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Park S, Myong Y, Cho M, Cho SY, Lee WH, Oh BM, Kim S. Design and validation of a wearable dynamometry system for knee extension-flexion torque measurement. Sci Rep 2024; 14:10428. [PMID: 38714762 PMCID: PMC11076506 DOI: 10.1038/s41598-024-60985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024] Open
Abstract
Muscle strength assessments are vital in rehabilitation, orthopedics, and sports medicine. However, current methods used in clinical settings, such as manual muscle testing and hand-held dynamometers, often lack reliability, and isokinetic dynamometers (IKD), while reliable, are not easily portable. The aim of this study was to design and validate a wearable dynamometry system with high accessibility, accuracy, and reliability, and to validate the device. Therefore, we designed a wearable dynamometry system (WDS) equipped with knee joint torque sensors. To validate this WDS, we measured knee extension and flexion strength in 39 healthy adults using both the IKD and WDS. Comparing maximal isometric torque measurements, WDS and IKD showed strong correlation and good reliability for extension (Pearson's r: 0.900; intraclass correlation coefficient [ICC]: 0.893; standard error of measurement [SEM]: 9.85%; minimal detectable change [MDC]: 27.31%) and flexion (Pearson's r: 0.870; ICC: 0.857; SEM: 11.93%; MDC: 33.07%). WDS demonstrated excellent inter-rater (Pearson's r: 0.990; ICC: 0.993; SEM: 4.05%) and test-retest (Pearson's r: 0.970; ICC: 0.984; SEM: 6.15%) reliability during extension/flexion. User feedback from 35 participants, including healthcare professionals, underscores WDS's positive user experience and clinical potential. The proposed WDS is a suitable alternative to IKD, providing high accuracy, reliability, and potentially greater accessibility.
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Affiliation(s)
- Sungwoo Park
- Interdisciplinary Program in Bioengineering, The Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
- Innovative Medical Technology Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Youho Myong
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
| | - Seung Yeon Cho
- Interdisciplinary Program in Bioengineering, The Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Institute on Aging, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sungwan Kim
- Interdisciplinary Program in Bioengineering, The Graduate School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Institute of Bio engineering, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Cho SY, Myong Y, Park S, Cho M, Kim S. A portable articulated dynamometer for ankle dorsiflexion and plantar flexion strength measurement: a design, validation, and user experience study. Sci Rep 2023; 13:22221. [PMID: 38097727 PMCID: PMC10721896 DOI: 10.1038/s41598-023-49263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
Monitoring ankle strength is crucial for assessing daily activities, functional ability, and preventing lower extremity injuries. However, the current methods for measuring ankle strength are often unreliable or not easily portable to be used in clinical settings. Therefore, this study proposes a portable dynamometer with high reliability capable of measuring ankle dorsiflexion and plantar flexion. The proposed portable dynamometer comprised plates made of aluminum alloy 6061 and a miniature tension-compression load cell. A total of 41 healthy adult participants applied maximal isometric dorsiflexor and plantar flexor forces on a Lafayette Handheld Dynamometer (HHD) and the portable dynamometer. The results were cross-validated, using change in mean, and two independent examiners evaluated the inter-rater and test-retest reliabilities in separate sessions using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. Both dorsiflexion and plantar flexion measurements demonstrated a strong correlation with the HHD (r = 0.827; r = 0.973) and showed high inter-rater and test-retest reliabilities. Additionally, the participant responses to the user experience questionnaire survey indicated vastly superior positive experiences with the portable dynamometer. The study findings suggest that the designed portable dynamometer can provide accurate and reliable measurements of ankle strengths, making it a potential alternative to current methods in clinical settings.
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Affiliation(s)
- Seung Yeon Cho
- Interdisciplinary Program in Bioengineering, The Graduate School, Seoul National University, Seoul, South Korea
| | - Youho Myong
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sungwoo Park
- Interdisciplinary Program in Bioengineering, The Graduate School, Seoul National University, Seoul, South Korea
- Institute of Innovative Medical Technology, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sungwan Kim
- Interdisciplinary Program in Bioengineering, The Graduate School, Seoul National University, Seoul, South Korea.
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.
- Institute of Bioengineering, Seoul National University, Seoul, South Korea.
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Onerup A, Mehlig K, Ekblom‐Bak E, Lissner L, Börjesson M, Åberg M. Cardiorespiratory fitness and BMI measured in youth and 5-year mortality after site-specific cancer diagnoses in men-A population-based cohort study with register linkage. Cancer Med 2023; 12:20000-20014. [PMID: 37732468 PMCID: PMC10587926 DOI: 10.1002/cam4.6553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Our aim was to assess associations between cardiorespiratory fitness (CRF) and body mass index (BMI) in youth and 5-year mortality after site-specific cancer diagnoses in men. METHODS Men with cancer from a population who underwent military conscription at ages 16-25 during 1968-2005 in Sweden were included. CRF was assessed as maximal aerobic workload on a cycle ergometer test and was classified as low, moderate, or high. BMI (kg/m2 ) was classified as underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), or obesity (>30). Conscription data were linked with register data on cancer diagnosis and mortality. Analyses included CRF, BMI, date of diagnosis, and age, year, and center for conscription. RESULTS A total of 84,621 cancer cases were included. Mean age at diagnosis was 52 years. Follow-up data were available during a mean of 6.5 years. There were linear protective associations between CRF and mortality after any cancer diagnosis (hazard ratio [HR] for high vs. low CRF 0.70), malignant skin cancer (HR 0.80), non-Hodgkin lymphoma (HR 0.78), and cancer in the lungs (HR 0.80), head and neck (HR 0.68), pancreas (HR 0.83), stomach (HR 0.78), liver (HR 0.84), rectum (HR 0.79), and bladder (HR 0.71). Overweight and/or obesity were associated with increased mortality after any cancer (HR for obesity vs. normal weight 1.89), malignant skin cancer (HR 2.03), Hodgkin lymphoma (HR 2.86) and cancer in the head and neck (HR 1.38), thyroid (HR 3.04), rectum (HR 1.53), kidney (HR 1.90), bladder (HR 2.10), and prostate (HR 2.44). CONCLUSION We report dose-dependent associations between CRF and BMI in youth and mortality after site-specific cancer diagnoses in men. The associations with mortality could be due to both cancer inhibition and an improved tolerance to withstand cancer treatment. These results strengthen the incentive for public health efforts aimed at establishing a high CRF and normal weight in youth.
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Affiliation(s)
- Aron Onerup
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Pediatric Oncology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Elin Ekblom‐Bak
- Department of Physical activity and HealthThe Swedish School of Sport and Health SciencesStockholmSweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Center for Lifestyle Intervention, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
- Department of MGAÖRegion of Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, RegionhälsanGothenburgSweden
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Myong Y, Park S, Cho M, Cho SY, Lee WH, Oh BM, Kim S. Development and validation of a portable articulated dynamometry system to assess knee extensor muscle strength. Sci Rep 2023; 13:11887. [PMID: 37482569 PMCID: PMC10363537 DOI: 10.1038/s41598-023-39062-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/19/2023] [Indexed: 07/25/2023] Open
Abstract
Muscle strength assessment is important in predicting clinical and functional outcomes in many disorders. Manual muscle testing, although commonly used, offers suboptimal accuracy and reliability. Isokinetic dynamometers (IKDs) have excellent accuracy and reliability; but are bulky and expensive, offering limited accessibility. This study aimed to design a portable dynamometer that is accessible, accurate and reliable, and to validate the device in a general population. The portable articulated dynamometry system (PADS) is a portable device with an embedded high-precision load cell, designed to measure muscle strength with optimal accuracy. Seventy-two participants underwent maximal isometric and isokinetic knee extensor torque measurement with the PADS and IKD, respectively. The PADS results were cross-validated against IKD results using change in mean (CIM). Interrater and intra-rater reliabilities were assessed using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. The PADS maximal knee extensor strength results were not significantly different from those by IKD (CIM: - 2.13 Nm; 95% CI - 4.74, 0.49 Nm). The PADS showed interrater reliability (Pearson's r: 0.958; ICC: 0.979; SEM: 5.51%) and excellent intra-rater reliability (Pearson's r: 0.912; ICC: 0.954; SEM: 8.38%). The proposed PADS may be an effective alternative to IKD, offering good accuracy, reliability, and potentially better accessibility.
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Affiliation(s)
- Youho Myong
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
| | - Sungwoo Park
- Graduate School, Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea
- Institute of Innovative Medical Technology, Seoul National University Hospital Biomedical Research Institute, Jongno gu, Seoul, 03122, Republic of Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
- Department of Medicine, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea
| | - Seung Yeon Cho
- Graduate School, Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea.
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi, 12564, Republic of Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea.
- Graduate School, Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea.
- Institute of Bioengineering, Seoul National University, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea.
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Luo L, Xu J, Jiang R, Yao B, Di J. Association between serum copper, zinc and their ratio and handgrip strength among adults: a study from National Health and Nutrition Examination Survey (NHANES) 2011-2014. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:29100-29109. [PMID: 36402884 DOI: 10.1007/s11356-022-23998-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Evidence for the association between serum copper and zinc status and handgrip strength is very limited only in several observational studies with study participants of specific population or a narrower age range. The aim of this study was to evaluate the association between serum copper, zinc and their ratio and handgrip strength in the general population. This study included adult participants aged 20-80 years with complete data of serum copper and zinc status and handgrip strength from NHANES 2011-2014. Handgrip strength was calculated as the average of the maximum measure obtained in each hand with a grip strength dynamometer and corrected using BMI. Serum copper and zinc levels were measured using inductively coupled plasma dynamic reaction cell mass spectrometry, and their ratios were calculated. The multivariable linear regression and restricted cubic spline models were used. Serum copper level was inversely associated with BMI-corrected handgrip strength, and the beta coefficients (95% confidence intervals) comparing the second, third, and fourth to the lowest quartiles of serum copper level were - 0.17 kg (- 0.26; - 0.08), - 0.22 kg (- 0.32; - 0.13), and - 0.36 kg (- 0.44; - 0.28), respectively (P for trend < 0.001). Non-linear association was detected between serum copper level and BMI-corrected handgrip strength (P < 0.01). Consistent with serum copper, serum copper/zinc ratio was inversely associated with BMI-corrected handgrip strength. However, no significant associations were observed between serum zinc level and BMI-corrected handgrip strength (all P > 0.05). Higher serum copper level and copper/zinc ratios were significantly associated with lower handgrip strength. Further research is needed to address related issues.
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Affiliation(s)
- Li Luo
- Hospital Management Research Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Center for Hospital Management Research, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, 200233, China
| | - Jumi Xu
- Center for Hospital Management Research, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, 200233, China
- Department of Performance Management, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Ruo Jiang
- Center for Hospital Management Research, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, 200233, China
- Department of Medical Affairs, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Baodong Yao
- Department of Performance Management, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jianzhong Di
- Center for Hospital Management Research, Shanghai Jiao Tong University China Hospital Development Institute, Shanghai, 200233, China.
- Hospital Office, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
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Djekic D, Lindgren M, Åberg ND, Åberg M, Fengsrud E, Poci D, Adiels M, Rosengren A. Body Mass Index in Adolescence and Long-Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke. J Am Heart Assoc 2022; 11:e025984. [PMID: 36260422 DOI: 10.1161/jaha.121.025984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF. Methods and Results We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m2 to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m2, compared with those with BMI of 18.5 to <20.0 kg/m2. During a median follow-up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m2 compared with those with BMI <20 kg/m2 were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively. Conclusions Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke.
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Affiliation(s)
- Demir Djekic
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden.,Cardiology unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden.,Cardiology unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - N David Åberg
- Department of Internal Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg Sweden.,Department of Acute Medicine and Geriatrics (SU/Sahlgrenska), Region Västra Götaland Sahlgrenska University Hospital Gothenburg Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine/Primary Health Care Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden.,Region Västra Götaland Regionhälsan Gothenburg Sweden
| | - Espen Fengsrud
- Department of Cardiology, Örebro University, Örebro, Sweden Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Dritan Poci
- Department of Clinical Physiology Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital Gothenburg Sweden
| | - Martin Adiels
- Cardiology unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden.,Cardiology unit Sahlgrenska University Hospital/Östra Gothenburg Sweden
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Orsatti FL, Nunes PRP, da Silva Carneiro MA, Orsatti CL, Souza MVC. Heterogeneity in resistance training-induced muscle strength responses is associated with training frequency and insulin resistance in postmenopausal women. Exp Gerontol 2022; 163:111807. [PMID: 35421558 DOI: 10.1016/j.exger.2022.111807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In older adults, muscle strength (MS), a key component of sarcopenia, is essential to maintaining independence and physical capacity. The rate of muscle strength decline typically accelerates during the menopausal transition. Although MS has been shown to increase with resistance training (RT), the response to training is quite heterogeneous. Thus, if contributing factors to RT non-responsiveness to MS gains are identified, it may be possible to develop more effective and personalized ways to improve MS or identify individuals who may benefit from RT interventions. This study assessed potential factors that may contribute to MS response heterogeneity in postmenopausal women: training frequency, serum FSH and estrogen levels, adiposity, inflammation marker, and insulin resistance. METHODS One hundred and thirteen individuals participated in a 16-week program of supervised RT (3 sets, 8-12 repetitions, and 2-3 times/week). A control group (CTL, n = 63 - no performed the RT) was used as the comparator arm. Body composition (skinfold) and blood samples (metabolic and inflammatory indicators and hormones) were measured at baseline. Knee extensor strength (1RM) was measured at baseline, 8 weeks, and 16 weeks. RESULTS Only the RT group increased 1RM after 8 weeks (RT = 14 ± 12% vs. CTL = 6 ± 15%). Both groups increased 1RM after 16 weeks, with the RT group showing a greater increase than the CTL group (RT = 31 ± 23% vs CTL = 13 ± 25%). After 8 weeks of RT, 41 (36% of total) individuals were considered non-responders (based on control group responses) and 27 (24% of total) individuals after 16 weeks. At week 8, lower RT frequency (2 times/week vs. 3 times/week) was associated with higher odds of being non-responder (3 times, P = 0.048). At week 16, lower RT frequency (13 times, P = 0.009) and higher HOMA-IR (for every unit increase, odds increase by 40%, P = 0.022) were associated with higher odds of being non-responder. Higher QUICKI was associated with lower odds of being non-responder (for every unit increase, odds decrease by 16%, P = 0.039). Moreover, higher RT frequency (17 times, P = 0.028) and higher QUICKI (for every unit increase, odds increase by 41%, P = 0.017) were associated with higher odds of becoming a responder at week 16, being a non-responder at week 8. CONCLUSION Heterogeneity in RT-induced MS responses is associated with training frequency and insulin resistance in postmenopausal women.
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Affiliation(s)
- Fábio Lera Orsatti
- Exercise Biology Research Lab (BioEx), Department of Sport Sciences, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
| | - Paulo Ricardo Prado Nunes
- Department of Physical Education, Minas Gerais State University (UEMG), Passos, Minas Gerais, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Marcelo Augusto da Silva Carneiro
- Metabolism, Nutrition and Exercise Laboratory, Physical Education and Sport Center, Londrina State University, Londrina, Paraná, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Cláudio Lera Orsatti
- Department Health Science, Oeste Paulista University - UNOESTE, Jaú, SP, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | - Markus Vinícius Campus Souza
- Exercise Biology Research Lab (BioEx), Department of Sport Sciences, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil; Applied Physiology, Nutrition and Exercise Research Group, Federal University of Triangulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
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Insulin resistance and muscle weakness are synergistic risk factors for silent lacunar infarcts: the Bunkyo Health Study. Sci Rep 2021; 11:21093. [PMID: 34702849 PMCID: PMC8548532 DOI: 10.1038/s41598-021-00377-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Insulin resistance and muscle weakness are risk factors for silent lacunar infarcts (SLI), but it is unclear whether they are still independent risk factors when adjusted for each other. In addition, the effect of their combination on SLI is completely unknown. We evaluated SLI, insulin sensitivity, and knee extensor muscle strength by magnetic resonance imaging, PREDIM, and dynamometer, respectively, in 1531 elderly people aged 65–84 years living in an urban area of Tokyo. Among the study subjects, 251 (16.4%) had SLI. Impaired insulin sensitivity (High; 1.00 [reference], Medium; 1.53 [95% confidence interval (CI) 0.94–2.48], Low; 1.86 [1.02–3.39], p for trend 0.047) and reduced muscle strength (High; 1.00 [reference], Medium; 1.40 [0.98–2.02], Low; 1.49 [1.04–2.15], p for trend 0.037) were independently associated with increased risk for SLI in the fully adjusted model. In terms of combined, subjects classified as having the lowest insulin sensitivity and lowest strength were 4.33 times (95% CI 1.64–11.45) more likely to have a SLI than those classified as having the highest insulin sensitivity and highest strength. Impaired insulin sensitivity and reduced muscle strength were independently associated with higher risk of SLI in elderly subjects, and their combination synergistically increased this risk.
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Åberg ND, Adiels M, Lindgren M, Nyberg J, Georg Kuhn H, Robertson J, Schaufelberger M, Sattar N, Åberg M, Rosengren A. Diverging trends for onset of acute myocardial infarction, heart failure, stroke and mortality in young males: role of changes in obesity and fitness. J Intern Med 2021; 290:373-385. [PMID: 33826195 DOI: 10.1111/joim.13285] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/30/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND As opposed to the decreasing overall rates of coronary heart disease (CHD) incidence and overall cardiovascular disease (CVD) mortality, heart failure (HF) and stroke incidence are increasing in young people, potentially due to rising rates of obesity and reduced cardiorespiratory fitness (CRF). OBJECTIVES We investigated trends in early major CVD outcomes in a large cohort of young men. METHODS Successive cohorts of Swedish military conscripts from 1971 to 1995 (N = 1,258,432; mean age, 18.3 years) were followed, using data from the National Inpatient and Cause of Death registries. Cox proportional hazard models were used to analyse changes in 21-year CVD event rates. RESULTS 21-year CVD and all-cause mortality and incidence of acute myocardial infarction (AMI) decreased progressively. Compared with the cohort conscripted in 1971-1975 (reference), the hazard ratios (HRs) for the last 1991-1995 cohort were 0.50 [95% confidence interval (CI) 0.42-0.59] for CVD mortality; 0.57 (95% CI 0.54-0.60) for all-cause mortality; and 0.63 (95% CI 0.53-0.75) for AMI. In contrast, the incidence of ischaemic stroke, intracerebral haemorrhage and HF increased with HRs of 1.43 (95% CI 1.17-1.75), 1.30 (95% CI 1.01-1.68) and 1.84 (95% CI 1.47-2.30), respectively. During the period, rates of obesity increased from 1.04% to 2.61%, whilst CRF scores decreased slightly. Adjustment for these factors influenced these secular trends only moderately. CONCLUSION Secular trends of young-onset CVD events demonstrated a marked shift from AMI and CVD mortality to HF and stroke incidence. Trends were significantly, though moderately, influenced by changing baseline BMI and CRF.
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Affiliation(s)
- N D Åberg
- From the, Department of Internal Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Acute Medicine and Geriatrics (SU/Sahlgrenska), Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Adiels
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Lindgren
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Nyberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Neurology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Georg Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Neurology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute for Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Robertson
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Schaufelberger
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N Sattar
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M Åberg
- School of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan, Gothenburg, Sweden
| | - A Rosengren
- Region Västra Götaland, Sahlgrenska University Hospital, Östra/MGAÖ, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Af Geijerstam A, Mehlig K, Börjesson M, Robertson J, Nyberg J, Adiels M, Rosengren A, Åberg M, Lissner L. Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts. BMJ Open 2021; 11:e051316. [PMID: 34226237 PMCID: PMC8260308 DOI: 10.1136/bmjopen-2021-051316] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the possible connection between cardiorespiratory fitness (CRF) and muscle strength in early adulthood and severity of COVID-19 later in life. DESIGN Prospective registry-based cohort study. PARTICIPANTS 1 559 187 Swedish men, undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years. MAIN OUTCOME MEASURES Hospitalisation, intensive care or death due to COVID-19 from March to September 2020, in relation to CRF and muscle strength. RESULTS High CRF in late adolescence and early adulthood had a protective association with severe COVID-19 later in life with OR (95% CI) 0.76 (0.67 to 0.85) for hospitalisation (n=2 006), 0.61 (0.48 to 0.78) for intensive care (n=445) and 0.56 (0.37 to 0.85) for mortality (n=149), compared with the lowest category of CRF. The association remains unchanged when controlled for body mass index (BMI), blood pressure, chronic diseases and parental education level at baseline, and incident cardiovascular disease before 2020. Moreover, lower muscle strength in late adolescence showed a linear association with a higher risk of all three outcomes when controlled for BMI and height. CONCLUSIONS Physical fitness at a young age is associated with severity of COVID-19 many years later. This underscores the necessity to increase the general physical fitness of the population to offer protection against future viral pandemics.
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Affiliation(s)
- Agnes Af Geijerstam
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Center for Health and Performance, University of Gothenburg, Goteborg, Västra Götaland, Sweden
| | - Josefina Robertson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Jenny Nyberg
- Section for Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Martin Adiels
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Sahlgrenska University Hospital, Goteborg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Regionhälsan, Region Västra Götaland, Göteborg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
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11
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Zhang L, Sun J, Li Z, Zhang D. The relationship between serum folate and grip strength in American adults. Arch Osteoporos 2021; 16:97. [PMID: 34148134 DOI: 10.1007/s11657-021-00937-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We used data from NHANES to explore the associations between serum folate and grip strength, and found that high levels of serum folate were associated with increased grip strength among females rather than males. It is recommended to maintain a proper level of serum folate, especially in women. PURPOSE Associations and dose-response relationships between serum total folate, 5-methyltetrahydrofolate, and grip strength in general adults were unknown. Thus, we conducted this analysis for further exploration. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) database of 2011-2014 cycle were used. The independent variables including serum total folate, combined total folate (total folate plus Mefox), and 5-methyltetrahydrofolate. The dependent variable was BMI-corrected grip strength. Linear regression and the restricted cubic splines were used in our analyses. RESULTS A total of 9079 adults aged over 20 years were included. In multivariate-adjusted model 2, compared with quartile (Q) 1, grip strength increased in Q3 of combined total folate and total folate, and the weighted β values with 95% confidence intervals (CIs) of grip strength were 0.06 (0.01, 0.12) and 0.06 (0.00, 0.10) for combined total folate and total folate, respectively. In the stratified analysis by gender, positive relationships between combined total folate, total folate, and 5-methyltetrahydrofolate and grip strength were found only in females, with β (95% CIs) of 0.07 (0.02, 0.12), 0.07 (0.03, 0.12), and 0.09 (0.05, 0.13) for combined total folate, total folate, and 5-methyltetrahydrofolate in Q4, respectively. Non-linear positive dose-response relationships between serum folate and grip strength were also found only in females, not in males. CONCLUSION Our study suggested a positive association between serum folate and grip strength, while this positive association was only found in females; besides, the dose-response relationships were in a non-linear trend. Thus, it is recommended to maintain a proper serum folate level to keep better muscle strength, especially for women.
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Affiliation(s)
- Liming Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, No.308 Ningxia Road, Qingdao, 266021, China
| | - Jing Sun
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, No.308 Ningxia Road, Qingdao, 266021, China
| | - Zhaoying Li
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, No.308 Ningxia Road, Qingdao, 266021, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, No.308 Ningxia Road, Qingdao, 266021, China.
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12
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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: 40] [Impact Index Per Article: 13.3] [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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13
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Pinoniemi BK, Tomkinson GR, Walch TJ, Roemmich JN, Fitzgerald JS. Temporal Trends in the Standing Broad Jump Performance of United States Children and Adolescents. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2021; 92:71-81. [PMID: 32053474 DOI: 10.1080/02701367.2019.1710446] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/21/2019] [Indexed: 06/10/2023]
Abstract
Purpose: To estimate temporal trends in broad jump performance for United States youth, a marker of muscular fitness and health. Method: Electronic databases, topical systematic reviews, and personal libraries were systematically searched for studies reporting descriptive standing broad jump data for apparently healthy United States youth (age 10-17 years). Temporal trends at the sex-age level were estimated using sample-weighted regression models associating the year of testing to mean jump performance, with national trends standardized to the year 1985 using a post-stratified population-weighting procedure. Results: Collectively, there was a small increase of 12.6 cm (95%CI: 12.5 to 12.7) or 7.9% (95%CI: 7.1 to 8.6) in 65,527 United States youth between 1911 and 1990. Increases were greater for girls (change in means [95% CI]: 17.1 cm [16.9 to 17.3]; 11.4% [10.7 to 12.2]) compared to boys (change in means [95% CI]: 8.5 cm [8.3 to 8.7]; 4.6% [3.8 to 5.4]), but did not differ between children (10-12 years) and adolescents (13-17 years). Increases in broad jump performance were not always uniform across time, with steady and progressive increases observed for boys and children, respectively, and a diminishing rate of increase observed for girls and adolescents. Conclusions: Muscular fitness is a good marker of health, so greater broad jump performance from 1911 to 1990 may reflect corresponding changes in health. Routine assessment of broad jump performance may be useful to monitor trends in health and muscular fitness of United States youth due to its practicality, scalability, and predictive utility.
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14
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2972] [Impact Index Per Article: 990.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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15
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Someya Y, Tamura Y, Kaga H, Sugimoto D, Kadowaki S, Suzuki R, Aoki S, Hattori N, Motoi Y, Shimada K, Daida H, Ishijima M, Kaneko K, Nojiri S, Kawamori R, Watada H. Reduced muscle strength of knee extensors is a risk factor for silent lacunar infarcts among Japanese elderly people: the Bunkyo Health Study. JCSM CLINICAL REPORTS 2020. [DOI: 10.1002/crt2.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yuki Someya
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
| | - Yoshifumi Tamura
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hideyoshi Kaga
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Daisuke Sugimoto
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Satoshi Kadowaki
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Ruriko Suzuki
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shigeki Aoki
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Radiology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Nobutaka Hattori
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Neurology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Yumiko Motoi
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Diagnosis Prevention and Treatment of Dementia Juntendo University Graduate School of Medicine Tokyo Japan
| | - Kazunori Shimada
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroyuki Daida
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Cardiovascular Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Muneaki Ishijima
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Medicine for Orthopaedics and Motor Organ Juntendo University Graduate School of Medicine Tokyo Japan
| | - Kazuo Kaneko
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Medicine for Orthopaedics and Motor Organ Juntendo University Graduate School of Medicine Tokyo Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center Juntendo University Tokyo Japan
| | - Ryuzo Kawamori
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hirotaka Watada
- Sportology Center Juntendo University Graduate School of Medicine Tokyo Japan
- Department of Metabolism & Endocrinology Juntendo University Graduate School of Medicine Tokyo Japan
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16
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Salamt N, Muhajir M, Aminuddin A, Ugusman A. The effects of exercise on vascular markers and C-reactive protein among obese children and adolescents: An evidence-based review. Bosn J Basic Med Sci 2020; 20:149-156. [PMID: 31509733 PMCID: PMC7202183 DOI: 10.17305/bjbms.2019.4345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022] Open
Abstract
Numerous studies have evaluated the effects of exercise training on obese children and adolescents. However, the impact of aerobic and/or resistance exercise alone, without any other interventions, on vascular markers and C-reactive protein (CRP) in obese children and adolescents is still not clear. We performed a literature search in Ovid Medline, PubMed, and SCOPUS databases to identify articles on the effects of exercise on vascular markers and CRP among obese children and adolescents, published between January 2009 and May 2019. Only full-text articles in English that reported on the effect of aerobic and/or resistance exercise on the vascular markers pulse wave velocity (PWV), carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), augmentation index (AIx), or CRP in obese children and adolescents (5-19 years old) were included. The literature search identified 36 relevant articles; 9 articles that fulfilled all the inclusion criteria were selected by two independent reviewers. Aerobic exercise or a combination of aerobic and resistance exercise training significantly improved CIMT and PWV in obese children and adolescents in all studies in which they were measured (2 studies for PWV and 4 studies for CIMT). However, the effects of exercise on FMD and CRP levels were inconclusive, as only half of the studies demonstrated significant improvements (1/2 studies for FMD and 4/8 studies for CRP). The results of our review support the ability of exercise to improve vascular markers such as PWV and CIMT in obese children and adolescents. This finding is important as obesity is a modifiable risk factor of cardiovascular disease (CVD), and exercise may help in reducing the future occurrence of CVD in this population.
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Affiliation(s)
- Norizam Salamt
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Musilawati Muhajir
- Data Unit, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Amilia Aminuddin
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
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17
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4716] [Impact Index Per Article: 1179.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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18
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Affiliation(s)
- Qiwei Fan
- From the Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China (Q.F., J.J.)
| | - Jie Jia
- From the Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China (Q.F., J.J.)
- School of Life and Environmental Sciences, University of Sydney, Australia (J.J.)
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19
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Ekblom MM, Ekblom ÖB, Börjesson M, Bergström G, Jern C, Wallin A. Device-Measured Sedentary Behavior, Physical Activity and Aerobic Fitness Are Independent Correlates of Cognitive Performance in Healthy Middle-Aged Adults-Results from the SCAPIS Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245136. [PMID: 31888199 PMCID: PMC6949984 DOI: 10.3390/ijerph16245136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 01/06/2023]
Abstract
High aerobic fitness, more moderate to vigorous physical activity (MVPA) and less sedentary behavior (SED) have all been suggested to promote cognitive functions, but it is unclear whether they are independent predictors of specific cognitive domains. This study aimed to investigate to what extent aerobic fitness MVPA and SED are independently associated with cognitive performance among middle-aged Swedish adults. We acquired device-based measures of aerobic fitness, cognitive performance and percent daily time spent in MVPA and SED in Swedish adults (n = 216; 54–66 years old). Aerobic fitness was associated with better performance at one out of two tests of speed/attention and one out of four tests of executive attention, and with worse performance at one of seven tests of memory. Increasing %MVPA was associated with better performance at one out of seven tests of memory and two out of three tests of verbal ability, whereas increasing %SED was associated with better performance at all four tests of executive attention and four out of seven tests of memory. These findings suggest that aerobic fitness, %MVPA and %SED are partly independent correlates of cognitive performance. To fully understand the association between SED and performance at several tests of cognitive function, future investigations might attempt to investigate intellectually engaging SED (such as reading books) separately from mentally undemanding SED (such as watching TV).
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Affiliation(s)
- Maria M. Ekblom
- The Swedish School of Sport and Health Sciences, 11486 Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
- Correspondence:
| | - Örjan B. Ekblom
- Department of Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Mats Börjesson
- Department of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburgh, Sweden; (M.B.); (A.W.)
- Center for Health and Performance, Department of Food, Nutrition and Sports Science, 40530 Gothenburgh, Sweden
- Sahlgrenska University Hospital/Ostra, University of Gothenburg, 41345 Gothenburgh, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, University of Gothenburg, 40530 Gothenburgh, Sweden;
- Department of Clinical Physiology, Sahlgrenska University Hospital, 41345 Gothenburgh, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden;
- Department of Clinical genetics and genomics, Sahlgrenska University Hospital, 41345 Gothenburgh, Sweden
| | - Anders Wallin
- Department of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburgh, Sweden; (M.B.); (A.W.)
- The Memory Clinic, Sahlgrenska University Hospital, 40530 Gothenburgh, Sweden
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20
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5219] [Impact Index Per Article: 1043.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Wang Y, Li F, Cheng Y, Gu L, Xie Z. Cardiorespiratory fitness as a quantitative predictor of the risk of stroke: a dose–response meta-analysis. J Neurol 2019; 267:491-501. [DOI: 10.1007/s00415-019-09612-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
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22
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Nyberg J, Gustavsson S, Linde M, Åberg ND, Rohmann JL, Åberg M, Kurth T, Waern M, Kuhn GH. Cardiovascular fitness and risk of migraine: a large, prospective population-based study of Swedish young adult men. BMJ Open 2019; 9:e029147. [PMID: 31473616 PMCID: PMC6719773 DOI: 10.1136/bmjopen-2019-029147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To examine the longitudinal relationship between cardiovascular fitness in young adult men and future risk of migraine and to estimate eventual differential effects among categories of body mass index (BMI) and blood pressure. DESIGN National, prospective, population-based cohort study. SETTING Sweden 1968-2014. PARTICIPANTS 18-year-old Swedish men (n=1 819 828) who underwent mandatory military conscription examinations during the years 1968-2005. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the first dispensation of prescribed migraine-specific medication, identified using the Swedish Prescribed Drug Register. The secondary outcome was documented migraine diagnosis from the Swedish National Hospital Register. RESULTS During follow-up, 22 533 men filled a prescription for migraine-specific medication. After confounding adjustment, compared with high cardiovascular fitness, low and medium fitness increased the risk of migraine-specific medication (risk ratio (RR)low: 1.29, 95% CI 1.24 to 1.35; population attributable fraction: 3.6%, 95% CI 1.7% to 5.3% and RRmedium: 1.15, 95% CI 1.12 to 1.19; population attributable fraction: 8.0%, 95% CI 4.0% to 11.7%). To assess potential effect measure modification, stratified analyses of these association by levels of BMI and blood pressure showed that lower fitness levels increased risk of migraine across all groups except among underweight men or men with high diastolic blood pressure. CONCLUSIONS Young men with a lower cardiovascular fitness had a higher long-term risk of developing pharmacological prescription-requiring migraine. This study contributes with information regarding risk factors for migraine in men, an understudied population in migraine research.
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Affiliation(s)
- Jenny Nyberg
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Neurology Clinic, Gothenburg, Sweden
| | - Sara Gustavsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology; Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway
| | - N David Åberg
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden
| | - Jessica L Rohmann
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Åberg
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan, Gothenburg, Sweden
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
| | - Georg Hans Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Stroke Research and Neurocure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
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23
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Lissner L, Mehlig K, Rosengren A, Toren K, Åberg M. A Growing Social Divide in Body Mass Index, Strength, and Fitness of Swedish Male Conscripts. J Adolesc Health 2019; 65:232-238. [PMID: 31028008 DOI: 10.1016/j.jadohealth.2019.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the study was to monitor trends in socioeconomic inequalities in body mass index (BMI), cardiorespiratory fitness (CRF), and muscular strength over several decades in a population of Swedish males aged 18-19 years. METHODS The cohort consists of 1.5 million young men attending military conscript examinations from late 1968 to 2005. Parental education was used as a marker for socioeconomic conditions in the conscripts' families of origin. Changing gradient in BMI, CRF, and muscular strength in sons of parents with higher and lower educational attainment was evaluated during four periods covering 36 years. RESULTS Over the course of the obesity epidemic, BMI remained higher in conscripts with lesser (vs. higher) parental education. Moreover, the absolute difference in obesity prevalence between groups showed a continuous increase, from .6% to 3.9%, indicating growing inequalities. Regarding fitness, lower CRF was consistently associated with less parental education, but with no clear secular trend in the magnitude of the difference. Finally, social differences in muscular strength changed in direction, from lower strength among conscripts with higher parental education in the initial observation period to lower strength associated with lower parental education in the final decade studied. CONCLUSIONS Among Swedish conscripts entering adulthood, social gradients in BMI and obesity widened continuously between 1968 and 2005. An apparent reversal of the earlier gradient in muscular strength in young men may be related to societal trends in occupational and leisure-time physical activity over the observation period. This cohort is being continually monitored through national registries for obesity-related comorbidities in later life.
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Affiliation(s)
- Lauren Lissner
- Department of Public Health and Community Medicine/Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
| | - Kirsten Mehlig
- Department of Public Health and Community Medicine/Epidemiology and Social Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Cardiovascular and Molecular Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Kjell Toren
- Department of Public Health and Community Medicine/Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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24
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Lindbohm JV, Rautalin I, Jousilahti P, Salomaa V, Kaprio J, Korja M. Physical activity associates with subarachnoid hemorrhage risk- a population-based long-term cohort study. Sci Rep 2019; 9:9219. [PMID: 31239477 PMCID: PMC6592878 DOI: 10.1038/s41598-019-45614-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022] Open
Abstract
Benefit of physical activity in prevention of aneurysmal subarachnoid hemorrhage (SAH) is unclear. We aimed to clarify this by studying how different types of physical activity associate with SAH risk. By following 65 521 population-based FINRISK participants prospectively from medical and autopsy registries since 1972 until 2014, we detected 543 incident SAHs. At baseline, we measured leisure-time physical activity (LTPA), occupational physical activity (OPA), and commuting physical activity (CPA) levels. The Cox model adjusted for all well-known SAH risk factors and for socioeconomic status, provided hazard ratios (HRs) for physical activity variables. Every 30-minute increase in weekly LTPA decreased SAH risk linearly in men and women HR = 0.95 (95% CI = 0.90–1.00). CPA reduced SAH risk as well, but the association diminished as participants retired. In contrast, individuals with moderate (1.41, 1.04–1.92) and high OPA (1.34, 0.99–1.81) had elevated SAH risk. Protective association of LTPA persisted in all age and hypertension groups, and was even greater in current smokers 0.88 (0.81–0.96) than non-smokers (p = 0.04 for difference). Commuting and leisure time physical activity seem to reduce SAH risk in men and women and is most beneficial for smokers. Future intervention studies should investigate whether physical activity can reduce the rupture risk of intracranial aneurysms.
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Affiliation(s)
- Joni V Lindbohm
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland. .,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland.
| | - Ilari Rautalin
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
| | - Pekka Jousilahti
- National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jaakko Kaprio
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 41, FI-00014, Helsinki, Finland.,Institute for Molecular Medicine FIMM, P.O. Box 20, FI-00014, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
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25
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Seo YG, Lim H, Kim Y, Ju YS, Lee HJ, Jang HB, Park SI, Park KH. The Effect of a Multidisciplinary Lifestyle Intervention on Obesity Status, Body Composition, Physical Fitness, and Cardiometabolic Risk Markers in Children and Adolescents with Obesity. Nutrients 2019; 11:nu11010137. [PMID: 30634657 PMCID: PMC6356576 DOI: 10.3390/nu11010137] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/03/2019] [Accepted: 01/05/2019] [Indexed: 12/02/2022] Open
Abstract
This study aimed to develop a multidisciplinary lifestyle intervention program targeted at children and adolescents with moderate to severe obesity, and assess the additional effects of exercise intervention when compared to usual care. Overall, the 103 enrolled participants were ≥85th percentile of age and sex-specific body mass index (BMI). Participants were divided into groups that received 16 weeks of either usual care or exercise intervention. The BMI z-score of the overall completers decreased by about 0.05 after the 16-week intervention (p = 0.02). After the intervention, only the exercise group had a significantly lower BMI z-score than the baseline score by about 0.1 (p = 0.03), but no significant group by time interaction effects were observed. At the 16-week follow-up, significant group by time interaction effects were observed in percentage body fat (%BF) (β = −1.52, 95%CI = −2.58–−0.45), lean body mass (LM) (β = 1.20, 95%CI = 0.12–2.29), diastolic blood pressure (β = −5.24, 95%CI = −9.66–−0.83), high-sensitivity C-reactive protein (β = −1.67, 95%CI = −2.77–−1.01), and wall sit test score (β = 50.74, 95%CI = 32.30–69.18). We developed a moderate-intensity intervention program that can be sustained in the real-world setting and is practically applicable to both moderate and severe obesity. After interventions, the exercise group had lower %BF and cardiometabolic risk markers, and higher LM and leg muscle strength compared to the usual care group.
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Affiliation(s)
- Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea.
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin, Gyeonggi-do 17104, Korea.
| | - YoonMyung Kim
- University College, Yonsei University International Campus, Incheon 21983, Korea.
| | - Young-Su Ju
- Department of Occupational and Environmental Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea.
| | - Hye-Ja Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea.
| | - Han Byul Jang
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea.
| | - Sang Ick Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk 28159, Korea.
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, Korea.
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26
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Prestgaard E, Mariampillai J, Engeseth K, Erikssen J, Bodegård J, Liestøl K, Gjesdal K, Kjeldsen S, Grundvold I, Berge E. Change in Cardiorespiratory Fitness and Risk of Stroke and Death: Long-Term Follow-Up of Healthy Middle-Aged Men. Stroke 2019; 50:155-161. [PMID: 30580727 DOI: 10.1161/strokeaha.118.021798] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background and Purpose- Low cardiorespiratory fitness is associated with increased risk of cardiovascular disease. The present study aims to assess whether change of fitness over time has any impact on long-term risk of stroke and death. Methods- We recruited healthy men aged 40 to 59 years in 1972 to 1975, and followed them until 2007. Physical fitness was assessed with a bicycle ECG test at baseline and again at 7 years, by dividing the total exercise work by body weight. Participants were categorized as remained fit, became unfit, remained unfit, or became fit, depending on whether fitness remained or crossed the median values from baseline to the 7-year visit. Outcome data were collected up to 35 years, from study visits, hospital records, and the National Cause of Death Registry. Risks of stroke and death were estimated by Cox regression analyses and expressed as hazard ratios (HRs) with 95% CIs. Results- Of 2014 participants, 1403 were assessed both at baseline and again at 7 years, and were followed for a mean of 23.6 years. Compared with the became unfit group, risk of stroke was 0.85 (0.54-1.36) for the remained unfit, 0.43 (0.28-0.67) for the remained fit, and 0.34 (0.17-0.67) for the became fit group. For all-cause death, risks were 0.99 (0.76-1.29), 0.57 (0.45-0.74), and 0.65 (0.46-0.90), respectively. Among those with high fitness at baseline, the became unfit group had a significantly higher risk of stroke (HR, 2.35; CI, 1.49-3.63) and death (HR, 1.74; CI, 1.35-2.23) than those who remained fit. Among those who had low fitness at baseline, the became fit group had a significantly lower risk of stroke (HR, 0.40; CI, 0.21-0.72) and death (HR, 0.66; CI, 0.50-0.85) than participants in the remained unfit group. Conclusions- Cardiorespiratory fitness at baseline and change in fitness was associated with large changes in long-term risk of stroke and death. These findings support the encouragement of regular exercise as a stroke prevention strategy.
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Affiliation(s)
- Erik Prestgaard
- From the Institute of Clinical Medicine (E.P., K.E., J.E., K.G., S.K.), University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Julian Mariampillai
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Kristian Engeseth
- From the Institute of Clinical Medicine (E.P., K.E., J.E., K.G., S.K.), University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Jan Erikssen
- From the Institute of Clinical Medicine (E.P., K.E., J.E., K.G., S.K.), University of Oslo, Norway
| | - Johan Bodegård
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo, Norway
| | - Knut Gjesdal
- From the Institute of Clinical Medicine (E.P., K.E., J.E., K.G., S.K.), University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Sverre Kjeldsen
- From the Institute of Clinical Medicine (E.P., K.E., J.E., K.G., S.K.), University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Irene Grundvold
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway (E.P., J.M., K.E., J.B., K.G., S.K., I.G., E.B.)
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Williamson W, Huckstep OJ, Frangou E, Mohamed A, Tan C, Alsharqi M, Bertagnolli M, Lapidaire W, Newton J, Hanssen H, McManus R, Dawes H, Foster C, Lewandowski AJ, Leeson P. Trial of exercise to prevent HypeRtension in young adults (TEPHRA) a randomized controlled trial: study protocol. BMC Cardiovasc Disord 2018; 18:208. [PMID: 30400774 PMCID: PMC6220491 DOI: 10.1186/s12872-018-0944-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Hypertension prevalence in young adults has increased and is associated with increased incidence of cerebrovascular and cardiovascular events in middle age. However, there is significant debate regards how to effectively manage young adult hypertension with recommendation to target lifestyle intervention. Surprisingly, no trials have investigated whether lifestyle advice developed for blood pressure control in older adults is effective in these younger populations. Methods/Design TEPHRA is an open label, parallel arm, randomised controlled trial in young adults with high normal and elevated blood pressure. The study will compare a supervised physical activity intervention consisting of 16 weeks structured exercise, physical activity self-monitoring and motivational coaching with a control group receiving usual care/minimal intervention. Two hundred young adults aged 18–35 years, including a subgroup of preterm born participants will be recruited through open recruitment and direct invitation. Participants will be randomised in a ratio of 1:1 to either the exercise intervention group or control group. Primary outcome will be ambulatory blood pressure monitoring at 16 weeks with measure of sustained effect at 12 months. Study measures include multimodal cardiovascular assessments; peripheral vascular measures, blood sampling, microvascular assessment, echocardiography, objective physical activity monitoring and a subgroup will complete multi-organ magnetic resonance imaging. Discussion The results of this trial will deliver a novel, randomised control trial that reports the effect of physical activity intervention on blood pressure integrated with detailed cardiovascular phenotyping in young adults. The results will support the development of future research and expand the evidence-based management of blood pressure in young adult populations. Trial Registration Clinicaltrials.gov registration number NCT02723552, registered on 30 March, 2016.
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Affiliation(s)
- Wilby Williamson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Odaro J Huckstep
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Eleni Frangou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Afifah Mohamed
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Cheryl Tan
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Maryam Alsharqi
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Mariane Bertagnolli
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Centre Integré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal Research Center, Montréal, Canada
| | - Winok Lapidaire
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Richard McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Helen Dawes
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Charlie Foster
- School of Policy Studies, University of Bristol, Bristol, UK
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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28
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Williamson W, Lewandowski AJ, Forkert ND, Griffanti L, Okell TW, Betts J, Boardman H, Siepmann T, McKean D, Huckstep O, Francis JM, Neubauer S, Phellan R, Jenkinson M, Doherty A, Dawes H, Frangou E, Malamateniou C, Foster C, Leeson P. Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults. JAMA 2018; 320:665-673. [PMID: 30140877 PMCID: PMC6142949 DOI: 10.1001/jama.2018.11498] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/22/2018] [Indexed: 12/28/2022]
Abstract
Importance Risk of stroke and brain atrophy in later life relate to levels of cardiovascular risk in early adulthood. However, it is unknown whether cerebrovascular changes are present in young adults. Objective To examine relationships between modifiable cardiovascular risk factors and cerebrovascular structure, function, and white matter integrity in young adults. Design, Setting, and Participants A cross-sectional observational study of 125 young adults (aged 18-40 years) without clinical evidence of cerebrovascular disease. Data collection was completed between August 2014 and May 2016 at the University of Oxford, United Kingdom. Final data collection was completed on May 31, 2016. Exposures The number of modifiable cardiovascular risk factors at recommended levels, based on the following criteria: body mass index (BMI) <25; highest tertile of cardiovascular fitness and/or physical activity; alcohol consumption <8 drinks/week; nonsmoker for >6 months; blood pressure on awake ambulatory monitoring <130/80 mm Hg; a nonhypertensive diastolic response to exercise (peak diastolic blood pressure <90 mm Hg); total cholesterol <200 mg/dL; and fasting glucose <100mg/dL. Each risk factor at the recommended level was assigned a value of 1, and participants were categorized from 0-8, according to the number of risk factors at recommended levels, with higher numbers indicating healthier risk categories. Main Outcomes and Measures Cerebral vessel density, caliber and tortuosity, brain white matter hyperintensity lesion count. In a subgroup (n = 52), brain blood arrival time and cerebral blood flow assessed by brain magnetic resonance imaging (MRI). Results A total of 125 participants, mean (SD) age 25 (5) years, 49% women, with a mean (SD) score of 6.0 (1.4) modifiable cardiovascular risk factors at recommended levels, completed the cardiovascular risk assessment and brain MRI protocol. Cardiovascular risk factors were correlated with cerebrovascular morphology and white matter hyperintensity count in multivariable models. For each additional modifiable risk factor categorized as healthy, vessel density was greater by 0.3 vessels/cm3 (95% CI, 0.1-0.5; P = .003), vessel caliber was greater by 8 μm (95% CI, 3-13; P = .01), and white matter hyperintensity lesions were fewer by 1.6 lesions (95% CI, -3.0 to -0.5; P = .006). Among the 52 participants with available data, cerebral blood flow varied with vessel density and was 2.5 mL/100 g/min higher for each healthier category of a modifiable risk factor (95% CI, 0.16-4.89; P = .03). Conclusions and Relevance In this preliminary study involving young adults without clinical evidence of cerebrovascular disease, a greater number of modifiable cardiovascular risk factors at recommended levels was associated with higher cerebral vessel density and caliber, higher cerebral blood flow, and fewer white matter hyperintensities. Further research is needed to verify these findings and determine their clinical importance.
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Affiliation(s)
- Wilby Williamson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Adam J. Lewandowski
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nils D. Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ludovica Griffanti
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Thomas W. Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jill Betts
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - David McKean
- Department of Radiology, Stoke Mandeville Hospital, Buckinghamshire NHS Trust, Buckinghamshire, England, United Kingdom
| | - Odaro Huckstep
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
| | - Jane M. Francis
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Renzo Phellan
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB Division, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Aiden Doherty
- Nuffield Department of Population Health, BHF Centre of Research Excellence and Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Helen Dawes
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, Oxford, United Kingdom
| | - Eleni Frangou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Christina Malamateniou
- School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom
- Department of Family Care and Mental Health, University of Greenwich, London, United Kingdom
| | - Charlie Foster
- School of Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
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Sui X, Howard VJ, McDonnell MN, Ernstsen L, Flaherty ML, Hooker SP, Lavie CJ. Racial Differences in the Association Between Nonexercise Estimated Cardiorespiratory Fitness and Incident Stroke. Mayo Clin Proc 2018; 93:884-894. [PMID: 29903604 PMCID: PMC6154797 DOI: 10.1016/j.mayocp.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the association between estimated cardiorespiratory fitness (eCRF) and incident stroke by black and white race. PARTICIPANTS AND METHODS A total of 24,162 participants from the REasons for Geographic And Racial Differences in Stroke study (13,232 [54.8%] women; 9543 [39.5%] blacks; mean age, 64.6±9.3 years) without stroke at enrollment between January 15, 2003, and October 30, 2007, were followed for incident stroke through March 31, 2016. Baseline eCRF in maximal metabolic equivalents was determined using nonexercise sex-specific algorithms and further grouped into age- and sex-specific tertiles. RESULTS Over a mean of 8.3±3.2 years of follow-up, 945 (3.9%) incident strokes occurred (377 in blacks and 568 in whites). The association between eCRF and stroke risk differed significantly by race (PInteraction<.001). In whites, after adjustment for stroke risk factors and physical functioning score, the hazard ratio of stroke was 0.82 (95% CI, 0.67-1.00) times lower in the middle tertile of eCRF than in the lowest tertile and was 0.54 (95% CI, 0.43-0.69) times lower in the highest tertile of eCRF. The protective effect of higher levels of eCRF on stroke incidence was more pronounced in those 60 years or older among whites. No association between eCRF and stroke risk was observed in blacks. CONCLUSION Estimated cardiorespiratory fitness measured using nonexercise equations is a useful predictor of stroke in whites. The lack of an overall association between eCRF and stroke risk in blacks suggests that the assessment of eCRF in blacks may not be helpful in primary stroke prevention.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham
| | - Michelle N McDonnell
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Matthew L Flaherty
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Steven P Hooker
- College of Health Solutions, Arizona State University, Phoenix
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Health and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA
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Kim Y, White T, Wijndaele K, Westgate K, Sharp SJ, Helge JW, Wareham NJ, Brage S. The combination of cardiorespiratory fitness and muscle strength, and mortality risk. Eur J Epidemiol 2018; 33:953-964. [PMID: 29594847 PMCID: PMC6153509 DOI: 10.1007/s10654-018-0384-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/21/2018] [Indexed: 12/11/2022]
Abstract
Little is known about the combined associations of cardiorespiratory fitness (CRF) and hand grip strength (GS) with mortality in general adult populations. The purpose of this study was to compare the relative risk of mortality for CRF, GS, and their combination. In UK Biobank, a prospective cohort of > 0.5 million adults aged 40–69 years, CRF was measured through submaximal bike tests; GS was measured using a hand-dynamometer. This analysis is based on data from 70,913 men and women (832 all-cause, 177 cardiovascular and 503 cancer deaths over 5.7-year follow-up) who provided valid CRF and GS data, and with no history of heart attack/stroke/cancer at baseline. Compared with the lowest CRF category, the hazard ratio (HR) for all-cause mortality was 0.76 [95% confidence interval (CI) 0.64–0.89] and 0.65 (95% CI 0.55–0.78) for the middle and highest CRF categories, respectively, after adjustment for confounders and GS. The highest GS category had an HR of 0.79 (95% CI 0.66–0.95) for all-cause mortality compared with the lowest, after adjustment for confounders and CRF. Similar results were found for cardiovascular and cancer mortality. The HRs for the combination of highest CRF and GS were 0.53 (95% CI 0.39–0.72) for all-cause mortality and 0.31 (95% CI 0.14–0.67) for cardiovascular mortality, compared with the reference category of lowest CRF and GS: no significant association for cancer mortality (HR 0.70; 95% CI 0.48–1.02). CRF and GS are both independent predictors of mortality. Improving both CRF and muscle strength, as opposed to either of the two alone, may be the most effective behavioral strategy to reduce all-cause and cardiovascular mortality risk.
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Affiliation(s)
- Youngwon Kim
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK.
- Department of Health, Kinesiology, and Recreation, College of Health, University of Utah, 250 South 1850 East Room 204, Salt Lake City, UT, 84112, USA.
| | - Tom White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Jørn W Helge
- Department of Biomedical Sciences, Center of Healthy Aging, University of Copenhagen, Blegdamsvej 3, 2200 N, Copenhagen, Denmark
| | - Nick J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, Cambridgeshire, CB2 0QQ, UK
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4454] [Impact Index Per Article: 742.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Scherr C, Fabiano LCC, Guerra RL, Belém LHJ, Câmara ACG, Campos A. Sports Practices and Cardiovascular Risk in Teenagers. Arq Bras Cardiol 2018; 110:248-255. [PMID: 29466486 PMCID: PMC5898775 DOI: 10.5935/abc.20180024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background Cardiovascular diseases are the leading cause of deaths in the world, and
many events could be prevented by healthy life habits. Objectives To compare the occurrence of cardiovascular risk factors in adolescents
enrolled at public schools in the city of Rio de Janeiro, including a
renowned school for sport practices. Methods Cross-sectional study, convenience sampling of 422 students enrolled at the
Experimental Olympic Gymnasium (EOG) and at Figueiredo Pimentel School (FP).
Using descriptive analyses, continuous variables were expressed as mean and
standard deviation or median and interquartile ranges, and the Student's
t-test or the chi-square test, respectively, was used for comparisons. The
sports were classified according to the metabolic equivalent of task (MET)
(below or above 5). Results We included 274 students enrolled at the EOG and 148 at FP. Mean age was
similar between schools -12.5 ± 1.6 years at FP and 12.6 ± 0.9
at the EOG; 65.5% of the students at FP and 43.8% of the students at the EOG
were female (p < 0.01). Significant differences in the prevalence of
hypertension (20% vs. 6.3%, p < 0.01) and borderline cholesterol levels
(27.7% vs. 17.3%, p = 0.01) were found between FP and EOG students,
respectively. Conclusion High prevalence of hypertension, overweight/obesity and altered blood lipid
profile was found in this group of adolescents. Regular sports training
program combined with little influence of their eating habits outside school
may contribute to a better metabolic profile and reduction in cardiovascular
risk factors in students. Public health measures are also need.
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Affiliation(s)
- Carlos Scherr
- Fundação Pró Coração, Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Adriana Campos
- Fundação Pró Coração, Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
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Wallin A, Kettunen P, Johansson PM, Jonsdottir IH, Nilsson C, Nilsson M, Eckerström M, Nordlund A, Nyberg L, Sunnerhagen KS, Svensson J, Terzis B, Wahlund LO, Georg Kuhn H. Cognitive medicine - a new approach in health care science. BMC Psychiatry 2018; 18:42. [PMID: 29422020 PMCID: PMC5806385 DOI: 10.1186/s12888-018-1615-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 01/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The challenges of today's society call for more knowledge about how to maintain all aspects of cognitive health, such as speed/attention, memory/learning, visuospatial ability, language, executive capacity and social cognition during the life course. MAIN TEXT Medical advances have improved treatments of numerous diseases, but the cognitive implications have not been sufficiently addressed. Disability induced by cognitive dysfunction is also a major issue in groups of patients not suffering from Alzheimer's disease or related disorders. Recent studies indicate that several negative lifestyle factors can contribute to the development of cognitive impairment, but intervention and prevention strategies have not been implemented. Disability due to cognitive failure among the workforce has become a major challenge. Globally, the changing aging pyramid results in increased prevalence of cognitive disorders, and the diversity of cultures influences the expression, manifestation and consequences of cognitive dysfunction. CONCLUSIONS Major tasks in the field of cognitive medicine are basic neuroscience research to uncover diverse disease mechanisms, determinations of the prevalence of cognitive dysfunction, health-economical evaluations, and intervention studies. Raising awareness for cognitive medicine as a clinical topic would also highlight the importance of specialized health care units for an integrative approach to the treatment of cognitive dysfunctions.
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Affiliation(s)
- Anders Wallin
- University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
| | - Petronella Kettunen
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden ,0000 0004 1936 8948grid.4991.5Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Per M. Johansson
- 0000 0000 9919 9582grid.8761.8Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H. Jonsdottir
- Institute for Stress Medicine, Region Västra Götaland, Gothenburg, Sweden ,0000 0000 9919 9582grid.8761.8Department of Food, Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Christer Nilsson
- 0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Michael Nilsson
- 0000 0000 8831 109Xgrid.266842.cUniversity of Newcastle, Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Marie Eckerström
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Arto Nordlund
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Lars Nyberg
- 0000 0001 1034 3451grid.12650.30Center for Functional Brain Imaging and Department of Radiation Sciences & Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Katharina S. Sunnerhagen
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Johan Svensson
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK ,0000 0004 0624 0275grid.413652.7Department of Endocrinology, Skaraborg Central Hospital, Skövde, Sweden
| | | | - Lars-Olof Wahlund
- 0000 0004 1937 0626grid.4714.6Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Solna, Sweden
| | - H. Georg Kuhn
- 0000 0000 9919 9582grid.8761.8University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden ,0000 0001 2218 4662grid.6363.0Department of Neurology, Center for Stroke Research, Charité – Universitätsmedizin, Berlin, Germany
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Strasser B, Volaklis K, Fuchs D, Burtscher M. Role of Dietary Protein and Muscular Fitness on Longevity and Aging. Aging Dis 2018; 9:119-132. [PMID: 29392087 PMCID: PMC5772850 DOI: 10.14336/ad.2017.0202] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 02/02/2017] [Indexed: 12/21/2022] Open
Abstract
Muscle atrophy is an unfortunate effect of aging and many diseases and can compromise physical function and impair vital metabolic processes. Low levels of muscular fitness together with insufficient dietary intake are major risk factors for illness and mortality from all causes. Ultimately, muscle wasting contributes significantly to weakness, disability, increased hospitalization, immobility, and loss of independence. However, the extent of muscle wasting differs greatly between individuals due to differences in the aging process per se as well as physical activity levels. Interventions for sarcopenia include exercise and nutrition because both have a positive impact on protein anabolism but also enhance other aspects that contribute to well-being in sarcopenic older adults, such as physical function, quality of life, and anti-inflammatory state. The process of aging is accompanied by chronic immune activation, and sarcopenia may represent a consequence of a counter-regulatory strategy of the immune system. Thereby, the kynurenine pathway is induced, and elevation in the ratio of kynurenine to tryptophan concentrations, which estimates the tryptophan breakdown rate, is often linked with inflammatory conditions and neuropsychiatric symptoms. A combined exercise program consisting of both resistance-type and endurance-type exercise may best help to ameliorate the loss of skeletal muscle mass and function, to prevent muscle aging comorbidities, and to improve physical performance and quality of life. In addition, the use of dietary protein supplementation can further augment protein anabolism but can also contribute to a more active lifestyle, thereby supporting well-being and active aging in the older population.
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Affiliation(s)
- Barbara Strasser
- Division of Medical Biochemistry, Biocenter, Medical University Innsbruck, Austria
| | | | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, Medical Section, University Innsbruck, Austria
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García-Esquinas E, Rodríguez-Artalejo F. Association between serum uric acid concentrations and grip strength: Is there effect modification by age? Clin Nutr 2017; 37:566-572. [PMID: 28139280 DOI: 10.1016/j.clnu.2017.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given that some of the deleterious effects of uric acid (UA) on health are greater in younger than in older subjects, and that age is strongly associated with skeletal muscle composition and function, this study tested the hypothesis that the association between UA and muscle strength differs by age. METHODS Cross-sectional analysis with 3595 individuals who participated in NHANES 2011-2012. Serum uric acid was determined by the uricase-peroxidase technique. Grip strength was calculated as the average of the best measure obtained in each hand with a Takei digital grip strength dynamometer. Linear regression models were adjusted for the main confounders. RESULTS In individuals aged 20-40 years, the beta coefficients (95% CI) of muscle strength as dependent variable and UA as independent variable comparing the second and third to the lowest tertile of UA were -0.45 kg (-1.46; 0.57) and -2.36 kg (-3.27; -1.44), respectively, p-linear trend ≤0.01. By contrast, in subjects aged 40-60 years the corresponding beta coefficients were 0.21 kg (-1.00; 1.42) and -0.45 kg (-2.10; 1.20), p-linear trend: 0.60; and for subjects ≥60 years they were 0.58 kg (-3.27; 1.65) and 1.57 kg (0.63; 2.50), p-linear trend <0.01. These results held after numerous sensitivity analyses. CONCLUSION The association between UA and muscle strength differed depending on age: while a negative link was observed in adults aged 20-40 years, this relationship disappeared later in life, and was reversed after the age of 60. Future research should evaluate if uric acid targets for individuals with hyperuricemia should consider patients age and muscle strength.
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Affiliation(s)
- Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain; CIBER of Epidemioloy and Public Health (CIBERESP), Madrid, Spain.
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz, Madrid, Spain; CIBER of Epidemioloy and Public Health (CIBERESP), Madrid, Spain
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Wändell P, Carlsson AC, Holzmann MJ, Ärnlöv J, Johansson SE, Sundquist J, Sundquist K. Warfarin treatment and risk of stroke among primary care patients with atrial fibrillation. SCAND CARDIOVASC J 2016; 50:311-316. [PMID: 27460750 DOI: 10.1080/14017431.2016.1215519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our aim was to study the risk of a first ischaemic stroke (IS) in patients with atrial fibrillation (AF) treated in primary healthcare. DESIGN The study population included all adults (n = 11,517), 45 years and older diagnosed with AF, from 75 primary care centres in Sweden between 2001 and 2007. IS was defined as a hospital care event of stroke between 2001 and 2010. Association between incident stroke and warfarin treatment was explored using Cox regression analysis, with hazard ratios (HRs), and 95% confidence intervals (95%CIs). Adjustment was made for age, socioeconomic factors and co-morbidity. RESULTS Persistent treatment with warfarin was present among 33.7% of women and 40.0% among men. Persistent warfarin treatment, compared to no persistent treatment, was associated with a stroke preventing effect with fully adjusted HRs of 0.25 (95%CI 0.18-0.36) in women, and 0.25 (95%CI 0.19-0.32) in men. A CHA2DS2-VASc score of at least two among women, and three among men, was associated with a stroke risk exceeding 18% during a mean follow-up of 5.4 years. Risk of haemorrhagic stroke was not increased. CONCLUSIONS Warfarin is effective in preventing stroke in AF patients in primary healthcare.
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Affiliation(s)
- Per Wändell
- a Division of Family Medicine, Department of Neurobiology, Care Science and Society , Karolinska Institutet , Huddinge , Sweden.,b Academic Primary Healthcare Centre, Stockholm County Council , Huddinge , Sweden
| | - Axel C Carlsson
- a Division of Family Medicine, Department of Neurobiology, Care Science and Society , Karolinska Institutet , Huddinge , Sweden.,c Department of Medical Sciences , Cardiovascular Epidemiology, Uppsala University , Uppsala , Sweden
| | - Martin J Holzmann
- d Department of Emergency Medicine , Karolinska University Hospital , Stockholm , Sweden.,e Department of Internal Medicine , Karolinska Institutet , Stockholm , Sweden
| | - Johan Ärnlöv
- c Department of Medical Sciences , Cardiovascular Epidemiology, Uppsala University , Uppsala , Sweden.,f School of Health and Social Studies , Dalarna University , Falun , Sweden
| | | | - Jan Sundquist
- g Center for Primary Health Care Research, Lund University , Malmö , Sweden
| | - Kristina Sundquist
- g Center for Primary Health Care Research, Lund University , Malmö , Sweden
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Wändell P, Carlsson AC, Holzmann MJ, Ärnlöv J, Johansson SE, Sundquist J, Sundquist K. Warfarin treatment and risk of myocardial infarction - A cohort study of patients with atrial fibrillation treated in primary health care. Int J Cardiol 2016; 221:789-93. [PMID: 27428322 DOI: 10.1016/j.ijcard.2016.07.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/08/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). METHODS The study population included subjects (n=12,283) 45years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. RESULTS Persistent treatment ("per protocol" treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16-0.41) and for men 0.28 (95% CI 0.20-0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37-0.87), and for men 0.44 95% CI (0.31-0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27-0.80), and for men 0.58 (95% CI 0.38-0.89). CONCLUSIONS Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Healthcare Centre, Stockholm County Council, Huddinge, Sweden.
| | - Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Martin J Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ärnlöv
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
| | | | - Jan Sundquist
- Centre for Primary Health Care Research, Lund University, Malmö, Sweden
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Interactive effects of physical fitness and body mass index on risk of stroke: A national cohort study. Int J Stroke 2016; 11:683-94. [PMID: 27016513 DOI: 10.1177/1747493016641961] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/30/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND High body mass index (BMI) and low physical fitness are risk factors for stroke, but their interactive effects are unknown. Elucidation of interactions between these modifiable risk factors can help inform preventive interventions in susceptible subgroups. METHODS National cohort study of all 1,547,294 military conscripts in Sweden during 1969-1997 (97-98% of all 18-year-old males). Standardized aerobic capacity, muscular strength, and body mass index measurements were examined in relation to stroke identified from inpatient and outpatient diagnoses through 2012 (maximum age 62 years). RESULTS Sixteen thousand nine hundred seventy-nine men were diagnosed with stroke in 39.7 million person-years of follow-up. High body mass index, low aerobic fitness, and (less strongly) low muscular fitness were associated with higher risk of any stroke, ischemic stroke, and intracerebral hemorrhage, independently of family history and sociodemographic factors. High body mass index (overweight/obese vs. normal) and low aerobic capacity (lowest vs. highest tertile) had similar effect magnitudes, and their combination was associated with highest stroke risk (incidence rate ratio, 2.36; 95% CI, 2.14-2.60; P < 0.001). Aerobic capacity and muscular strength had a positive additive and multiplicative interaction (P < 0.001), indicating that low aerobic capacity accounted for more strokes among men with low compared with high muscular strength. CONCLUSIONS High body mass index and low aerobic capacity in late adolescence are associated with increased risk of stroke in adulthood. Low aerobic capacity and low muscular strength also have a synergistic effect on stroke risk. These findings suggest that preventive interventions should include weight control and aerobic fitness early in life, and muscular fitness especially among those with low aerobic capacity.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jan Sundquist
- Clinical Research Centre (CRC), Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Kristina Sundquist
- Clinical Research Centre (CRC), Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Åberg MAI, Torén K, Nilsson M, Henriksson M, Kuhn HG, Nyberg J, Rosengren A, Åberg ND, Waern M. Nonpsychotic Mental Disorders in Teenage Males and Risk of Early Stroke: A Population-Based Study. Stroke 2016; 47:814-21. [PMID: 26846861 PMCID: PMC4760382 DOI: 10.1161/strokeaha.115.012504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although the incidence of stroke is on the decline worldwide, this is not the case for early stroke. We aimed to determine whether nonpsychotic mental disorder at the age of 18 years is a risk factor for early stroke, and if adolescent cardiovascular fitness and intelligence quotient might attenuate the risk. METHOD Population-based Swedish cohort study of conscripts (n=1 163 845) who enlisted during 1968 to 2005. At conscription, 45 064 males were diagnosed with nonpsychotic mental disorder. Risk of stroke during follow-up (5-42 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. RESULTS There were 7770 first-time stroke events. In adjusted models, increased risk for stroke was observed in men diagnosed with depressive/neurotic disorders (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.11-1.37), personality disorders (HR, 1.52; 95% CI, 1.29-1.78), and alcohol/substance use disorders (HR, 1.61; 95% CI, 1.41-1.83) at conscription. Corresponding figures for fatal stroke were HR, 1.38; 95% CI, 1.06 to 1.79; HR, 2.26; 95% CI, 1.60 to 3.19; and HR, 2.20; 95% CI, 1.63 to 2.96. HRs for stroke were attenuated when fitness level and intelligence quotient were introduced. Associations remained significant for personality disorders and alcohol/substance use in the fully adjusted models. The interaction term was statistically significant for fitness but not for intelligence quotient. CONCLUSIONS Our findings suggest that fitness may modify associations between nonpsychotic disorders and stroke. It remains to be clarified whether interventions designed to improve fitness in mentally ill youth can influence future risk of early stroke.
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Affiliation(s)
- Maria A I Åberg
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
| | - Kjell Torén
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Michael Nilsson
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Malin Henriksson
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - H Georg Kuhn
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Jenny Nyberg
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Annika Rosengren
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - N David Åberg
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Margda Waern
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
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