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Son WH, Ha MS, Park TJ. Effect of physical activity on free fatty acids, insulin resistance, and blood pressure in obese older women. Phys Act Nutr 2024; 28:1-6. [PMID: 39097991 PMCID: PMC11298281 DOI: 10.20463/pan.2024.0009] [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: 03/06/2024] [Revised: 03/23/2024] [Accepted: 04/03/2024] [Indexed: 08/06/2024] Open
Abstract
PURPOSE Obesity is characterized by a progressive increase in body fat accompanied by insulin resistance (IR) and elevated blood pressure (BP), and presents significant health risks, particularly in aged individuals. This study aimed to evaluate the effects of physical activity (PA) on free fatty acid (FFA) levels, IR, and BP in obese older women. METHODS Twenty-three participants were randomly assigned to either the control group (CON, n = 11) or the physical activity group (PA, n = 12). The PA group was provided with a target of achieving >7,000 steps/day for 5 days each week. Body composition, FFA levels, IR, and BP were measured at pre- and post- of the 12-week intervention. RESULTS The analysis revealed a statistically significant interaction between FFA (p < 0.01), IR (p < 0.01), and SBP (p < 0.001). FFA (p < 0.5), IR (p < 0.5), and systolic blood pressure (SBP) (p < 0.01) were significantly decreased in the PA group compared to those in the CON group, which showed no significant changes in FFA, IR, and SBP. CONCLUSION PA significantly decreased FFA, IR, and SBP in older women with obesity. Therefore, PA is an effective intervention for the prevention and management of obesity and cardiovascular diseases in obese older women.
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Affiliation(s)
- Woo-Hyeon Son
- Institute of Convergence Bio-Health, Dong-A University, Busan, Republic of Korea
| | - Min-Seong Ha
- Laboratory of Sports Conditioning: Nutrition Biochemistry and Neuroscience, Department of Sport, College of the Arts and Sports, University of Seoul, Seoul, Republic of Korea
| | - Tae-Jin Park
- Department of Sports Healthcare, College of Humanities & Social Sciences, Inje University, Gimhae, Republic of Korea
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Della Guardia L, Codella R. Exercise Restores Hypothalamic Health in Obesity by Reshaping the Inflammatory Network. Antioxidants (Basel) 2023; 12:antiox12020297. [PMID: 36829858 PMCID: PMC9951965 DOI: 10.3390/antiox12020297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Obesity and overnutrition induce inflammation, leptin-, and insulin resistance in the hypothalamus. The mediobasal hypothalamus responds to exercise enabling critical adaptions at molecular and cellular level that positively impact local inflammation. This review discusses the positive effect of exercise on obesity-induced hypothalamic dysfunction, highlighting the mechanistic aspects related to the anti-inflammatory effects of exercise. In HFD-fed animals, both acute and chronic moderate-intensity exercise mitigate microgliosis and lower inflammation in the arcuate nucleus (ARC). Notably, this associates with restored leptin sensitivity and lower food intake. Exercise-induced cytokines IL-6 and IL-10 mediate part of these positive effect on the ARC in obese animals. The reduction of obesity-associated pro-inflammatory mediators (e.g., FFAs, TNFα, resistin, and AGEs), and the improvement in the gut-brain axis represent alternative paths through which regular exercise can mitigate hypothalamic inflammation. These findings suggest that the regular practice of exercise can restore a proper functionality in the hypothalamus in obesity. Further analysis investigating the crosstalk muscle-hypothalamus would help toward a deeper comprehension of the subject.
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Affiliation(s)
- Lucio Della Guardia
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, 20138 Milan, Italy
- Correspondence: ; Tel.: +39-02-50330356
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3
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Morgan KA, Taylor KL, Walker CW, Tucker S, Dashner JL, Hollingsworth H. Mobility Disability and Exercise: Health Outcomes of an Accessible Community-Based Center. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:836655. [PMID: 36188910 PMCID: PMC9397740 DOI: 10.3389/fresc.2022.836655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThe purpose of this study was to determine how support and guidance provided by trained professionals during a 12-week, community-based transition exercise program, impact health outcomes and continued engagement in physical activity for persons with a mobility disability (PwMD).DesignA single arm pre-post design was used.SettingAccessible community-based health and wellness center.ParticipantsThe study included 244 PwMD using a mobility device.InterventionsParticipants completed a 12-week transition exercise program provided through an accessible community facility that provided education and support to complete endurance and strength related exercises as well as programming to encourage transition to self-directed engagement in exercise.Main Outcome MeasuresBodyweight, BMI, pain, perceived exertion, speed, and distance during cardiovascular fitness testing, and strength were measured pre and post exercise program. The number of participants that signed up for a monthly membership after the program was also monitored.ResultsFor the total group, average pain reported over previous 30 days decreased significantly (p < 0.01), current daily pain decreased significantly (p < 0.05), perceived exertion at the end of the 9-min endurance test decreased significantly (p < 0.05), and the four upper extremity strength exercises showed large, significant strength gains (p < 0.01) after the program. There was no significant change in bodyweight, BMI, or speed and distance completed during endurance testing. At the completion of the program, 76% of participants enrolled in a monthly membership at the facility with the intentions to continue to exercise regularly.ConclusionsThis study provides evidence that an accessible community-based exercise program, with a transitional component supported by trained professionals, can support the exercise goals of PwMD and improve strength, decrease pain, and may promote regular exercise adoption for PwMD.
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Affiliation(s)
- Kerri A. Morgan
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
- *Correspondence: Kerri A. Morgan
| | - Kelly L. Taylor
- Occupational Therapy Program, Murray State University, Paducah, KY, United States
| | - Carla Wilson Walker
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan Tucker
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Jessica L. Dashner
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Holly Hollingsworth
- Enabling Mobility in the Community Laboratory, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Della Guardia L, Codella R. Exercise tolls the bell for key mediators of low-grade inflammation in dysmetabolic conditions. Cytokine Growth Factor Rev 2021; 62:83-93. [PMID: 34620559 DOI: 10.1016/j.cytogfr.2021.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
Metabolic conditions share a common low-grade inflammatory milieu, which represents a key-factor for their ignition and maintenance. Exercise is instrumental for warranting systemic cardio-metabolic balance, owing to its regulatory effect on inflammation. This review explores the effect of physical activity in the modulation of sub-inflammatory framework characterizing dysmetabolic conditions. Regular exercise suppresses plasma levels of TNFα, IL-1β, FFAs and MCP-1, in dysmetabolic subjects. In addition, a single session of training increases the anti-inflammatory IL-10, IL-1 receptor antagonist (IL-1ra), and muscle-derived IL-6, mitigating low-grade inflammation. Resting IL-6 levels are decreased in trained-dysmetabolic subjects, compared to sedentary. On the other hand, the acute release of muscle-IL-6, after exercise, seems to exert a regulatory effect on the metabolic and inflammatory balance. In fact, muscle-released IL-6 is presumably implicated in fat loss and boosts plasma levels of IL-10 and IL-1ra. The improvement of adipose tissue functionality, following regular exercise, is also critical for the mitigation of sub-inflammation. This effect is likely mediated by muscle-released IL-15 and IL-6 and partly relies on the brown-shifting of white adipocytes, induced by exercise. In obese-dysmetabolic subjects, moderate training is shown to restore gut-microbiota health, and this mitigates the translocation of bacterial-LPS into bloodstream. Finally, regular exercise can lower plasma advanced glycated endproducts. The articulated physiology of circulating mediators and the modulating effect of the pathophysiological background, render the comprehension of the exercise-regulatory effect on sub-inflammation a key issue, in dysmetabolism.
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Affiliation(s)
- Lucio Della Guardia
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Fratelli Cervi 93, Segrate, 20090 Milano, Italy
| | - Roberto Codella
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Fratelli Cervi 93, Segrate, 20090 Milano, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milano, Italy.
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5
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Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors. Sci Rep 2021; 11:13372. [PMID: 34183726 PMCID: PMC8238988 DOI: 10.1038/s41598-021-92736-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 05/25/2021] [Indexed: 02/05/2023] Open
Abstract
The relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.
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Sutton KM, Hunter EG, Logsdon B, Santella B, Kitzman PH. The Role of Physical Therapy in Multiple Risk Factor Management Poststroke: A Scoping Review. J Geriatr Phys Ther 2020; 44:165-174. [PMID: 32511115 DOI: 10.1519/jpt.0000000000000248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Individuals after stroke often have multiple chronic conditions, such as hypertension, diabetes, dyslipidemia, obesity, and tobacco use. These comorbidities not only are commonly found in individuals with stroke, but also negatively affect functional outcomes and increase risk for hospital readmission and overall mortality. It is important for physical therapists to address the whole person during treatment after stroke, including comorbidities, not just the problems resulting from the stroke itself. However, it is unclear how common it is for physical therapists to address multiple diagnoses at once using a wellness model. Therefore, the purpose of this scoping review was to examine current evidence regarding the role of physical therapy in addressing modifiable risk factors for individuals after stroke, to identify gaps in research associated with physical therapy management of related comorbid diagnoses during treatment for stroke. METHODS A scoping review methodology was utilized searching PubMed and CINAHL databases to identify interventional research studies specifically addressing multiple modifiable risk factors utilizing physical therapy for individuals after stroke. RESULTS The initial search yielded 5358 articles and 12 articles met full inclusion criteria. Only 2 studies included participants with significant mobility impairments, and none included individuals with communication impairments. Only 4 of the 12 studies provided education in their design. Eight studies did not include any patient-reported outcome measures. Only 3 studies included long-term follow-up assessments. DISCUSSION Secondary stroke risk factors can be positively addressed using physical therapy interventions; however, more research is needed regarding individuals with moderate to severe mobility or communication deficits. Opportunities for physical therapy research to address stroke risk factors in this complex population include expanding follow-up periods, improving educational interventions, and including caregivers in study design. CONCLUSIONS This review highlights the need for better integration of clinical considerations into stroke rehabilitation research as a whole, along with the need for additional research regarding the role physical therapy can play in addressing multimorbidity in individuals with stroke.
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Affiliation(s)
| | | | - Brooke Logsdon
- Department of Physical Therapy, University of Kentucky, Lexington
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7
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Soltani N, Marandi SM, Kazemi M, Esmaeil N. The Exercise Training Modulatory Effects on the Obesity-Induced Immunometabolic Dysfunctions. Diabetes Metab Syndr Obes 2020; 13:785-810. [PMID: 32256095 PMCID: PMC7090203 DOI: 10.2147/dmso.s234992] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Reduced physical activity rate in people's lifestyle is a global concern associated with the prevalence of health disorders such as obesity and metabolic disturbance. Ample evidence has indicated a critical role of the immune system in the aggravation of obesity. The type, duration, and production of adipose tissue-released mediators may change subsequent inactive lifestyle-induced obesity, leading to the chronic systematic inflammation and monocyte/macrophage (MON/MФ) phenotype polarization. Preliminary adipose tissue expansion can be inhibited by changing the lifestyle. In this context, exercise training is widely recommended due to a definite improvement of energy balance and the potential impacts on the inflammatory signaling cascades. How exercise training affects the immune system has not yet been fully elucidated, because its anti-inflammatory, pro-inflammatory, or even immunosuppressive impacts have been indicated in the literature. A thorough understanding of the mechanisms triggered by exercise can suggest a new approach to combat meta-inflammation-induced metabolic diseases. In this review, we summarized the obesity-induced inflammatory pathways, the roles of MON/MФ polarization in adipose tissue and systemic inflammation, and the underlying inflammatory mechanisms triggered by exercise during obesity.
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Affiliation(s)
- Nakisa Soltani
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
| | - Sayed Mohammad Marandi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran
- Sayed Mohammad Marandi Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, IranTel +983137932358Fax +983136687572 Email
| | - Mohammad Kazemi
- Department of Genetics and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Esmaeil
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Correspondence: Nafiseh Esmaeil Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan81744-176, IranTel +98 31 37929097Fax +98 3113 7929031 Email
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Serra MC, Accardi CJ, Ma C, Park Y, Tran V, Jones DP, Hafer-Macko CE, Ryan AS. Metabolomics of Aerobic Exercise in Chronic Stroke Survivors: A Pilot Study. J Stroke Cerebrovasc Dis 2019; 28:104453. [PMID: 31668688 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Understanding the metabolic response to exercise may aid in optimizing stroke management. Therefore, the purpose of this pilot study was to evaluate plasma metabolomic profiles in chronic stroke survivors following aerobic exercise training. METHODS Participants (age: 62 ± 1 years, body mass index: 31 ± 1 kg/m2, mean ± standard error of the mean) were randomized to 6 months of treadmill exercise (N = 17) or whole-body stretching (N = 8) with preintervention and postintervention measurement of aerobic capacity (VO2peak). Linear models for microarray data expression analysis was performed to determine metabolic changes over time, and Mummichog was used for pathway enrichment analysis following analysis of plasma samples by high-performance liquid chromatography coupled to ultrahigh resolution mass spectrometry. RESULTS VO2peak change was greater following exercise than stretching (18.9% versus -.2%; P < .01). Pathway enrichment analysis of differentially expressed metabolites results showed significant enrichment in 4 pathways following treadmill exercise, 3 of which (heparan-, chondroitin-, keratan-sulfate degradation) involved connective tissue metabolism and the fourth involve lipid signaling (linoleate metabolism). More pathways were altered in pre and post comparisons of stretching, including branched-chain amino acid, tryptophan, tyrosine, and urea cycle, which could indicate loss of lean body mass. CONCLUSIONS These preliminary data show different metabolic changes due to treadmill training and stretching in chronic stroke survivors and suggest that in addition to improved aerobic capacity, weight-bearing activity, like walking, could protect against loss of lean body mass. Future studies are needed to examine the relationship between changes in metabolomic profiles to reductions in cardiometabolic risk after treadmill rehabilitation.
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Affiliation(s)
- Monica C Serra
- San Antonio GRECC, South Texas VA and the Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, Texas.
| | - Carolyn J Accardi
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Chunyu Ma
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Younja Park
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia; College of Pharmacy, Korea University, Sejong City, Korea
| | - ViLinh Tran
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Charlene E Hafer-Macko
- Baltimore VA Research Service and GRECC and the Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Baltimore VA Research Service and GRECC and the Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Acheampong IK, Moses MO, Baffour-Awuah B, Essaw E, Mensah W, Afrifa D, Owusu L. Effectiveness of combined and conventional exercise trainings on the biochemical responses of stroke patients. J Exerc Rehabil 2018; 14:473-480. [PMID: 30018936 PMCID: PMC6028219 DOI: 10.12965/jer.1836200.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/28/2018] [Indexed: 11/24/2022] Open
Abstract
Stroke is the topmost cause of mortality and disability in Ghana. Conventional exercise is mostly used aside pharmacological management technique but the complimentary effects of combined exercise training (CET) have not been reported. This study investigated the effectiveness of combined and conventional exercise trainings on lipid-cardiovascular profiles and body composition among stroke patients in Kumasi. Thirteen stroke survivors between ages 35–68 years (mean±standard deviation: age, 59.88±10.88 years; duration of illness, 18.11±7.72 years) participated in the study. Participants were randomly assigned to CET and conventional exercise group. The CET had 10 weeks of 3 types of exercise trainings, 3 days/wk; conventional exercise group monitored for daily conventional activities during the same period. Post weight (P= 0.003), body mass index (P=0.004), systolic blood pressure (P=0.022), diastolic blood pressure (P=0.004), heart rate (P=0.003), and total cholesterol (P=0.044) of the CET were significantly improved. CET significantly improved total cholesterol (P=0.005) and low-density lipoprotein (P=0.006) better than the conventional exercises. Effectiveness of CET to positively enhance biochemical responses in the management of strove patients was established.
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Affiliation(s)
- Isaac Kwaku Acheampong
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Monday Omoniyi Moses
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Biggie Baffour-Awuah
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ebenezer Essaw
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Winifred Mensah
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Afrifa
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lemuel Owusu
- Department of Sports and Exercise Science, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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10
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Inverse association of resistin with physical activity in the general population. PLoS One 2017; 12:e0182493. [PMID: 28771611 PMCID: PMC5542630 DOI: 10.1371/journal.pone.0182493] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022] Open
Abstract
Aim Resistin is a cytokine related with inflammation and ischemic heart disease. Physical activity (PA) prevents chronic inflammation and ischemic heart disease. We studied the relationship of serum concentration of resistin with HDL cholesterol, a known biomarker of PA, and with different measures of PA, in a large sample of the general adult population in the Canary Islands. Methods Cross-sectional study of 6636 adults recruited randomly. We analyzed the correlation of resistin and HDL cholesterol with PA (as metabolic equivalent level [MET]), and fitted the results with linear and logistic regression models using adjustment for age, alcohol consumption and smoking. Results Mean resistin level was higher in women (p<0.001), correlated inversely with age, HDL cholesterol (p<0.001) and alcohol consumption (p<0.001 in men), and correlated directly with smoking (p<0.001). Resistin correlated inversely with the duration of leisure time PA (p<0.001), leisure time MET (p<0.001) and moderate leisure time PA (p<0.001), with some differences between sexes. Men (OR = 0.78 [0.61–0.99; p<0.05]) and women (OR = 0.75 [0.61–0.92; p<0.01]) in the upper quintile of leisure time PA had a lower risk of elevated resistin. In contrast, a high degree of sedentarism was associated with an increased risk elevated resistin in women (OR = 1.24 [1.04–1.47; p<0.05] and in men (OR = 1.40 [1.01–1.82; p<0.05]). Conclusions In our sample of the general population, resistin was inversely associated with measures and levels of PA and HDL cholesterol. The association of resistin with PA was stronger than the association of HDL cholesterol with PA, making resistin a potentially useful biomarker of PA.
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Kim HJ, Lee HK, Cho JH. Comparison between the treatment area of electrode used for radiofrequency ablation of liver cancer focusing on 15G cooled-tip and CWT electrode. Pak J Med Sci 2016; 32:555-8. [PMID: 27375688 PMCID: PMC4928397 DOI: 10.12669/pjms.323.8538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives: To analyze the comparison between the treatment area of 15Gage internally cooled electrodes and 17 Gage Cool Wet-tip(CWT) electrodes. They are manufactured to broaden treatment area of the tumor in the radiofrequency ablation of hepatocellular carcinoma(HCC). Methods: The study was designed for 62 patients with a mean age of 61, ranging from 44 to 87 years. The sample comprised of patients who used 15 G internally cooled electrodes and 17 G CWT electrodes respectively. Computed tomography (CT) images obtained after the procedure were observed, however, for the ablation lesion, the volume was determined by measuring complete necrotic tissue that did not contrast enhancement in the image. Results: The treatment area of the tumor after radiofrequency ablation was 17.26±6.02 in the CWT, which was bigger than 15G. The treatment area ratio of the treatment before or after was significant at 581.85±339.56 in the CWT. After radiofrequency ablation, the treatment area got bigger, as 15G electrodes went toward CWT electrodes. Treatment area per electrode was 1.34 times higher in CWT than in 15G while the treatment area ratio of the treatment before or after was 1.001 times higher in the CWT than 15G. Conclusions: Ablation is more common for the safety margin in stable tumor and CWT type electrodes that can make larger ablation to reduce the number of times ablation is required for residual tumor and it decreases recurrence, ablation time and reoperation. Therefore it is considered t useful to reduce patients’ pain.
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Affiliation(s)
- Hyun-Jin Kim
- Hyun-Jin Kim, Department of Radiology, Asan Medical Center, Seoul Republic of Korea
| | - Hae-Kag Lee
- Hae-Kag Lee, Department of Computer Science and Engineering, Soonchunhyang University, Asan, Republic of Korea
| | - Jae-Hwan Cho
- Jae-Hwan Cho, Department of Radiological Technology, Ansan College, Ansan, Republic of Korea
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Park J, Kim S. Validity of muscle-to-fat ratio as a predictor of adult metabolic syndrome. J Phys Ther Sci 2016; 28:1036-45. [PMID: 27134408 PMCID: PMC4842420 DOI: 10.1589/jpts.28.1036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/15/2015] [Indexed: 01/26/2023] Open
Abstract
[Purpose] This study was aimed at determining the validity of the muscle-to-fat ratio as
an indicator for the prevention and management of metabolic syndrome by establishing an
optimal cutoff value. [Subjects and Methods] Data from the first and second year of the
fifth Korea National Health Nutrition Examination Survey, conducted by the Korean Ministry
of Health and Welfare and Korean Centers for Disease Control and Prevention, were used. A
total of 6,256 subjects were included in the study. Diagnostic accuracy was measured by
using the area under the receiver operating characteristic curve. [Results] The receiver
operating characteristic curve for the muscle-to-fat ratio, which represents the
diagnostic power for predicting metabolic syndrome, was 0.713 in men and 0.721 in women.
The optimal cutoff value for the prediction and diagnosis of metabolic syndrome was
3.09 kg/kg in men and 1.83 kg/kg in women. Intergroup differences based on the
muscle-to-fat ratio indicated that the low-ratio group had higher values for all
indicators of metabolic syndrome than the high-ratio group. [Conclusion] The muscle-to-fat
ratio can be used as an indicator for the prediction and diagnosis of metabolic syndrome,
and early prevention and management of metabolic syndrome can help in improving public
health.
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Affiliation(s)
- Jongsuk Park
- School of Global Sport Studies, Korea University, Republic of Korea
| | - Sangho Kim
- School of Global Sport Studies, Korea University, Republic of Korea
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Jeon MY, Jeong H. Effects of a Stroke Primary Prevention Program on Risk Factors for At-Home Elderly. Med Sci Monit 2015; 21:3696-703. [PMID: 26615035 PMCID: PMC4671448 DOI: 10.12659/msm.895519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background To prevent stroke from occurring, stroke risk factors in at-risk subjects should be controlled and the diseases causing stroke should be managed. This study evaluated a nursing intervention to prevent stroke in at-risk elderly living at home. The program consisted of stroke and nutrition education as well as exercise guidance. Material/Methods This study targeted 93 elderly people living at home residing in E province with 1 or more stroke risk factors, including high blood pressure, diabetes, hyperlipidemia, obesity, smoking, or drinking alcohol. The 12-week program included a stroke education class once a week, a nutrition management class once a week, and exercise guidance 3 times a week. Each session lasted 50–70 min. Each disease education and nutrition management session lasted for 20 min and each exercise session lasted for 30–50 min. Results The experimental group’s body mass index (BMI) (t=8.27, p<.001), systolic blood pressure (t=2.39, p=.021), fasting blood sugar (t=0.39, p=.700), total cholesterol (t=4.18, p<.001), triglyceride levels (t=2.50, p=.016), and depression scores (t=5.48, p<.001) were significantly reduced and high-density phospholipid protein levels increased significantly by the end of the program (t=−2.94, p=.005). Conclusions Based on the results of this study, participating in a stroke prevention program enabled at-risk elderly participants who lived at home in rural areas to perform health-promoting behaviors. This program may reduce the incidence of stroke by reducing risk factors and managing stroke precursor diseases.
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Alghadir AH, Gabr SA, Aly FA. The effects of four weeks aerobic training on saliva cortisol and testosterone in young healthy persons. J Phys Ther Sci 2015; 27:2029-33. [PMID: 26311920 PMCID: PMC4540811 DOI: 10.1589/jpts.27.2029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/17/2015] [Indexed: 01/10/2023] Open
Abstract
[Purpose] The purpose of this study was to evaluate the effect of 4 weeks moderate aerobic exercise on outcome measures of saliva stress hormones and lactate levels in healthy adult volunteers. [Subjects and Methods] Sixteen healthy students with an age range of 15-25 years participated in this study. The participants performed an exercise test of moderate intensity for 4 weeks, three times per week. The exercise was treadmill walking. Saliva concentrations of cortisol, testosterone and lactate dehydrogenase (LDH) were measured before and after the 4 weeks of moderate aerobic training using immunoassay techniques. [Results] After 4 weeks of exercise, there were significant increases in cortisol, free testosterone levels, and LDH activity along with a significant decrease in the ratios between testosterone and cortisol levels. No significant correlations were found among the studied parameters in the resting stage, a result which supports the positive effect of exercise on stress hormones following 4 weeks of training. [Conclusion] The results suggest that four weeks exercise of moderate intensity significantly affects the salivary stress hormones of young healthy volunteers. The data support the importance of salivary stress hormones as potential biological markers especially for older ages. However, more research is required to validate these biological markers which determine the host response to physical activity.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair (RRC), Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Sami A Gabr
- Rehabilitation Research Chair (RRC), Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia ; Department of Anatomy, Faculty of Medicine, Mansoura University, Egypt
| | - Farag A Aly
- Rehabilitation Research Chair (RRC), Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia ; Faculty of Physical Therapy, Cairo University, Egypt
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15
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Kim TW, Lee SH, Choi KH, Kim DH, Han TK. Comparison of the effects of acute exercise after overnight fasting and breakfast on energy substrate and hormone levels in obese men. J Phys Ther Sci 2015; 27:1929-32. [PMID: 26180350 PMCID: PMC4500013 DOI: 10.1589/jpts.27.1929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/07/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We compared the effects of acute aerobic exercise following overnight fasting
and breakfast on energy substrate and hormone levels in obese male college students.
[Subjects and Methods] This crossover study recruited 10 obese male college students with
a body mass index >25 kg/m2 or >20% body fat. One week post-recruitment,
the subjects exercised in the morning after an overnight fast. At 2 weeks, they exercised
post-breakfast. Energy substrate (glucose, free fatty acid) and metabolic hormone
(insulin, growth hormone, and cortisol) levels were measured immediately before and after
exercise and at 60 min post-exercise. [Results] We observed interaction effects between
the measurement time and exercise treatment for glucose; significant differences between
measurement times and between exercise treatments for free fatty acids; interaction
effects between the measurement time and exercise treatment for insulin and significant
differences in the measurement time; significance differences between measurement times
and between exercise treatments for growth hormone; and significant differences between
measurement times and between exercise treatments for cortisol. [Conclusion]
Morning exercise following an overnight fast can be more effective in reducing body fat
than post-prandial exercise. However, increased cortisol levels following exercise after
overnight fasting may negatively affect long-term weight loss in obese men.
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Affiliation(s)
- Tae Woon Kim
- Department of Physiology, College of Medicine, Kyung Hee University, Republic of Korea
| | - Sang Hoon Lee
- School of Sport Science, Sungkyunkwan University, Republic of Korea
| | - Kyu Hwan Choi
- School of Sport Science, Sungkyunkwan University, Republic of Korea
| | - Dong Hyun Kim
- School of Sport Science, Sungkyunkwan University, Republic of Korea
| | - Tae Kyung Han
- School of Protection Science, Kyungwoon University, Republic of Korea
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16
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Liao HY, Sun MF, Lin JG, Chang SL, Lee YC. Electroacupuncture plus metformin lowers glucose levels and facilitates insulin sensitivity by activating MAPK in steroid-induced insulin-resistant rats. Acupunct Med 2015; 33:388-94. [PMID: 26025384 DOI: 10.1136/acupmed-2014-010724] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus is the predominant form of diabetes. Although metformin is the preferred first-line drug for treatment of the disease, it is associated with a risk of secondary failure. Electroacupuncture (EA) can enhance insulin sensitivity and reduce blood glucose levels. OBJECTIVES To examine, in an animal study, whether EA combined with metformin (EA-metformin) results in a better glucose-lowering effect and greater insulin sensitivity than metformin alone in steroid-induced insulin-resistant rats. METHODS Adult Wistar rats were injected with dexamethasone to induce diabetes and subsequently treated with EA plus metformin or metformin alone. Variations in plasma glucose, plasma insulin, and plasma free fatty acid levels were studied at the midpoint and end of the experimental course. Insulin receptor substrate 1 (IRS-1) and peroxisome proliferator-activated receptor γ (PPAR-γ), which are associated with glucose transporter type 4 (GLUT4) translocation, and mitogen-activated protein kinase (MAPK), which is related to GLUT4 activation, were measured after EA treatment. RESULTS We found that EA-metformin resulted in a better glucose-lowering effect, greater insulin sensitivity, lower plasma free fatty acid levels and higher levels of MAPK than metformin alone (p<0.05). There were no significant differences between treatment groups in expression of IRS-1 or PPAR-γ. CONCLUSIONS The glucose-lowering effect and increased insulin sensitivity associated with EA-metformin administration is governed, at least in part, by its ability to stimulate the activation of GLUT4 via upregulation of MAPK expression.
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Affiliation(s)
- Hsien-Yin Liao
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Mao-Feng Sun
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Liang Chang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua, Taiwan
| | - Yu-Chen Lee
- Department of Acupuncture, China Medical University Hospital, Taichung, Taiwan Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan
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17
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Cho YK, Kim DY, Jung SY, Seong JH. Synergistic effect of a rehabilitation program and treadmill exercise on pain and dysfunction in patients with chronic low back pain. J Phys Ther Sci 2015; 27:1187-90. [PMID: 25995585 PMCID: PMC4434006 DOI: 10.1589/jpts.27.1187] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study examined the influence of treadmill exercise added to a low
back pain rehabilitation program on low back extensor strength, pain, and dysfunction in
chronic low back pain patients. [Subjects and Methods] Twenty men aged 22–36 years with
chronic low back pain were randomly divided into experimental and control groups of 10
patients each. Both groups underwent a low back pain rehabilitation program lasting 30 min
each, thrice/week for 8 weeks. The experimental group was prescribed an additional 30 min
of treadmill exercise without a slope at a speed of 3.0–3.5 km/h, at which patients could
walk comfortably. Low back extensor strength was tested using the Medx lumbar extension
machine, pain level was tested, using the visual analog scale, and dysfunction was tested,
using the Oswestry Low Back Pain Disability Questionnaire. [Results] Changes in low back
extensor strength by angle showed significant interaction effects between measurement time
and group at 12°, 24°, and 36°. The results of the visual analog scale and Oswestry
Questionnaire showed a decreasing trend after the experiment in both groups. However,
there was no interaction effect of the additional treadmill exercise in the experimental
group. [Conclusion] The combination of a low back pain rehabilitation program and
treadmill exercise has a synergistic effect, to some extent, on the improvement of low
back extensor strength and should be considered for treatment and rehabilitation of low
back pain patients.
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Affiliation(s)
- Young-Ki Cho
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of
| | | | - Sun-Young Jung
- Department of Sports Healthcare, Inje University, Republic of Korea
| | - Jun-Hyuk Seong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of
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18
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Lim W, So WY. Lifestyle-related factors and their association with metabolic syndrome in Korean adults: a population-based study. J Phys Ther Sci 2015; 27:555-8. [PMID: 25931679 PMCID: PMC4395663 DOI: 10.1589/jpts.27.555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to investigate whether lifestyle-related factors are
associated with metabolic syndrome (MetS) in community-dwelling Korean adults. [Subjects
and Methods] The subjects comprised 590 men and 1,138 women aged 20 years and above. The
subjects visited a public health promotion center in Seoul, Republic of Korea to
participate in a survey regarding sleep duration, mental stress, educational level,
economic status, and frequency of alcohol consumption and smoking. MetS was defined
according to the standard definition of the National Cholesterol Education Program’s Adult
Treatment Panel III report. The relationship between lifestyle-related factors and MetS
was assessed using multivariate logistic regression analysis after adjustments for age and
sex. [Results] Sleep duration, educational level, economic status, and frequency of
alcohol consumption and smoking were not associated with MetS. Mental stress was the only
lifestyle-related factor associated with MetS. [Conclusion] Well-designed studies will be
necessary in order to establish the lifestyle-related factors of MetS.
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Affiliation(s)
- Wanki Lim
- Department of Leisure Sports, Hoseo University, Republic of Korea
| | - Wi-Young So
- Sports and Health Care Major, College of Humanities and Arts, Korea National University of Transportation, Republic of Korea
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Kim JS, Lee DJ, Lee YS, Lee BK. A study of abdominal ultrasound therapy combined with complex exercise for effective obesity management among shift work employees. J Phys Ther Sci 2015; 27:231-3. [PMID: 25642080 PMCID: PMC4305570 DOI: 10.1589/jpts.27.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/03/2014] [Indexed: 12/28/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of abdominal ultrasound accompanied by
complex exercise in shift work employees working in industry. [Subjects and Methods]
Thirty shift work employees were randomly assigned to either a complex exercise group
(control group) or a complex exercise and ultrasound treatment group (experimental group).
The control group carried out complex exercise five times per week for 4 weeks, while the
experimental group performed complex exercise twice per week and received deep ultrasound
three times per week for 4 weeks. [Results] The results showed that there were no
significant differences in body composition between the two groups. There were significant
changes in weight, lean body mass, body fat mass, and body mass index in the control
group; meanwhile, significant changes in weight and body fat mass were observed in the
experimental group. There were no significant differences in blood lipids between the two
groups. There was a significant decrease in high-density lipoprotein cholesterol (HDL-C)
in the control group; furthermore, a significant decrease in total cholesterol was
observed in the experimental group, along with significant increases in HDL-C and
low-density lipoprotein cholesterol. [Conclusion] According to the results of this study
concerning short-term obesity management programs, complex exercise was effective for
improving of body composition and weight loss, while complex exercise combined with
abdominal ultrasound had a good effect on blood lipids and secondary complication
prevention.
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Affiliation(s)
- Jin-Seop Kim
- Department of Physical Therapy, Sunmoon University, Republic of Korea
| | - Dong-Jin Lee
- Department of Physical Therapy, Gwangju Health College, Republic of Korea
| | - Yeon-Seop Lee
- Department of Physical Therapy, Daewon University College, Republic of Korea
| | - Byoung-Kwon Lee
- Department of Physical Therapy, Konyang University, Republic of Korea
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20
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Kim JS, Oh DW. Effects of high-frequency current therapy on abdominal obesity in young women: a randomized controlled trial. J Phys Ther Sci 2015; 27:31-3. [PMID: 25642031 PMCID: PMC4305589 DOI: 10.1589/jpts.27.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/04/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to determine the effects of high-frequency current therapy on the abdominal obesity levels of young women. [Subjects] Twenty-two women with abdominal obesity were randomly allocated to either an experimental group (n 1 = 10) or a control group (n 2 = 12). [Methods] The experimental group subjects received high-frequency current therapy for the abdominal region 3 times per week for 6 weeks (a total of 18 sessions). Outcome measures were waist circumference, body mass index, and body composition data (abdominal obesity rate, subcutaneous fat mass, and body fat percentage). [Results] Significant main effects of time in the waist circumference, abdominal obesity rate, subcutaneous fat mass, and body fat percentage were found. Significant time-by-group interactions were found for waist circumference, abdominal obesity rate, subcutaneous fat mass, and body fat percentage. [Conclusion] The use of the high-frequency current therapy may be beneficial for reducing the levels of abdominal obesity in young women.
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Affiliation(s)
- Jin-seop Kim
- Department of Physical Therapy, College of Health Science,
Sunmoon University, Republic of Korea
| | - Duck-won Oh
- Department of Physical Therapy, College of Health Science,
Cheongju University, Republic of
Korea
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21
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Kim DY, Jung SY. Effect of aerobic exercise on risk factors of cardiovascular disease and the apolipoprotein B / apolipoprotein a-1 ratio in obese woman. J Phys Ther Sci 2014; 26:1825-9. [PMID: 25435709 PMCID: PMC4242964 DOI: 10.1589/jpts.26.1825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/21/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to confirm whether consistent aerobic exercise
has an effect on the apolipoprotein B/apolipoprotein A-1 ratio or reduces the risk of
cardiovascular disease in obese women. [Subjects and Methods] The participants included 32
obese women between the ages of 40 and 49. Subjects were randomly divided into two groups
(n = 16 in each group): the control group and the exercise group. The exercise program in
this study corresponded to an intensity of 50 to 60% of the maximum volume of minute
oxygen consumption and was performed three times per week over 12 weeks. Physical
measurements, measurement of cardiorespiratory fitness and blood pressure, and blood
collection were done before and after the 12 weeks of exercise at the same time and under
the same conditions. [Results] Based on the results of this study, there were significant
interaction effects in both time and group weight, for body mass index, percent body fat,
maximum volume of minute oxygen consumption, high-density lipoprotein cholesterol, and the
apolipoprotein B/apolipoprotein A-1 ratio. Moreover, waist circumference, total
cholesterol, and the atherogenic index decreased significantly after 12 weeks of aerobic
exercise. [Conclusion] Regular aerobic exercise effectively improved cardiovascular risk
factors and decreased the obesity index in obese women.
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Affiliation(s)
- Dae-Young Kim
- Research Institute of Sports Medicine, Department of Protection Science, Kyungwoon University, Republic of Korea
| | - Sun-Young Jung
- Department of Physiology, College of Medicine, Kyung Hee University: 1 Hoigi-dong, Dongdaemoon-gu, Seoul 130-701, Republic of Korea
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