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Wang L, Zhou B, Li X, Wang Y, Yang XM, Wang H, Yan J, Dong J. The beneficial effects of exercise on glucose and lipid metabolism during statin therapy is partially mediated by changes of the intestinal flora. BIOSCIENCE OF MICROBIOTA, FOOD AND HEALTH 2022; 41:112-120. [PMID: 35854693 PMCID: PMC9246419 DOI: 10.12938/bmfh.2021-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 02/03/2022] [Indexed: 11/09/2022]
Abstract
Recent research has confirmed that moderate-intensity exercise affects the gut microbiome
composition and improves cardiac function in an animal model after myocardial infarction
(MI). However, few studies have investigated the effects of exercise on glucose and lipid
metabolism in patients with coronary heart disease (CHD) receiving a statin treatment and
successful percutaneous coronary intervention (PCI). Meanwhile, since statin therapy may
lead to the risk of an increase in blood glucose level in CHD patients, we hypothesized
that moderate-intensity exercise may be helpful for regulating glucose-lipid metabolism
and stabilizing the blood glucose level in CHD patients. Therefore, to confirm our
conjecture, we conducted a clinical retrospective study and animal experiment,
respectively. The clinical study involved a total of 501 statin-treated patients with CHD
after PCI. According to the study protocol, patients were divided into the following three
groups: a non-exercise group, exercise at the recommended standard group, and exercise not
at the recommended standard group. We found that qualified moderate-intensity exercise
decreased blood glucose and lipid levels at follow-up at a mean of 2.2 years, and the
incidence of new-onset diabetes showed a downward trend compared with the non-exercise and
exercise not at the recommended standard groups. Furthermore, we used a high-fat rat model
to explore an additional mechanism of the beneficial effects of exercise-based management
on glucose-lipid metabolism apart from the known mechanism. We used 16S rRNA
high-throughput sequencing technology to analyze the changes induced by exercise in the
composition of intestinal flora in experimental rats. We found that rats that exercised
with or without statin administration had lower plasma glucose and lipid levels and that
these parameters were higher in the control and statin-treated rats that did not exercise.
These results were consistent with the human study. The results from high-throughput
sequencing of the intestinal flora of rats showed, to the best of our knowledge, that
exercise leads to an increased relative abundance of Akkermansia
muciniphila, which contributes to improved glucose and lipid metabolism. Based
on our current results, we suggest that moderate-intensity exercise can improve glucose
and lipid metabolism and prevent statin treatment-related side effects, such as
hyperglycemia, in patients after PCI. Exercise could facilitate the applicability of
statins for lower lipid levels. Exercise training also provides additional benefits, such
as alteration of the gut microbiota, which contributes to improved glucose and lipid
metabolism.
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Affiliation(s)
- Lijun Wang
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China.,Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China
| | - Baihua Zhou
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China.,Department of Respiratory and Critical Care Medicine, Yueyang Second People's Hospital, Yueyang, Hunan, China
| | - Xinying Li
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an 710061, China
| | - Xiu Mei Yang
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China
| | - Hongwei Wang
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China
| | - Jun Yan
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China
| | - Jiakun Dong
- Department of Cardiology, Affiliated Zhongshan Hospital, Dalian University, Dalian 116001, China
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Nemoto S, Kasahara Y, Izawa KP, Watanabe S, Yoshizawa K, Takeichi N, Kamiya K, Suzuki N, Omiya K, Kida K, Matsunaga A, Akashi YJ. New Formula to Predict Heart Rate at Anaerobic Threshold That Considers the Effects of β-Blockers in Patients With Myocardial Infarction: MULTI-INSTITUTIONAL RETROSPECTIVE CROSS-SECTIONAL STUDY. J Cardiopulm Rehabil Prev 2022; 42:E1-E6. [PMID: 33883473 DOI: 10.1097/hcr.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE It is recommended that patients with myocardial infarction (MI) be prescribed exercise by target heart rate (HR) at the anaerobic threshold (AT) via cardiopulmonary exercise testing (CPX). Although percent HR reserve using predicted HRmax (%HRRpred) is used to prescribe exercise if CPX or an exercise test cannot be performed, %HRRpred is especially difficult to use when patients take β-blockers. We devised a new formula to predict HR at AT (HRAT) that considers β-blocker effects in MI patients and validated its accuracy. METHODS The new formula was created using the data of 196 MI patients in our hospital (derivation sample), and its accuracy was assessed using the data of 71 MI patients in other hospitals (validation sample). All patients underwent CPX 1 mo after MI onset, and resting HR, resting systolic blood pressure (SBP), and HRAT were measured during CPX. RESULTS The results of multiple regression analysis in the derivation sample gave the following formula (R2 = 0.605, P < .001): predicted HRAT = 2.035 × (≥65 yr:-1, <65 yr:1) + 3.648 × (body mass index <18.5 kg/m2:-1, body mass index ≥18.5 kg/m2:1) + 4.284 × (β1-blocker(+):-1, β1-blocker(-):1) + 0.734 × (HRrest) + 0.078 × (SBPrest) + 36.812. This formula consists entirely of predictors that can be obtained at rest. HRAT and predicted HRAT with the new formula were not significantly different in the validation sample (mean absolute error: 5.5 ± 4.1 bpm). CONCLUSIONS The accuracy of the new formula appeared to be favorable. This new formula may be a practical method for exercise prescription in MI patients, regardless of their β-blocker treatment status, if CPX is unavailable.
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Affiliation(s)
- Shinji Nemoto
- Department of Rehabilitation Medicine, St Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan (Drs Nemoto and Kasahara); Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan (Drs Nemoto, Kamiya, and Matsunaga); Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan (Dr Izawa); Department of Rehabilitation Medicine, St Marianna University School of Medicine Hospital, Kawasaki, Japan (Messrs Watanabe and Takeichi); Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan (Mr Yoshizawa); Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine Hospital, Kawasaki, Japan (Drs Suzuki and Akashi); Department of Internal Medicine, Shimazu Medical Clinic, Yokohama, Japan (Dr Omiya); and Department of Pharmacology, St Marianna University School of Medicine, Kawasaki, Japan (Dr Kida)
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