limited. Methods Altogether 140 children and adolescents with chronic diseases or physical disabilities participated in this cross-sectional study. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake by body weight or fat-free mass. Body adiposity was assessed using waist circumference, body mass index standard deviation score and body fat percentage. Sports participation was assessed by a questionnaire. Aortic pulse wave velocity and augmentation index were assessed by a non-invasive oscillometric tonometry device. Results Peak oxygen uptake/body weight (standardised regression coefficient β −0.222, 95% confidence interval (CI) −0.386 to −0.059, P = 0.002) and peak oxygen uptake/fat-free mass (β −0.173, 95% CI −0.329 to −0.017, P = 0.030) were inversely and waist circumference directly (β 0.245, 95% CI 0.093 to 0.414, P = 0.002) associated with aortic pulse wave velocity. However, the associations of the measures of cardiorespiratory fitness with aortic pulse wave velocity were attenuated after further adjustment for waist circumference. A higher waist circumference (β −0.215, 95% CI −0.381 to −0.049, P = 0.012) and a higher body mass index standard deviation score (β 0.218, 95% CI −0.382 to −0.054, P = 0.010) were related to lower augmentation index. Conclusions Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in children and adolescents with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist circumference.
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Affiliation(s)
- Eero A Haapala
- 1 Faculty of Sport and Health Sciences, University of Jyväskylä, Finland.,2 Institute of Biomedicine, University of Eastern Finland, Finland.,3 Child Development and Exercise Center, Wilhelmina Children's Hospital, the Netherlands
| | - Kristel Lankhorst
- 4 Research Group Lifestyle and Health, University of Applied Sciences, the Netherlands.,5 Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, the Netherlands
| | - Janke de Groot
- 3 Child Development and Exercise Center, Wilhelmina Children's Hospital, the Netherlands.,4 Research Group Lifestyle and Health, University of Applied Sciences, the Netherlands.,5 Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, the Netherlands
| | - Maremka Zwinkels
- 5 Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, the Netherlands.,6 Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Olaf Verschuren
- 5 Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, the Netherlands.,6 Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Harriet Wittink
- 4 Research Group Lifestyle and Health, University of Applied Sciences, the Netherlands
| | - Frank Jg Backx
- 7 Department of Rehabilitation, University Medical Center Utrecht, the Netherlands
| | - Anne Visser-Meily
- 6 Center of Excellence in Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, the Netherlands.,7 Department of Rehabilitation, University Medical Center Utrecht, the Netherlands
| | - Tim Takken
- 3 Child Development and Exercise Center, Wilhelmina Children's Hospital, the Netherlands.,5 Partner of Shared Utrecht Pediatric Exercise Research (SUPER) Lab, the Netherlands
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Baykara M, Demirel A, Yavuzatmaca İ, Bilgen M. Response of Arterial Stiffness Four Weeks After Terminating Short-term Aerobic Exercise Training in a Sedentary Lifestyle. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:353-359. [PMID: 28039898 DOI: 10.7863/ultra.15.12043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the response of arterial stiffness in individuals with a sedentary lifestyle at 4 weeks after terminating a 2-week aerobic exercise session. METHODS Arterial stiffness was evaluated in 38 participants before starting and after completing a prescribed aerobic exercise program and also at 4 weeks after returning back to their sedentary lifestyle. Parameters regarding arterial compliance, distensibility, wall stress, and the elastic modulus were estimated from the information gained from sonography on the dimensions of carotid and femoral arteries and a sphygmomanometer on the pulse pressure. RESULTS Primary outcomes included whether short-term aerobic exercise reduced the heart rate, arterial pressure, and intima-media thickness and improved vascular biomechanics in physically inactive but otherwise healthy individuals. The benefits gained in arterial compliance and distensibility deteriorated with termination of exercise, but diastolic wall stress and the elastic modulus improved further. CONCLUSIONS In individuals with sedentary lifestyles, short-term aerobic exercise has strong four-week residual benefits on diastolic wall stress and the elastic modulus, but the effects appear to be negligible on arterial stiffness and distensibility.
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Affiliation(s)
- Murat Baykara
- Department of Radiology, Kahramanmaraş Sütçü İmam University, Faculty of Medicine, Kahramanmaraş, Turkey
| | - Adnan Demirel
- Departments of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University, Faculty of Medicine, Kahramanmaraş, Turkey
| | - İhsan Yavuzatmaca
- Department of Radiology, Kahramanmaraş Sütçü İmam University, Faculty of Medicine, Kahramanmaraş, Turkey
| | - Mehmet Bilgen
- Department of Biophysics, Adnan Menderes University, Faculty of Medicine, Aydın, Turkey
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Gaye B, Mustafic H, Laurent S, Perier MC, Thomas F, Guibout C, Tafflet M, Pannier B, Boutouyrie P, Jouven X, Empana JP. Ideal Cardiovascular Health and Subclinical Markers of Carotid Structure and Function: The Paris Prospective Study III. Arterioscler Thromb Vasc Biol 2016; 36:2115-24. [PMID: 27585698 DOI: 10.1161/atvbaha.116.307920] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/19/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We hypothesized that subclinical markers of vascular structure and function, which are independent predictors of cardiovascular disease, would be less frequent in subjects with ideal than poor cardiovascular health (CVH) as defined by the American Heart Association (AHA). APPROACH AND RESULTS Carotid parameters were measured using high-precision echotracking device in 9155 nonreferred participants attending a health checkup in a large health center in Paris (France) between 2008 and 2012. According to the AHA, participants with 0 to 2, 3 to 4, and 5 to 7 metrics (smoking, physical activity, body mass index, diet, blood glucose and total cholesterol, blood pressure) at the ideal level were categorized as having poor, intermediate, and ideal CVH. Carotid parameters were dichotomized according to their median value, and multivariable logistic regression analysis was performed. Mean age was 59.5 (SD 6.3) years; 39% were females, and ideal CVH was present in 10.11% of the study participants. After adjustment for age, sex, education, and living alone and compared with a poor CVH, an ideal CVH was associated with lower common carotid artery intima-media thickness (odds ratio=1.64; 95% confidence interval 1.40, 1.93), absence of carotid plaques (odds ratio=2.14; 95% confidence interval 1.60, 2.87), lower Young's elastic modulus (odds ratio=2.43; 95% confidence interval 2.07, 2.84), and higher carotid distensibility coefficient (odds ratio=2.90; 95% confidence interval 2.47, 3.41). CONCLUSIONS In community subjects aged 50 to 75 years, ideal CVH was associated with substantially less arterial stiffness and thickness. These associations might contribute to the lower risk of cardiovascular diseases in subjects with ideal CVH.
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Affiliation(s)
- Bamba Gaye
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.).
| | - Hazrije Mustafic
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Stéphane Laurent
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Marie-Cécile Perier
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Frédérique Thomas
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Catherine Guibout
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Muriel Tafflet
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Bruno Pannier
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Pierre Boutouyrie
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Xavier Jouven
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
| | - Jean-Philippe Empana
- From the INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, France (B.G., S.L., M.C.P., C.G., M.T., P.B., X.J., J.P.E.); APHP, Georges Pompidou European Hospital, Pharmacology Departments, Paris, France (S.L., P.B.); Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.); APHP, Georges Pompidou European Hospital, Cardiology Department, Paris, France (X.J.); and Department of Cardiology, University Hospital of Geneva, Switzerland (H.M.)
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21
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Aasa U, Lundell S, Barnekow-Bergkvist M, Jansson E, Westerståhl M. The Swedish physical activity and fitness cohort born in 1958 - dropout analysis and overview at 36-year follow-up. Scand J Med Sci Sports 2016; 27:418-429. [DOI: 10.1111/sms.12665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- U. Aasa
- Department of Community Medicine and Rehabilitation; Umeå University; Umeå Sweden
| | - S. Lundell
- Department of Community Medicine and Rehabilitation; Umeå University; Umeå Sweden
| | | | - E. Jansson
- Department of Laboratory Medicine; Clinical Physiology Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital; SE-141 86 Stockholm Sweden
| | - M. Westerståhl
- Department of Laboratory Medicine; Clinical Physiology Karolinska Institutet, and Unit of Clinical Physiology, Karolinska University Hospital; SE-141 86 Stockholm Sweden
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22
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Hespanhol LC, Barboza SD, van Mechelen W, Verhagen E. Measuring sports injuries on the pitch: a guide to use in practice. Braz J Phys Ther 2015; 19:369-80. [PMID: 26537807 PMCID: PMC4647148 DOI: 10.1590/bjpt-rbf.2014.0110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/12/2015] [Accepted: 05/25/2015] [Indexed: 12/22/2022] Open
Abstract
Sports participation is a major ally for the promotion of physical activity. However, sports injuries are important adverse effects of sports participation and should be monitored in sports populations. The purpose of this paper is to review the basic concepts of injury monitoring and discuss the implementation of these concepts in practice. The aspects discussed are: (1) sports injury definition; (2) classification of sports injuries; (3) population at risk, prevalence, and incidence; (4) severity measures; (5) economic costs; (6) systems developed to monitor sports injuries; and (7) online technology. Only with reliable monitoring systems applied in a continuous and long-term manner will it be possible to identify the burden of injuries, to identify the possible cases at an early stage, to implement early interventions, and to generate data for sports injury prevention. The implementation of sports injuries monitoring systems in practice is strongly recommended.
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Affiliation(s)
- Luiz C. Hespanhol
- Department of Public & Occupational Health, EMGO+ Institute for
Health and Care Research, VU University Medical Center, Amsterdam, The
Netherlands
| | - Saulo D. Barboza
- Department of Public & Occupational Health, EMGO+ Institute for
Health and Care Research, VU University Medical Center, Amsterdam, The
Netherlands
| | - Willem van Mechelen
- Department of Public & Occupational Health, EMGO+ Institute for
Health and Care Research, VU University Medical Center, Amsterdam, The
Netherlands
| | - Evert Verhagen
- Department of Public & Occupational Health, EMGO+ Institute for
Health and Care Research, VU University Medical Center, Amsterdam, The
Netherlands
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23
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Doumas M, Faselis C, Kokkinos P. Exaggerated Blood Pressure Response to Exercise: Will It Ever Be Ready for Prime Time? J Clin Hypertens (Greenwich) 2015; 17:845-7. [PMID: 26234157 DOI: 10.1111/jch.12630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Doumas
- Department of Veterans Affairs and George Washington University, Washington, DC
| | - Charles Faselis
- Department of Veterans Affairs and George Washington University, Washington, DC
| | - Peter Kokkinos
- Department of Veterans Affairs and George Washington University, Washington, DC
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24
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Endes S, Schaffner E, Caviezel S, Dratva J, Autenrieth CS, Wanner M, Martin B, Stolz D, Pons M, Turk A, Bettschart R, Schindler C, Künzli N, Probst-Hensch N, Schmidt-Trucksäss A. Physical activity is associated with lower arterial stiffness in older adults: results of the SAPALDIA 3 Cohort Study. Eur J Epidemiol 2015. [PMID: 26220521 DOI: 10.1007/s10654-015-0076-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Associations of physical activity (PA) intensity with arterial stiffness in older adults at the population level are insufficiently studied. We examined cross-sectional associations of self-reported PA intensities with arterial stiffness in elderly Caucasians of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults. Mixed central and peripheral arterial stiffness was measured oscillometrically by the cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). The self-reported International Physical Activity Questionnaire long version was administered to classify each subject's PA level. We used univariable and multivariable mixed linear and logistic regression models for analyses in 1908 persons aged 50 years and older. After adjustment for several confounders moderate, vigorous and total PA were inversely associated with CAVI (p = 0.02-0.03). BaPWV showed negative and marginally significant associations with vigorous and moderate PA (each p = 0.06), but not with total PA (p = 0.28). Increased arterial stiffness (CAVI ≥ 9, upper tertile) was inversely and significantly associated with vigorous PA [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.48-0.88], and marginally significantly with total PA (OR 0.76, 95% CI 0.57-1.02) and moderate PA (OR 0.75, 95% CI 0.56-1.01). The odds ratio for baPWV ≥ 14.4 was 0.67 (95% CI 0.48-0.93) across the vigorous PA levels, and was non-significant across the total (OR 0.91, 95% CI 0.66-1.23) and moderate PA levels (OR 0.94, 95% CI 0.69-1.28). In this general Caucasian population of older adults higher levels especially of vigorous PA were associated with lower arterial stiffness. These data support the importance of PA for improving cardiovascular health in elderly people.
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Affiliation(s)
- Simon Endes
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland.
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Seraina Caviezel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Dratva
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Miriam Wanner
- Physical Activity and Health Working Unit, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Brian Martin
- Physical Activity and Health Working Unit, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Daiana Stolz
- Clinic of Pneumology and Respiratory Cell Research, University Hospital, Basel, Switzerland
| | - Marco Pons
- Division of Pulmonary Medicine, Regional Hospital Lugano, Lugano, Switzerland
| | - Alexander Turk
- Zürcher Höhenklinik, Wald-Faltigberg, Faltigberg-Wald, Switzerland
| | | | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Birsstrasse 320B, 4052, Basel, Switzerland
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25
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Caviezel S, Dratva J, Schaffner E, Schindler C, Endes S, Autenrieth CS, Wanner M, Martin B, de Groot E, Gaspoz JM, Künzli N, Probst-Hensch N, Schmidt-Trucksäss A. Carotid Stiffness and Physical Activity in Elderly--A Short Report of the SAPALDIA 3 Cohort Study. PLoS One 2015; 10:e0128991. [PMID: 26035590 PMCID: PMC4452761 DOI: 10.1371/journal.pone.0128991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/04/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction Regular physical activity has been shown to reduce cardiovascular disease risk in the general population. While smaller studies in specified groups (highly trained versus untrained individuals) indicate a certain dose-dependent effect of physical activity on the reduction of carotid stiffness (an indicator of subclinical vascular disease), it is unclear whether this association is present in a representative sample. Thus, we investigated this question cross-sectionally in participants from the population-based Swiss Cohort Study on Air Pollution And Lung and Heart Diseases In Adults (SAPALDIA). Methods Self-reported total, moderate and vigorous physical activity and distensibility as a measure of local arterial stiffness among 1636 participants aged 50 to 81 years without clinically manifest diseases were evaluated. Mixed regression models were used to examine associations of physical activity intensity with distensibility. Results Vigorous physical activity, but not total nor moderate physical activity, was significantly associated with increased distensibility (= reduced carotid stiffness) in univariate analyses (percent change in the geometric mean and 95% confidence interval per 1 standard deviation increment in vigorous physical activity = 2.54 (0.69; 4.43), p<0.01; in total physical activity = 1.62 (-0.22; 3.50), p = 0.08; in moderate physical activity = 0.70 (-1.12; 2.56), p = 0.45). These associations disappeared when we additionally adjusted for age. Conclusion After adjustment for the most important confounders and risk factors, we found no evidence for an association of physical activity with carotid stiffness in the general middle aged to elderly population.
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Affiliation(s)
- Seraina Caviezel
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Dratva
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Simon Endes
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Basel, Switzerland
| | - Christine S. Autenrieth
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Miriam Wanner
- Institute of Social and Preventive Medicine, Physical Activity and Health Unit, University of Zurich, Zurich, Switzerland
| | - Brian Martin
- Institute of Social and Preventive Medicine, Physical Activity and Health Unit, University of Zurich, Zurich, Switzerland
| | - Eric de Groot
- Imagelabonline, Science Centre, Amsterdam, The Netherlands
| | - Jean-Michel Gaspoz
- Department of Community Medicine and Primary Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Basel, Switzerland
- * E-mail:
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26
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Müller J, Wilms M, Oberhoffer R. Acute effects of submaximal endurance training on arterial stiffness in healthy middle- and long-distance runners. J Clin Hypertens (Greenwich) 2015; 17:371-4. [PMID: 25782686 PMCID: PMC8031483 DOI: 10.1111/jch.12530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/27/2022]
Abstract
Measures of arterial stiffness are indicators for cardiovascular health and predictors of cardiovascular events. Arterial stiffness is responsive to acute physiologic stressors such as exercise. However, the acute effects of intensive exercise and recovery on arterial stiffness are controversial. Thirty-seven healthy middle- and long-distance runners (33 men, mean age 26.5±6.6 years) underwent evaluation of their cardiovascular stiffness at rest, after a 15-minute warm-up, immediately after vigorous running 3 km at the pace of their 10-km personal best, and finally 30 minutes after terminating their workout. Peripheral and central systolic blood pressure, as well as augmentation index and pulse wave velocity (PWV), increased during exercise in comparison to baseline (P<.001, general linear model). Thirty minutes after terminating the workout, a drop in peripheral blood pressure (P<.001), central blood pressure (P<.001), and PWV (P=.001) below baseline was observed. Therefore, the authors found that exercise of either moderate or vigorous intensity causes a temporary increase in arterial stiffness in middle- and long-distance runners.
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Affiliation(s)
- Jan Müller
- Institute of Preventive PediatricsTechnische Universität MünchenMünchenGermany
| | - Michael Wilms
- Institute of Preventive PediatricsTechnische Universität MünchenMünchenGermany
| | - Renate Oberhoffer
- Institute of Preventive PediatricsTechnische Universität MünchenMünchenGermany
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27
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Gkaliagkousi E, Gavriilaki E, Douma S. Effects of acute and chronic exercise in patients with essential hypertension: benefits and risks. Am J Hypertens 2015; 28:429-39. [PMID: 25362114 DOI: 10.1093/ajh/hpu203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The importance of regular physical activity in essential hypertension has been extensively investigated over the last decades and has emerged as a major modifiable factor contributing to optimal blood pressure control. Aerobic exercise exerts its beneficial effects on the cardiovascular system by promoting traditional cardiovascular risk factor regulation, as well as by favorably regulating sympathetic nervous system (SNS) activity, molecular effects, cardiac, and vascular function. Benefits of resistance exercise need further validation. On the other hand, acute exercise is now an established trigger of acute cardiac events. A number of possible pathophysiological links have been proposed, including SNS, vascular function, coagulation, fibrinolysis, and platelet function. In order to fully interpret this knowledge into clinical practice, we need to better understand the role of exercise intensity and duration in this pathophysiological cascade and in special populations. Further studies in hypertensive patients are also warranted in order to clarify the possibly favorable effect of antihypertensive treatment on exercise-induced effects.
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Affiliation(s)
- Eugenia Gkaliagkousi
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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28
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Vigorous physical activity and carotid distensibility in young and mid-aged adults. Hypertens Res 2015; 38:355-60. [PMID: 25693850 DOI: 10.1038/hr.2015.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 12/09/2014] [Accepted: 12/12/2014] [Indexed: 11/09/2022]
Abstract
Although physical activity (PA) improves arterial distensibility, it is unclear which type of activity is most beneficial. We aimed to examine the association of different types of PA with carotid distensibility (CD) and the mechanisms involved. Data included 4503 Australians and Finns aged 26-45 years. Physical activity was measured by pedometers and was self-reported. CD was measured using ultrasound. Other measurements included resting heart rate (RHR), cardiorespiratory fitness (CRF), blood pressure, biomarkers and anthropometry. Steps/day were correlated with RHR (Australian men r = -0.10, women r = - 0.14; Finnish men r = -0.15, women r = -0.11; P<0.01), CRF and biochemical markers, but not with CD. Self-reported vigorous leisure-time activity was more strongly correlated with RHR (Australian men r = -0.23, women r = -0.19; Finnish men r = -0.20, women r = -0.13; P < 0.001) and CRF, and was correlated with CD (Australian men r = 0.07; Finnish men r = 0.07, women r = 0.08; P < 0.05). This relationship of vigorous leisure-time activity with CD was mediated by RHR independently of potential confounders. In summary, vigorous leisure-time PA but not total or less intensive PA was associated with arterial distensibility in young to mid-aged adults. Promotion of vigorous PA is therefore recommended among this population. RHR was a key intermediary factor explaining the relationship between vigorous PA and arterial distensibility.
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29
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Hanssen H, Nussbaumer M, Moor C, Cordes M, Schindler C, Schmidt-Trucksäss A. Acute effects of interval versus continuous endurance training on pulse wave reflection in healthy young men. Atherosclerosis 2014; 238:399-406. [PMID: 25558034 DOI: 10.1016/j.atherosclerosis.2014.12.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 12/04/2014] [Accepted: 12/21/2014] [Indexed: 12/17/2022]
Abstract
AIM Our aim was to investigate the acute and 24-hour (h) effects of high-intensity interval training (HIIT) and moderate continuous training (MCT) on arterial pulse wave reflection, an established marker of arterial stiffness and cardiovascular risk. METHODS In a randomized cross-over design, 21 young healthy male participants performed a HIIT or a MCT on separate visits. Before and 5 (t5), 20 (t20), 35 (t35), and 50 (t50) minutes after the acute exercise bouts, the crude augmentation index (AIx) and the AIx at a set heart rate (AIx@75) were analysed by applanation tonometry. Starting 1 h post-exercise, both indices were captured over 24-h with an oscillometric monitoring device. RESULTS AIx did not change significantly after MCT but declined progressively after HIIT, reaching significantly lower values compared to MCT at t35 (P = 0.045) and t50 (P = 0.008). AIx@75 increased after both acute exercise types but was higher after HIIT at t5 (P < 0.001), t20 (P < 0.001) and t35 (P = 0.009) compared to MCT. The 24-h follow-up revealed a significant decline in AIx@75 after HIIT (P = 0.007) but not after MCT (P = 0.813). CONCLUSIONS Exercise intensity affects pulse wave reflection, with different time courses for AIx and AIx@75 post-exercise. Although initially higher after HIIT, AIx@75 declines in the 24-h recovery period indicating more favourable effects on pulse wave reflection compared to MCT. This may result in substantial positive chronic training effects on arterial stiffness in health and cardiovascular disease.
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Affiliation(s)
- Henner Hanssen
- Division of Sports and Exercise Medicine, Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Switzerland.
| | - Monique Nussbaumer
- Division of Sports and Exercise Medicine, Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Switzerland
| | - Christoph Moor
- Division of Sports and Exercise Medicine, Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Switzerland
| | - Mareike Cordes
- Division of Sports and Exercise Medicine, Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sports, Exercise and Health, Medical Faculty, University of Basel, Switzerland
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30
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Nishiwaki M, Kurobe K, Kiuchi A, Nakamura T, Matsumoto N. Sex differences in flexibility-arterial stiffness relationship and its application for diagnosis of arterial stiffening: a cross-sectional observational study. PLoS One 2014; 9:e113646. [PMID: 25427157 PMCID: PMC4245207 DOI: 10.1371/journal.pone.0113646] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/27/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Arterial stiffness might be related to trunk flexibility in middle-aged and older participants, but it is also affected by age, sex, and blood pressure. This cross-sectional observational study investigated whether trunk flexibility is related to arterial stiffness after considering the major confounding factors of age, sex, and blood pressure. We further investigated whether a simple diagnostic test of flexibility could be helpful to screen for increased arterial stiffening. METHODS According to age and sex, we assigned 1150 adults (male, n = 536; female, n = 614; age, 18-89 y) to groups with either high- or poor-flexibility based on the sit-and-reach test. Arterial stiffness was assessed by cardio-ankle vascular index. RESULTS In all categories of men and in older women, arterial stiffness was higher in poor-flexibility than in high-flexibility (P<0.05). This difference remained significant after normalizing arterial stiffness for confounding factors such as blood pressure, but it was not found among young and middle-aged women. Stepwise multiple-regression analysis also supported the notion of the sex differences in flexibility-arterial stiffness relationship. Receiver operating characteristic curve analysis revealed that cut-off values for sit-and-reach among men and women were 33.2 (area under the curve [AUC], 0.711; 95% confidence interval [CI], 0.666-0.756; sensitivity, 61.7%; specificity, 69.7%) and 39.2 (AUC, 0.639; 95% CI, 0.592-0.686; sensitivity, 61.1%; specificity, 62.0%) cm, respectively. CONCLUSION Our results indicate that flexibility-arterial stiffness relationship is not affected by BP, which is a major confounding factor. In addition, sex differences are observed in this relationship; poor trunk flexibility increases arterial stiffness in young, middle-aged, and older men, whereas the relationship in women is found only in the elderly. Also, the sit-and-reach test can offer a simple method of predicting arterial stiffness at home or elsewhere.
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Affiliation(s)
- Masato Nishiwaki
- Faculty of Engineering, Osaka Institute of Technology, Osaka, Japan
| | - Kazumichi Kurobe
- Faculty of Business, Sports Management Course, Hannan University, Osaka, Japan
| | - Atsushi Kiuchi
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Naoyuki Matsumoto
- Faculty of Environmental Symbiotic Sciences, Prefectural University of Kumamoto, Kumamoto, Japan
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31
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Affiliation(s)
- Peter Kokkinos
- From the Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Department of Cardiology, Georgetown University School of Medicine, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC; and Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
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32
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Lima MCS, Barbosa MF, Diniz TA, Codogno JS, Freitas Júnior IF, Fernandes RA. Early and current physical activity: relationship with intima-media thickness and metabolic variables in adulthood. Braz J Phys Ther 2014; 18:462-9. [PMID: 25372009 PMCID: PMC4228632 DOI: 10.1590/bjpt-rbf.2014.0040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/25/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND It is unclear whether early physical activity has a greater influence on intima-media thickness and metabolic variables than current physical activity. OBJECTIVE To analyze the relationship between current and early physical activity, metabolic variables, and intima-media thickness measures in adults. METHOD The sample was composed of 55 healthy subjects of both sexes (33 men and 22 women). Total body fat and trunk fat were estimated by dual-energy X-ray absorptiometry. Carotid and femoral intima-media thickness were measured using a Doppler ultrasound device. A 12-hour fasting blood sample collection was taken (fasting glucose and lipid profile). Early physical activity was assessed through face-to-face interview, and the current physical activity was assessed by pedometer (Digi-Walker Yamax, SW200), which was used for a period of seven days. RESULTS Current physical activity was negatively related to total cholesterol (rho=-0.31), while early physical activity was negatively related to triglycerides (rho=-0.42), total cholesterol (rho=-0.28), very low density lipoprotein (rho=-0.44), and carotid intima-media thickness (rho=-0.50). In the multivariate model, subjects engaged in sports activities during early life had lower values of very low density lipoprotein (b=-8.74 [b95%CI=-16.1; -1.47]) and carotid intima-media thickness (b=-0.17 [95%CI: -0.28; -0.05]). CONCLUSION Early 95%CI physical activity has a significant influence on carotid intima-media thickness, regardless of the current physical activity.
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Affiliation(s)
- Manoel C S Lima
- Instituto de Biociências, Universidade Estadual Paulista, Rio Claro, SP, Brazil
| | - Maurício F Barbosa
- Departamento de Radiologia e Diagnóstico por Imagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tiego A Diniz
- Departamento de Educação Física, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | - Jamile S Codogno
- Departamento de Educação Física, Universidade Estadual Paulista, Presidente Prudente, SP, Brazil
| | | | - Rômulo A Fernandes
- Instituto de Biociências, Universidade Estadual Paulista, Rio Claro, SP, Brazil
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Ried-Larsen M, Grøntved A, Østergaard L, Cooper AR, Froberg K, Andersen LB, Møller NC. Associations between bicycling and carotid arterial stiffness in adolescents: The European Youth Hearts Study. Scand J Med Sci Sports 2014; 25:661-9. [PMID: 25156494 DOI: 10.1111/sms.12296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 12/13/2022]
Abstract
The aim of the study was to investigate the associations between bicycling and carotid arterial stiffness, independent of objectively measured moderate-and-vigorous physical activity. This cross-sectional study included 375 adolescents (age 15.7 ± 0.4 years) from the Danish site of the European Youth Heart Study. Total frequency of bicycle usage was assessed by self-report, and carotid arterial stiffness was assessed using B-mode ultrasound. After adjusting for pubertal status, body height, and objectively measured physical activity and other personal lifestyle and demographic factors, boys using their bicycle every day of the week displayed a higher carotid arterial compliance {standard beta 0.47 [95% confidence interval (CI) 0.07-0.87]} and distension [standard beta 0.38 (95% CI -0.04 to 0.81)]. Boys using their bicycle every day of the week furthermore displayed a lower Young's elastic modulus [standard beta -0.48 (95% CI -0.91 to -0.06)]. Similar trends were observed when investigating the association between commuter bicycling and carotid arterial stiffness. These associations were not observed in girls. Our observations suggest that increasing bicycling in adolescence may be beneficial to carotid arterial health among boys.
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Affiliation(s)
- M Ried-Larsen
- The Centre of Inflammation and Metabolism (CIM), Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark.,The Danish Diabetes Academy, Odense, Denmark
| | - A Grøntved
- Department of Sport Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - L Østergaard
- Department of Sport Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - A R Cooper
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - K Froberg
- Department of Sport Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - L B Andersen
- Department of Sport Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - N C Møller
- Department of Sport Science and Clinical Biomechanics, Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
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Gerber M, Brand S, Herrmann C, Colledge F, Holsboer-Trachsler E, Pühse U. Increased objectively assessed vigorous-intensity exercise is associated with reduced stress, increased mental health and good objective and subjective sleep in young adults. Physiol Behav 2014; 135:17-24. [PMID: 24905432 DOI: 10.1016/j.physbeh.2014.05.047] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/30/2014] [Indexed: 01/10/2023]
Abstract
The role of physical activity as a factor that protects against stress-related mental disorders is well documented. Nevertheless, there is still a dearth of research using objective measures of physical activity. The present study examines whether objectively assessed vigorous physical activity (VPA) is associated with mental health benefits beyond moderate physical activity (MPA). Particularly, this study examines whether young adults who accomplish the American College of Sports Medicine's (ACSM) vigorous-intensity exercise recommendations differ from peers below these standards with regard to their level of perceived stress, depressive symptoms, perceived pain, and subjective and objective sleep. A total of 42 undergraduate students (22 women, 20 men; M=21.24years, SD=2.20) volunteered to take part in the study. Stress, pain, depressive symptoms, and subjective sleep were assessed via questionnaire, objective sleep via sleep-EEG assessment, and VPA via actigraphy. Meeting VPA recommendations had mental health benefits beyond MPA. VPA was associated with less stress, pain, subjective sleep complaints and depressive symptoms. Moreover, vigorous exercisers had more favorable objective sleep pattern. Especially, they had increased total sleep time, more stage 4 and REM sleep, more slow wave sleep and a lower percentage of light sleep. Vigorous exercisers also reported fewer mental health problems if exposed to high stress. This study provides evidence that meeting the VPA standards of the ACSM is associated with improved mental health and more successful coping among young people, even compared to those who are meeting or exceeding the requirements for MPA.
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Affiliation(s)
- Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Serge Brand
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland; Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland.
| | - Christian Herrmann
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Flora Colledge
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Edith Holsboer-Trachsler
- Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland.
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
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Pälve KS, Pahkala K, Magnussen CG, Koivistoinen T, Juonala M, Kähönen M, Lehtimäki T, Rönnemaa T, Viikari JSA, Raitakari OT. Association of physical activity in childhood and early adulthood with carotid artery elasticity 21 years later: the cardiovascular risk in Young Finns Study. J Am Heart Assoc 2014; 3:e000594. [PMID: 24755150 PMCID: PMC4187482 DOI: 10.1161/jaha.113.000594] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Decreased arterial elasticity is a risk factor for several cardiovascular outcomes. Longitudinal data on the effect of physical activity in youth on adult arterial elasticity are limited. The aim of this study was to determine the long-term effects of physical activity in children and young adults on carotid artery elasticity after 21 years of follow-up. METHODS AND RESULTS Participants were 1417 children (aged 9 to 15 years) and 999 young adults (aged 18 to 24 years) from the prospective Cardiovascular Risk in Young Finns Study. Participants had questionnaire measures of leisure-time physical activity available from 1986 and ultrasound-derived indices of carotid artery elasticity measured in 2007. Carotid artery elasticity indices were distensibility (%/10 mm Hg), Young's elastic modulus (kPa), and stiffness index (unitless). Physical activity at age 18 to 24 years was directly associated with distensibility (β=0.068, P=0.014) and inversely with Young's elastic modulus (β=-0.057, P=0.0037) and indirectly with stiffness index (β=-0.050, P=0.0028) 21 years later in males and females. The associations remained after adjustment for age, sex, body mass index, smoking, systolic blood pressure, serum lipids and insulin, and 21-year change in physical activity. At age 9 to 15 years, the favorable association, remaining after adjustment, was found in males (distensibility [β=0.097, P=0.010], Young's elastic modulus [β=-0.060, P=0.028], and stiffness index [β=-0.062, P=0.007]) but not in females (P=0.70, P=0.85, and P=0.91, respectively). CONCLUSIONS Leisure-time physical activity in boys and young adults is associated with carotid artery elasticity later in life, suggesting that higher levels of physical activity in youth may benefit future cardiovascular health.
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Affiliation(s)
- Kristiina S Pälve
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood. Curr Opin Cardiol 2014; 28:561-8. [PMID: 23928921 DOI: 10.1097/hco.0b013e32836428f4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood. RECENT FINDINGS Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor. SUMMARY Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
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What the Long Term Cohort Studies that Began in Childhood Have Taught Us about the Origins of Coronary Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0373-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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García-Ortiz L, Recio-Rodríguez JI, Schmidt-Trucksäss A, Puigdomenech-Puig E, Martínez-Vizcaíno V, Fernández-Alonso C, Rubio-Galan J, Agudo-Conde C, Patino-Alonso MC, Rodríguez-Sánchez E, Gómez-Marcos MA. Relationship between objectively measured physical activity and cardiovascular aging in the general population--the EVIDENT trial. Atherosclerosis 2014; 233:434-440. [PMID: 24530775 DOI: 10.1016/j.atherosclerosis.2014.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/08/2014] [Accepted: 01/11/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Aging has been associated with an increase in arterial stiffness. We analyzed the relationship between regular physical activity and cardiovascular aging evaluated by the radial augmentation index (rAIx), ambulatory arterial stiffness index (AASI), pulse pressure (PP) and heart age in subjects without atherosclerotic disease. METHODS A cross-sectional study was performed including 1365 subjects from the EVIDENT trial (mean age 54.9±13.7 years; 60.3% women). As a measure of total volume of physical activity we used counts/minute recorded in an accelerometer (Actigraph GT3X) that participants wore for seven days, collecting data in 60-sec epochs, and respondents with ≥4 valid days were retained for the analysis. Arterial stiffness was evaluated using measures of rAIx, AASI, and central and peripheral PP on the B-pro device. rAIx was adjusted to 75 heart rate(rAIx75). Cardiovascular risk and heart age was estimated by the Framingham Risk Score. RESULTS The median (IQR) of counts/min was 236.9 (176.3-307.8), rAIx75 90 (77-100), sleep PP 40 mmHg (33-47), central PP 39 mmHg (32-47) and heart age 57 years (45-73) and the mean±SD of the ASSI was 0.44±0.07. We found an inverse correlation between counts/minute and rAIx75 (r=-0.086; p<0.01), AASI (r=-0.146; p<0.001), heart age (r=-0.163; p<0.001) and peripherals PP. These associations were remained after controlling for potential confounders, except for rAIx75. In the multiple regression analysis, after adjustment, an inverse association persisted between counts/minute and AASI, sleep PP and heart age, but not with rAIx75. Accordingly, for every 100 higher counts/minute of accelerometer measures, both AASI and sleep PP would be lower by one measurement unit (beta=-0.979 and -1.031 respectively, p<0.001) and the estimated heart age by half year (beta=-0.525, p=0.023). CONCLUSIONS Regular physical activity was inversely associated with parameters related to advanced cardiovascular aging after adjustment for potentially influencing variables. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT01083082.
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Affiliation(s)
- Luis García-Ortiz
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - José I Recio-Rodríguez
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - Arno Schmidt-Trucksäss
- Division Sports and Exercise Medicine, Institute of Exercise and Health Sciences, University of Basel, Switzerland.
| | - Elisa Puigdomenech-Puig
- Primary Health care Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain.
| | | | | | | | - Cristina Agudo-Conde
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | - Maria C Patino-Alonso
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
| | | | - Manuel A Gómez-Marcos
- The Alamedilla Health Center, Castilla y León Health Service-SACYL, USAL, IBSAL, Salamanca, Spain.
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Effect of Cardio-Metabolic Risk Factors Clustering with or without Arterial Hypertension on Arterial Stiffness: A Narrative Review. Diseases 2013. [DOI: 10.3390/diseases1010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Peak stepping cadence is associated with leg vascular compliance in young adults. J Sci Med Sport 2013; 17:683-7. [PMID: 24268938 DOI: 10.1016/j.jsams.2013.10.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/21/2013] [Accepted: 10/13/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To test the hypothesis that volume or intensity of daily ambulatory activity would associate with greater large artery compliance in healthy untrained adults. DESIGN Cross-sectional study. METHODS Forty-five recreationally active young adults (22 ± 3 yr, 51% women) wore an accelerometer for 5.3 ± 1.3 days for determination of average daily steps (volume) and 30-min peak stepping cadence (intensity; average steps per min for the 30 highest min in a day). Arterial compliance of the common carotid artery, superficial femoral artery (SFA), and popliteal artery was estimated using Doppler ultrasound. Data were analyzed using correlational analysis and analysis of covariance. RESULTS Average daily steps and peak stepping cadence was 8957 ± 3422 steps per day and 97 ± 24 steps per min, respectively. Weight was the main independent predictor of daily steps (r(2) = 0.13, p = 0.01) and peak stepping cadence (r(2) = 0.17, p<0.01). After adjusting ambulatory activity for weight, SFA compliance was positively correlated with peak stepping cadence (r = 0.53, p<0.01) but not with daily steps (r = 0.23, p > 0.05). No other correlations were found between ambulatory activity and carotid or popliteal artery compliance (p>0.05). Adults with peak stepping cadence ≥ 102 steps per min had greater carotid (1.26 ± 0.08 vs. 1.57 ± 0.09 mm(2) kPa(-1); p = 0.01) and SFA compliance (0.43 ± 0.03 vs. 0.54 ± 0.03 mm(2) kPa(-1); p = 0.04) than adults with lower stepping cadence. CONCLUSIONS "Brisk" stepping cadence during daily ambulation is associated with greater leg vascular compliance. These results support the promotion of accumulating 30 min of "brisk" walking per day as a strategy to improve vascular health.
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Ultra-endurance sports have no negative impact on indices of arterial stiffness. Eur J Appl Physiol 2013; 114:49-57. [PMID: 24141936 DOI: 10.1007/s00421-013-2753-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/10/2013] [Indexed: 01/21/2023]
Abstract
PURPOSE Marathon running has been linked with higher arterial stiffness. Blood pressure is a major contributor to pulse wave velocity (PWV). We examined indices of arterial stiffness with a blood pressure-independent method in marathon runners and ultra-endurance athletes. METHODS Male normotensive amateur runners were allocated to three groups according to former participation in competitions: group I (recreational athletes), group II (marathon runners) and group III (ultra-endurance athletes). Indices of arterial stiffness were measured with a non-invasive device (VaSera VS-1500N, Fukuda Denshi, Japan) to determine the cardio-ankle vascular index (CAVI, primary endpoint) and brachial-ankle PWV (baPWV). Lifetime training hours were calculated. Cumulative competitions were expressed as marathon equivalents. Linear regression analysis was performed to determine predictors for CAVI and baPWV. RESULTS Measurements of arterial stiffness were performed in 51 subjects (mean age 44.6 ± 1.2 years): group I (n = 16), group II (n = 19) and group III (n = 16). No between-group differences existed in age, anthropometric characteristics and resting BP. CAVI and baPWV were comparable between all groups (P = 0.604 and P = 0.947, respectively). In linear regression analysis, age was the only independent predictor for CAVI (R(2) = 0.239, β = 0.455, P = 0.001). Systolic BP was significantly associated with baPWV (R(2) = 0.225, β = 0.403, P = 0.004). CONCLUSIONS In middle-aged normotensive athletes marathon running and ultra-endurance sports had no negative impact on arterial stiffness.
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van de Laar RJ, Stehouwer CD, Prins MH, van Mechelen W, Twisk JW, Ferreira I. Self-reported time spent watching television is associated with arterial stiffness in young adults: the Amsterdam Growth and Health Longitudinal Study. Br J Sports Med 2013; 48:256-64. [DOI: 10.1136/bjsports-2013-092555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Bussel BCT, Soedamah-Muthu SS, Henry RMA, Schalkwijk CG, Ferreira I, Chaturvedi N, Toeller M, Fuller JH, Stehouwer CDA. Unhealthy dietary patterns associated with inflammation and endothelial dysfunction in type 1 diabetes: the EURODIAB study. Nutr Metab Cardiovasc Dis 2013; 23:758-764. [PMID: 22795869 DOI: 10.1016/j.numecd.2012.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 03/19/2012] [Accepted: 04/16/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS A healthy diet has been inversely associated with endothelial dysfunction (ED) and low-grade inflammation (LGI). We investigated the association between nutrient consumption and biomarkers of ED and LGI in type 1 diabetes. METHODS AND RESULTS We investigated 491 individuals. Nutrient consumption and lifestyle risk factors were measured in 1989 and 1997. Biomarkers of ED (von Willebrand factor, soluble vascular cell adhesion molecule-1 and soluble endothelial selectin) and LGI (C-reactive protein, interleukin 6 and tumour necrosis factor α) were measured in 1997 and averaged into Z-scores. The nutrient residual method was used to adjust individual nutrient intake for energy intake. Data were analysed with generalised estimation equations. We report increments/decrements in nutrient consumption, averaged over time, per +1 standard deviation (SD) of 1997 ED or LGI Z-scores, after adjustment for sex, age, duration of diabetes, investigation centre, body mass index, energy intake, smoking behaviour, alcohol consumption, and each of the other nutrients. One SD elevation in ED Z-score was associated with a diet lower in fibre [β(95%CI);-0.09(-0.18;-0.004)], polyunsaturated fat [-0.18(-0.31;-0.05)] and vegetable protein [-0.10(-0.20;-0.001)]. For the LGI Z-score results showed associations with fibre [-0.09(-0.17;-0.01)], polyunsaturated fat [-0.14(-0.24;-0.03)] and cholesterol [0.10(0.01; 0.18)]. CONCLUSION In type 1 diabetes, consumption of less fibre, polyunsaturated fat and vegetable protein, and more cholesterol over the study period was associated with more ED and LGI. Following dietary guidelines in type 1 diabetes may reduce cardiovascular disease risk by favourably affecting ED and LGI.
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Affiliation(s)
- B C T van Bussel
- Department of Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands.
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Nieman D, Dew D, Krasen P. Gender difference in the acute influence of a 2-hour run on arterial stiffness in trained runners. Res Sports Med 2013; 21:66-77. [PMID: 23286423 DOI: 10.1080/15438627.2012.738445] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Arterial stiffness scores over a 5-h period following a 2-h run were measured in trained males (N = 8, age 39.3 ± 2.3 y) and females (N = 8, 35.8 ± 2.8 y). Subjects reported for two lab sessions (randomized, crossover design) from 7:30 am to 4:15 pm, separated by 1-2 weeks, and either rested or ran for 2 h on a treadmill at 75% VO(2 max) from 9:15 to 11:15 am. Augmentation index standardized to a heart rate of 75 bpm (AIx75), and carotid to femoral pulse wave velocity (PWV), were measured by applanation tonometry. Significant interaction effects were measured for AIx75 (P = 0.039) and PWV (P = 0.020), and compared with the rest condition, female runners experienced decreased AIx75 from 11:45 am to 3:15 pm, and in PWV at 11:45 am and 12:15 pm, in contrast to no change in the male runners. These data support a notable gender difference in arterial stiffness following a 2-h bout of running.
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Affiliation(s)
- David Nieman
- Appalachian State University, Boone, North Carolina 28608, USA.
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Shokrvash B, Majlessi F, Montazeri A, Nedjat S, Rahimi A, Djazayeri A, Shojaeezadeh D. Correlates of physical activity in adolescence: a study from a developing country. Glob Health Action 2013; 6:20327. [PMID: 23663416 PMCID: PMC3651954 DOI: 10.3402/gha.v6i0.20327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/09/2013] [Accepted: 04/16/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical activity is important for adolescent health. The current study aimed to explore factors that predict physical activity among adolescents. METHODS This was a cross-sectional study of physical activity among a sample of adolescents in Tabriz, Iran. Information on physical activity was collected using a modified version of the Adolescent Physical Activity and Recall Questionnaire (APARQ). In addition, a self-administrated questionnaire was used to collect data on demographic characteristics, perceived family support, and self-efficacy. Both univariate and multivariate logistic regression analyses were performed to examine the association between physical activity and independent variables including gender and psychosocial predictors. RESULTS In all, 402 students were studied. The mean age of adolescents was 12.93 (SD=0.49) years; 51.5% were female. The mean time of moderate and vigorous physical activity for all adolescents was 44.64 (SD=23.24) Metabolic Equivalent (MET) min per day. This figure for female adolescents was 38.77 (SD=19.94) MET min per day and for males it was 50.87 (SD=24.88) (P<0.001). The results obtained from multiple logistic regression analysis indicated that female gender (OR=2.59, 95% CI=1.46-4.57, P=0.001) and poor family support (OR=1.10, 95% CI=1.03-1.20, P=0.038) were the most significant contributing factors to low level physical activity in adolescents. Other variables studied did not show any significant results. CONCLUSION The findings from the current study indicated that female adolescents were at risk of lower level of physical activity. In addition, it was found that the lack of family support represented an increased risk for low-level physical activity. It seems that family support should be an integrated part of any health education/promotion programs for improving physical activity among young adolescents in general and for female adolescents in particular.
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Affiliation(s)
- Behjat Shokrvash
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ried-Larsen M, Grøntved A, Møller NC, Larsen KT, Froberg K, Andersen LB. Associations between objectively measured physical activity intensity in childhood and measures of subclinical cardiovascular disease in adolescence: prospective observations from the European Youth Heart Study. Br J Sports Med 2013; 48:1502-7. [DOI: 10.1136/bjsports-2012-091958] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ried-Larsen M, Grøntved A, Kristensen PL, Froberg K, Andersen LB. Moderate-and-vigorous physical activity from adolescence to adulthood and subclinical atherosclerosis in adulthood: prospective observations from the European Youth Heart Study. Br J Sports Med 2013; 49:107-12. [PMID: 23584827 DOI: 10.1136/bjsports-2013-092409] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM To investigate the independent associations between mean exposure to or the change in moderate-and-vigorous physical activity (PA) from adolescence to adulthood and subclinical atherosclerosis in adulthood. METHODS This was a prospective cohort study among Danish boys and girls (N=277) followed for up to 12 years (age 15.7 (0.4) at baseline) enrolled in the European Youth Heart Study. PA intensity was objectively measured at baseline and follow-up, and ultrasonography was performed on the Carotid arteries at follow-up. Data on carotid intima-media thickness (cIMT), Carotid Compliance and Young's Elastic Modules were used as outcome measures. RESULTS In the multivariable analyses (adjusted for personal-lifestyle and demographic factors) the mean exposure to moderate-and-vigorous PA from adolescence to adulthood was negatively associated with Young's Elastic Modules (β=-0.001×10(3) kPa (95% CI -0.0015 to -0.0002), p=0.02) and positively associated with Carotid Compliance (β=0.004 mm(2) kPa(-1) (95% CI 0.002 to 0.008), p=0.003) and cIMT (β=0.0003 mm (95% CI 0.00001 to 0.0007), p=0.013). Increases in moderate-and-vigorous PA from adolescence to adulthood were negatively associated with Young's Elastic Modules in adulthood (β=-0.00007×10(3) kPa (95% CI -0.0012 to -0.0001), p=0.01). Furthermore, participants with the largest decline in moderate-and-vigorous PA from adolescence to adulthood displayed significantly less compliant arteries compared with the remaining sample (p<0.05). CONCLUSIONS High mean exposure to moderate-and-vigorous PA levels and increases herein were independently associated with lower levels of carotid arterial stiffness in adulthood.
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Affiliation(s)
- Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Peter Lund Kristensen
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Karsten Froberg
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Lars Bo Andersen
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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McDonnell BJ, Maki-Petaja KM, Munnery M, Wilkinson IB, Cockcroft JR, McEniery CM. Habitual exercise and blood pressure: age dependency and underlying mechanisms. Am J Hypertens 2013; 26:334-41. [PMID: 23382483 DOI: 10.1093/ajh/hps055] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Regular exercise is associated with a reduction in cardiovascular risk, but the precise mechanisms responsible are unknown. The aim of the current study was to examine the relationship between regular exercise, aortic stiffness, and wave reflections, and to determine whether this relationship differs by age. METHODS Younger (<30 years) and older (>50 years) individuals, who were either sedentary or undertook regular aerobic exercise, were drawn from the Anglo-Cardiff Collaborative Trial population. This yielded 1,036 individuals, all of whom were nonsmokers, and were free of cardiovascular disease and medication. All individuals undertook a detailed lifestyle and medical history questionnaire including details of physical activity. Brachial and central blood pressure, together with aortic stiffness, wave reflections, cardiac output, and peripheral vascular resistance were assessed in all individuals. RESULTS In younger individuals, regular exercise was associated with lower diastolic blood pressure but elevated pulse pressure. In contrast, both systolic and pulse pressure were lower in older active individuals, compared with their sedentary counterparts. Moreover, regular exercise was associated with lower wave reflections and peripheral vascular resistance in younger individuals, but lower large artery stiffness in older individuals. CONCLUSIONS These data suggest that regular exercise is associated with a beneficial vascular profile. However, this differs between younger and older individuals such that the smaller preresistance and resistance vessels are involved in younger individuals whereas the large elastic arteries are involved in older individuals. Despite these differential findings, the current data provide support for strategies that increase habitual physical activity levels in the general population.
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Affiliation(s)
- Barry J McDonnell
- Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
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50
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Ried-Larsen M, Grøntved A, Froberg K, Ekelund U, Andersen LB. Physical activity intensity and subclinical atherosclerosis in Danish adolescents: The European Youth Heart Study. Scand J Med Sci Sports 2013; 23:e168-77. [PMID: 23336399 DOI: 10.1111/sms.12046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2012] [Indexed: 11/28/2022]
Affiliation(s)
- M. Ried-Larsen
- Institute of Sport Science and Clinical Biomechanics; Research unit for Exercise Epidemiology; Centre of Research in Childhood Health; University of Southern Denmark; Odense; Denmark
| | - A. Grøntved
- Institute of Sport Science and Clinical Biomechanics; Research unit for Exercise Epidemiology; Centre of Research in Childhood Health; University of Southern Denmark; Odense; Denmark
| | - K. Froberg
- Institute of Sport Science and Clinical Biomechanics; Research unit for Exercise Epidemiology; Centre of Research in Childhood Health; University of Southern Denmark; Odense; Denmark
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