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Saeidi A, Motamedi P, Hoteit M, Sadek Z, Ramadan W, Dara MM, Almaqhawi A, Shahrbanian S, Abednatanzi H, Escobar KA, Pashaei Z, Al Kiyumi MH, Laher I, Zouhal H. Impact of spinach thylakoid extract-induced 12-week high-intensity functional training on specific adipokines in obese males. J Int Soc Sports Nutr 2024; 21:2398467. [PMID: 39308032 PMCID: PMC11421126 DOI: 10.1080/15502783.2024.2398467] [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: 01/15/2024] [Accepted: 08/26/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Obesity presents multifarious etiopathologies with its management being a global challenge. This article presents the first ever report on the impact of spinach thylakoid extract-induced high-intensity functional training (HIFT) on obesity management via regulating the levels of novel adipokine, C1q/TNF-related Protein-12 (CTRP-12), furin, and Krüppel-like factor 15 (KLF-15). METHODS Sixty-eight obese male subjects were randomly divided into four groups: control group (CG), supplement group (SG), training group (TG), and the combined training and supplement group (TSG). After initial assessments of all groups, the training group commenced a twelve-week HIFT using the CrossFit program (comprising of three training sessions per week, each lasting 30 min). Eligible candidates were randomly assigned to either receive thylakoid-rich spinach extract (5 g per day) or a matching placebo (5 g per day of corn starch, 30 min before lunch) for a total duration of 12 weeks. All required data and investigations were collected at 48 h pre- and post-training. RESULTS The results indicated a substantial correlation between exercise and the time of KLF-15, furin, and CTRP-12 demonstrating effect sizes of 0.3, 0.7, and 0.6, respectively. Additionally, the training and supplementation group (TSG) exhibited a substantial decrease in low-density lipoprotein (LDL), total cholesterol (TC), and triglyceride (TG) levels (p < 0.0001). Concurrently, there was a significant increase in high-density lipoprotein-cholesterol (HDL-C) levels (p = 0.0001). Furthermore, a notable difference between the groups emerged in HDL, LDL, TC, and TG levels, supported by effect sizes of 0.73, 0.86, 0.96, and 0.89, respectively (p < 0.05). CONCLUSION The study offered novel insights into the management of obesity using supplements induced by spinach-derived thylakoid extract during a 12-week HIFT program. The proposed combination intervention may reverse obesity-induced insulin resistance and metabolic dysfunctions by positive regulation of CTRP-12/adipolin and KLF15 and simultaneous suppression of furin levels.
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Affiliation(s)
- Ayoub Saeidi
- University of Kurdistan, Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, Sanandaj, Kurdistan, Iran
| | - Pezhman Motamedi
- Tarbiat Modares University, Faculty of Humanities, Department of Sport Science, Tehran, Iran
| | - Maha Hoteit
- California State University, Department of Kinesiology, Long Beach, CA, USA
- University of Tabriz, Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Tabriz, Iran
| | - Zahra Sadek
- Sultan Qaboos University, Department of Family Medicine and Public Health, Muscat, Oman
- Sultan Qaboos University Hospital, Department of Family Medicine and Public Health, Muscat, Oman
| | - Wiam Ramadan
- The University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, Canada
| | | | | | - Shahnaz Shahrbanian
- Kharazmi University, Department of Exercise Physiology, Faculty of Physical Education and Sports Science, Tehran, Iran
| | | | - Kurt A Escobar
- National Council for Scientific Research-Lebanon (CNRS-L), Food Science Unit, Beirut, Lebanon
| | - Zhaleh Pashaei
- Lebanese University, Faculty of Public Health, Section I, Beirut, Lebanon
| | - Maisa Hamed Al Kiyumi
- Lebanese University, Faculty of Public Health, Section I, Beirut, Lebanon
- Lebanese University, Laboratory of Motor System, Handicap and Rehabilitation (MOHAR), Faculty of Public Health, Beirut, Lebanon
| | - Ismail Laher
- Lebanese International University (LIU), Lebanese Institutes for Biomedical Research and Application (LIBRA), Beirut, Lebanon
| | - Hassane Zouhal
- Islamic Azad University, Department of Physical Education and Sport Science, Science and Research Branch, Tehran, Iran
- King Faisal University, Department of Family Medicine and Community, College of Medicine, Al Ahsa, Saudi Arabia
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Yang J, Félix-Soriano E, Martínez-Gayo A, Ibañez-Santos J, Sáinz N, Martínez JA, Moreno-Aliaga MJ. SIRT1 and FOXO1 role on MASLD risk: effects of DHA-rich n-3 PUFA supplementation and exercise in aged obese female mice and in post-menopausal overweight/obese women. J Physiol Biochem 2024:10.1007/s13105-024-01044-9. [PMID: 39264516 DOI: 10.1007/s13105-024-01044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 08/07/2024] [Indexed: 09/13/2024]
Abstract
Sirtuins 1 (SIRT1) and Forkhead box protein O1 (FOXO1) expression have been associated with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD). Exercise and/or docosahexaenoic acid (DHA) supplementation have shown beneficial effects on MASLD. The current study aims to assess the relationships between Sirt1, Foxo1 mRNA levels and several MASLD biomarkers, as well as the effects of DHA-rich n-3 PUFA supplementation and/or exercise in the steatotic liver of aged obese female mice, and in peripheral blood mononuclear cells (PBMCs) of postmenopausal women with overweight/obesity. In the liver of 18-month-old mice, Sirt1 levels positively correlated with the expression of genes related to fatty acid oxidation, and negatively correlated with lipogenic and proinflammatory genes. Exercise (long-term treadmill training), especially when combined with DHA, upregulated hepatic Sirt1 mRNA levels. Liver Foxo1 mRNA levels positively associated with hepatic triglycerides (TG) content and the expression of lipogenic and pro-inflammatory genes, while negatively correlated with the lipolytic gene Hsl. In PBMCs of postmenopausal women with overweight/obesity, FOXO1 mRNA expression negatively correlated with the hepatic steatosis index (HSI) and the Zhejiang University index (ZJU). After 16-weeks of DHA-rich PUFA supplementation and/or progressive resistance training (RT), most groups exhibited reduced MASLD biomarkers and risk indexes accompanying with body fat mass reduction, but no significant changes were found between the intervention groups. However, in PBMCs n-3 supplementation upregulated FOXO1 expression, and the RT groups exhibited higher SIRT1 expression. In summary, SIRT1 and FOXO1 could be involved in the beneficial mechanisms of exercise and n-3 PUFA supplementation related to MASLD manifestation.
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Affiliation(s)
- Jinchunzi Yang
- Center for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain
- Current Address: Center for Energy Metabolism and Reproduction, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518000, China
| | - Elisa Félix-Soriano
- Center for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain
| | - Alejandro Martínez-Gayo
- Center for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain
| | - Javier Ibañez-Santos
- Studies, Research and Sports Medicine Centre (CEIMD), Government of Navarre, 31005, Pamplona, Spain
| | - Neira Sáinz
- Center for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain
| | - J Alfredo Martínez
- Center for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain
| | - María J Moreno-Aliaga
- Center for Nutrition Research and Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, 31008, Pamplona, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain.
- IdISNA, Navarra Institute for Health Research, 31008, Pamplona, Spain.
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Deli CK, Fatouros IG, Poulios A, Liakou CA, Draganidis D, Papanikolaou K, Rosvoglou A, Gatsas A, Georgakouli K, Tsimeas P, Jamurtas AZ. Gut Microbiota in the Progression of Type 2 Diabetes and the Potential Role of Exercise: A Critical Review. Life (Basel) 2024; 14:1016. [PMID: 39202758 PMCID: PMC11355287 DOI: 10.3390/life14081016] [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: 07/16/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
Type 2 diabetes (T2D) is the predominant metabolic epidemic posing a major threat to global health. Growing evidence indicates that gut microbiota (GM) may critically influence the progression from normal glucose tolerance, to pre-diabetes, to T2D. On the other hand, regular exercise contributes to the prevention and/or treatment of the disease, and evidence suggests that a possible way regular exercise favorably affects T2D is by altering GM composition toward health-promoting bacteria. However, research regarding this potential effect of exercise-induced changes of GM on T2D and the associated mechanisms through which these effects are accomplished is limited. This review presents current data regarding the association of GM composition and T2D and the possible critical GM differentiation in the progression from normal glucose, to pre-diabetes, to T2D. Additionally, potential mechanisms through which GM may affect T2D are presented. The effect of exercise on GM composition and function on T2D progression is also discussed.
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Affiliation(s)
- Chariklia K. Deli
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Ioannis G. Fatouros
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Athanasios Poulios
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Christina A. Liakou
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Dimitrios Draganidis
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Konstantinos Papanikolaou
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Anastasia Rosvoglou
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Athanasios Gatsas
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Kalliopi Georgakouli
- Department of Dietetics and Nutrition, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece;
| | - Panagiotis Tsimeas
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
| | - Athanasios Z. Jamurtas
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science, and Dietetics, University of Thessaly, 42100 Trikala, Greece; (I.G.F.); (A.P.); (C.A.L.); (D.D.); (K.P.); (A.R.); (A.G.); (P.T.); (A.Z.J.)
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Chen X, He H, Xie K, Zhang L, Cao C. Effects of various exercise types on visceral adipose tissue in individuals with overweight and obesity: A systematic review and network meta-analysis of 84 randomized controlled trials. Obes Rev 2024; 25:e13666. [PMID: 38031812 DOI: 10.1111/obr.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
The purpose of this systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) was to investigate the effects of various exercise categories on visceral adipose tissue (VAT) and other anthropometric variables in individuals with overweight and obesity. A total of 84 RCTs (4836 patients) were included. Aerobic exercise (AE) of at least moderate intensity, resistance training (RT), AE combined with RT (AE + RT), and high-intensity interval training (HIIT) were beneficial for reducing VAT. A subgroup analysis showed that RT improves VAT in males and those with BF% < 40% but not in females and those with body fat percentage (BF%) ≥ 40%. AE, RT, AE + RT, and HIIT significantly improved weight (except RT), total body fat (TBF), body mass index (BMI), waist circumference (WC), and subcutaneous adipose tissue (SAT). Surface under the cumulative ranking curve (SUCRA) probability ranking showed that AE with vigorous intensity and HIIT have the highest probability of being the best exercise intervention for improving VAT, weight, TBF, BMI, WC, and SAT. These findings suggest that regular exercise can improve VAT in individuals with overweight and obesity. AE of vigorous intensity and HIIT may be the best exercise treatment, and RT is the least effective intervention.
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Affiliation(s)
- Xiaoke Chen
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Hui He
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Kejia Xie
- School of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Lingtao Zhang
- Department of Physical Education, Tsinghua University, Beijing, China
| | - Chunmei Cao
- Department of Physical Education, Tsinghua University, Beijing, China
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Sammut MJ, McBey DP, Sayal AP, Melling CWJ. The Effects of Resistance Exercise Training on Skeletal Muscle Metabolism and Insulin Resistance Development in Female Rodents with Type 1 Diabetes. J Diabetes Res 2024; 2024:5549762. [PMID: 38435452 PMCID: PMC10904684 DOI: 10.1155/2024/5549762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
The etiology of insulin resistance (IR) development in type 1 diabetes mellitus (T1DM) remains unclear; however, impaired skeletal muscle metabolism may play a role. While IR development has been established in male T1DM rodents, female rodents have yet to be examined in this context. Resistance exercise training (RT) has been shown to improve IR and is associated with a lower risk of hypoglycemia onset in T1DM compared to aerobic exercise. The purpose of this study was to investigate the effects of RT on IR development in female T1DM rodents. Forty Sprague Dawley eight-week-old female rats were divided into four groups: control sedentary (CS; n = 10), control trained (CT; n = 10), T1DM sedentary (DS; n = 10), and T1DM trained (DT; n = 10). Multiple low-dose streptozotocin injections were used to induce T1DM. Blood glucose levels were maintained in the 4-9 mmol/l range with intensive insulin therapy. CT and DT underwent weighted ladder climbing 5 days/week for six weeks. Intravenous glucose tolerance tests (IVGTT) were conducted on all animals following the six-week period. Results demonstrate that DS animals exhibited significantly increased weekly blood glucose measures compared to all groups including DT (p < 0.0001), despite similar insulin dosage levels. This was concomitant with a significant increase in insulin-adjusted area under the curve following IVGTT in DS (p < 0.05), indicative of a reduction in insulin sensitivity. Both DT and DS exhibited greater serum insulin concentrations compared to CT and CS (p < 0.05). DS animals also exhibited significantly greater glycogen content in white gastrocnemius muscle compared to CS and DT (p < 0.05), whereas DT and DS animals exhibited greater p-Akt: Akt ratio in the white vastus lateralis muscle and citrate synthase activity in the red vastus lateralis muscle compared to CS and CT (p < 0.05). These results indicate that female rodents with T1DM develop poor glycemic control and IR which can be attenuated with RT, possibly related to differences in intramyocellular glycogen content.
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Affiliation(s)
- Mitchell J. Sammut
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David P. McBey
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Amit P. Sayal
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
| | - C. W. James Melling
- School of Kinesiology, Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Milovac T. Are Physicians Obligated to Recommend a Plant-Based Diet? A Response to Maximilian Storz. New Bioeth 2023; 29:363-381. [PMID: 37788230 DOI: 10.1080/20502877.2023.2261729] [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] [Indexed: 10/05/2023]
Abstract
Maximilian Storz argues that physicians have an ethical obligation to recommend a plant-based diet to patients because such a diet: relieves certain chronic conditions, outperforms the Western diet (e.g. a diet containing animal products, among other things), and is ecologically sustainable. Contrary to these claims, I argue that a plant-based diet alone may not relieve chronic conditions, but potentially does so in combination with other lifestyle factors. With respect to the environment, I illuminate the landscape by discussing agricultural factors consistent across animal and plant farming such as energy and water. I conclude that physicians ought to recommend a diet that follows the science; such a diet as I have claimed is exclusionary: it excludes processed foods, especially added sugars. Lifestylfe factors also deserve to be discussed in the medical encounter as their incorporation may lead to even better health outcomes.
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Affiliation(s)
- Thomas Milovac
- Department of Philosophy, University of Waterloo, Waterloo, Canada
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Elks W, Rooks A, Schulte S, Batra K, Burke J, Jain V. Resistance Training in Patients After Metabolic and Bariatric Surgery: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e49513. [PMID: 37995123 DOI: 10.2196/49513] [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: 05/31/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Resistance training has been consistently shown to have multiple health benefits, especially for patients who have undergone bariatric surgery. Patients who have undergone bariatric surgery are recommended to participate in resistance exercise; however, protocols and guidelines for resistance training remain poorly implemented. OBJECTIVE This is a protocol for a systematic review and possibly a meta-analysis that will synthesize evidence of the effects of resistance exercise on changes in body composition, muscular strength, overall weight loss or maintenance of weight loss, and quality of life in patients after metabolic and bariatric surgery (MBS). The findings of this study may provide practice recommendations for resistance training among patients who have undergone MBS. METHODS We registered this systematic review on PROSPERO (CRD42023464928) on September 18, 2023. A systematic search of electronic databases (Embase, PubMed, Scopus, Web of Science, and CINAHL) was conducted on studies published from January 1, 1991, to May 15, 2023, to identify English-language human studies on adult patients who have undergone MBS that include a resistance training intervention and describe outcome measurements of body composition or strength. Screening will be performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and relevant data elements will be extracted. RESULTS Searches and screenings commenced in May 2023. Data extraction and analyses will be completed by the end of December 2023, after which findings will be synthesized and reported by the end of March 2024. CONCLUSIONS This systematic review will summarize the evidence regarding resistance training in patients after MBS. The findings from this systematic review and possible meta-analysis may provide practice recommendations for resistance training protocols in this patient population and identify characteristics of protocols with the best adherence and outcomes. With these results, we anticipate that we will gain a deeper understanding of the role of resistance training after MBS. TRIAL REGISTRATION PROSPERO CRD42023464928; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=464928. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49513.
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Affiliation(s)
- Whitney Elks
- Department of Medical Education, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Adam Rooks
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, United States
| | - Spencer Schulte
- Department of Medical Education, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, United States
- ,
| | - Jocelyn Burke
- Department of Medical Education, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Varun Jain
- Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, United States
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Bandeira-Guimarães M, Blanco-Rambo E, Vieira AF, Sáez de Asteasu ML, Pinto RS, Izquierdo M, Cadore EL. Chronic Effects of Different Intensities of Power Training on Neuromuscular Parameters in Older People: A Systematic Review with Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:98. [PMID: 37874417 PMCID: PMC10597949 DOI: 10.1186/s40798-023-00646-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Power training (PT) has been shown to be an effective method for improving muscle function, including maximal strength, measured by one-repetition maximum (1RM), and power output in older adults. However, it is not clear how PT intensity, expressed as a percentage of 1RM, affects the magnitude of these changes. The aim of this systematic review (International prospective register of systematic reviews-PROSPERO-registration: CRD42022369874) was to summarize the evidence from randomized clinical trials (RCT) assessing the effects of low-intensity (≤ 49% of 1RM) and moderate-intensity (50-69% of 1RM) versus high-intensity (≥ 70% of 1RM) PT on maximal power output and maximal strength in older adults. METHODS We included RCTs that examined the effects of different intensities of power training on maximum strength and power output in older people. The search was performed using PubMed, LILACS, Embase, and Scopus. Methodological quality was assessed using the preferred reporting items for systematic reviews and meta-analyses (PRISMA 2020 statement checklist), and the quality of evidence was determined using the PEDro scale. Data were analyzed using standardized mean differences (SMD) with a 95% confidence interval (CI), and random effects models were used for calculations. A significance level of p ≤ 0.05 was accepted. RESULTS Three RCTs assessing 179 participants, all of high methodological quality, were included. There were no significant differences between different PT intensities in terms of power output gains for leg press [SMD = 0.130 (95% CI - 0.19, 0.45), p = 0.425] and knee extension exercises [SMD: 0.016 (95% CI - 0.362, 0.395), p = 0.932], as well as leg press 1RM increases [SMD: 0.296 (95% CI - 0.03, 0.62); p = 0.072]. However, high-intensity PT (70-80% of 1RM) was significantly more effective than low-intensity PT in increasing 1RM for knee extension exercise [SMD: 0.523 (95% CI 0.14, 1.91), p = 0.008]. CONCLUSIONS PT performed at low-to-moderate intensities induces similar power gains compared to high-intensity PT (70-80% of 1RM) in older adults. Nonetheless, the influence of PT intensity on lower-limb strength gains seems to be dependent on the assessed exercise. Cautious interpretation is warranted considering the inclusion of only three studies.
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Affiliation(s)
- Marcelo Bandeira-Guimarães
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Eduarda Blanco-Rambo
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Alexandra Ferreira Vieira
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain
| | - Ronei S Pinto
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IDISNA, Pamplona, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Institute of Health Carlos III, Madrid, Spain
| | - Eduardo Lusa Cadore
- Exercise Research Laboratory (LAPEX), School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Rua Felizardo 750, Bairro Jardim Botânico, Porto Alegre, Rio Grande do Sul, CEP 90690-200, Brazil.
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Way KL, Thomas HJ, Parker L, Maiorana A, Keske MA, Scott D, Reed JL, Tieng J, Hackett D, Hawkins T, Latella C, Cordina R, Tran DL. Cluster Sets to Prescribe Interval Resistance Training: A Potential Method to Optimise Resistance Training Safety, Feasibility and Efficacy in Cardiac Patients. SPORTS MEDICINE - OPEN 2023; 9:86. [PMID: 37725296 PMCID: PMC10509118 DOI: 10.1186/s40798-023-00634-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
The integration of resistance training for cardiac patients leads to important health outcomes that are not optimally obtained with aerobic exercise; these include an increase in muscle mass, maintenance of bone mineral density, and improvements in muscular fitness parameters. Despite the proliferation of evidence supporting resistance exercise in recent decades, the implementation of resistance training is underutilised, and prescription is often sub-optimal in cardiac patients. This is frequently associated with safety concerns and inadequate methods of practical exercise prescription. This review discusses the potential application of cluster sets to prescribe interval resistance training in cardiac populations. The addition of planned, regular passive intra-set rest periods (cluster sets) in resistance training (i.e., interval resistance training) may be a practical solution for reducing the magnitude of haemodynamic responses observed with traditional resistance training. This interval resistance training approach may be a more suitable option for cardiac patients. Additionally, many cardiac patients present with impaired exercise tolerance; this model of interval resistance training may be a more suitable option to reduce fatigue, increase patient tolerance and enhance performance to these workloads. Practical strategies to implement interval resistance training for cardiac patients are also discussed. Preliminary evidence suggests that interval resistance training may lead to safer acute haemodynamic responses in cardiac patients. Future research is needed to determine the efficacy and feasibility of interval resistance training for health outcomes in this population.
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Affiliation(s)
- Kimberley L Way
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3125, Australia.
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Hannah J Thomas
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3125, Australia
| | - Lewan Parker
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3125, Australia
| | - Andrew Maiorana
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia
| | - Michelle A Keske
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3125, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3125, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jessica Tieng
- Epigenetics and RNA Biology Program, Centenary Institute, Camperdown, NSW, Australia
- Central Clinical School, The University of Sydney School of Medicine, Camperdown, NSW, 2006, Australia
| | - Daniel Hackett
- Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Tess Hawkins
- Concord Centre for STRONG Medicine, Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Christopher Latella
- School of Health and Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Rachael Cordina
- Central Clinical School, The University of Sydney School of Medicine, Camperdown, NSW, 2006, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Charles Perkins Centre, Heart Research Institute, Camperdown, NSW, Australia
| | - Derek L Tran
- Central Clinical School, The University of Sydney School of Medicine, Camperdown, NSW, 2006, Australia.
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
- Charles Perkins Centre, Heart Research Institute, Camperdown, NSW, Australia.
- Human Performance Research Centre, School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney, Moore Park, NSW, Australia.
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10
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Tan J, Krasilshchikov O, Kuan G, Hashim HA, Aldhahi MI, Al-Mhanna SB, Badicu G. The Effects of Combining Aerobic and Heavy Resistance Training on Body Composition, Muscle Hypertrophy, and Exercise Satisfaction in Physically Active Adults. Healthcare (Basel) 2023; 11:2443. [PMID: 37685476 PMCID: PMC10487730 DOI: 10.3390/healthcare11172443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated the effects of combined aerobic and heavy resistance training on the variables of body composition, muscle hypertrophy, and exercise satisfaction in physically active adults in comparison with heavy resistance training only (predominantly designed for hypertrophy). Twenty-two healthy male adults between the ages of 18 and 35, who had limited previous experience with muscle resistance training, participated in the intervention program while maintaining their physical activity level. The participants were randomly allocated into two groups: the resistance training group (control group) and the combined training group (experimental group), which involved both resistance training and aerobic training. Aerobic training consisted of 30 min aerobic interval training sessions three times a week with a total of 8 min work bouts in each at 60-70% of heart rate reserve (HRR). The intervention training program lasted for eight weeks. Resistance training consisted of a 3-day muscle group split (2-3 exercises per muscle group, 8 sets per muscle group, 6-12 repetition maximum (RM). Upon completion, body composition, muscle hypertrophy, and exercise satisfaction were analyzed using the mixed-design ANOVA. Variables selected for this study as markers of body composition responded differently to the different interventions and time; however, some trends were not statistically significant. Overall, it is not possible to state unequivocally that one training modality was superior to another in the body composition cluster, for significant improvements were observed within the groups from pre- to post-interventions, but no significant differences were observed between the resistance training and combined training groups, while, both interventions showed improvement with time in some variables of muscle hypertrophy. Compared to baseline, the exercise satisfaction post-intervention improved within the groups. From pre- to post-testing, both resistance and combined training groups improved exercise satisfaction (p < 0.05 in both groups). However, there was no significant difference in exercise satisfaction observed between the resistance training and combined training groups after the training intervention (p > 0.05).
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Affiliation(s)
- Jerrican Tan
- Fitness Innovations Malaysia Sendirian Berhad, Petaling Jaya 47820, Selangor, Malaysia
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Oleksandr Krasilshchikov
- Faculty of Sports Science and Recreation, Universiti Teknologi MARA, Shah Alam 40450, Selangor, Malaysia
| | - Garry Kuan
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Hairul Anuar Hashim
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Sameer Badri Al-Mhanna
- Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Georgian Badicu
- Department of Physical Education and Special Motricity, Faculty of Physical Education and Mountain Sports, Transilvania University of Braşov, 500068 Braşov, Romania
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11
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McDonough DJ, Mathew M, Pope ZC, Schreiner PJ, Jacobs DR, VanWagner LB, Carr JJ, Terry JG, Gabriel KP, Reis JP, Pereira MA. Aerobic and Muscle-Strengthening Physical Activity, Television Viewing, and Nonalcoholic Fatty Liver Disease: The CARDIA Study. J Clin Med 2023; 12:5603. [PMID: 37685671 PMCID: PMC10488389 DOI: 10.3390/jcm12175603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The prevalence of non-alcoholic fatty liver disease (NAFLD) in U.S. adults is over 30%, yet the role of lifestyle factors in the etiology of NAFLD remains understudied. We examined the associations of physical activity, by intensity and type, and television viewing with prevalent NAFLD. METHODS Cross-sectional analysis of a population-based sample of 2726 Black (49%) and White (51%) adults (Mean (SD) age, 50 (3.6) years; 57.3% female) from the CARDIA study. Exposures were aerobic activity by intensity (moderate, vigorous; hours/week); activity type (aerobic, muscle-strengthening; hours/week); and television viewing (hours/week), examined concurrently in all models and assessed by validated questionnaires. Our outcome was NAFLD (liver attenuation < 51 Hounsfield Units), measured by non-contrast computed tomography, after exclusions for other causes of liver fat. Covariates were sex, age, race, study center, education, diet quality, smoking status, alcohol consumption, and body mass index or waist circumference. RESULTS 648 participants had NAFLD. In the fully adjusted modified Poisson regression model, the risk ratios per interquartile range of each exposure were moderate-intensity aerobic activity, 1.10 (95% CI, 0.97-1.26); vigorous-intensity aerobic activity, 0.72 (0.63-0.82); muscle-strengthening activity, 0.89 (0.80-1.01); and television viewing, 1.20 (1.10-1.32). Relative to less active participants with higher levels of television viewing, those who participated in ≥2 h/week of both vigorous-intensity aerobic and muscle-strengthening activity and <7 h/week of television viewing had 65% lower risk of NAFLD (risk ratio = 0.35, 95% CI = 0.23-0.51). CONCLUSION Adults who follow public health recommendations for vigorous-aerobic and muscle-strengthening activity, as well as minimize television viewing, are considerably less likely to have NAFLD than those who do not follow the recommendations and who have relatively high levels of television viewing.
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Affiliation(s)
- Daniel J. McDonough
- Division of Epidemiology & Community Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA; (M.M.); (P.J.S.); (D.R.J.J.); (M.A.P.)
| | - Mahesh Mathew
- Division of Epidemiology & Community Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA; (M.M.); (P.J.S.); (D.R.J.J.); (M.A.P.)
| | - Zachary C. Pope
- Well Living Lab, Rochester, NY 55902, USA;
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, NY 14625, USA
| | - Pamela J. Schreiner
- Division of Epidemiology & Community Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA; (M.M.); (P.J.S.); (D.R.J.J.); (M.A.P.)
| | - David R. Jacobs
- Division of Epidemiology & Community Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA; (M.M.); (P.J.S.); (D.R.J.J.); (M.A.P.)
| | - Lisa B. VanWagner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - John Jeffrey Carr
- Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37232, USA; (J.J.C.); (J.G.T.)
| | - James G. Terry
- Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37232, USA; (J.J.C.); (J.G.T.)
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Jared P. Reis
- National Heart Lung and Blood Institute, Bethesda, MD 20892, USA;
| | - Mark A. Pereira
- Division of Epidemiology & Community Health, University of Minnesota-Twin Cities, Minneapolis, MN 55455, USA; (M.M.); (P.J.S.); (D.R.J.J.); (M.A.P.)
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12
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Arhab A, Junod N, Rossel JB, Giet O, Sittarame F, Beer S, Sofra D, Durrer D, Delgado H, Castellsague M, Laimer M, Puder JJ. Effectiveness of a real-life program (DIAfit) to promote physical activity in patients with type 2 diabetes: a pragmatic cluster randomized clinical trial. Front Endocrinol (Lausanne) 2023; 14:1155217. [PMID: 37484961 PMCID: PMC10359883 DOI: 10.3389/fendo.2023.1155217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/08/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The aim of this study was to evaluate the effectiveness of a real-life clinical physical activity program (DIAfit) on improving physical fitness, body composition, and cardiometabolic health in an unselected population with type 2 diabetes mellitus, and to compare the effects of two variants a different exercise frequencies on the same outcomes. Research design and methods This was a cluster randomized-controlled assessor-blind trial conducted in 11 clinical centres in Switzerland. All participants in the clinical program with type 2 diabetes were eligible and were randomized to either standard (3 sessions/week for 12 weeks) or alternative (1 session/week for the first four weeks, then 2 sessions/week for the rest of 16 weeks) physical activity program each consisting of 36 sessions of combined aerobic and resistance exercise. Allocation was concealed by a central office unrelated to the study. The primary outcome was aerobic fitness. Secondary outcome measures included: body composition, BMI, HbA1c, muscle strength, walking speed, balance, flexibility, blood pressure, lipid profile. Results All 185 patients with type 2 diabetes (mean age 59.7 +-10.2 years, 48% women) agreed to participate and were randomized in two groups: a standard group (n=88) and an alternative group (n=97)). There was an 11% increase in aerobic fitness after the program (12.5 Watts; 95% CI 6.76 to 18.25; p<0.001). Significant improvements in physical fitness, body composition, and cardiometabolic parameters were observed at the end of the DIAfit program (improvements between 2-29%) except for lean body mass, triglycerides and cholesterol. No differences were observed between both programs, except for a larger weight reduction of -0.97kg (95% CI -0.04 to -1.91; p=0.04) in the standard program. Conclusions Both frequency variants of the nation-wide DIAfit program had beneficial effects on physical fitness, HbA1c, body composition, and blood pressure in type 2 diabetes patients and differences were negligible. Clinical trial registration clinicaltrials.gov, identifier NCT01289587.
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Affiliation(s)
- Amar Arhab
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
| | - Nicolas Junod
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
- La Lignière Clinic, Department of Medicine, Cardiovascular and Metabolic Rehabilitation Service, Gland, Switzerland
- Lavaux Hospital, Cully, Switzerland
| | - Jean-Benoit Rossel
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
| | - Olivier Giet
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
- Socio-medical Centre, Sierre, Switzerland
| | - Frederic Sittarame
- Cardiac Rehabilitation and Heart Failure Unity, Cardiology Service, Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Sandra Beer
- Private Practice for Diabetes and Endocrinology, Lausanne, Switzerland
| | - Daniela Sofra
- Private Practice for Diabetes and Endocrinology, Lausanne, Switzerland
| | - Dominique Durrer
- European Association for the Study of Obesity (EASO), Collaborating Centre for Obesity Management (COMs), Vevey, Switzerland
| | - Humberto Delgado
- La Lignière Clinic, Department of Medicine, Cardiovascular and Metabolic Rehabilitation Service, Gland, Switzerland
| | | | - Markus Laimer
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital Bern University Hospital, Bern, Switzerland
| | - Jardena J. Puder
- Obstetric Service, Department Woman-Mother-Child, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Lausanne, Switzerland
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13
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Soares ALDS, Machado-Lima A, Brech GC, Greve JMD, Dos Santos JR, Inojossa TR, Rogero MM, Salles JEN, Santarem-Sobrinho JM, Davis CL, Alonso AC. The Influence of Whey Protein on Muscle Strength, Glycemic Control and Functional Tasks in Older Adults with Type 2 Diabetes Mellitus in a Resistance Exercise Program: Randomized and Triple Blind Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105891. [PMID: 37239618 DOI: 10.3390/ijerph20105891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To evaluate the effect of whey protein (WP) supplementation associated with resistance training (RT) on glycemic control, functional tasks, muscle strength, and body composition in older adults living with type 2 diabetes mellitus (T2DM). Secondly, to evaluate the safety of the protocol for renal function. METHODS The population comprised twenty-six older men living with T2DM (68.5 ± 11.5 years old). The participants were randomly assigned to the Protein Group (PG) and the Control Group (CG). The handgrip test and evolution of exercise loads, according to the Omni Resistance Exercise Scale, evaluated muscle strength. Functional tasks were assessed by force platform in three different protocols: Sit-to-Stand, Step/Quick Turn, and Step Up/Over. Body composition was evaluated by bioimpedance and glycemic control and renal function were assessed by biochemical analyses. Both groups performed RT for 12 weeks, twice a week, prioritizing large muscle groups. Protein supplementation was 20 g of whey protein isolate and the CG was supplemented with an isocaloric drink, containing 20 g of maltodextrin. RESULTS There was a significant difference in muscle strength, according to the evolution of the exercise loads, but it was not confirmed in the handgrip test. However, there was no significant difference between the groups, regarding performance in functional tasks, glycemic control, or body composition. Renal function showed no alteration. CONCLUSION The intake of 20 g of WP in older male adults living with T2DM did not increase the effect of RT on muscle strength, functional tasks, and glycemic control. The intervention was proven safe regarding renal function.
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Affiliation(s)
- André Luiz de Seixas Soares
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Adriana Machado-Lima
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Guilherme Carlos Brech
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Júlia Maria D'Andréa Greve
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Joselma Rodrigues Dos Santos
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Thiago Resende Inojossa
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
| | - Marcelo Macedo Rogero
- Department of Nutrition, Faculty of Public Health, FMSUP, São Paulo 01151-000, SP, Brazil
| | - João Eduardo Nunes Salles
- Department of Internal Medicine, The Discipline of Endocrinology, Santa Casa of São Paulo Medical School, São Paulo 01224-001, SP, Brazil
| | | | - Catherine L Davis
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Angelica Castilho Alonso
- Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo 03166-000, SP, Brazil
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo 05402-000, SP, Brazil
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14
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Della LJ, Reitenga A, King KM. Communication Strategies and Resources for Health and Fitness Professionals to Minimize Diabetes-Related Social Stigma. ACSM'S HEALTH & FITNESS JOURNAL 2023. [DOI: 10.1249/fit.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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15
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Changes in Cognition and Brain Function After 26 Weeks of Progressive Resistance Training in Older Adults at Risk for Diabetes: A Pilot Randomized Controlled Trial. Can J Diabetes 2023; 47:250-256. [PMID: 36858923 DOI: 10.1016/j.jcjd.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Type 2 diabetes is associated with deficits in cognition and brain health. Individuals with at least 1 risk factor for diabetes (i.e. obesity, prediabetes) already experience some neurocognitive impairment and are at risk for further decline. One way to combat these deficits is through exercise, but its is unknown whether resistance exercise can improve these functions in this at-risk group. METHODS This study was a pilot randomized controlled trial. Participants were 60 to 80 years of age and had prediabetes (fasting capillary glucose 6.1 to 6.9 mmol/L) and/or were overweight or obese (body mass index ≥25). Participants completed resistance training or balance and stretching exercise (control) thrice weekly for 6 months. Neuropsychological tests were used to assess cognitive ability, whereas functional magnetic resonance imaging was used to examine brain activation patterns. RESULTS Resistance training led to improvements in task-switching, attention and conflict resolution, as well as improved patterns of brain activation that may mimic healthy older adults. CONCLUSIONS Resistance exercise may serve as an effective behavioural strategy to improve neurocognition in older adults at risk for type 2 diabetes. A large-scale powered trial is needed to further explore these findings.
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16
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HIIT Ameliorates Inflammation and Lipid Metabolism by Regulating Macrophage Polarization and Mitochondrial Dynamics in the Liver of Type 2 Diabetes Mellitus Mice. Metabolites 2022; 13:metabo13010014. [PMID: 36676939 PMCID: PMC9862084 DOI: 10.3390/metabo13010014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
High-intensity interval training (HIIT), a new type of exercise, can effectively prevent the progression of metabolic diseases. The aim of this study was to investigate the effects of HIIT on liver inflammation and metabolic disorders in type 2 diabetes mellitus (T2DM) mice induced by a high-fat diet (HFD) combined with streptozotocin (STZ) and to explore the possible mechanisms of macrophage polarization and mitochondrial dynamics. Our results showed that HIIT can increase fatty acid oxidation-related gene (PPARα, CPT1α, and ACOX1) mRNA levels and decrease adipogenesis-related gene (PPARγ) mRNA levels to improve liver metabolism in T2DM mice. The improvement of lipid metabolism disorder may occur through increasing liver mitochondrial biosynthesis-related genes (PGC-1α and TFAM) and restoring mitochondrial dynamics-related gene (MFN2 and DRP1) mRNA levels. HIIT can also reduce the mRNA levels of liver inflammatory factors (TNF-α, IL-6, and MCP-1) in T2DM mice. The reduction in liver inflammation may occur through reducing the expression of total macrophage marker (F4/80) and M1 macrophage marker (CD86) mRNA and protein and increasing the expression of M2 macrophage marker (CD163, CD206, and Arg1) mRNA and protein in the liver. HIIT can also increase the expression of insulin signaling pathway (IRS1, PI3K, and AKT) mRNA and protein in the liver of T2DM mice, which may be related to the improvements in liver inflammation and lipid metabolism. In conclusion, these results suggested that 8 weeks of HIIT can improve inflammation and lipid metabolism disorders in the liver of type 2 diabetes mellitus mice, macrophage M1/M2 polarization, and mitochondrial dynamics may be involved in this process.
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17
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Malin SK, Stewart NR, Ude AA, Alderman BL. Brain insulin resistance and cognitive function: influence of exercise. J Appl Physiol (1985) 2022; 133:1368-1380. [PMID: 36269295 PMCID: PMC9744647 DOI: 10.1152/japplphysiol.00375.2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
Exercise has systemic health benefits in people, in part, through improving whole body insulin sensitivity. The brain is an insulin-sensitive organ that is often underdiscussed relative to skeletal muscle, liver, and adipose tissue. Although brain insulin action may have only subtle impacts on peripheral regulation of systemic glucose homeostasis, it is important for weight regulation as well as mental health. In fact, brain insulin signaling is also involved in processes that support healthy cognition. Furthermore, brain insulin resistance has been associated with age-related declines in memory and executive function as well as Alzheimer's disease pathology. Herein, we provide an overview of brain insulin sensitivity in relation to cognitive function from animal and human studies, with particular emphasis placed on the impact exercise may have on brain insulin sensitivity. Mechanisms discussed include mitochondrial function, brain growth factors, and neurogenesis, which collectively help combat obesity-related metabolic disease and Alzheimer's dementia.
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Affiliation(s)
- Steven K Malin
- Department of Kinesiology & Health, Rutgers University, New Brunswick, New Jersey
- Division of Endocrinology, Metabolism & Nutrition, Rutgers University, New Brunswick, New Jersey
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, New Jersey
- Institute of Translational Medicine and Science, Rutgers University, New Brunswick, New Jersey
| | - Nathan R Stewart
- Department of Kinesiology & Health, Rutgers University, New Brunswick, New Jersey
| | - Andrew A Ude
- Department of Kinesiology & Health, Rutgers University, New Brunswick, New Jersey
| | - Brandon L Alderman
- Department of Kinesiology & Health, Rutgers University, New Brunswick, New Jersey
- Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, New Jersey
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18
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Roldán García B, Esbrí Víctor M, López-Jiménez E, Gómez Ballesteros C, Alcantud Córcoles R, Andrés Pretel F, Sánchez-Jurado PM, Avendaño Céspedes A, Sánchez-Flor Alfaro V, López Bru R, Ruíz Grao MC, Noguerón García A, Romero Rizos L, García Molina R, Izquierdo M, Abizanda P. Limits of stability and falls during a multicomponent exercise program in faller older adults: A retrospective cohort study. Exp Gerontol 2022; 169:111957. [PMID: 36150587 DOI: 10.1016/j.exger.2022.111957] [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: 02/11/2022] [Revised: 06/06/2022] [Accepted: 09/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJETIVES Multicomponent exercise programs have been demonstrated to prevent falls in older adults. However, the underlying responsible mechanisms are not clear. We aimed to analyze the association between changes in the limits of stability (LOS) as a relevant balance component, and falls occurrence during a multicomponent physical exercise program. METHODS Retrospective study, including ninety-one participants who had experienced a fall in the previous year, and were attended in a falls unit. All of them were included in a twice-a-week multicomponent exercise program during 16 weeks. Pre- and post-program measurements were collected for leg press, gait speed, the short physical performance battery (SPPB), and LOS (point of excursion [POE] and maximal excursion [MEX]) with posturography. Falls occurrence was assessed between the beginning and the completion of the exercise program (16 week). RESULTS The mean age was 77.2 years, and 72 were female. Thirty-two participants fell at least once during the exercise period. The global baseline POE was 47.6 %, and the MEX was 64.7 %, and there were no differences between fallers and nonfallers. Nonfallers presented greater improvements in POE (6.3 % versus 1.3 %; p < .05) and MEX (9.2 % versus 3.0 %; p < .01) than fallers. The POE and MEX were independently associated with a reduced probability of having had a fall, OR: 0.95 (95 % CI: 0.91 to 0.99) and 0.94 (95 % CI: 0.90 to 0.99), respectively. Changes in SPPB results or leg press strength were not associated with decreased falls. Adjusted probability of fall occurrence decreased by 5 % and 6 % per 1 % improvement in absolute values in POE and MEX, respectively. CONCLUSIONS Improvements in LOS after a multicomponent physical exercise program in older adults with previous falls may be associated with a decreased occurrence of falls.
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Affiliation(s)
- Belén Roldán García
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Mariano Esbrí Víctor
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Esther López-Jiménez
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Fernando Andrés Pretel
- Department of Statistics, Foundation of the National Paraplegics Hospital of Toledo, Toledo, Spain
| | - Pedro Manuel Sánchez-Jurado
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain
| | - Almudena Avendaño Céspedes
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Spain
| | | | - Rita López Bru
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Luis Romero Rizos
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain
| | - Rafael García Molina
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Department of Statistics, Foundation of the National Paraplegics Hospital of Toledo, Toledo, Spain
| | - Míkel Izquierdo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Pedro Abizanda
- Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina de Albacete, Universidad de Castilla-La Mancha, Spain.
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DHULI KRISTJANA, NAUREEN ZAKIRA, MEDORI MARIACHIARA, FIORETTI FRANCESCO, CARUSO PAOLA, PERRONE MARCOALFONSO, NODARI SAVINA, MANGANOTTI PAOLO, XHUFI SUELA, BUSHATI MARSIDA, BOZO DHURATA, CONNELLY STEPHENTHADDEUS, HERBST KARENL, BERTELLI MATTEO. Physical activity for health. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E150-E159. [PMID: 36479484 PMCID: PMC9710390 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Physical activity plays a substantial role in maintaining people's good health and mental wellbeing, but that is not all: not only it positively affects the individuals' mental and physical health, but a lack of physical exercise exerts a negative impact also on the overall economy of a nation. In addition, physical inactivity not only increases the risk of non-communicable diseases (NCD), but also contributes significantly to the increased morbidity and mortality in patients suffering from these diseases. On the contrary, physical activity reduces the risk of NCDs - such as cardiovascular diseases, type 2 diabetes, and cancer - in a dose-dependent manner; regular exercise is also associated with many health benefits and delayed mortality. However, understanding the role of physical activity in modern society and creating an awareness in the general population is one of the most important tasks of health and recreation promoters. Correspondingly, there is a dire need to enhance our knowledge, perception, and awareness of physical activity and its impacts on an individual's health, ultimately contributing to developing a healthy society. The current review will focus on the health benefits of the two most widely studied modifiable lifestyle risk factors, physical activity and diet, focusing particularly on the Mediterranean diet.
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Affiliation(s)
- KRISTJANA DHULI
- MAGI’S LAB, Rovereto (TN), Italy
- Correspondence: Kristjana Dhuli, MAGI’S LAB, Rovereto (TN), 38068, Italy. E-mail:
| | | | | | - FRANCESCO FIORETTI
- Department of Cardiology, University of Brescia and ASST “Spedali Civili” Hospital, Brescia, Italy
| | - PAOLA CARUSO
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | | | - SAVINA NODARI
- Department of Cardiology, University of Brescia and ASST “Spedali Civili” Hospital, Brescia, Italy
| | - PAOLO MANGANOTTI
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, Trieste, Italy
| | | | | | | | - STEPHEN THADDEUS CONNELLY
- San Francisco Veterans Affairs Health Care System, Department of Oral & Maxillofacial Surgery, University of California, San Francisco, CA, USA7
| | - KAREN L. HERBST
- Total Lipedema Care, Beverly Hills California and Tucson Arizona, USA
| | - MATTEO BERTELLI
- MAGI’S LAB, Rovereto (TN), Italy
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Peachtree Corners (GA), USA
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20
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Martínez-Gayo A, Félix-Soriano E, Sáinz N, González-Muniesa P, Moreno-Aliaga MJ. Changes Induced by Aging and Long-Term Exercise and/or DHA Supplementation in Muscle of Obese Female Mice. Nutrients 2022; 14:nu14204240. [PMID: 36296923 PMCID: PMC9610919 DOI: 10.3390/nu14204240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity and aging promote chronic low-grade systemic inflammation. The aim of the study was to analyze the effects of long-term physical exercise and/or omega-3 fatty acid Docosahexaenoic acid (DHA) supplementation on genes or proteins related to muscle metabolism, inflammation, muscle damage/regeneration and myokine expression in aged and obese mice. Two-month-old C57BL/6J female mice received a control or a high-fat diet for 4 months. Then, the diet-induced obese (DIO) mice were distributed into four groups: DIO, DIO + DHA, DIO + EX (treadmill training) and DIO + DHA + EX up to 18 months. Mice fed a control diet were sacrificed at 2, 6 and 18 months. Aging increased the mRNA expression of Tnf-α and decreased the expression of genes related to glucose uptake (Glut1, Glut4), muscle atrophy (Murf1, Atrogin-1, Cas-9) and myokines (Metrnl, Il-6). In aged DIO mice, exercise restored several of these changes. It increased the expression of genes related to glucose uptake (Glut1, Glut4), fatty acid oxidation (Cpt1b, Acox), myokine expression (Fndc5, Il-6) and protein turnover, decreased Tnf-α expression and increased p-AKT/AKT ratio. No additional effects were observed when combining exercise and DHA. These data suggest the effectiveness of long-term training to prevent the deleterious effects of aging and obesity on muscle dysfunction.
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Affiliation(s)
- Alejandro Martínez-Gayo
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain
- Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
| | - Elisa Félix-Soriano
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain
- Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
| | - Neira Sáinz
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain
- Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
| | - Pedro González-Muniesa
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain
- Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- IdISNA–Navarra Institute for Health Research, 31008 Pamplona, Spain
- Correspondence: (P.G.-M.); (M.J.M.-A.)
| | - María J. Moreno-Aliaga
- Department of Nutrition, Food Science and Physiology, Faculty of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain
- Center for Nutrition Research, University of Navarra, 31008 Pamplona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Health Institute (ISCIII), 28029 Madrid, Spain
- IdISNA–Navarra Institute for Health Research, 31008 Pamplona, Spain
- Correspondence: (P.G.-M.); (M.J.M.-A.)
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21
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Park JH, Lim NK, Park HY. Relative Handgrip Strength is Inversely Associated with Hypertension in Consideration of Visceral Adipose Dysfunction: A Nationwide Cross-Sectional Study in Korea. Front Physiol 2022; 13:930922. [PMID: 35928568 PMCID: PMC9344337 DOI: 10.3389/fphys.2022.930922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
This study investigated the associations of relative handgrip strength (rHGS) and hypertension. Individual differences in visceral adipose dysfunction (VAD) were evaluated to verify whether rHGS was associated with a reduction in the risk of hypertension, even in individuals with VAD. We included 77,991 participants (50,616 women) from nationwide cohorts in Korea. Participants were categorized into three groups based on sex-specific tertiles of rHGS (Low, Mid, and High). The visceral adiposity index (VAI) was used to evaluate VAD. The multiple logistic regression model was used to assess the risk of hypertension. High rHGS is associated with reduction of hypertension risk in 38 and 26% of men and women, respectively, although rHGS was significantly low in women compared to men. The benefit of rHGS was observed from middle-aged to older participants in both sexes. High rHGS is associated with risk reduction for hypertension in both VAD and non-VAD groups. In the VAD group, compared to Low rHGS, High rHGS was associated with 32 and 22% risk reductions in hypertension in men and women, respectively, and these associations remained significant even when classified according to age, such as in middle-aged and older subgroups. Therefore, the present study suggests that high levels of rHGS are significantly associated with a reduced risk of hypertension even in participants with VAD. Thus, maintaining a higher level of rHGS may be associated with protective benefits against hypertension.
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Affiliation(s)
- Jae Ho Park
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Nam-Kyoo Lim
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Hyun-Young Park
- Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Korea
- *Correspondence: Hyun-Young Park,
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22
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Rezaeinezhad N, Alizadeh R, Ghanbari-Niaki A. Short-term circuit resistance training improves insulin resistance probably via increasing circulating Adropin. J Diabetes Metab Disord 2022; 21:583-588. [PMID: 35673513 PMCID: PMC9167342 DOI: 10.1007/s40200-022-01020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/24/2022]
Abstract
Aim and background The underlying mechanism of exercise-induced insulin resistance (IR) improvement is unclear. Adropin is a multifunctional peptide has a significant role in the regulation of physical activity and insulin sensitivity. Thus, the aim of this study was to evaluate the effects of various circuit resistance (CRT) intensities on circulating adropin levels and IR and their relation. Method Forty-five voluntarily male men randomly were divided into 5 groups; control and 4 groups of CRT (20%, 40%, 60% and 80% of one-repetition maximum (1-RM)). Training groups performed CRT protocol 3 times a week for 6 weeks. Blood samples were drawn before and 48 h after the last training session and used for analyzing serum levels of adropin, glucose and insulin. Results The results showed that varying CRT intensities were associated with adropin elevation in comparison to the control group. Further analysis revealed that plasma adropin is higher in the 20% 1-RM group compared to the 40% 1-RM group. Furthermore, fasting insulin and glucose, as well as IR, were decreased in response to different CRT intensities. In addition, these reductions were significantly correlated with adropin level. Conclusion It can be speculated that different CRT intensities improve IR probably via increasing adropin level, and should be considered as an effective training method for diminishing glucose metabolism disorders.
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Affiliation(s)
- Najmeh Rezaeinezhad
- Department of Sports Science, School of Literature and Humanities, Ilam University, Ilam, I.R Iran
| | - Rostam Alizadeh
- Department of Sports Science, School of Literature and Humanities, Ilam University, Ilam, I.R Iran
| | - Abbas Ghanbari-Niaki
- Department of Exercise Biochemistry Division, Faculty of Sport Sciences, University of Mazandaran, Babolsar, I.R Iran
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23
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Bekhet AH, Jahan AM, Bochkezanian V, Musselman KE, Elsareih AA, Gorgey AS. Effects of Electrical Stimulation Training on Body Composition Parameters After Spinal Cord Injury: A Systematic Review. Arch Phys Med Rehabil 2022; 103:1168-1178. [PMID: 34687676 DOI: 10.1016/j.apmr.2021.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES), or both, training on different body composition parameters in individuals with spinal cord injury. DATA SOURCES Three independent reviewers searched PubMed, Web of Science, Scopus, Cochrane Central, and Virtual Health Library until March 2020. STUDY SELECTION Studies were included if they applied NMES/FES on the lower limb muscles after spinal cord injury, reported stimulation parameters (frequency, pulse duration, and amplitude of current), and body composition parameters, which included muscle cross-sectional area (CSA), fat-free mass, lean mass (LM), fat mass, visceral adipose tissue, and intramuscular fat. DATA SYNTHESIS A total of 46 studies were included in the final analysis with a total sample size of 414 subjects. NMES loading exercise and FES cycling exercise were commonly used for training. Increases in muscle CSA ranged from 5.7-75%, with an average of 26% (n=33). Fifteen studies reported changes (both increase and decrease) in LM or fat-free mas ranged from -4% to 35%, with an average of less than 5%. Changes in fat mass (n=10) were modest. The effect on ectopic adipose tissue is inconclusive, with 2 studies showing an average reduction in intramuscular fat by 9.9%. Stimulation parameters ranged from 200-1000 μs for pulse duration, 2-60 Hz for the frequency, and 10-200 mA in amplitude. Finally, increase in weekly training volumes after NMES loading exercise resulted in a remarkable increase in percentage changes in LM or muscle CSA. CONCLUSIONS NMES/FES is an effective rehabilitation strategy for muscle hypertrophy and increasing LM. Weekly training volumes are associated with muscle hypertrophy after NMES loading exercise. Furthermore, positive muscle adaptations occur despite the applied stimulation parameters. Finally, the included studies reported wide range of stimulation parameters without reporting rationale for such selection.
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Affiliation(s)
| | - Alhadi M Jahan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
| | - Vanesa Bochkezanian
- Department of Exercise and Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Kristin E Musselman
- KITE, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amr A Elsareih
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ashraf S Gorgey
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA; Virginia Commonwealth University, Department of Physical Medicine & Rehabilitation, Richmond, VA.
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24
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Abdi A. The effect of aerobic, resistance, and concurrent training on the expression and protein levels of RBP4 visceral and subcutaneous adipose tissue in diabetic rats with STZ. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Seidu S, Khunti K, Yates T, Almaqhawi A, Davies M, Sargeant J. The importance of physical activity in management of type 2 diabetes and COVID-19. Ther Adv Endocrinol Metab 2021; 12:20420188211054686. [PMID: 34721838 PMCID: PMC8554560 DOI: 10.1177/20420188211054686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Over time, various guidelines have emphasised the importance of physical activity and exercise training in the management of type 2 diabetes, chronic diseases, including cardiovascular disease and musculoskeletal disorders. The aim of this review is to evaluate the effectiveness of physical activity in people with type 2 diabetes and COVID-19. Most research to date indicates that people with type 2 diabetes who engage in both aerobic and resistance exercise see the greatest improvements in insulin sensitivity. Physical activity is now also known to be effective at reducing hospitalisation rates of respiratory viral diseases, such as COVID-19, due to the beneficial impacts of exercise on the immune system. Preliminary result indicates that home-based exercise may be an essential component in future physical activity recommendations given the current COVID-19 pandemic and the need for social distancing. This home-based physical exercise can be easily regulated and monitored using step counters and activity trackers, enabling individuals to manage health issues that benefit from physical exercise.
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Affiliation(s)
- Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Dammam, Saudi Arabia
| | - M.J. Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Jack Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
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O'Reilly CL, Uranga S, Fluckey JD. Culprits or consequences: Understanding the metabolic dysregulation of muscle in diabetes. World J Biol Chem 2021; 12:70-86. [PMID: 34630911 PMCID: PMC8473417 DOI: 10.4331/wjbc.v12.i5.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of type 2 diabetes (T2D) continues to rise despite the amount of research dedicated to finding the culprits of this debilitating disease. Skeletal muscle is arguably the most important contributor to glucose disposal making it a clear target in insulin resistance and T2D research. Within skeletal muscle there is a clear link to metabolic dysregulation during the progression of T2D but the determination of culprits vs consequences of the disease has been elusive. Emerging evidence in skeletal muscle implicates influential cross talk between a key anabolic regulatory protein, the mammalian target of rapamycin (mTOR) and its associated complexes (mTORC1 and mTORC2), and the well-described canonical signaling for insulin-stimulated glucose uptake. This new understanding of cellular signaling crosstalk has blurred the lines of what is a culprit and what is a consequence with regard to insulin resistance. Here, we briefly review the most recent understanding of insulin signaling in skeletal muscle, and how anabolic responses favoring anabolism directly impact cellular glucose disposal. This review highlights key cross-over interactions between protein and glucose regulatory pathways and the implications this may have for the design of new therapeutic targets for the control of glucoregulatory function in skeletal muscle.
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Affiliation(s)
| | - Selina Uranga
- Health and Kinesiology, Texas A&M University, TX 77843, United States
| | - James D Fluckey
- Health and Kinesiology, Texas A&M University, TX 77843, United States
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Effects of DHA-Rich n-3 Fatty Acid Supplementation and/or Resistance Training on Body Composition and Cardiometabolic Biomarkers in Overweight and Obese Post-Menopausal Women. Nutrients 2021; 13:nu13072465. [PMID: 34371972 PMCID: PMC8308734 DOI: 10.3390/nu13072465] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 01/04/2023] Open
Abstract
Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.
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Two-Year Follow-up of a Multimodal Intervention on Functional Capacity and Muscle Power in Frail Patients With Type 2 Diabetes. J Am Med Dir Assoc 2021; 22:1906-1911. [PMID: 34265268 DOI: 10.1016/j.jamda.2021.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To analyze the effects of a program composed of resistance training and nutritional interventions on functional capacity, maximal strength, and power output after 2 years of follow-up, including 2 periods of 16 weeks of intervention followed by several weeks of intervention cessation in frail patients with type 2 diabetes. DESIGN MIDPOW is a substudy of a multicenter, multimodal intervention composed of resistance training combined with a structured diabetes and nutritional education program in frail and prefrail older people with type 2 diabetes (MID-Frail). SETTING AND PARTICIPANTS This study recruited 52 participants (mean age: 79 ± 5.6, 63% women), with type 2 diabetes mellitus, frail or prefrail using Fried's frailty phenotype. METHODS Primary outcomes of this substudy were Short Physical Performance Battery (SPPB) and maximal power output at 30% and 80% of 1RM. RESULTS Each set of 16 weeks of intervention resulted in significant improvements in SPPB performance by a mean of 36.1% at week 18 (P < .001) and 10.2% at week 68 (P < .05). Maximal power output improvements at 30% and 80% of the 1RM ranged from 45.2% to 57.2% at week 18 (P < .01-.001); and no significant changes were observed after the second period of intervention. After 2 years of follow-up, the SPPB and maximal power values observed remained significantly higher than the baseline. CONCLUSIONS AND IMPLICATIONS Resistance training combined with nutritional program improved SPPB, maximal strength, and power output in older frail patients with diabetes. These improvements were maintained above the basal levels after several weeks of intervention cessation during a 2-year follow-up.
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McKendry J, Stokes T, Mcleod JC, Phillips SM. Resistance Exercise, Aging, Disuse, and Muscle Protein Metabolism. Compr Physiol 2021; 11:2249-2278. [PMID: 34190341 DOI: 10.1002/cphy.c200029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skeletal muscle is the organ of locomotion, its optimal function is critical for athletic performance, and is also important for health due to its contribution to resting metabolic rate and as a site for glucose uptake and storage. Numerous endogenous and exogenous factors influence muscle mass. Much of what is currently known regarding muscle protein turnover is owed to the development and use of stable isotope tracers. Skeletal muscle mass is determined by the meal- and contraction-induced alterations of muscle protein synthesis and muscle protein breakdown. Increased loading as resistance training is the most potent nonpharmacological strategy by which skeletal muscle mass can be increased. Conversely, aging (sarcopenia) and muscle disuse lead to the development of anabolic resistance and contribute to the loss of skeletal muscle mass. Nascent omics-based technologies have significantly improved our understanding surrounding the regulation of skeletal muscle mass at the gene, transcript, and protein levels. Despite significant advances surrounding the mechanistic intricacies that underpin changes in skeletal muscle mass, these processes are complex, and more work is certainly needed. In this article, we provide an overview of the importance of skeletal muscle, describe the influence that resistance training, aging, and disuse exert on muscle protein turnover and the molecular regulatory processes that contribute to changes in muscle protein abundance. © 2021 American Physiological Society. Compr Physiol 11:2249-2278, 2021.
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Affiliation(s)
- James McKendry
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Tanner Stokes
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan C Mcleod
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials. Int J Obes (Lond) 2021; 45:982-997. [PMID: 33558643 DOI: 10.1038/s41366-021-00767-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Visceral adipose tissue (VAT) are deleterious fat deposits in the human body and can be effectively reduced by exercise intervention. Despite well-established exercise prescriptions are available, the effective dosage of exercise for reducing VAT requires verification. OBJECTIVES The aims of this systematic review and meta-analysis were to determine the most effective exercise dosage (modality, intensity, duration, and amount) for decreasing VAT. METHODS Nine databases (EMBASE, Medline, Cochrane Central Register of Controlled Trial, PubMed, CINAHL, Scopus, Web of Science, Airiti Library, and PerioPath) were systematically searched for randomized controlled trials that objectively assessed VAT. The arms of included studies covered with different exercise modalities and dosage. Relevant databases were searched through February 2020. RESULTS Of the 34 studies (n = 1962) included in systematic review, 32 (n = 1900) were pooled for pairwise or network meta-analysis. The results indicated that high-intensity interval training (SMD -0.39, 95% CI -0.60 to -0.18) and aerobic exercise (SMD -0.26, 95% CI -0.38 to -0.13) of at least moderate intensity were beneficial for reducing VAT. By contrast, resistance exercise, aerobic exercise combined with resistance exercise, and sprint interval training had no significant effects. No difference in VAT reduction was observed between exercising more or less than 150 min per week. Meta-regression revealed that the effect of VAT reduction was not significantly influenced by an increase in the duration of or amount of exercise in an exercise program. The effective dosage of exercise for reducing VAT was three times per week for 12 to 16 weeks, while duration per session for aerobic exercise was 30-60 min, and either less than 30 min or 30-60 min of high-intensity interval training accomplished sufficient energy expenditure to impact VAT. CONCLUSIONS These results can inform exercise prescriptions given to the general population for improving health by reducing VAT.
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Benham JL, Booth JE, Dunbar MJ, Doucette S, Boulé NG, Kenny GP, Prud'homme D, Sigal RJ. Significant Dose-Response between Exercise Adherence and Hemoglobin A1c Change. Med Sci Sports Exerc 2021; 52:1960-1965. [PMID: 32175973 DOI: 10.1249/mss.0000000000002339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Diabetes Aerobic and Resistance Exercise trial found that aerobic training and resistance training alone each reduced hemoglobin A1c (HbA1c) compared with nonexercising controls, and combined aerobic and resistance training caused greater HbA1c reduction than either training type alone. Our objective was to determine whether a dose-response relationship existed between frequency of exercise training and HbA1c change, and whether this varied by exercise modality or participant characteristics. METHODS Post hoc analysis of data from 185 Diabetes Aerobic and Resistance Exercise trial participants with type 2 diabetes randomized to aerobic, resistance or combined training thrice weekly. Dose-response relationships between adherence (percent of prescribed training sessions completed) and HbA1c change were assessed with linear regression. RESULTS Median overall adherence was 84.9% (interquartile range, 74.4%-93.6%). Higher exercise adherence was associated with greater HbA1c reduction; a 20% increase in adherence (e.g., an additional two sessions per month) was associated with a 0.15% (2 mmol·mol) decrease in HbA1c (β = -0.0076, R = -0.170, P = 0.021). Significant dose-response relationships were identified for aerobic (β = -0.0142, R = -0.313, P = 0.016) and combined training (β = -0.0109, R = -0.259, P = 0.041), but not resistance training (β = 0.0068, R = 0.153, P = 0.233). Dose-response relationships in all training groups combined were significant in subgroups younger than 55 yr (β = -0.0113, R = -0.286, P = 0.005), males (β = -0.0123, R = -0.234, P = 0.010), and baseline HbA1c ≥7.5% (58 mmol·mol) (β = -0.013, R = -0.263, P = 0.011). CONCLUSIONS There was a dose-response relationship between adherence to prescribed exercise and HbA1c reduction suggesting that glycemic control is improved more in individuals with type 2 diabetes with a higher training volume. Dose-response relationships existed for aerobic and combined training but not resistance training. These findings support aerobic and combined exercise prescriptions outlined in clinical practice guidelines.
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Affiliation(s)
| | - Jane E Booth
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, CANADA
| | | | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, CANADA
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA
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Pfeifer LO, Botton CE, Diefenthaeler F, Umpierre D, Pinto RS. Effects of a power training program in the functional capacity, on body balance and lower limb muscle strength of elderly with type 2 diabetes mellitus. J Sports Med Phys Fitness 2021; 61:1529-1537. [PMID: 33480514 DOI: 10.23736/s0022-4707.21.11880-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The effects of interventions with muscle power training on balance and functionality in individuals with type 2 diabetes mellitus (T2DM) are still poorly investigated. We evaluated the efficacy of a twelve-week power training program in the functional capacity, balance and lower limb muscle power and strength of elderly with T2DM. METHODS Twenty-one subjects (14 women and seven men) were allocated into two groups. One of the groups (PTG) performed a power training program twice a week (N.=11; age 70.5±7.8 years old), and the other was an active control group (CG) that performed a weekly stretching session (N.=10; age 66±3.2 years old). Outcomes of interest were assessed at baseline and after 12 weeks, these included functional capacity, balance, muscle strength and power. RESULTS The PTG participants improved their dynamic balance (P=0.027) and decrease in the time to perform the gait speed test (P<0.001), evaluated by the short physical performance battery (SPPB). Also showed a statically significant change muscle power (P=0.034) and maximal dynamic knee extension strength (P=0.023), with increments of 24% and 34%, respectively, in comparison to the CG. Both groups showed significant changes in the performance of the five-times-sit-to-stand test (P<0.001) and the SPPB score (P=0.001). CONCLUSIONS The power training program was able to promote improvements in some functional parameters as on the body balance and functional capacity and muscle strength of the elderly with T2DM. The training method was effective and safe, with no adverse effects during sessions.
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Affiliation(s)
- Lucinéia O Pfeifer
- Exercise Pathophysiology Laboratory, Rio Grande do Sul Federal University, (Universidade Federal do Rio Grande do Sul, UFRGS), Porto Alegre, Brazil -
| | - Cíntia E Botton
- Exercise Pathophysiology Laboratory, Rio Grande do Sul Federal University, (Universidade Federal do Rio Grande do Sul, UFRGS), Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil
| | | | - Daniel Umpierre
- Exercise Pathophysiology Laboratory, Rio Grande do Sul Federal University, (Universidade Federal do Rio Grande do Sul, UFRGS), Porto Alegre, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil
| | - Ronei S Pinto
- Exercise Research Laboratory (LAPEX), Rio Grande do Sul Federal University, (Universidade Federal do Rio Grande do Sul, UFRGS), Porto Alegre, Brazil
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 388] [Impact Index Per Article: 129.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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Saqib ZA, Dai J, Menhas R, Mahmood S, Karim M, Sang X, Weng Y. Physical Activity is a Medicine for Non-Communicable Diseases: A Survey Study Regarding the Perception of Physical Activity Impact on Health Wellbeing. Risk Manag Healthc Policy 2020; 13:2949-2962. [PMID: 33335436 PMCID: PMC7737939 DOI: 10.2147/rmhp.s280339] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background A modifiable risk factor for many diseases is physical inactivity. In this modern era, physical activity is acknowledged as a vital strategy to promote good health. According to the WHO, regular physical activity has various benefits for psycho-physical health. Decreased physical inactivity is happening in China due to the increased participation of the Chinese population in physical activity. The human body needs a specific level of physical activity to maintain good health. Objective The main aim of the present study was to assess the Chinese people’s understanding of physical activity and participation in physical activity as a preventive measure against different diseases. Methods The present study was exploratory and conducted in the Kunshan county-level city in Jiangsu Province, China. A well-designed questionnaire was used to collect the data from the survey participants. A total of 3390 residents were selected from 1300 households through a simple random sampling technique. The collected data were analyzed through SPSS software. Both univariate and bivariate analysis were performed. Results The survey results showed that the majority of women are participating in physical activity. Most of the Kunshan people participate in physical activity one time or more than one time per week. They perform 30–60 minutes of moderate-intensity physical activity to improve physical fitness, recreation, and disease prevention. Fitness walking is the most common type of physical activity among Kunshan people, and most of them participate in physical activity at night. Wilcoxon signed-rank test indicated that post-test ranks are statistically higher than pre-test ranks (P<0.0039, 0.0039, 0.0039, 0.0020, 0.0001, 0.0156, 0.0313). Conclusion The study results showed that physical activity plays a catalyst role in improving human health on a natural path. It reduces the risk factor of non-communicable diseases and promotes general wellbeing. These findings show that physical activity level increases in Chinese society as more people participate in physical activity for health-being.
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Affiliation(s)
- Zulkaif Ahmed Saqib
- Research Institute of Business Analytics & Supply Chain Management, College of Management, Shenzhen University, Shenzhen, Guangdong Province 518060, People's Republic of China
| | - Jianhui Dai
- School of Physical Education and Sports, Soochow University, Suzhou 215006, Jiangsu Province, People's Republic of China
| | - Rashid Menhas
- Research Center of Sports Social Sciences, School of Physical Education and Sports, Soochow University, Suzhou 215006, Jiangsu Province, People's Republic of China
| | - Shahid Mahmood
- College of Management, Shenzhen University, Shenzhen, Guangdong Province 518060, People's Republic of China
| | - Maria Karim
- International Institute of Islamic Economics (IIIE), International Islamic University (IIU), Islamabad, 44000, Islamic Republic of Pakistan
| | - Xuehui Sang
- School of Physical Education and Sports, Soochow University, Suzhou 215006, Jiangsu Province, People's Republic of China
| | - Yu Weng
- School of Physical Education and Sports, Soochow University, Suzhou 215006, Jiangsu Province, People's Republic of China
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Bhargava Y, Bopardikar A, Bland M. Diabetes and Composition of Weight Lifting and Cardio in Exercise. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5353-5356. [PMID: 33019192 DOI: 10.1109/embc44109.2020.9175262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The prevalence of type-2 diabetes(T2D) has increased globally. This has led to greater mortality, morbidity and disability in the general population. It is thus crucial to identify methods to prevent its onset among the healthy, and to also discover solutions to adequately manage the complications among those affected. Most research in this area has focused on the role of diet and exercise. More recently, different exercise types and their relationship with T2D has received considerable attention. In our work, we investigate the association between T2D (primary outcome) and two types of exercises: cardio (CR) and weight lifting (WL). Specifically, the relationship between duration of time spent in the two exercises and the odds of T2D is explored. Data are obtained from the Behavioural Risk Factor Surveillance System (BRFSS) survey, USA. Three ethnic populations are considered: White American, Black American and Hispanic American. Both WL and CR are found to be associated with negative log-odds of diabetes across all three ethnicities (WL: p <; 0.0001 and CR: p=0.00431). The association between WL and T2D is found to be modified for females (interaction-term coefficient: -0.096 (p=0.0115)).
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Teodoro JL, Izquierdo M, da Silva LXN, Baroni BM, Grazioli R, Lopez P, Fritsch CG, Radaelli R, Saez de Asteasu ML, Bottaro M, Farinha JB, Pinto RS, Cadore EL. Effects of long-term concurrent training to failure or not in muscle power output, muscle quality and cardiometabolic risk factors in older men: A secondary analysis of a randomized clinical trial. Exp Gerontol 2020; 139:111023. [PMID: 32697957 DOI: 10.1016/j.exger.2020.111023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/25/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
This study investigated the effects of concurrent training performed either with repetitions to failure or not to failure in muscle power, muscle quality (MQ), peak oxygen uptake (VO2peak), and visceral fat in older men. This is an ancillary analysis of a randomized controlled trial. 36 older men (mean age ± SD; 67.1 ± 5.1 years) were randomized into three groups: one performing repetitions to failure (RFG, n = 13), another performing repetitions not to failure and 50% of the repetitions of the RFG (NFG, n = 12), and third performing repetitions not to failure with equal training volume of the RFG (ENFG, n = 11). The training was performed twice a week for 20 weeks at intensities ranging from 65 to 80% of maximal strength. In each session, the individuals started with strengthening exercises and then performed aerobic exercise (i.e., walking) on a treadmill. The primary endpoint was change from baseline to post-20 wk of absolute and relative muscle power output during squat and countermovement jump, ultrasound measurements for MQ using quadriceps echo intensity, and visceral fat thickness, as well as their VO2peak through a maximal incremental test on a treadmill. All training groups improved similarly and significantly jump height (ranging from 9 to 16%) and all their muscle power outcomes (mean change ranging from 2 to 7%) (P < .001). In addition, all groups significantly decreased visceral fat thickness (ranging from -11 to -21%) (P < .001), and significantly increased VO2peak (ranging from 4 to 8%) (P < .01), with no differences between groups. No changes were observed in the MQ outcomes. Concurrent training performed using repetitions to failure or not to failure promoted similar gains in the muscle power output, aerobic capacity, and visceral fat in healthy older men.
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Affiliation(s)
- Juliana L Teodoro
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Larissa X N da Silva
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bruno M Baroni
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Rafael Grazioli
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Pedro Lopez
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carolina G Fritsch
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Régis Radaelli
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mikel L Saez de Asteasu
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Navarrabiomed, Complejo Hospitalario de Navarra (CHN)-Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Martim Bottaro
- College of Physical Education, University of Brasilia, Brasília, DF, Brazil
| | - Juliano Boufleur Farinha
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ronei S Pinto
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo L Cadore
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Wang M, Baker JS, Quan W, Shen S, Fekete G, Gu Y. A Preventive Role of Exercise Across the Coronavirus 2 (SARS-CoV-2) Pandemic. Front Physiol 2020; 11:572718. [PMID: 33013486 PMCID: PMC7506115 DOI: 10.3389/fphys.2020.572718] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
The coronavirus 2019 (COVID-19) pandemic has posed a significant threat to human health around the world. A severe risk of infection has been observed in elderly populations. In addition, individuals with obesity and obesity-related comorbidities have also been identified to be at a higher risk of infection for COVID-19. We have attempted here to provide evidence in support of exercise management as a prevention strategy for improving health and minimizing the effects of COVID-19. Therefore, exercise duration, frequency, and intensity benefits are summarized in an attempt to provide guidelines for the general population. In terms of exercise effects, there are multiple benefits of exercise related to human health. These include, decreases in adipose tissue, improvements in cardio-respiratory fitness, enhanced metabolic homeostasis, and suppress inflammation active. With respect to the amount of exercise performed individuals should exercise at a moderate intensity for at least 150 min/wk as an initial target. Increases in intensity and duration of exercise training are necessary for significant fitness benefits, weight loss, and prevention of weight regain. In relation to walking, 10,000 steps/day at a rate of 64-170 steps/minute for at least 10 min duration is reasonable for healthy adults. For exercise intensity, a combination of resistance training (RT), aerobic training (AT) as well as high-intensity interval training (HIIT) incorporated with moderate-intensity continuous training (MICT) can be recognized as an optimal exercise mode for health benefits. Aerobic training and MICT should be viewed as a basis for exercise in combination with appropriate volumes and types of RT and HIIT. Activities should be performed according to professional guidelines and advice. If implemented, these measures may reduce infection rates, underlying pathologies, and assist in decreasing mortality associated with COVID-19 pandemic.
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Affiliation(s)
- Meizi Wang
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprém, Hungary
| | - Julien S. Baker
- Department of Sport, Physical Education and Health, Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Wenjing Quan
- Faculty of Engineering, University of Pannonia, Veszprém, Hungary
| | - Siqin Shen
- Faculty of Engineering, University of Pannonia, Veszprém, Hungary
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Huang CC, Hsu CC, Chiu CC, Lin HJ, Wang JJ, Weng SF. Association between exercise and health-related quality of life and medical resource use in elderly people with diabetes: a cross-sectional population-based study. BMC Geriatr 2020; 20:331. [PMID: 32894048 PMCID: PMC7487942 DOI: 10.1186/s12877-020-01750-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Exercise improves glycemic control and functional capacity in elderly people with diabetes; however, its effect on health-related quality of life (HRQoL) and medical resource use remains unclear. This study aims to clarify the effect of exercise. METHODS Using the data from National Health and Nutrition Examination Survey between 2007 and 2016, we identified 1572 elderly people with diabetes for this cross-sectional population-based study. Demographic characteristics, health conditions, comorbidities, HRQoL, and medical resource were compared among four groups (no exercise, low-intensity exercise, moderate-intensity exercise, and high-intensity exercise). RESULTS The mean age of all participants was between 71.5 and 73.3 years. Male participants with higher education performed more exercise than their counterparts. The moderate- and high-intensity groups reported better general health condition than the no exercise group. Depression and worse health were more common in the no exercise group. Participants in the moderate-intensity exercise group had lower risk for depression than those in the no exercise group (adjusted odds ratio: 0.13, 95% confidence interval: 0.02-0.92) after adjusting for demographic characteristics, health conditions, and comorbidities, whereas participants in the low- and high-intensity exercise did not have a lower risk. The no exercise group had the highest proportions of emergency, hospitalization, and total healthcare visits. CONCLUSIONS Exercise is associated with better HRQoL, and lack of exercise is associated with higher medical resource use in elderly people with diabetes. Encouraging exercise is recommended in this population.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, 100 Shin-Chuan 1st Road, Kaohsiung, 807, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Center for Medical Informatics and Statistics, Office of R&D, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
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Lopes LMP, de Oliveira EC, Becker LK, Costa GDP, Pinto KMDC, Talvani A, Carraro JCC, Coelho DB. Resistance Training Associated with Dietetic Advice Reduces Inflammatory Biomarkers in the Elderly. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7351716. [PMID: 32964042 PMCID: PMC7492897 DOI: 10.1155/2020/7351716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/05/2020] [Indexed: 02/08/2023]
Abstract
Aging is a biological process during which chronic low-grade inflammation is present due to changes in the immune system of the elderly. The main objective of this study is to evaluate the effects of resistance training associated with dietary advice on chronic inflammation in the elderly. We conducted a prospective intervention study in which we evaluated anthropometric parameters and inflammatory biomarkers (CRP, IL-8, CCL-2, and leptin) in 40 elderly people before and after long-term progressive resistance training (19 weeks) associated with dietary advice. The participants trained twice a week on nonconsecutive days, and the training lasted one hour with an intensity of 60-85% of 1-MR. Dietary advice was explained in person and individually focusing on foods rich in compounds with anti-inflammatory and antioxidant properties. Participants were instructed at the beginning of the training program, and dietary advice was reinforced verbally weekly. There was an improvement in body composition evidenced by a reduction in waist circumference and body fat percentage and by the increase in arm circumference, calf circumference, and corrected arm muscle area. In addition, there was a reduction in the inflammatory biomarkers CCL-2 (p = 0.01) and leptin (p < 0.01). Resistance training associated with dietary guidance can contribute to a healthy aging due to observed improvements in body composition and in the inflammatory profile of the elderly.
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Affiliation(s)
- Lilian Maria Peixoto Lopes
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Emerson Cruz de Oliveira
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Physical Education School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Lenice Kappes Becker
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Physical Education School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Guilherme de Paula Costa
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Kelerson Mauro de Castro Pinto
- Physical Education School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Inflammation Immunobiology Laboratory, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - André Talvani
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Inflammation Immunobiology Laboratory, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Júlia Cristina Cardoso Carraro
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- School of Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Daniel Barbosa Coelho
- Postgraduate Program in Health and Nutrition, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
- Physical Education School, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
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Guadalupe‐Grau A, López‐Torres O, Martos‐Bermúdez Á, González‐Gross M. Home-based training strategy to maintain muscle function in older adults with diabetes during COVID-19 confinement. J Diabetes 2020; 12:701-702. [PMID: 32384202 PMCID: PMC7267247 DOI: 10.1111/1753-0407.13051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/20/2020] [Accepted: 05/05/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Amelia Guadalupe‐Grau
- ImFINE Research Group, Department of Health and Human PerformanceUniversidad Politécnica de MadridMadridSpain
- CIBER of Frailty and Healthy Aging (CIBERFES), ISCIIIMadridSpain
| | - Olga López‐Torres
- ImFINE Research Group, Department of Health and Human PerformanceUniversidad Politécnica de MadridMadridSpain
| | - Álvaro Martos‐Bermúdez
- ImFINE Research Group, Department of Health and Human PerformanceUniversidad Politécnica de MadridMadridSpain
| | - Marcela González‐Gross
- ImFINE Research Group, Department of Health and Human PerformanceUniversidad Politécnica de MadridMadridSpain
- CIBER Pathophysiology of Obesity and Nutrition (CIBEROBN), ISCIIIMadridSpain
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Patten RK, Boyle RA, Moholdt T, Kiel I, Hopkins WG, Harrison CL, Stepto NK. Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Physiol 2020; 11:606. [PMID: 32733258 PMCID: PMC7358428 DOI: 10.3389/fphys.2020.00606] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive and metabolic manifestations. Exercise training has consistently been found to result in improved clinical outcomes in women with PCOS, but shortfalls with exercise prescription are evident. The aim of this systematic review and meta-analysis was to identify exercise intervention characteristics that provide favourable outcomes in women with PCOS. Methods: A systematic review of published literature was conducted using EBSCOhost and Ovid Medline up to May 2019. The review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines as per our PROSPERO protocol (CRD42018088367). Randomised controlled trials, non-randomised controlled trials, and uncontrolled trials that evaluated an exercise intervention of at least moderate intensity in women with PCOS were included. Meta-analyses were performed using general linear mixed modelling and Bayesian inferences about effect magnitudes. Results: Thirty-three articles were identified for systematic review of which 19 were meta-analysed. Intervention duration ranged from 6 to 26 weeks. A total number of 777 women were included in the meta-analysis. The meta-analysis found that improvements in health outcomes are more dependent on exercise intensity rather than dose. Fixed effects analysis reported a moderate increase in VO2peak (24.2%; 90% CL, 18.5–30.1), and small reductions in HOMA-IR (−36.2%; 90% CL, −55.3 to −9.0), and waist circumference (−4.2%; 90% CL −6.0 to −2.3) as a result of vigorous intensity exercise. These results are confirmed in the predicted analysis which reported the greatest improvements in VO2peak, BMI, and waist circumference after vigorous intensity exercise alone or when combined with diet, particularly for women with clinically adverse baseline values. Conclusions: Exercise training in the management of PCOS is becoming more common. Results from our analysis support the use of exercise and suggest that vigorous intensity exercise may have the greatest impact on cardiorespiratory fitness, body composition, and insulin resistance. Our results indicate that, a minimum of 120 min of vigorous intensity per week is needed to provide favourable health outcomes for women with PCOS with studies of longer duration required to evaluate outcomes with sustained exercise.
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Affiliation(s)
- Rhiannon K Patten
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Russell A Boyle
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ida Kiel
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - William G Hopkins
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nigel K Stepto
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, VIC, Australia
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43
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Tavoian D, Russ DW, Consitt LA, Clark BC. Perspective: Pragmatic Exercise Recommendations for Older Adults: The Case for Emphasizing Resistance Training. Front Physiol 2020; 11:799. [PMID: 32719618 PMCID: PMC7348658 DOI: 10.3389/fphys.2020.00799] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/15/2020] [Indexed: 01/10/2023] Open
Abstract
Optimal health benefits from exercise are achieved by meeting both aerobic and muscle strengthening guidelines, however, most older adults (OAs) do not exercise and the majority of those who do only perform one type of exercise. A pragmatic solution to this problem may be emphasizing a single exercise strategy that maximizes health benefits. The loss of muscle mass and strength at an accelerated rate are hallmarks of aging that, without intervention, eventually lead to physical disability and loss of independence. Additionally, OAs are at risk of developing several chronic diseases. As such, participating in activities that can maintain or increase muscle mass and strength, as well as decrease chronic disease risk, is essential for healthy aging. Unfortunately, there is a widely held belief that adaptations to aerobic and resistance exercise are independent of each other, requiring the participation of both types of exercise to achieve optimal health. However, we argue that this assertion is incorrect, and we discuss crossover adaptations of both aerobic and resistance exercise. Aerobic exercise can increase muscle mass and strength, though not consistently and may be limited to exercise that overloads a particular muscle group, such as stationary bicycling. In contrast, resistance exercise is effective at maintaining muscle health with increasing age, and also has significant effects on cardiovascular disease (CVD) risk factors, type 2 diabetes (T2D), cancer, and mortality. We posit that resistance exercise is the most effective standalone exercise strategy for improving overall health in OAs and should be emphasized in future guidelines.
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Affiliation(s)
- Dallin Tavoian
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, United States
| | - David W. Russ
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, United States
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Tampa, FL, United States
| | - Leslie A. Consitt
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, United States
- Department of Biomedical Sciences, Ohio University, Athens, OH, United States
- Diabetes Institute, Ohio University, Athens, OH, United States
| | - Brian C. Clark
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, United States
- Department of Biomedical Sciences, Ohio University, Athens, OH, United States
- Division of Geriatric Medicine, Ohio University, Athens, OH, United States
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Jung AR, Kim H, Kim HS, Kim C, Choi WS. Exercise Strategies to Prevent Hypoglycemia in Patients with Diabetes. Korean J Fam Med 2020; 42:91-95. [PMID: 32397690 PMCID: PMC8010442 DOI: 10.4082/kjfm.19.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/05/2019] [Indexed: 11/23/2022] Open
Abstract
The importance of adopting healthy exercise routines has been repeatedly emphasized to individuals with diabetes mellitus (DM). However, knowledge about the risk of exercise-induced hypoglycemia is limited. Regular exercise reduces and delays the onset of DM-related complications particularly in individuals who already have DM. However, an excessive exercise can lead to hypoglycemia. Excessive exercise in the evening can cause hypoglycemia while sleeping. Furthermore, if individuals with DM want to have a greater amount of exercise, the exercise duration rather than intensity must be increased. In weight resistance exercises, it is beneficial to first increase the number of repetitions, followed by the number of sets and gradually the weight of resistance. When performing intermittent high-intensity training within a short time period, hypoglycemia may develop for an extended period after exercise. In addition to adjusting exercise regimens, the medication doses must be modified accordingly. Delaying exercise, adjusting the number of snacks consumed prior to exercise, reducing insulin dose before exercise, and injecting insulin into the abdomen rather than the limbs prevent exercise-induced hypoglycemia prior to a spontaneous exercise. Ultimately, with personal knowledge on how to prevent hypoglycemia, the effects of exercise can be maximized in individuals with DM, and a healthy lifestyle can prevent future complications.
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Affiliation(s)
- Ah Reum Jung
- College of Physical Education, Kookmin University, Seoul, Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Churlmin Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Whan-Seok Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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45
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Affiliation(s)
- Colin E Champ
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - William S Yancy
- Duke Diet and Fitness Center, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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46
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Dos Santos WM, Junior ACT, Braz TV, Lopes CR, Brigatto FA, Dos Santos JW. Resistance-Trained Individuals Can Underestimate the Intensity of the Resistance Training Session: An Analysis Among Genders, Training Experience, and Exercises. J Strength Cond Res 2020; 36:1506-1510. [PMID: 31904718 DOI: 10.1519/jsc.0000000000003412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dos Santos, WM, Junior, ACT, Braz, TV, Lopes, CR, Brigatto, FA, and Dos Santos, JW. Resistance-trained individuals can underestimate the intensity of the resistance training session: An analysis among genders, training experience, and exercises. J Strength Cond Res XX(X): 000-000, 2019-Resistance training (RT) promotes improvements in healthy parameters for young to elderly adults and athlete's performance. Strength and muscle mass improvement are dependent on exercise intensity. This study verifies whether 53 healthy young adults underestimate exercise intensity in 3 different exercises bench press (BP), biceps curl (BC), and leg press 45 (LP). Researchers asked, "How much load do you use to perform 10 repetitions in this exercise usually in workout routines?" in each exercise. Individuals warmed up and then performed as many repetitions as possible until they reached the concentric fail. Deviations from data normality were found by Levene's test; a number of repetition per exercise within gender were test by Friedman test and Connovers' post hoc and Kruskal-Wallis to compare number of repetitions between gender and RT experience. We correlated number of repetition and training experience using Spearman test. The number of repetitions for both groups (male and female) are greater than 8-12 repetitions for BC and LP and female BP, except for men, which perform around 8-12 repetitions on BP. Frequency of maximal repetition reached for 8-12 repetitions for women was 12% for BP, 28% BC, and 28% LP. Men reached repetitions for BP was 46.5%, BC 14.3 and LP 14.3%. Training experience did not influence the number of repetitions reached. Resistance training practitioners underestimate exercise load (56% of total sample) independent of experience. Women underestimate exercise load more than men. Based on the present results, it seems possible to state that the prescription of RT should not be prescribed considering a predefined number of repetitions, as well as a linked percentage of load, without the guidance for frequent adjustments of loads, according to the exercise performed.
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Affiliation(s)
- Wellington Martins Dos Santos
- Laboratory of Exercise Physiology (FISEX), Faculty of Physical Education, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Antonio Carlos Tavares Junior
- Laboratory and Research Group on Physiology Applied to Sports Training (FITES), Departament of Physical Education, São Paulo State University (UNESP), School of Science, Bauru, São Paulo, Brazil.,Anhanguera University Center, Leme, São Paulo, Brazil
| | - Tiago Volpi Braz
- Methodist University of Piracicaba, Human Performance Research Laboratory, Piracicaba, São Paulo, Brazil
| | - Charles Ricardo Lopes
- Methodist University of Piracicaba, Human Performance Research Laboratory, Piracicaba, São Paulo, Brazil.,Adventist Faculty of Hortolândia, Hortolândia, São Paulo, Brazil
| | - Felipe Alves Brigatto
- Methodist University of Piracicaba, Human Performance Research Laboratory, Piracicaba, São Paulo, Brazil.,Anhanguera University Center, Leme, São Paulo, Brazil
| | - Júlio Wilson Dos Santos
- Laboratory and Research Group on Physiology Applied to Sports Training (FITES), Departament of Physical Education, São Paulo State University (UNESP), School of Science, Bauru, São Paulo, Brazil
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Baz-Valle E, Schoenfeld BJ, Torres-Unda J, Santos-Concejero J, Balsalobre-Fernández C. The effects of exercise variation in muscle thickness, maximal strength and motivation in resistance trained men. PLoS One 2019; 14:e0226989. [PMID: 31881066 PMCID: PMC6934277 DOI: 10.1371/journal.pone.0226989] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/09/2019] [Indexed: 01/24/2023] Open
Abstract
Background The objective of the present study was to compare the effects of a traditional resistance training program (fixed exercises and repetition ranges) to a resistance training program where exercises and repetition ranges were randomized on a session-by-session basis on markers of muscular adaptations and intrinsic motivation. Methods Twenty-one resistance trained men were randomized to perform an 8-week resistance training program using either a fixed exercise selection (CON) or having exercises randomly varied each session via a computerized app. Both groups performed 3 sets of 6 exercises, with training carried out 4 times per week. Results Both conditions promoted large, statistically significant increases in the bench press and back-squat 1 repetition maximum without differences between groups. Muscle thickness (MT) measures for the individual quadriceps showed large, statistically significant increases in of the vastus lateralis and rectus femoris for both conditions, with no observed between-group differences. Although no between-group in MT were noted for the vastus intermedius, only the CON displayed significant increases from baseline. Participants in EXP showed a significant, moderate improvement in the intrinsic motivation to training, while participants in the CON group presented non-significant decreases in this variable. Conclusions Varying exercise selection had a positive effect on enhancing motivation to train in resistance-trained men, while eliciting similar improvements in muscular adaptations.
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Affiliation(s)
- Eneko Baz-Valle
- Department of Physical Education and Sport, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | | | - Jon Torres-Unda
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Jordan Santos-Concejero
- Department of Physical Education and Sport, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Carlos Balsalobre-Fernández
- Department of Physical Education, Sport and Human Movement, Autonomous Univerisity of Madrid, Madrid, Spain
- * E-mail:
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48
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Fragala MS, Cadore EL, Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, Ryan ED. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J Strength Cond Res 2019; 33:2019-2052. [PMID: 31343601 DOI: 10.1519/jsc.0000000000003230] [Citation(s) in RCA: 534] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.
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Affiliation(s)
| | - Eduardo L Cadore
- School of Physical Education, Physiotherapy and Dance, Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandor Dorgo
- Department of Kinesiology, University of Texas at El Paso, El Paso, Texas
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, CIBER of Frailty and Healthy Aging (CIBERFES), Navarrabiomed, Pamplona, Navarre, Spain
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan-Medicine, Ann Arbor, Michigan
| | - Eric D Ryan
- Department of Exercise and Sport Science, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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49
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Current Concepts in Healthy Aging and Physical Activity: A Viewpoint. J Aging Phys Act 2019; 27:755-761. [PMID: 30747553 DOI: 10.1123/japa.2018-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Physical activity plays an important role for achieving healthy aging by promoting independence and increasing the quality of life. However, current guidelines for physical activity in older adults may be difficult to achieve in an older population. Indeed, there is evidence to suggest that increasing exercise intensity in older adults may be associated with greater reductions in the risk of cardiovascular disease and mortality. Therefore, the idea prescribing high-intensity exercise protocols such as high-intensity interval training and high-intensity resistance training becomes an intriguing strategy for healthy aging. Collectively, the literature review in this viewpoint will briefly focus on summarizing alternative/novel time-efficient approaches in physical activity toward healthy aging. Our goal is to hopefully open a discussion on possibly revising the current physical activity guidelines in older adults.
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50
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Rodriguez-Mañas L, Laosa O, Vellas B, Paolisso G, Topinkova E, Oliva-Moreno J, Bourdel-Marchasson I, Izquierdo M, Hood K, Zeyfang A, Gambassi G, Petrovic M, Hardman TC, Kelson MJ, Bautmans I, Abellan G, Barbieri M, Peña-Longobardo LM, Regueme SC, Calvani R, De Buyser S, Sinclair AJ. Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus. J Cachexia Sarcopenia Muscle 2019; 10:721-733. [PMID: 31016897 PMCID: PMC6711410 DOI: 10.1002/jcsm.12432] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged ≥70 years with type 2 diabetes mellitus. METHODS The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. RESULTS After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. CONCLUSIONS We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus.
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Affiliation(s)
| | - Olga Laosa
- Foundation for Biomedical Research-Hospital Universitario de Getafe, Madrid, Spain
| | - Bruno Vellas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Eva Topinkova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Mikel Izquierdo
- IdiSNA, Navarra Institute for Health Research, Public University of Navarra, Pamplona, Spain
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Mark J Kelson
- Department of Mathematics, University of Exeter, Exeter, UK
| | - Ivan Bautmans
- Gerontology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gabor Abellan
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | | | | | | | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
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