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Teixeira JMM, Roever L, Ramasamy A, Pereira R, Carneiro I, Krustrup P, Póvoas SCA. Statistical heterogeneity in meta-analysis of hypertension and exercise training: A meta-review. J Sports Sci 2023; 41:2033-2044. [PMID: 38341865 DOI: 10.1080/02640414.2024.2309055] [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: 07/14/2023] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
We aim to evaluate the prevalence of reporting and the extent of statistical heterogeneity of systematic reviews with meta-analyses (SRMAs) of exercise training for hypertension and to provide practical recommendations for dealing with statistical heterogeneity. We systematically searched on four databases (from 2002 to September of 2023) for SRMAs comparing exercise interventions vs. a non-exercise control on blood pressure (BP) control in adults with hypertension. Fifty-nine SRMAs, with a median of 14 studies, were analysed. Cochran's Q (41%), I2 (24%), forest plots (44%), and particularly τ2 (54%) and prediction intervals (96.6%) frequently were not reported for the hypertension subgroup. The recalculated prediction intervals were discrepant (i.e., crossed the null effect) of significant 95% confidence intervals of most meta-analyses (systolic BP: 65%; diastolic BP: 92%). This suggests substantial heterogeneity across studies, which was often not acknowledged by authors' conclusions (78%). Consequently, downgrading the certainty of the available evidence may be justified alone due to heterogeneity across studies. Finally, we illustrate areas for improving I2 interpretation and provide practical recommendations on how to address statistical heterogeneity across all stages of a SRMA.
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Affiliation(s)
- Jorge M M Teixeira
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
| | - Leonardo Roever
- Department of Clinical Research, Brazilian Evidence-Based Health Network, Uberlândia, Brazil
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Akilesh Ramasamy
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Karaikal Campus, Kovilpathu, Karaikal, Puducherry, India
| | - Rita Pereira
- Laboratory of Metabolism and Exercise, Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Ivone Carneiro
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
- Sport and Health Sciences, College of Life and Environment Sciences, University of Exeter, Exeter, UK
- Danish Institute for Advanced Study (DIAS), University of Southern Denmark, Odense, Denmark
| | - Susana C A Póvoas
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), University of Maia, Maia, Portugal
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, Odense, Denmark
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Alzahrani AA, Alqahtani AS, Vennu V, Bindawas SM. Feasibility and Efficacy of Low-to-Moderate Intensity Aerobic Exercise Training in Reducing Resting Blood Pressure in Sedentary Older Saudis with Hypertension Living in Social Home Care: A Pilot Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1171. [PMID: 37374375 DOI: 10.3390/medicina59061171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The effect of non-pharmacological aerobic exercise training on blood pressure in sedentary older individuals receiving social home care in Saudi Arabia has not been investigated. This study aimed to examine the effects of aerobic exercise on blood pressure in sedentary older Saudis with hypertension residing in these settings. Materials and Methods: A pilot randomized control trial was conducted with 27 sedentary individuals, aged 60-85, diagnosed with hypertension, and living in social home care in Makkah, Saudi Arabia. Recruitment took place between November 2020 and January 2021, and participants were randomly assigned to either the experimental or control group. The experimental group engaged in three 45 min sessions of low-to-moderate intensity aerobic activity per week for eight weeks. This trail was registered with the ISRCTN registry (ISRCTN50726324). Results: Following eight weeks of mild to moderate aerobic exercise training, the primary outcome of resting blood pressure showed a significant reduction in the experimental group (systolic blood pressure: mean difference [MD] = 2.91 mmHg, 95% confidence interval [CI] = 1.61, 4.21, p = 0.001; and diastolic blood pressure: MD = 1.33 mmHg, 95% CI = 1.16, 1.50, p = 0.001) compared to the control group. Within the experimental group, there was also a significant decrease in systolic blood pressure (MD = -2.75 mmHg, 95% CI = -7.73, 2.22, p = 0.005) and diastolic blood pressure (MD = -0.83 mmHg, 95% CI = -5.81, 4.14, p = 0.02). Conclusions: This trial demonstrates the feasibility and potential benefits of low-to-moderate intensity aerobic exercise training in reducing resting blood pressure among sedentary older Saudis with hypertension residing in this aged care setting.
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Affiliation(s)
- Abdulrahman A Alzahrani
- Social Care Center for the Elderly, Mecca 12840, Saudi Arabia
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abdulfattah S Alqahtani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
- King Salman Center for Disability Research, Riyadh 11614, Saudi Arabia
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Qin X, Mao Y, Wang H, Wu H, Xu Y, Zhao J. Effects of the Otago Exercise Program in older hypertensive patients with pre-frailty. J Phys Ther Sci 2022; 34:509-514. [PMID: 35784605 PMCID: PMC9246411 DOI: 10.1589/jpts.34.509] [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: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We aimed to investigate the effects of the Otago Exercise Program in older hypertensive patients with pre-frailty. [Participants and Methods] Participants were randomly divided into the (Otago Exercise Program OEP) group (n=37) and the control group (n=38). The OEP group completed the exercise step 3 times during hospitalization. For 12 weeks, the OEP group exercised at home and the control group completed daily walking activities ≥3 times per week. [Results] There were significant differences in FRAIL scale score, 10-meter gait speed, one-leg standing test results, and functional reach test results between the two groups. In addition to the above indicators, the differences in diastolic blood pressure were also statistically significant between the two groups before and after intervention. [Conclusion] The OEP can improve frailty and the ability to perform activity in older hypertensive patients with pre-frailty. Diastolic blood pressure decreases significantly after intervention.
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Affiliation(s)
- Xia Qin
- Department of Nursing, Wuxi Medical College, Jiangnan University, China.,Department of Nursing, Taizhou Integrated Traditional Chinese and Western Medicine Hospital, China
| | - Yong Mao
- Department of Oncology, Affiliated Hospital of Jiangnan University: No. 200, Huihe Road, Wuxi City, Jiangsu Province, China
| | - Hongmei Wang
- Department of Cardiology, Taizhou Integrated Traditional Chinese and Western Medicine Hospital, China
| | - Hongxia Wu
- Department of Cardiology, Taizhou Integrated Traditional Chinese and Western Medicine Hospital, China
| | - Yong Xu
- Department of Cardiology, Taizhou Integrated Traditional Chinese and Western Medicine Hospital, China
| | - Jie Zhao
- Department of Oncology, Affiliated Hospital of Jiangnan University: No. 200, Huihe Road, Wuxi City, Jiangsu Province, China
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Chen S, Malete L, Ling J. An examination of physical activity guidelines and health-related quality of life among U.S. older adults. Prev Med 2022; 156:106986. [PMID: 35150753 DOI: 10.1016/j.ypmed.2022.106986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/30/2021] [Accepted: 02/06/2022] [Indexed: 01/02/2023]
Abstract
Physical activity can help improve the poor health-related quality of life in older adult population. Although the Physical Activity Guidelines for Americans recommend both aerobic and muscle strengthening activities for adults, previous studies predominantly focused on aerobic activity with limited research on muscle strengthening activities. The purpose of this cross-sectional study was to examine the relationships between meeting physical activity guidelines (i.e., aerobic activity, muscle strengthening activity) and health-related quality of life in the older adult population. Data of 87,495 older adults aged ≥65 years from the U.S. 2019 Behavioral Risk Factor Surveillance System were analyzed. Phone interviews and validated questionnaires were used to assess aerobic activity, muscle strengthening activity, and health-related quality of life. Binomial logistic regression was used to examine the relationships between meeting physical activity guidelines and health-related quality of life while adjusting for key covariates (i.e., age, sex, race, education, marital status, employment status, income, body mass index, smoking, drinking, and comorbidities). Participants meeting both or aerobic activity guideline only had significantly lower odds of reporting all components of health-related quality of life (i.e., general health, mental health, physical health, activity limitation) than those who met neither guideline (OR = 0.37-0.58) and those who met muscle strengthening activity guideline only (OR = 0.34 - 0.74). Given the stronger positive association between aerobic activity and health-related quality of life than that between muscle strengthening activity and health-related quality of life, future research should focus on promoting aerobic activity to increase health-related quality of life among older people.
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Affiliation(s)
- Sisi Chen
- Michigan State University, East Lansing, MI 48824, USA.
| | | | - Jiying Ling
- Michigan State University, East Lansing, MI 48824, USA
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5
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Lu Z, Song Y, Chen H, Li S, Teo EC, Gu Y. A Mixed Comparisons of Aerobic Training With Different Volumes and Intensities of Physical Exercise in Patients With Hypertension: A Systematic Review and Network Meta-Analysis. Front Cardiovasc Med 2022; 8:770975. [PMID: 35127851 PMCID: PMC8813975 DOI: 10.3389/fcvm.2021.770975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/16/2021] [Indexed: 01/01/2023] Open
Abstract
It is essential for patients with hypertension to effectively reduce and maintain appropriate blood pressure levels. As one of the non-pharmacological and invasive methods, physical exercise seems to improve blood pressure of the patients with hypertension. However, different volumes and intensities of physical exercise on the improvement of hypertension are different. To understand the effects of the type of exercise training on blood pressure and the other health status of patients with hypertension, a network meta-analysis was used to compare the mixed effects of different types of exercise training. This systematic review includes all eligible randomized controlled trials of PubMed, Medline, Cochrane Library, and CINAHL. Twelve studies met the inclusion criteria (n = 846 participants at the end of the study). The results show that a medium-intensity training (MIT) is best in improving the blood pressure of patients with hypertension, while a high-volume high-intensity interval training (HVHIIT) is better in reducing body mass and resting heart rate. In addition, the analysis of the exercise capacity shows that HVHIIT has a better effect on the improvement of patients with hypertension. Noticeably, long-term high-volume and appropriate intensity exercise can effectively improve the health status of patients with hypertension. In short, for patients with high blood pressure, MIT seems to be better at lowering blood pressure, while HVHIIT can better improve exercise ability and physical fitness. However, larger randomized controlled trials with a longer duration than those included in this meta-analysis are needed to confirm these results.
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Affiliation(s)
- Zhenghui Lu
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Doctoral School on Safety and Security Sciences, Óbuda University, Budapest, Hungary
- Faculty of Engineering, University of Szeged, Szeged, Hungary
| | - Hairong Chen
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Shudong Li
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Ee-Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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Pihl K, Roos EM, Taylor RS, Grønne DT, Skou ST. Prognostic Factors for Health Outcomes After Exercise Therapy and Education in Individuals With Knee and Hip Osteoarthritis With or Without Comorbidities: A Study of 37,576 Patients Treated in Primary Care. Arthritis Care Res (Hoboken) 2021; 74:1866-1878. [PMID: 34085408 PMCID: PMC7613737 DOI: 10.1002/acr.24722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify prognostic factors for health outcomes following an 8-week supervised exercise therapy and education program for individuals with knee and hip osteoarthritis (OA) alone or with concomitant hypertension, heart or respiratory disease, diabetes mellitus, or depression. METHODS We included individuals with knee and/or hip OA from the Good Life With OsteoArthritis in Denmark (GLA:D) program. GLA:D consists of 2 patient education sessions and 12 supervised exercise therapy sessions. Before GLA:D, participants self-reported any comorbidities and were categorized into 8 comorbidity groups. Twenty-one potential prognostic factors (demographic information, clinical data, and performance-based physical function) gathered from participants and clinicians before the program were included. Outcomes were physical function using the 40-meter Fast-Paced Walk Test (FPWT), health-related quality of life using the 5-level EuroQol 5-domain (EQ-5D-5L) index score, and pain intensity using a visual analog scale (VAS; range 0-100) assessed before and immediately after the GLA:D program. Within each comorbidity group, associations of prognostic factors with outcomes were estimated using multivariable linear regression. RESULTS Data from 35,496 (40-meter FPWT) and 37,576 (EQ-5D-5L and VAS) participants were included in the analyses. Clinically relevant associations were demonstrated between age, self-efficacy, self-rated health, and pain intensity and change in 40-meter FPWT, EQ-5D-5L, or VAS scores across comorbidity groups. Furthermore, anxiety, education, physical function, and smoking were associated with outcomes among subgroups having depression or diabetes mellitus in addition to OA. CONCLUSION Age, self-efficacy, self-rated health, and pain intensity may be prognostic of change in health outcomes following an 8-week exercise therapy and patient education program for individuals with OA, irrespective of comorbidities.
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Affiliation(s)
- Kenneth Pihl
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, UK,Institute of Health Services Research, University of Exeter Medical School, UK
| | - Dorte T Grønne
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved- Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
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7
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Igarashi Y, Akazawa N, Maeda S. The form of exercise to decrease resting blood pressure in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2021; 96:104431. [PMID: 34082273 DOI: 10.1016/j.archger.2021.104431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/08/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The current systematic review and meta-analysis evaluated the relationship between the form of exercise and changes in resting blood pressure (RBP) in older adults and the overall level of evidence. METHODS The inclusion criteria were studies involving intervention with only regular exercise limited to subjects ≥65 years old. The combined changes in RBP in each study were calculated and the relationship between the form of exercise and changes in the RBP were evaluated. The overall evidence was assessed using the GRADE approach. RESULTS Nineteen studies (1081 subjects) were analyzed. The combined changes in the RBP decreased as a result of aerobic exercise or resistance exercise. The intensity of resistance exercise (METs) was related to the change in the RBP of systolic (meta-regression coefficient, -2.5 [95% confidence interval, -4.7 to -0.4]; R2=35.4%). When excluding studies with high overall risk of bias, the overall duration of aerobic exercise (weeks) was related to the change in the RBP of systolic (meta-regression coefficient, -0.6 [95% confidence interval, -1.0 to -0.2]; R2=93.2%). In addition, there was a low level of evidence overall for a decrease in RBP as a result of aerobic exercise, but there was a moderate level of evidence for a decrease in RBP as a results of resistance exercise. CONCLUSION A decrease in the RBP of systolic may be associated with active exercise in older adults. However, there may be insufficient evidence for the decrease in RBP as a result of aerobic exercise.
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Affiliation(s)
- Yutaka Igarashi
- Osaka City University, 3‑3‑138 Sugimoto, Sumiyoshi‑ku, Osaka 558-8585, Japan.
| | - Nobuhiko Akazawa
- Japan Institute of Sports Sciences, 3-15-1 Nishiga-oka, Kita-ku, Tokyo 115-0056, Japan; Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574, Japan
| | - Seiji Maeda
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama 359-1192, Japan; Faculty of Health and Sport Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8574, Japan
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Hanssen H, Boardman H, Deiseroth A, Moholdt T, Simonenko M, Kränkel N, Niebauer J, Tiberi M, Abreu A, Solberg EE, Pescatello L, Brguljan J, Coca A, Leeson P. Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension. Eur J Prev Cardiol 2021; 29:205-215. [PMID: 33758927 DOI: 10.1093/eurjpc/zwaa141] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
Treatment of hypertension and its complications remains a major ongoing health care challenge. Around 25% of heart attacks in Europe are already attributed to hypertension and by 2025 up to 60% of the population will have hypertension. Physical inactivity has contributed to the rising prevalence of hypertension, but patients who exercise or engage in physical activity reduce their risk of stroke, myocardial infarction, and cardiovascular mortality. Hence, current international guidelines on cardiovascular disease prevention provide generic advice to increase aerobic activity, but physiological responses differ with blood pressure (BP) level, and greater reductions in BP across a population may be achievable with more personalized advice. We performed a systematic review of meta-analyses to determine whether there was sufficient evidence for a scientific Consensus Document reporting how exercise prescription could be personalized for BP control. The document discusses the findings of 34 meta-analyses on BP-lowering effects of aerobic endurance training, dynamic resistance training as well as isometric resistance training in patients with hypertension, high-normal, and individuals with normal BP. As a main finding, there was sufficient evidence from the meta-review, based on the estimated range of exercise-induced BP reduction, the number of randomized controlled trials, and the quality score, to propose that type of exercise can be prescribed according to initial BP level, although considerable research gaps remain. Therefore, this evidence-based Consensus Document proposes further work to encourage and develop more frequent use of personalized exercise prescription to optimize lifestyle interventions for the prevention and treatment of hypertension.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Henry Boardman
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Arne Deiseroth
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Nicolle Kränkel
- Charité, University Medicine Berlin, Department of Cardiology, Campus Benjamin-Franklin (CBF), Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Berlin, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria.,Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1 Pesaro, Italy
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte, Portugal.,Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa, Portugal
| | | | - Linda Pescatello
- Department of Kinesiology, College of Agriculture, Health and Natural Resources, University of Connecticut, USA
| | - Jana Brguljan
- Universitiy Medical Centre Ljubljana, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clínic, University of Barcelona, Spain
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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Rosenberg DE, Anderson ML, Renz A, Matson TE, Lee AK, Greenwood-Hickman MA, Arterburn DE, Gardiner PA, Kerr J, McClure JB. Reducing Sitting Time in Obese Older Adults: The I-STAND Randomized Controlled Trial. J Aging Phys Act 2020; 28:864-874. [PMID: 32498040 PMCID: PMC9067913 DOI: 10.1123/japa.2019-0470] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/17/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The authors tested the efficacy of the "I-STAND" intervention for reducing sitting time, a novel and potentially health-promoting approach, in older adults with obesity. METHODS The authors recruited 60 people (mean age = 68 ± 4.9 years, 68% female, 86% White; mean body mass index = 35.4). The participants were randomized to receive the I-STAND sitting reduction intervention (n = 29) or healthy living control group (n = 31) for 12 weeks. At baseline and at 12 weeks, the participants wore activPAL devices to assess sitting time (primary outcome). Secondary outcomes included fasting glucose, blood pressure, and weight. Linear regression models assessed between-group differences in the outcomes. RESULTS The I-STAND participants significantly reduced their sitting time compared with the controls (-58 min per day; 95% confidence interval [-100.3, -15.6]; p = .007). There were no statistically significant changes in the secondary outcomes. CONCLUSION I-STAND was efficacious in reducing sitting time, but not in changing health outcomes in older adults with obesity.
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Promoting Physical Activity in Older Adults With Knee Osteoarthritis and Hypertension: A Randomized Controlled Trial. J Aging Phys Act 2020; 29:207-218. [PMID: 32887850 DOI: 10.1123/japa.2019-0498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/16/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
A 6-month self-efficacy intervention was compared with attention-control intervention on physical activity, clinical outcomes, and mediators immediate postintervention and 6-month postintervention in 182 older adults with knee osteoarthritis and hypertension using a randomized controlled trial design. The intervention group received six weekly individual physical therapy sessions for lower-extremity exercise and fitness walking and nine biweekly nurse telephone counseling sessions. The attention-control group received six weekly and nine biweekly nurse telephone sessions on health topics. Lower-extremity exercise was assessed by e-diary; fitness walking was assessed by accelerometer and e-diary; blood pressure was assessed by automated monitor; function was assessed by performance-based tests and questionnaires; and pain, self-efficacy, and outcome expectancy were assessed by questionnaires. Self-reported lower-extremity exercise and fitness walking, function, pain, self-efficacy, and outcome expectancy showed significant group or group by time effects favoring intervention. The intervention did not improve physical activity by accelerometer and blood pressure. Mean minutes of fitness walking fell short of the 150 min/week goal.
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Ahn N, Kim K. Can Active Aerobic Exercise Reduce the Risk of Cardiovascular Disease in Prehypertensive Elderly Women by Improving HDL Cholesterol and Inflammatory Markers? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165910. [PMID: 32824020 PMCID: PMC7459903 DOI: 10.3390/ijerph17165910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022]
Abstract
This study aims to verify the efficacy of exercise programs designed to prevent and treat hypertension-induced cardiovascular disease (CVD) by analyzing the effects of a 6-month active aerobic exercise program, administered to prehypertensive elderly women, on reducing the risk of developing CVD by enhancing their physical fitness level and improving the detailed markers of high-density lipoprotein cholesterol (HDL-C) and inflammatory markers. We assigned the elderly women (≥65 years) recruited into normal blood pressure (120–129/80–84; NBP, n = 18) and high-normal blood pressure (130–139/85–89; HNBP, n = 12) groups according to the European guidelines for the management of arterial hypertension. The exercise program was made up of combined workouts of elastic band resistance exercise and aerobics with dance music. The program took place three times a week for six months, with each session lasting 60 min. We measured pre- and post-intervention body composition, blood pressure, physical fitness level, blood lipids profile, HDL-C, SAA, TNF-α, IL-6, IL-4, IL-15, CRP, and HSP70 and calculated the Framingham risk scores for comparison. A significant post-intervention reduction in the mean systolic blood pressure (SBP) was observed in the HNBP group (p < 0.001), with significant increase in HDL-C (p < 0.01) and significant decrease in serum amyloid A (SAA) concentration (p < 0.01). A significant improvement in physical fitness factors such as physical efficiency index (PEI) was also observed in the HNBP group (p < 0.05). The post-intervention TNF-α, IL-6, and SAA concentrations were more significantly lower in the HNBP than in the NBP group (p < 0.05). Compared to the baseline values, a significant decrease in SAA concentration (p < 0.01) and significant increase in HSP70 concentration (p < 0.001) were observed in the HNBP group. The HNBP group’s 10-year CVD risk was also significantly reduced (p < 0.05). The pre–post differences in SBP and DBP were significantly correlated with those in the anti-inflammatory markers IL-4 and IL-15 (p < 0.01). In conclusion, the 6-month active aerobic exercise program of moderate intensity administered to prehypertensive elderly women (≥65 years) had the effect of reducing the 10-year CVD risk through a substantial reduction in SBP, overall physical fitness improvement, increase in HDL-C, decrease in SAA concentration, and substantial decrease in inflammatory biomarkers. It was also confirmed that an increase in anti-inflammatory markers, which showed a small range of increase with respect to the decrease in blood pressure, may have a major effect.
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Sardeli AV, Griffith GJ, Dos Santos MVMA, Ito MSR, Nadruz W, Chacon-Mikahil MPT. Do baseline blood pressure and type of exercise influence level of reduction induced by training in hypertensive older adults? A meta-analysis of controlled trials. Exp Gerontol 2020; 140:111052. [PMID: 32795629 DOI: 10.1016/j.exger.2020.111052] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exercise recommendations for hypertensive individuals encourage the use of aerobic training (AT) for lowering blood pressure (BP). However, it is not clear whether equivalent BP-lowering effects are obtained with different exercise training types in older adults, among whom hypertension is more prevalent. DESIGN We meta-analyzed previous literature testing different types of training [AT, resistance (RT) and combined (CT)] effects on casual systolic BP (SBP) and diastolic BP (DBP), taking into account age and baseline BP influences. METHODS Randomized controlled trials (RCTs), published up to August 2019 (PubMed), assessing exercise training effects on BP in hypertensive older adults (aged ≥50 years) were included (11, 8 and 3 RCTs tested the effects of AT, RT and CT, respectively). RESULTS AND CONCLUSIONS First, both AT and RT reduced SBP (-12.31 [-16.39; -8.24] and - 6.76 [-8.36; -5.17] mm Hg, respectively) and DBP (-4.31 [-5.96; -2.65] and - 3.53 [-4.22; -2.85] mm Hg, respectively) in older adults, while there was not enough evidence for the effects of CT on SBP, due to high variance among the small number of CT studies. Second, training-induced BP reductions were more prominent in patients <65 years compared to those >65 years. However, this difference was mostly driven by differences between AT and CT versus RT intervention on age subgroups. Third, baseline BP values, rather than type of exercise and age, were the main determinant of BP response to exercise (predicted 74% and 53% of SBP and DBP reduction, respectively), indicating this is a major confounding factor to be considered in studies evaluating the impact of exercise training on BP.
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Affiliation(s)
- Amanda Veiga Sardeli
- Laboratory of Exercise Physiology - FISEX, University of Campinas (UNICAMP), Campinas, Brazil; Gerontology Program, School of Medical Sciences, UNICAMP, Campinas, Brazil.
| | | | | | | | - Wilson Nadruz
- Department of Internal Medicine, School of Medical Sciences, UNICAMP, Campinas, Brazil
| | - Mara Patrícia Traina Chacon-Mikahil
- Laboratory of Exercise Physiology - FISEX, University of Campinas (UNICAMP), Campinas, Brazil; Gerontology Program, School of Medical Sciences, UNICAMP, Campinas, Brazil
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Leal JM, Galliano LM, Del Vecchio FB. Effectiveness of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in Hypertensive Patients: a Systematic Review and Meta-Analysis. Curr Hypertens Rep 2020; 22:26. [PMID: 32125550 DOI: 10.1007/s11906-020-1030-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The purpose of this meta-analysis is to compare the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on blood pressure of hypertensive individuals. RECENT FINDINGS Continuous aerobic training programs are successful in health promotion and are effective in systolic blood pressure (SBP) and diastolic blood pressure (DBP) modulation. However, HIIT seems to be superior to MICT to improvement of cardiorespiratory fitness. PubMed, ScienceDirect, and Google Scholar were searched for randomized clinical trials that compared chronic effects of HIIT and MICT on BP in hypertensive subjects. Pre- and post-intervention changes in maximal oxygen uptake (VO2max) between MICT and HIIT were analyzed. Both interventions presented significant differences in SBP (MICT: mean difference (MD), 3.7 mmHg [95% CI = 2.57, 4.82], p < 0.00001; and HIIT: MD, 5.64 mmHg [95% CI = 1.69, 9.52], p = 0.005) and in DBP (MICT: MD, 2.41 mmHg [95% CI = 1.09, 3.72], p = 0.0003; and HIIT: MD, 4.8 mmHg [95% CI = 2.9, 6.7], p < 0.00001) compared with the control group. No differences were found in the SBP values (MD, 1.13 mmHg [95% CI = - 0.01, 2.27], p = 0.05); however, differences were found between groups in DBP (MD, 1.63 mmHg [95% CI = 0.83, 2.44], p = 0.0001). In the secondary outcome, both interventions increased VO2max in comparison with control groups (MICT: MD, 1.30 ml/kg/min [95% CI = 0.92, 1.68], p < 0.00001; and HIIT: MD, 4.90 ml/kg/min [95% CI = 3.77, 6.04], p < 0.00001), and HIIT promoted greater improvement than MICT (MD, 2.52 ml/kg/min [95% CI = 1.90, 3.13], p < 0.0001). In conclusion, HIIT and MICT promote reduction in SBP in adults with hypertension, and HIIT showed a greater magnitude in DBP reduction. For hypertensive patients, HIIT may be associated with a greater improvement in VO2max than MICT might.
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Affiliation(s)
- Juliana Moraes Leal
- Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil. .,, Pelotas, Brazil.
| | - Leony Morgana Galliano
- Superior School of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
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Abstract
Hypertension is a fatal yet preventable risk factor for cardiovascular disease and is responsible for majority of cardiovascular mortality. Hypertension is closely associated with inactive lifestyle. Physical activity and/or exercise are shown to delay development of hypertension. Both aerobic and resistance exercise have been proven to reduce blood pressure (BP) effectively. Since brisk walking is an easy, inexpensive, simple, and effective way of exercise, this type of an aerobic workout can be recommended to society. All professional organizations and government bodies recommend moderate-intensity aerobic exercise for at least 30 min on at least 3 days of the week or resistance exercise on 2-3 days of the week. Exercise sessions can either be continuous for 30 min or be composed of at least 10 min of short exercise duration to a daily total of 30 min. After an exercise session, BP decreases, and this decline continues for up to 24 h; which is called post-exercise hypotension. Overall 5 mmHg decrease in BP with regular exercise may be ensured. With a decrease of 5 mmHg in systolic BP, mortality due to coronary heart disease decreases by 9%, mortality due to stroke decreases by 14% and all-cause mortality decreases by 7%. Regular exercise should therefore be recommended for all individuals including normotensives, prehypertensives, and hypertensives.
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Affiliation(s)
- Şeref Alpsoy
- Faculty of Medicine, Department of Cardiology, Namık Kemal University, Tekirdag, Turkey.
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15
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Schulz JM, Birmingham TB, Atkinson HF, Woehrle E, Primeau CA, Lukacs MJ, Al-Khazraji BK, Khan MCM, Zomar BO, Petrella RJ, Beier F, Appleton CT, Shoemaker JK, Bryant DM. Are we missing the target? Are we aiming too low? What are the aerobic exercise prescriptions and their effects on markers of cardiovascular health and systemic inflammation in patients with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2019; 54:771-775. [DOI: 10.1136/bjsports-2018-100231] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesWe systemically reviewed published studies that evaluated aerobic exercise interventions in patients with knee osteoarthritis (OA) to: (1) report the frequency, intensity, type and time (FITT) of exercise prescriptions and (2) quantify the changes in markers of cardiovascular health and systemic inflammation.Data sourcesPubMed, CINAHL, Scopus; inception to January 2019.Eligibility criteriaRandomised clinical trials (RCT), cohort studies, case series.DesignWe summarised exercise prescriptions for all studies and calculated effect sizes with 95% CIs for between-group (RCTs that compared exercise and control groups) and within-group (pre-post exercise) differences in aerobic capacity (VO2), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and inflammatory markers (interleukin-6 (IL-6), tumour necrosis factor-alpha). We pooled results where possible using random effects models.ResultsInterventions from 49 studies were summarised; 8% (4/49) met all FITT guidelines; 16% (8/49) met all or most FITT guidelines. Fourteen studies (10 RCTs) reported at least one marker of cardiovascular health or systemic inflammation. Mean differences (95% CI) indicated a small to moderate increase in VO2 (0.84 mL/min/kg; 95% CI 0.37 to 1.31), decrease in HR (−3.56 beats per minute; 95% CI −5.60 to −1.52) and DBP (−4.10 mm Hg; 95% CI −4.82 to −3.38) and no change in SBP (−0.36 mm Hg; 95% CI −3.88 to 3.16) and IL-6 (0.37 pg/mL; 95% CI −0.11 to 0.85). Within-group differences were also small to moderate.ConclusionsIn studies of aerobic exercise in patients with knee OA, very few interventions met guideline-recommended dose; there were small to moderate changes in markers of cardiovascular health and no decrease in markers of systemic inflammation. These findings question whether aerobic exercise is being used to its full potential in patients with knee OA.PROSPERO registration numberCRD42018087859.
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Ballin M, Lundberg E, Sörlén N, Nordström P, Hult A, Nordström A. Effects of interval training on quality of life and cardiometabolic risk markers in older adults: a randomized controlled trial. Clin Interv Aging 2019; 14:1589-1599. [PMID: 31564841 PMCID: PMC6732517 DOI: 10.2147/cia.s213133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/07/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To explore the effects of 10 weeks of progressive vigorous interval training as a single intervention on health-related quality of life (HRQoL) and cardiometabolic risk markers in centrally obese 70-year-old individuals. Participants and methods A randomized controlled trial (ClinicalTrials.gov registration no. NCT03450655) including seventy-seven community-dwelling 70-year-old men and women with central obesity defined as > 1 kg visceral adipose tissue for women and > 2 kg for men. Participants randomized to the intervention group were offered a 10-week progressive vigorous interval training program performed three times per week. Control subjects were asked to maintain their daily living and routines throughout the trial. All participants in both groups had received tailored lifestyle recommendations focused on diet and physical activity at one occasion within 12 months prior to trial initiation. Prespecified outcome measures included: changes in HRQoL using the Short Form Health Survey Questionnaire (SF-36), blood pressure; resting heart rate (HR) and blood lipids. All analyses were conducted on an intention-to-treat basis. Results The intervention resulted in significant effects on the SF-36 mental component summary (MCS) score and the mental health (MH) subscale (P< 0.05 for both), when compared to the control group. Specifically, the intervention group increased their MCS score by 6.3 points (95% confidence interval [CI] = 0.3-12.3) and their MH score by 6.0 points (95% CI = 1.7-10.4) compared to the control group. Moreover, significant effects were seen on resting HR, total cholesterol and LDL-cholesterol (P<0.05 for all). Conclusion It was shown that 10 weeks of vigorous interval training as a single intervention was sufficient to improve mental aspects of HRQoL in older individuals with central obesity, which is a critical aspect of healthy ageing. Positive effects were seen also on cardiometabolic risk markers.
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Affiliation(s)
- Marcel Ballin
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Emmy Lundberg
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Niklas Sörlén
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Andreas Hult
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.,Department of Sport Science, School of Sport Sciences, The Arctic University of Norway, Tromsø, Norway
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17
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Radenkovic D, Aswani R, Ahmad I, Kreindler J, Robinson R. Lifestyle medicine and physical activity knowledge of final year UK medical students. BMJ Open Sport Exerc Med 2019; 5:e000518. [PMID: 31275603 PMCID: PMC6579569 DOI: 10.1136/bmjsem-2019-000518] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives It has previously been reported in the British Journal of Sports Medicine that final year UK medical students are lacking knowledge of the physical activity guidelines. This study assesses whether the knowledge and training of final year UK medical students has improved, whether knowledge correlates with lifestyle choices and whether there is a need for lifestyle medicine training, which includes physical activity guidance, to be offered to this cohort. Methods A questionnaire consisting of nine key questions was sent to 1356 final year medical students from seven different UK medical schools. Results Completed questionnaires (n=158) were analysed and revealed that 52% were unaware of the current exercise guidelines in the UK. 80% stated they had not received training in lifestyle medicine over the last 2 years while 48.1% were unacquainted with motivational interviewing. 76% wanted more lifestyle medicine teaching to be incorporated into the medical school curriculum. Conclusions These findings suggest that final year UK medical students still lack knowledge of the physical activity guidelines. In addition, there is a demand among this cohort for increased lifestyle medicine training which may in turn be an effective way of improving physical activity knowledge.
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Affiliation(s)
- Dina Radenkovic
- University College London Medical School, London, UK.,Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Ram Aswani
- University College London Medical School, London, UK
| | - Imtiaz Ahmad
- The South Lambeth Road Practice and Medical Department, Queens Park Rangers Football and Athletic Club, London, UK
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18
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Cardiorespiratory Effects of Air Pollution in a Panel Study of Winter Outdoor Physical Activity in Older Adults. J Occup Environ Med 2018; 60:673-682. [DOI: 10.1097/jom.0000000000001334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Bouaziz W, Kanagaratnam L, Vogel T, Schmitt E, Dramé M, Kaltenbach G, Geny B, Lang PO. Effect of Aerobic Training on Peak Oxygen Uptake Among Seniors Aged 70 or Older: A Meta-Analysis of Randomized Controlled Trials. Rejuvenation Res 2018; 21:341-349. [DOI: 10.1089/rej.2017.1988] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Walid Bouaziz
- Geriatric Department, Medical School, University Hospitals of Strasbourg, Strasbourg, France
- Department of Physiology and EA-3072, Medical School, Strasbourg University, Strasbourg, France
- Research Unit of the University of Rouen (EA-3832), UFR STAPS, CETAPS, Mont Saint Aignan, France
| | - Lukshe Kanagaratnam
- Department of Research and Innovation, University Hospitals of Reims, Reims, France
| | - Thomas Vogel
- Geriatric Department, Medical School, University Hospitals of Strasbourg, Strasbourg, France
- Department of Physiology and EA-3072, Medical School, Strasbourg University, Strasbourg, France
| | - Elise Schmitt
- Geriatric Department, Medical School, University Hospitals of Strasbourg, Strasbourg, France
- Department of Physiology and EA-3072, Medical School, Strasbourg University, Strasbourg, France
| | - Moustapha Dramé
- Department of Research and Innovation, University Hospitals of Reims, Reims, France
- EA-3797, Faculty of Medicine, University of Reims-Champagne-Ardenne, Reims, France
| | - Georges Kaltenbach
- Geriatric Department, Medical School, University Hospitals of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Department of Physiology and EA-3072, Medical School, Strasbourg University, Strasbourg, France
- Functional Explorations Department, Medical School, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Olivier Lang
- Health and Wellbeing Academy, Anglia Ruskin University, Cambridge, United Kingdom
- Geriatric and Rehabilitation Geriatric Division, University Hospital of Lausanne, Lausanne, Switzerland
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20
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Cardio-Respiratory Effects of Air Pollution in a Panel Study of Outdoor Physical Activity and Health in Rural Older Adults. J Occup Environ Med 2018. [PMID: 28628045 PMCID: PMC5374748 DOI: 10.1097/jom.0000000000000954] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To examine cardio-respiratory effects of air pollution in rural older adults exercising outdoors. Methods: Adults 55 and over completed measurements of blood pressure, peak expiratory flow and oximetry daily, and of heart rate variability, endothelial function, spirometry, fraction of exhaled nitric oxide and urinary oxidative stress markers weekly, before and after outdoor exercise, for 10 weeks. Data were analyzed using linear mixed effect models. Results: Pooled estimates combining 2013 (n = 36 participants) and 2014 (n = 41) indicated that an interquartile increase in the air quality health index (AQHI) was associated with a significant (P < 0.05) increase in heart rate (2.1%) and significant decreases in high frequency power (−19.1%), root mean square of successive differences (−9.5%), and reactive hyperemia index (−6.5%). Conclusions: We observed acute subclinical adverse effects of air pollution in rural older adults exercising outdoors.
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21
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Herrod PJJ, Doleman B, Blackwell JEM, O'Boyle F, Williams JP, Lund JN, Phillips BE. Exercise and other nonpharmacological strategies to reduce blood pressure in older adults: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2018; 12:248-267. [PMID: 29496468 DOI: 10.1016/j.jash.2018.01.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 12/12/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022]
Abstract
The incidence of hypertension increases with advancing age and represents a significant burden of disease. Lifestyle modification represents the first-line intervention in treatment algorithms; however, the majority of evidence for this comes from studies involving young participants using interventions that may not always be feasible in the elderly. This manuscript presents a systematic review of all randomized controlled trials involving participants with a mean age of 65 or over investigating nonpharmacological strategies to reduce blood pressure (BP). Fifty-three randomized controlled trials were included. The majority of interventions described aerobic exercise training, dynamic resistance exercise training, or combined aerobic and dynamic resistance exercise training (COM), with limited studies reporting isometric exercise training or alternative lifestyle strategies. Aerobic exercise training, dynamic resistance exercise training, COM, and isometric exercise training all elicited significant reductions in both systolic and diastolic BP, with no additional benefit of COM compared with single modality exercise training. Three months of traditional exercise-based lifestyle intervention may produce a reduction in BP of approximately 5 mmHg systolic and 3 mmHg diastolic in older individuals, similar to that expected in younger individuals.
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Affiliation(s)
- Philip J J Herrod
- Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; Royal Derby Hospital, Derby, United Kingdom
| | - Brett Doleman
- Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; Royal Derby Hospital, Derby, United Kingdom
| | - James E M Blackwell
- Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; Royal Derby Hospital, Derby, United Kingdom
| | | | - John P Williams
- Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; Royal Derby Hospital, Derby, United Kingdom
| | - Jonathan N Lund
- Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom; Royal Derby Hospital, Derby, United Kingdom.
| | - Bethan E Phillips
- Medical Research Council-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Royal Derby Hospital, Derby, United Kingdom
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Hartman YAW, Hopman MTE, Schreuder TH, Verheggen RJHM, Scholten RR, Oudegeest‐Sander MH, Poelkens F, Maiorana AJ, Naylor LH, Willems PH, Tack CJ, Thijssen DHJ, Green DJ. Improvements in fitness are not obligatory for exercise training-induced improvements in CV risk factors. Physiol Rep 2018; 6:e13595. [PMID: 29464893 PMCID: PMC5820463 DOI: 10.14814/phy2.13595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/04/2017] [Indexed: 12/18/2022] Open
Abstract
The purpose of this study was to assess whether changes in physical fitness relate to changes in cardiovascular risk factors following standardized, center-based and supervised exercise training programs in subjects with increased cardiovascular risk. We pooled data from exercise training studies of subjects with increased cardiovascular risk (n = 166) who underwent 8-52 weeks endurance training. We determined fitness (i.e., peak oxygen uptake) and traditional cardiovascular risk factors (body mass index, blood pressure, total cholesterol, high-density lipoprotein cholesterol), before and after training. We divided subjects into quartiles based on improvement in fitness, and examined whether these groups differed in terms of risk factors. Associations between changes in fitness and in cardiovascular risk factors were further tested using Pearson correlations. Significant heterogeneity was apparent in the improvement of fitness and individual risk factors, with nonresponder rates of 17% for fitness, 44% for body mass index, 33% for mean arterial pressure, 49% for total cholesterol, and 49% for high-density lipoprotein cholesterol. Neither the number, nor the magnitude, of change in cardiovascular risk factors differed significantly between quartiles of fitness change. Changes in fitness were not correlated with changes in cardiovascular risk factors (all P > 0.05). Our data suggest that significant heterogeneity exists in changes in peak oxygen uptake after training, while improvement in fitness did not relate to improvement in cardiovascular risk factors. In subjects with increased cardiovascular risk, improvements in fitness are not obligatory for training-induced improvements in cardiovascular risk factors.
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Affiliation(s)
- Yvonne A. W. Hartman
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Maria T. E. Hopman
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Tim H. Schreuder
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Ralph R. Scholten
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Madelijn H. Oudegeest‐Sander
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
- Department of Geriatric MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Fleur Poelkens
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Andrew J. Maiorana
- Advanced Heart Failure and Cardiac Transplant ServiceRoyal Perth HospitalPerthWestern AustraliaAustralia
- School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWestern AustraliaAustralia
- Allied Health DepartmentFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Louise H. Naylor
- Allied Health DepartmentFiona Stanley HospitalMurdochWestern AustraliaAustralia
- The School of Hum an Sciences (Exercise and Sport Science)The University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Peter H. Willems
- Department of BiochemistryRadboud Institute for Molecular Life SciencesNijmegenThe Netherlands
| | - Cees J. Tack
- Department of Internal MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Dick H. J. Thijssen
- Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands
- Research institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Daniel J. Green
- The School of Hum an Sciences (Exercise and Sport Science)The University of Western AustraliaCrawleyWestern AustraliaAustralia
- Research institute for Sport and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
- National Health and Medical Research Council of AustraliaCanberraAustralia
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Schiavoni D, Pereira LM, Pereira HM, Cyrino ES, Cardoso JR. Effect of traditional resistance training on blood pressure in normotensive elderly persons: a systematic review of randomized controlled trials and meta-analyses. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2017. [DOI: 10.1590/1981-22562017020.160181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The objective of the present study was to determine the effectiveness of the regular practice of traditional resistance training (RT) on systolic (SBP) and diastolic blood pressure (DBP) in normotensive elderly persons. A systematic review of randomized clinical trials and meta-analyses was performed. Searches were performed without language restrictions in different databases. Randomized clinical trials published from 1966 to 2010 that assessed the effects of traditional RT on resting blood pressure (BP) and/or for the treatment of high BP were included. Only studies that assessed the effects of traditional RT on elderly adults, regardless of the number of exercises, with the presence of a control group and comparisons between groups, were included. Twenty-nine studies were found, but only six met the inclusion criteria. The mean difference was used for meta-analysis, using a 95% confidence interval and a random effect model. Traditional RT induced a significant decrease in SBP (-6.63 mmHg; p=0.02) but not in DBP (-3.34 mmHg; p=0.11). These results suggest that traditional RT may be a non-pharmacological strategy for the control of BP in the elderly.
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Turi BC, Bonfim MR, Codogno JS, Fernandes RA, Araújo LGMD, Amaral SLD, Monteiro HL. EXERCISE, BLOOD PRESSURE AND MORTALITY: FINDINGS OF EIGHT YEARS OF FOLLOW-UP. REV BRAS MED ESPORTE 2017. [DOI: 10.1590/1517-869220172302158989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: In the last decades, unhealthy habits, such as low levels of physical activity and poor diet, have increased. Consequently, the prevalence of cardiovascular diseases and mortality has increased significantly among adults. However, it is known that regular physical exercises help to improve health outcomes. Thus, the aim of this study was to analyze the effects of eight years of regular participation in an exercise program on blood pressure and mortality in the Brazilian public health system. Methods: The sample consisted of 34 participants with hypertension and/or type II diabetes who were followed up for eight years. They were paired by age, body mass index and chronic disease in two groups: exercise and control. During the follow-up period, medical records were used to assess systolic and diastolic blood pressure, as well as number of medical appointments and the occurrence of deaths. Results: In the follow-up period, five participants died in the control group and none in the exercise group. The Kaplan-Meier analysis identified 29.4% lower mortality among active participants (Fisher's exact test with p = 0.044). The number of medical appointments and the values of diastolic blood pressure were significantly lower for active participants. Conclusion: After a follow-up of eight years, participants in the exercise group attended fewer medical appointments, had better blood pressure control and a lower occurrence of deaths.
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Jung MH, Ihm SH, Lee DH, Chung WB, Jung HO, Youn HJ. Prehypertension is associated with early complications of atherosclerosis but not with exercise capacity. Int J Cardiol 2017; 227:387-392. [DOI: 10.1016/j.ijcard.2016.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/21/2016] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
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Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2016; 25 Suppl 3:1-72. [PMID: 26606383 DOI: 10.1111/sms.12581] [Citation(s) in RCA: 1662] [Impact Index Per Article: 207.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism and The Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Exercise as a Polypill for Chronic Diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 135:497-526. [PMID: 26477928 DOI: 10.1016/bs.pmbts.2015.07.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Exercise may be described as a polypill to prevent and/or treat almost every chronic disease, with obvious benefits such as its low cost and practical lack of adverse effects. Implementing physical activity interventions in public health is therefore a goal at the medical, social, and economic levels. This chapter describes the importance of health promotion through physical activity and discusses the impacts of exercise on the most prevalent chronic diseases, namely metabolic syndrome-related disorders, cardiovascular diseases, cancer, and Alzheimer's disease. For each of these chronic conditions, we discuss the epidemiological evidence supporting a beneficial role of exercise, provide guidelines for exercise prescription, and describe the biological mechanisms whereby exercise exerts its modulatory effects.
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Aerobic exercise training improves oxidative stress and ubiquitin proteasome system activity in heart of spontaneously hypertensive rats. Mol Cell Biochem 2015; 402:193-202. [DOI: 10.1007/s11010-015-2326-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/16/2015] [Indexed: 12/22/2022]
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Abstract
As the worldwide prevalence of hypertension continues to increase, the primary prevention of hypertension has become an important global public health initiative. Physical activity is commonly recommended as an important lifestyle modification that may aid in the prevention of hypertension. Recent epidemiologic evidence has demonstrated a consistent, temporal, and dose-dependent relationship between physical activity and the development of hypertension. Experimental evidence from interventional studies has further confirmed a relationship between physical activity and hypertension as the favorable effects of exercise on blood pressure reduction have been well characterized in recent years. Despite the available evidence strongly supporting a role for physical activity in the prevention of hypertension, many unanswered questions regarding the protective benefits of physical activity in high-risk individuals, the factors that may moderate the relationship between physical activity and hypertension, and the optimal prescription for hypertension prevention remain. We review the most recent evidence for the role of physical activity in the prevention of hypertension and discuss recent studies that have sought to address these unanswered questions.
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Almeida OP, Khan KM, Hankey GJ, Yeap BB, Golledge J, Flicker L. 150 minutes of vigorous physical activity per week predicts survival and successful ageing: a population-based 11-year longitudinal study of 12 201 older Australian men. Br J Sports Med 2013; 48:220-5. [DOI: 10.1136/bjsports-2013-092814] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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