Improvements in fitness are not obligatory for exercise training-induced improvements in CV risk factors

An updated systematic review on the effects of aerobic exercise on human blood lipid profile

Sedentary lifestyle and dyslipidemia are well-recognized risk factors for cardiovascular diseases (CVD). Changes in blood lipid profile (total cholesterol (TC), triglycerides, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]) due to the exercise may be beneficial for decreasing CVD-related events. In this review we aimed to investigate the effect of different types of exercise on lipid profile components in people with different health conditions and age ranges. A systematic search was performed covering PubMed, Web of Science, and Google Scholar for English articles from 2010 until November 2021. Finally, 31 studies were included in our study. Results showed that exercise in younger individuals sometimes resulted in no significant changes of any of the variables or some of them; however, efficient improvement was observed in all studies of older and middle-age groups. In terms of health condition and gender; healthy individuals, overweight people, subjects with type 2 diabetes and obesity, and male participants found to have benefited more from the exercise. In patients with chronic kidney diseases lipid profile improvement was not significant. The cardiac rehabilitation program, particularly comprehensive cardiac rehabilitation, proved to be more beneficial than exercise alone in the case of cardiovascular patients and those at elevated risk of CVD. In conclusion exercise is beneficial in terms of improving lipid profile but for younger population, and those with kidney problems and CVD patients, more further preparations are needed under the supervision of experts in the field of sports and medicine to achieve the desired result. Also, more studies are needed for these groups in order to provide a definite and reliable conclusion.

Regular exercise and patterns of response across multiple cardiometabolic traits: the HERITAGE family study

OBJECTIVES

We investigated whether high responsiveness or low responsiveness to exercise training aggregates in the same individuals across seven cardiometabolic traits.

METHODS

A total of 564 adults (29.2% black, 53.7% female) from the HERITAGE family study completed a 20-week endurance training programme (at 55%-75% of participants' maximal oxygen uptake (VO₂max)) with VO₂max, per cent body fat, visceral adipose tissue, fasting levels of insulin, high-density lipoprotein cholesterol, small low-density lipoprotein particles and inflammatory marker GlycA measured before and after training. For each exercise response trait, we created ethnicity-specific, sex-specific and generation-specific quintiles. High responses were defined as those within the 20th percentile representing the favourable end of the response trait distribution, low responses were defined as the 20th percentile from the least favourable end, and the remaining were labelled as average responses.

RESULTS

Only one individual had universally high or low responses for all seven cardiometabolic traits. Almost half (49%) of the cohort had at least one high response and one low response across the seven traits. About 24% had at least one high response but no low responses, 24% had one or more low responses but no high responses, and 2.5% had average responses across all traits.

CONCLUSIONS

Interindividual variation in exercise responses was evident in all the traits we investigated, and responsiveness did not aggregate consistently in the same individuals. While adherence to an exercise prescription is known to produce health benefits, targeted risk factors may not improve.

Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases

Cardiovascular diseases are the most common causes of mortality worldwide. They are frequently the reasons for patient hospitalization, their incapability for work, and disability. These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families. It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle, and so modification of the latter is an essential component of both primary and secondary prevention. Cardiac rehabilitation (CR) represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity. This review presents an overview of basic information on CR with a focus on current trends, such as the issue of the various training modalities, utilization, and barriers to it or the use of telemedicine technologies. Appropriate attention should be devoted to these domains, as CR continues evolving as an effective and readily available intervention in the future.

Efficacy of a Six-Week Dispersed Wingate-Cycle Training Protocol on Peak Aerobic Power, Leg Strength, Insulin Sensitivity, Blood Lipids and Quality of Life in Healthy Adults

The aim of this study was to evaluate the efficacy of a six-week dispersed Wingate Anaerobic test (WAnT) cycle exercise training protocol on peak aerobic power (VO_2peak), isokinetic leg strength, insulin sensitivity, lipid profile and quality of life, in healthy adults. Methods: We conducted a match-controlled cohort trial and participants were assigned to either the training (intervention, INT, N = 16) or non-training (control, CON, N = 17) group. INT performed 30-s WAnT bouts three times a day in the morning, afternoon and evening with each bout separated by ~4 h of rest, performed for 3 days a week for 6 weeks. Criterion measures of peak oxygen uptake (VO_2peak), leg strength, insulin markers such as homeostatic model assessment (HOMA) and quantitative insulin-sensitivity check index (QUICKI), blood lipids profile and health-related quality of life (HRQL) survey were assessed before and after 6 weeks in both groups. Results: Absolute VO_2peak increased by 8.3 ± 7.0% (p < 0.001) after INT vs. 0.9 ± 6.1% in CON (p = 0.41) group. Maximal voluntary contraction at 30°·s^-1 of the dominant lower-limb flexors in INT increased significantly post-training (p = 0.03). There were no changes in the INT individuals' other cardiorespiratory markers, HOMA, QUICKI, blood lipids, and HRQL measures (all p > 0.05) between pre- and post-training; but importantly, no differences were observed between INT and CON groups (all p > 0.05). Conclusions: The results indicate that 6 weeks of dispersed sprint cycle training increased cardiorespiratory fitness and dynamic leg strength but had minimal impact on insulin sensitivity, blood lipids and quality of life in the exercising individuals.

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

AIMS/HYPOTHESIS

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

METHODS

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

RESULTS

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

CONCLUSIONS/INTERPRETATION

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

TRIAL REGISTRATION

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

Increase in Physical Activity After Bariatric Surgery Demonstrates Improvement in Weight Loss and Cardiorespiratory Fitness

Background

Low cardiorespiratory fitness is strongly associated with cardiovascular diseases and mortality. Although increased physical activity can improve cardiorespiratory fitness, this relationship has not been examined in a large bariatric population undergoing perioperative care focusing on long-term lifestyle change.

Objectives

To evaluate changes in physical activity, weight loss, and cardiorespiratory fitness up to 24 months after bariatric surgery, and to evaluate the relationships of change in physical activity with weight loss and change in cardiorespiratory fitness.

Materials and Methods

Four thousand seven hundred eighty-five patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy between January 2012 and December 2014 were included. Physical activity was assessed by the Baecke questionnaire (work, leisure, and sport activity) and cardiorespiratory fitness, defined as VO₂max relative to fat-free mass (VO₂max/FFM), was assessed by the Åstrand test.

Results

Twenty-four months postoperative, significant improvements were seen in sport and leisure activity assessments (n = 3548, P < 0.001), weight loss (n = 3695, P < 0.001), and VO₂max/FFM (n = 1852, P < 0.001). Furthermore, regression analysis showed that change in leisure activity was positively associated with weight loss (n = 3535, ß = 1.352, P < 0.001) and change in sport activity was positively associated with change in VO₂max/FFM (n = 1743, ß = 1.730, P < 0.001).

Conclusion

Bariatric surgery complemented by a comprehensive bariatric care program can lead to improvement in physical activity, as well as weight loss and improvement in cardiorespiratory fitness. The positive associations of change in leisure activity with weight loss and change in sport activity with cardiorespiratory fitness suggest that bariatric care programs can enhance postoperative outcomes by improving the patient’s physical activity.

Protein supplementation improves lean body mass in physically active older adults: a randomized placebo-controlled trial

BACKGROUND

An inadequate protein intake may offset the muscle protein synthetic response after physical activity, reducing the possible benefits of an active lifestyle for muscle mass. We examined the effects of 12 weeks of daily protein supplementation on lean body mass, muscle strength, and physical performance in physically active older adults with a low habitual protein intake (<1.0 g/kg/day).

METHODS

A randomized double-blinded controlled trial was performed among 116 physically active older adults [age 69 (interquartile range: 67-73) years, 82% male] who were training for a 4 day walking event of 30, 40, or 50 km/day. Participants were randomly allocated to either 31 g of milk protein or iso-caloric placebo supplementation for 12 weeks. Body composition (dual-energy X-ray absorptiometry), strength (isometric leg extension and grip strength), quadriceps contractile function, and physical performance [Short Physical Performance Battery, Timed Up-and-Go test, and cardiorespiratory fitness (Åstrand-Rhyming submaximal exercise test)] were measured at baseline and after 12 weeks. We assessed vitamin D status and markers of muscle damage and renal function in blood and urine samples before and after intervention.

RESULTS

A larger increase in relative lean body mass was observed in the protein vs. placebo group (∆0.93 ± 1.22% vs. ∆0.44 ± 1.40%, P_Interaction  = 0.046). Absolute and relative fat mass decreased more in the protein group than in the placebo group (∆-0.90 ± 1.22 kg vs. ∆-0.31 ± 1.28 kg, P_Interaction  = 0.013 and ∆-0.92 ± 1.19% vs. ∆-0.39 ± 1.36%, P_Interaction  = 0.029, respectively). Strength and contractile function did not change in both groups. Gait speed, chair-rise ability, Timed Up-and-Go, and cardiorespiratory fitness improved in both groups (P < 0.001), but no between-group differences were observed. Serum urea increased in the protein group, whereas no changes were observed in the placebo group (P_Interaction  < 0.001). No between-group differences were observed for vitamin D status, muscle damage, and renal function markers.

CONCLUSIONS

In physically active older adults with relatively low habitual dietary protein consumption, an improvement in physical performance, an increase in lean body mass, and a decrease in fat mass were observed after walking exercise training. A larger increase in relative lean body mass and larger reduction in fat mass were observed in participants receiving 12 weeks of daily protein supplementation compared with controls, whereas this was not accompanied by differences in improvements between groups in muscle strength and physical performance.