Effects of Moderate Combined Resistance- and Aerobic-Exercise for 12 Weeks on Body Composition, Cardiometabolic Risk Factors, Blood Pressure, Arterial Stiffness, and Physical Functions, among Obese Older Men: A Pilot Study

Telerehabilitation improves cardiorespiratory and muscular fitness and body composition in older people with post-COVID-19 syndrome

BACKGROUND

The effects of post-coronavirus disease 2019 (COVID-19) syndrome on the cardiorespiratory and muscular fitness in older people are of utmost relevance. This study aimed to evaluate the effects of a 12-week telerehabilitation programme on cardiorespiratory and muscular fitness and body composition in older patients with post-COVID-19 syndrome.

METHODS

One hundred twenty older patients with post-COVID-19 syndrome were randomly assigned to one of two groups: patients who carried out the telerehabilitation programme (n = 60; age: 65.0 ± 5.2; female: 14.2%) and a control group (n = 60; age: 64.3 ± 5.0; female: 24.5%). An incremental cardiopulmonary exercise testing, isokinetic strength test, and bioelectrical impedance analysis were performed to compare cardiorespiratory and muscle strength responses and body composition between telerehabilitation and control groups.

RESULTS

A significant increase in the cardiopulmonary exercise testing duration was found in the telerehabilitation group compared to the control group (mean difference = 88.9 s, P = 0.001). Peak oxygen uptake increased in the telerehabilitation group (mean difference = 3.0 mL·kg-1·min-1, P < 0.001) and control group (mean difference = 1.9 mL·kg-1·min-1, P < 0.001). Power output in cycle ergometer (mean difference = 25.9 watts, P < 0.001), fat free mass (mean difference = 2.1 kg, P = 0.004), soft lean mass (mean difference = 2.1 kg, P = 0.003), and skeletal muscle mass (mean difference = 1.4 kg, P = 0.003) only increased in the telerehabilitation group. A significant increase in the power output was observed in the telerehabilitation group compared with the control group in both lower limbs after isokinetic strength test of the leg extension at a speed of 60° (right: mean difference = 18.7 watts, P = 0.012; left: mean difference = 15.3 watts, P = 0.010). The peak torque of right leg extension increased only in the telerehabilitation group after isokinetic strength test at a speed of 60° (mean difference = 13.1 N·m, P < 0.001). A significant increase in the power output was observed in the telerehabilitation group compared with the control group in the left leg extension after isokinetic strength test at a speed of 180° (mean difference = 30.2 watts, P = 0.003).

CONCLUSIONS

The telerehabilitation programme improved cardiorespiratory and muscular fitness, and body composition in older patients with post-COVID-19 syndrome to a greater extent than a control group. The telerehabilitation programmes may be an alternative to improve the sequelae of post-COVID-19 syndrome in older patients.

Relationship between the level of physical activity and body mass index to blood pressure among overweight and obese young adults in the Northern Emirates city: A cross-sectional study

BACKGROUND

Obesity affects both adults and children all over the world and it is a major causative factor for diabetes, cardiovascular disease, different types of cancer, and even death. Therefore, this study aimed to assess the level of PA and BMI to the risk of developing high BP among overweight and obese young adults.

METHODOLOGY

A cross-sectional study was carried out in the Thumbay Medi-city Northern Emirates, Ajman, UAE. Participants enrolled in the study under the convenient sampling method and inclusion criteria: young overweight and obese individuals, male and female, aged between 18 to 30 years. Approval was obtained from the Institutional Review Board (CoHS, GMU (IRB-COHS-STD-110-JUNE-2023). The blood pressure and body mass index were clinically measured using standard tools whereas the GPAQ questionnaire was used to determine the level of physical activity of all participants.

RESULTS

Out of 206 participants, 139 were overweight and 67 were obese. Further, 89 were found to have high normal BP, 93 normal BP, and 24 were found to have optimal blood pressure. The mean GPA scores were 322.8±62.28 in overweight individuals and 301.17±49.05 in obese individuals. Furthermore, among overweight and obese participants there is a weak correlation between PA & BMI (r = 0.06, p = 0.88) and (r = 0.15, p = 0.44) and the BP and BMI (r = 0.18, p = 1.02) and (r = 0.16, p = 0.90) were found.

CONCLUSION

Although PA, BMI, and BP are assumed to be related variables leading to various non-communicable diseases the present study showed a weak correlation between the level of PA and BMI to the risk of developing BP among overweight and obese young adults in the Northern Emirates.

Analysis of Common Exercise Modalities in Improving Athletic Performance in Older Adults: A Narrative Review

ABSTRACT

Exercise leads to robust cardiovascular, musculoskeletal, and psychological benefits that improve quality of life and longevity for older adults, but accompanying improvements in athletic parameters are less well explored. The aim of this review is to summarize some of the most common exercise modalities, namely, Pilates, martial arts (tai chi, Japanese-style karate, hard martial arts), locomotion (brisk walking/jogging and running), Masters sports, resistance training, and high-intensity interval training, in improving athletic performance for older adults. Regular participation in these activities can have robust yet unique impacts on physical performance that prolong exercise participation. In particular, this review will explore benefits in cardiorespiratory fitness, power, strength, flexibility, and balance, thereby hopefully improving endurance, exercise adherence, and overall fall risk. A narrative literature review was performed to explore benefits, pitfalls, and recommendations for some of the most popular exercise modalities for older adults.

Investigation of left atrial mechanical function and left ventricular systolic and diastolic parameters in athletes performing resistance exercise and combined exercise

Some individuals who go to fitness centers for various purposes perform resistance exercise (RE) alone, while others engage in combined exercise (CE) by including cardio exercises along with RE. Studying the effects of these two different training methods on left ventricular (LV) systolic and diastolic parameters and left atrial mechanical function is an important step toward understanding the effects of different types of exercise on cardiac function. This knowledge has significant implications for public health, as it can inform the development of targeted and effective exercise programs that prioritize cardiovascular health and reduce the risk of adverse outcomes. Therefore, the primary aim of this study is to comprehensively investigate the LV systolic and diastolic parameters of athletes who engage in RE and CE using ECHO, to contribute to the growing body of literature on the cardiovascular effects of different types of exercise. Forty-two amateur athletes aged between 17 and 52 were included in our study. The participants consisted of the RE (n = 26) group who did only resistance exercise during the weekly exercise period, and the CE group (n = 16) who also did cardio exercise with resistance exercises. After determining sports age (year), weekly exercise frequency (day), and training volume (min) in addition to demographic information of RE and CE groups, left ventricular systolic and diastolic parameters and left atrial functions were determined by ECHO. Findings from our study revealed that parameters including the left ventricular end-diastolic diameter (LVEDD) (p = .008), left ventricular end-diastolic volume (LVEDV) (p = .020), stroke volume index (SV-I) (p = .048), conduit volume (CV-I) (p = .001), and aortic strain (AS) (p = .017) were notably higher in the RE group compared to the CE group. Also left atrial active emptying volüme (LAAEV) of CE was higher than the RE group (p = .031). In conclusion, the cardiac parameters of the RE group showed more athlete's heart characteristics than the CE group. These results may help to optimize the cardiovascular benefits of exercise routines while minimizing the potential risks associated with improper training.

The effect of exercise on blood concentrations of angiogenesis markers in older adults: A systematic review and meta-analysis

Impaired angiogenesis is associated with cognitive decline in older adults. While exercise has been broadly associated with increased angiogenesis, the relevant mechanisms in older adults are not clear. Here, we present a systematic review and meta-analysis on the relationship between exercise and specific blood angiogenesis markers in older adults to better understand the relevant mechanisms. MEDLINE, Embase, and Cochrane CENTRAL were searched for original reports of angiogenesis markers' concentrations in blood before and after exercise in older adults (≥50 years). Heterogeneity was investigated using sub-group analyses and meta-regressions. Of the 44 articles included in the review, 38 were included in the meta-analyses for five markers: vascular endothelial growth factor (VEGF), e-selectin (CD62E), endostatin, fibroblast growth factor 2, and matrix metallopeptidase-9. VEGF levels were higher (SMD[95%CI]= 0.18[0.03, 0.34], and CD62E levels were lower (SMD[95%CI]= -0.72[-1.42, -0.03], p = 0.04) after exercise. No other markers were altered. Although more studies are needed, changes in angiogenesis markers may help explain the beneficial effects of exercise on angiogenesis in older adults.

Multidomain interventions for sarcopenia and cognitive flexibility in older adults for promoting healthy aging: a systematic review and meta-analysis of randomized controlled trials

The global population is undergoing rapid aging, making physical activity a crucial element in preventing mortality and lowering the risk of Alzheimer's disease. Age-related declines in muscle mass and cognitive abilities significantly contribute to frailty and dependency. Thus, this study focuses on a meticulous analysis of the protective effects of multidomain interventions, an emerging resource combating age-related declines. It seeks to underscore their profound impact on cognitive flexibility and sarcopenia, highlighting their pivotal role in mitigating the adverse effects of aging. To identify relevant randomized controlled trials up to November 2023, we reviewed eight online academic databases, following PERSiST guidelines, PRISMA reporting system, and PICOs criteria. Meta-analyses on selected functional outcomes utilized a random-effects model, including the Timed Up and Go Test, Sit to Stand Test, Victoria Stroop Test, and Trail Making Test. Out of 2082 scrutinized articles, 17 were included in the systematic review, and 8 in the meta-analysis. Positive effects (p = 0.05, I2 = 57%; 95% CI - 0.63 to - 0.05) were observed in cognitive flexibility for certain interventions. Similarly, interventions addressing muscle strength demonstrated improvements in the Sit to Stand Test for the exercise group compared to the control group (p = 0.02, I2 = 0%; 95% CI - 0.63 to - 0.05). These findings underscore the importance of incorporating physical activity as a primary component of public health interventions for promoting healthy aging and reducing the burden of age-related diseases. Future interventions may explore more homogeneous approaches and evaluate the impact of thrice multidomain weekly sessions.

Stiffness and Elasticity of Aorta Assessed Using Computed Tomography Angiography as a Marker of Cardiovascular Health-A Cross-Sectional Study

Cardiovascular (CV) health can be measured using the American Health Association's Life's Simple 7 scale (ALS7). Aortic stiffness (AoS) and elasticity (AoE) can be assessed using various methods, e.g., computed tomography (CT). To measure AoE, we use aortic strain and distensibility (AoD). The aim of this study was to examine the relationship between ALS7, AoS, and AoE. The study group (SG) was composed of 96 patients (mean age 70.41 ± 8.32 years) with a BMI of 25.58 ± 3.12 kg/m2; 28.1% were smokers, 54.2% had hypertension, 11.4% had diabetes, and 67.7% had hypercholesterolemia. The SG was further divided into three subgroups (optimal (ALS7-H), intermediate (ALS7-I), and inadequate (ALS7-L)) based on the ALS7. The AoS and AoE were assessed in each of them. We found that the ALS7-I and ALS7-H had significantly lower AoS values compared to the ALS7-L (AoS: 3.50 ± 0.53 and 4.10 ± 0.70 vs. 4.57 ± 1.03, respectively). The opposite relationship was observed for AoE measured with AoD in the ALS7-H vs. ALS7-L (AoD: 0.23 ± 0.14 vs. 0.11 ± 0.09 cm2/dyn). AoS correlated (r = 0.61) with systolic blood pressure (BP). In our regression model, higher scores on the ALS7 in BP, smoking, and BMI were independent protective factors against greater AoS. Higher ALS7 scores in BP, smoking, BMI, and physical activity were protective factors against lesser aortic strain. Higher scores in ALS7 for BP and smoking were protective factors against lesser AoD. We conclude that better cardiovascular health expressed via higher scores obtained on the ALS7 is associated with lower AoS and higher AoE on CT.

Arterial stiffness and hypertension

Arterial stiffness and hypertension are closely related in pathophysiology. Chronic high blood pressure (BP) can lead to arterial wall damage by mechanical stress, endothelial dysfunction, increased inflammation, oxidative stress, and renin-angiotensin-aldosterone system (RAAS) activation. Hypertension also increases collagen fiber production and accelerates elastin fiber degradation. Stiffened arteries struggle with BP changes, raising systolic BP and pulse pressure. The resulting increased systolic pressure further hardens arteries, creating a harmful cycle of inflammation and calcification. Arterial stiffness data can predict target organ damage and future cardiovascular events in hypertensive patients. Thus, early detection of arterial stiffness aids in initiating preventive measures and treatment plans to protect against progression of vascular damage. While various methods exist for measuring arterial stiffness, pulse wave velocity is a non-invasive, simple measurement method that maximizes effectiveness. Healthy lifestyle changes, RAAS blockers, and statins are known to reduce arterial stiffness. Further research is needed to ascertain if improving arterial stiffness will enhance prognosis in hypertensive patients.

The insufficiency of recreational exercises in improving cardiovascular fitness: an investigation of ventricular systolic and diastolic parameters and left atrial mechanical functions

AIM

This study aimed to compare the left ventricular (LV) systolic and diastolic parameters and left atrial (LA) mechanical functions of individuals engaging in recreational sports and resistance exercises on a weekly basis.

METHODS

A total of 43 male amateur athletes were included in this study, of which 24 performed resistance exercises (REs) (29.70 ± 8.74 year, weight: 81.70 ± 12.64 kg, height: 176.05 ± 7.73 cm, BMI: 27.64 ± 4.97 kg/m2), and 19 participated in recreational football training and were included in the recreational sports group (31.73 ± 6.82 year, weight: 86.00 ± 18.52 kg, height: 178.62 ± 4.95 cm, BMI: 25.55 ± 3.42 kg/m2). The exercises were standardized according to the weekly exercise frequency and volume. After recording the participants' demographic information, the LV systolic and diastolic parameters and LA mechanical functions were measured using echocardiography (ECHO) and Tissue Doppler Imaging.

RESULTS

Significant differences were observed in various cardiac parameters between the recreational sports group (REG) and resistance exercise Group (RSG). Specifically, the left ventricular (LV) diastolic diameter, LV end diastolic volume index (LVEDVi), and stroke volume index were notably higher in the REG compared to the RSG (t = 2.804, p = .010, effect size (ES) = 2.10; t = 3.174, p = .003, ES = 0.98; t = 3.36, p = .002, ES = 1.02, respectively). Notably, the RSG exhibited higher values for LV mass index (LVMi) and isovolumic relaxation time (IVRT) than the REG (t = 2.843, p = .007, ES = 0.87; t = 2.517, p = .016, ES = 0.76) in terms of LV systolic and diastolic parameters. Regarding left atrial (LA) mechanics, the REG demonstrated increased LA total emptying volume index, LA maximum volume index, LA volume before systole measured at the onset of the p-wave index, and conduit volume index compared to RSG (t = 2.419, p = .020, ES = 0.75; t = 2.669, p = .011, ES = 0.81; t = 2.111, p = .041, ES = 0.64; t = 2.757, p = .009, ES = 0.84, respectively).

CONCLUSION

Our study revealed significant variations in LV and LA functions between REG and RSG. Our data suggest that REs led to substantial cardiac remodeling, altering myocardial structure and function. In contrast, the effect of recreational exercise on cardiac adaptation was less pronounced than that of resistance exercise. Consequently, we propose that individuals engaging in recreational exercise should consider modalities that impose higher cardiovascular demand for more effective cardiac conditioning.

Effects of regular aerobic exercise on vascular function in overweight or obese older adults: A systematic review and meta-analysis

Background

Overweight and obese older adults have a high risk for developing cardiovascular disease. Aerobic exercise is a valuable strategy to improve vascular health, but the effects of aerobic exercise on vascular endothelial function in obese and overweight older adults remain controversial. The purpose of this meta-analysis was to investigate the effects of aerobic exercise on vascular function in obese and overweight older adults with or without comorbidity.

Methods

A systematic literature search for related studies published in English was conducted between January 1989 and October 30, 2022, in the PubMed, Embase, and Cochrane Library databases. A random effects model was chosen for meta-analysis, which calculated the effect sizes of control and intervention groups after exercise intervention using standardized mean differences (SMDs) corrected for Hedges' g bias and 95% confidence intervals (95% CIs).

Results

Twenty-six studies containing 1418 participants were included in the study. After excluding three studies contributing to higher heterogeneity by sensitivity analysis, there are small effects of regular aerobic exercise on vascular function of obese and overweight older adults, including flow-mediated dilation (FMD) [SMD = 0.21, 95% CI (0.02, 0.41), z = 2.16, df = 19, I² = 52.2%, P = 0.031] and pulse wave velocity (PWV) [SMD = -0.24, 95% CI (-0.46, -0.02), z = 2.17, df = 10, I² = 8.6%, P = 0.030], and no significant effect was observed on augmentation index (Aix). Subgroup analysis showed small effects of regular aerobic exercise on FMD [SMD = 0.37, 95% CI (0.13, 0.61), z = 3.05, df = 9, I² = 52.6%, P = 0.002] in the overweight not obese subgroup (25 = BMI <30 kg/m²), but no significant effect on the obese subgroup (BMI ≥30 kg/m²). Regular aerobic exercise for more than 24 weeks improved FMD by small effect sizes [SMD = 0.48, 95% CI (0.04, 0.93), z = 2.12, df = 5, I² = 56.4%, P = 0.034] and for more than three times per week improved FMD by moderate effect sizes [SMD = 0.55, 95% CI (0.12, 0.98), z = 2.50, df = 3, I² = 31.1%, P = 0.012] in obese and overweight older adults with or without CVD.

Conclusion

In obese and overweight older adults with or without comorbidity, regular aerobic exercise for more than 24 weeks improved FMD by small effect sizes and exercise for more than three times per week improved FMD by moderate effect sizes and regular aerobic exercise reduced PWV by small effect sizes and had no influence on Aix. Taken together, it was recommended that obese and overweight older adults should adhere to regular aerobic exercise, training at least 3 times per week for better results.

Effect of Aerobic/Strength Training on RANKL Gene DNA Methylation Levels

BACKGROUND

The osteoclastogenesis RANKL gene plays a key role in bone remodeling. The hypomethylation of its promoter region may cause osteoporosis. The present study aimed to elucidate the influence of physical activity on DNA methylation changes of RANKL promoter cytosine-phosphate-guanine (CpG)-rich region in active and sedentary adults and to assess the effect of aerobic and strength training on RANKL DNA methylation changes among Tunisian-North African adults.

METHODS

A total of 104 participants including 52 adults (58% males and 42% females) and 52 adults (31% males and 69% females) were recruited for the observational and interventional part of the study, respectively. The intervention consisted of 12 weeks of aerobic training (30 min/session) followed by 10 minutes of strengthening exercises. All participants completed the International Physical Activity Questionnaire and provided blood samples for quantitative methylation-specific polymerase chain reaction (PCR) analysis.

RESULTS

The study revealed a significant difference (P = 6 × 10-10) in the methylation level of the RANKL promoter region between active and sedentary adults, with a 6.68-fold increase observed in the active group. After the intervention, both the trained (P = 41 × 10-5) and untrained (P = .002) groups displayed high methylation levels in the RANKL promoter region. In addition, the trained group exhibited significant improvements in heart rate (P = 2.2 × 10-16), blood pressure (P = 39 × 10-3), maximal oxygen uptake (P = 1.5 × 10-7), and fat mass (P = 7 × 10-4).

CONCLUSION

Exploring epigenetic modifications in the RANKL promoter region may contribute to a more comprehensive understanding of the complexity of osteoporosis. This suggests that aerobic/strength training could potentially improve the bone system, reducing its vulnerability to osteoporosis by increasing RANKL DNA methylation.

Effect of Hypoxia Conditioning on Body Composition in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

The effects of hypoxia conditioning, which involves recurrent exposure to hypoxia combined with exercise training, on improving body composition in the ageing population have not been extensively investigated.

OBJECTIVE

This meta-analysis aimed to determine if hypoxia conditioning, compared to similar training near sea level, maximizes body composition benefits in middle-aged and older adults.

METHODS

A literature search of PubMed, EMBASE, Web of Science, Scopus and CNKI (China National Knowledge Infrastructure) databases (up to 27th November 2022) was performed, including the reference lists of relevant papers. Three independent reviewers extracted study characteristics and health outcome measures. Search results were limited to original studies of the effects of hypoxia conditioning on body composition in middle-aged and older adults.

RESULTS

Twelve studies with a total of 335 participants were included. Hypoxia conditioning induced greater reductions in body mass index (MD = -0.92, 95%CI: -1.28 to -0.55, I2 = 0%, p < 0.00001) and body fat (SMD = -0.38, 95%CI: -0.68 to -0.07, I2 = 49%, p = 0.01) in middle-aged and older adults compared with normoxic conditioning. Hypoxia conditioning improved lean mass with this effect not being larger than equivalent normoxic interventions in either middle-aged or older adults (SMD = 0.07, 95%CI -0.12 to 0.25, I2 = 0%, p = 0.48). Subgroup analysis showed that exercise in moderate hypoxia (FiO2 > 15%) had larger effects than more severe hypoxia (FiO2 ≤ 15%) for improving body mass index in middle-aged and older adults. Hypoxia exposure of at least 60 min per session resulted in larger benefits for both body mass index and body fat.

CONCLUSION

Hypoxia conditioning, compared to equivalent training in normoxia, induced greater body fat and body mass index improvements in middle-aged and older adults. Adding hypoxia exposure to exercise interventions is a viable therapeutic solution to effectively manage body composition in ageing population.

Effects of different exercise modalities on lipid profile in the elderly population: A meta-analysis

BACKGROUND

Dyslipidemia, characterized by elevated total cholesterol (TC), triglycerides, and low-density lipoprotein cholesterol (LDL-C), as well as decreased high-density lipoprotein cholesterol (HDL-C), has long been recognized as a major risk factor for age-related diseases. Recent studies have shown that exercise can be effective in mitigating dyslipidemia in older adults. The aim of this study was to systematically evaluate the effects of different exercise modalities (aerobic exercise [AE], resistance exercise [RE], aerobic+resistance exercise [AE+RE], and high-intensity interval training) on lipid profile in the elderly population, in order to identify the most effective exercise modality for maintaining lipid profile health in older adults.

METHODS

A comprehensive database search of PubMed, EBSCO, Web of Science, China National Knowledge Infrastructure, and Wanfang database. Eligible studies were individually assessed according to the Cochrane Risk of Bias Tool version 2, and the data were analyzed and processed using RevMan 5.4.1 analysis software.

RESULTS

This study identified 20 randomized controlled trials with a total of 988 subjects, of which 541 were in the exercise group and 447 in the control group. Our analysis showed that AE significantly reduced TC (P < .05), triglycerides (P < .01), and LDL-C (P < .01), while increasing HDL-C (P < .01) in the elderly population. RE significantly reduced the elevation of TC (P < .01) and LDL-C (P < .05) indices in the elderly population, while AE+RE had a significant effect on decreasing TC (P < .01) and LDL-C (P < .01) indices.

CONCLUSION

Our analysis indicates that AE is the most effective exercise modality for reducing dyslipidemia in older adults, compared to RE, AE+RE, and high-intensity interval training. These findings suggest that AE should be promoted as an important lifestyle intervention to improve lipid profile health in the elderly population. However, further research is needed to investigate the optimal duration, frequency, and intensity of AE required to achieve the most beneficial effects on lipid profile health in older adults.

The Effects of Obesity on the Inflammatory, Cardiovascular, and Neurobiological Responses to Exercise in Older Adults

Obesity with advancing age leads to increased health complications that are involved in various complex physiological processes. For example, inflammation is a critical cardiovascular disease risk factor that plays a role in the stages of atherosclerosis in both aging and obesity. Obesity can also induce profound changes to the neural circuitry that regulates food intake and energy homeostasis with advancing age. Here we discuss how obesity in older adults impacts inflammatory, cardiovascular, and neurobiological functions with an emphasis on how exercise mediates each topic. Although obesity is a reversible disorder through lifestyle changes, it is important to note that early interventions are crucial to prevent pathological changes seen in the aging obese population. Lifestyle modifications such as physical activity (including aerobic and resistance training) should be considered as a main intervention to minimize the synergistic effect of obesity on age-related conditions, such as cerebrovascular disease.

Moderate-Intensity Continuous Training Versus Moderate-Intensity Interval Training: Effects on Cardiometabolic Factors in Spanish Obese Adults

BACKGROUND

Excess weight and obesity are related to cardiometabolic diseases and limit physical activity. Until now, the effects of moderate-intensity continuous training (MICT) compared with moderate-intensity interval training (MIIT) in Spanish obese adults have not been analyzed.

OBJECTIVE

This study aimed to investigate the effect of MICT and MIIT together with a 1300-to-1400 caloric restrictive diet on cardiovascular disease risk factors in overweight and obese patients.

METHODS

The MICT and MIIT groups trained during 4 sessions a week for 12 weeks while performing the diet. The MICT group trained for 32 minutes per session in a cycloergometer, initially at 60% maximal oxygen uptake during the first month and increasing by 10% every 4 weeks. The MIIT group performed 4 × 4 intervals (at 60% maximal oxygen uptake and active rest at 60% maximal oxygen uptake minus 20 W), with a 10% increase every 4 weeks. The control group neither trained nor followed the restrictive diet.

RESULTS

One hundred fifty-nine obese adults participated in the study. The control group did not present any significant changes during the study. The MICT group significantly improved in all the variables (P < .05) except for high-density lipoproteins. The MIIT group improved in all the variables (P < .05) except for high-density lipoproteins and triglycerides. The MIIT group lost weight in less time than the MICT group.

CONCLUSIONS

Overweight and obese adults of both the MICT and MIIT groups decreased their risk for cardiovascular disease, although the MIIT group lost weight in a shorter amount of time.

Nutrition and exercise interventions to improve body composition for persons with overweight or obesity near retirement age: A systematic review and network meta-analysis of randomised controlled trials

The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI) and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70). We conducted a systematic review and network-meta-analysis (NMA) of randomised controlled trials, searching four databases from their inception up to 12 July 2022. The NMA was based on a random effects model, pooled mean differences, standardised mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. 92 studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e. 500-1000 kcal), energy restriction plus high protein (HP) intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training (RT), aerobic training (AT), HP plus RT, energy restriction plus HP plus exercise, energy restriction plus RT, energy restriction plus AT, and energy restriction plus mixed exercise (ME). Intervention durations ranged from 8 weeks to 6 months. Body fat was reduced with energy restriction plus any exercise or plus HP intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with ME. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except AT/RT alone or RT plus HP. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with RT or ME and HP. Healthcare professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/as CRD42021276465.

Combined training prescriptions for improving cardiorespiratory fitness, physical fitness, body composition, and cardiometabolic risk factors in older adults: Systematic review and meta-analysis of controlled trials

Background

Improved physical fitness is important for preventing COVID-19-related mortality. So, combined training can effectively increase peak oxygen consumption, physical fitness, body composition, blood pressure, and the healthrelated characteristics of adults; however, its impact in the elderly remains unclear.

Methods

This systematic review and meta-analysis aimed to evaluate the effects of combined training on older adults. Four electronic databases (PubMed, Scopus, Medline, and Web of Science) were searched (until April 2021) for randomized trials comparing the effect of combined training on cardiorespiratory fitness, physical fitness, body composition, blood pressure, and cardiometabolic risk factors in older adults.

Results

Combined training significantly improved peak oxygen consumption compared to no exercise (WMD = 3.10, 95% CI: 2.83 to 3.37). Combined resistance and aerobic training induced favorable changes in physical fitness (timed up-and-go = -1.06, 30-s chair stand = 3.85, sit and reach = 4.43, 6-minute walking test = 39.22, arm curl = 4.60, grip strength = 3.65, 10-m walk = -0.47, maximum walking speed = 0.15, one-leg balance = 2.71), body composition (fat mass = -2.91, body fat% = -2.31, body mass index = -0.87, waist circumference = -2.91), blood pressure (systolic blood pressure = -8.11, diastolic blood pressure = -4.55), and cardiometabolic risk factors (glucose = -0.53, HOMA-IR = -0.14, high-density lipoprotein = 2.32, total cholesterol = -5.32) in older individuals. Finally, the optimal exercise prescription was ≥ 30 min/session × 50-80% VO2peak, ≥ 3 times/week for ≥ 12 weeks and resistance intensity 70-75% one-repetition maximum, 8-12 repetitions × 3 sets.

Conclusions

Combined training improved VO2peak and some cardiometabolic risk factors in older populations. The dose-effect relationship varied between different parameters. Exercise prescriptions must be formulated considering individual needs during exercise.

Multicomponent Training in Progressive Phases Improves Functional Capacity, Physical Capacity, Quality of Life, and Exercise Motivation in Community-Dwelling Older Adults: A Randomized Clinical Trial

OBJECTIVE

To evaluate the effect of a multicomponent progressive training program (MPTP) on functionality, quality of life (QoL) and motivation to exercise (EM) in a group of older adults (OA) of a community.

METHODS

A total of 55 participants of 69.42 ± 6.01 years of age were randomized into two groups; experimental (EG:35) and control (CG:20), and subjected to 27 weeks of MPTP. Functionality (pre/post-intervention) was assessed using the Short Physical Performance Battery (SPPB), Time Up and Go (TUG), Walking While Talking Test (WWT), Manual Dynamometry (MD), Forced Expiratory Volume in the first second (FEV₁), Sit and Reach (SR), Back Scratch (BS), and walk for 2 min (2 mST). QoL was assessed using the SF-36 questionnaire and EM using the BREQ-3. The Kolmogorov-Smirnov and Levene tests were applied. A two-way repeated measures ANOVA was applied. A significance level of p < 0.05 was accepted for all comparisons.

RESULTS

The EG compared to the CG improved in SPPB (ΔEG/CG: 29.67%/p < 0.001), TUG (ΔEG/CG: 35.70%/p < 0.05), WWT (ΔEG/CG: 42.93%/p < 0.001), MD (ΔEG/CG: 20.40%/p < 0.05), FEV₁ (ΔEG/CG: 21.37%/p < 0.05), BS (ΔEG/CG: 80.34%/p < 0.05), 2 mST (ΔEG/CG: 33.02%/p < 0.05), SF-36 (ΔEG/CG: 13.85%/p < 0.001), and Intrinsic Regulation (ΔEG/CG: 27.97%/p < 0.001); Identified by regulation (ΔEG/CG: 9.29%/p < 0.05).

CONCLUSION

An MPTP improves functionality, QoL and EM, and is a safe and effective method for community OAs.

The effect of exercise on blood concentrations of angiogenesis markers in older adults: a systematic review and meta-analysis

Background

Physical exercise has positive impacts on health and can improve angiogenesis, which is impaired during aging, but the underlying mechanisms of benefit are unclear. This meta-analysis and systematic review investigated the effects of exercise on several peripheral angiogenesis markers in older adults to better understand the relationship between exercise and angiogenesis.

Methods

MEDLINE, Embase, and Cochrane CENTRAL were searched for original, peer-reviewed reports of peripheral concentrations of angiogenesis markers before and after exercise interventions in older adults (> 50 years). The risk of bias was assessed with standardized criteria. Standardized mean differences (SMD) with 95% confidence intervals (CIs) were calculated from random-effects models. Publication bias was assessed with Egger's test, funnel plots, and trim-and-fill. A priori subgroup analyses and meta-regressions were performed to investigate heterogeneity where possible.

Results

Of the 44 articles included in the review, 38 were included in meta-analyses for five proteins. Vascular endothelial growth factor (VEGF) was found to be higher after exercise (SMD[95%CI] = 0.18[0.03, 0.34], p = 0.02), and e-selectin (CD62E) was found to be lower after exercise (SMD[95%CI]= -0.72[-1.42, -0.03], p = 0.04). Endostatin (SMD[95%CI] = 0.28[-0.56, 1.11], p = 0.5), fibroblast growth factor 2 (SMD[95%CI] = 0.03[-0.18, 0.23], p = 0.8), and matrix metallopeptidase-9 (SMD[95%CI] = -0.26[-0.97, 0.45], p = 0.5) levels did not change after exercise.

Conclusions

Of the five angiogenesis blood markers evaluated in this meta-analysis, only VEGF and CD62E changed with exercise. Although more studies are needed, changes in angiogenesis markers may explain the beneficial effects of exercise on angiogenesis and health in older adults.

The Effects of Different Exercise Training Types on Body Composition and Physical Performance in Older Adults with Sarcopenic Obesity: A Systematic Review and Meta-Analysis

OBJECTIVES

To carry out a systematic review and meta-analysis to verify the effects of different exercise training types on body composition and physical performance in older adults with sarcopenic obesity (SO).

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Older adults (≥60 years).

METHODS

Database searches were performed in MEDLINE (via PubMed), EMBASE, Cochrane Library, Web of Science, SCOPUS, and LILACS on January 10th, 2023. We included: randomized and/or controlled clinical trials; physical exercise as an intervention; analysis of body composition and/or muscle function; and sarcopenic obesity diagnosis. We used the Risk of Bias 2 tool and PEDro scale. The GRADE certainty of evidence was also performed.

RESULTS

Fourteen studies were included in the systematic review and nine studies in the meta-analysis. A decrease in body fat (%) favoring the exercise group was identified (SMD: -0.34 [95% CI: -0.53 to -0.16]; p=0.0003) (GRADE: ⊕⊕⊕◯ Moderate). Only resistance training showed fat reduction (SMD: -0.27 [95% CI: -0.48 to -0.06]; p=0.01). Increases in upper (SMD: 0.41 [95% CI: 0.04 to 0.78]; p=0.03) (GRADE: ⊕⊕◯◯ Low) and lower (SMD: 0.80 [95% CI: 0.22 to 1.39]; p=0.007) (GRADE: ⊕⊕⊕⊕ High) limb strength was identified with exercise. Chair stand test showed increases with exercise (SMD: 0.73 [95% CI: 0.40 to 1.07]; p<0.0001) (GRADE: ⊕⊕⊕⊕ High), especially for resistance training (SMD: 0.62 [95% CI: 0.21 to 1.02]; p=0.003) and combined training (SMD: 0.99 [95% CI: 0.40 to 1.57]; p=0.0005). The PEDro scale for the studies in our review ranged from 3 to 8 (mean = 5.8 (1.6)), meaning fair methodological quality, and most studies were overall judged with at least low/some concerns in terms of risk of bias.

CONCLUSION AND IMPLICATIONS

Overall, moderate to high certainty of evidence was found for body fat, lower limb strength, and chair stand test. On the other hand, low certainty of evidence was found for upper limb strength. Resistance, combined, and aerobic training evoked divergent results between the variables analyzed. Although promising, our results should be considered sparingly, but may guide additional exercise recommendations to improve specific health parameters in older adults with SO.

The effects of low-volume combined training on health-related physical fitness outcomes in active young adults. A controlled clinical trial

The effects of combined training (CT) on improving general health are well known, however, few studies have investigated the effects of low-volume CT. So, the aim of this study is to investigate the effects of 6 weeks of low-volume CT on body composition, handgrip strength (HGS), cardiorespiratory fitness (CRF) and affective response (AR) to exercise. Eighteen healthy, active young adult man (mean ​± ​SD, [20.06 ± 1.66] years; [22.23 ± 2.76] ​kg/m²) performed either a low-volume CT (EG, n ​= ​9), or maintained a normal life (CG, n ​= ​9). The CT was composed of three resistance exercises followed by a high intensity-interval training (HIIT) on cycle ergometer performed twice a week. The measures of the body composition, HGS, maximal oxygen consumption ( V ˙ O_2max) and AR to exercise were taken at baseline and after training for analysis. Furthermore, an ANOVA test of repeated measures and t-test paired samples were used with a p ​≤ ​0.05. The results showed that EG improved HGS (pre: [45.67 ± 11.84] ​kg vs. post: [52.44 ± 11.90] ​kg, p ​< ​0.01) and V ˙ O_2max (pre: [41.36 ± 5.16] ​ml⋅kg^-1⋅min^-1 vs. post: [44.07 ± 5.98] ​ml⋅kg^-1⋅min^-1, p ​< ​0.01). Although, for all measures the body composition had not significant differences between weeks (p ​> ​0.05), nevertheless the feeling scale was positive in all weeks and without significant differences between them (p ​> ​0.05). Lastly, for active young adults, the low-volume CT improved HGS, CRF and had a positive outcome in AR, with less volume and time spent than traditional exercise recommendations.

Impact of Exercise on Vascular Function in Middle-Aged and Older Adults: A Scoping Review

There is a substantial literature gap related to the vascular response to different types of exercise training in middle-aged and older populations. Thus, this scoping review aimed to examine the outcomes of controlled trials testing the long-term effects of exercise interventions on vascular function-related outcomes in middle-aged and older populations. The literature search was conducted following PRISMA guidelines. Data sources: five databases were used (EBSCO, MEDLINE, Web of Science, Science Direct, and Google Scholar). Eligibility criteria: controlled trials, published in the last 10 years, in English, containing well-described exercise interventions, reporting vascular quantitative effects of exercise in middle-aged and older people. A total of 62 publications were included. The studies included distinct types and intensities of exercise and were heterogeneous in volume and frequency. The assessed vascular outcomes also presented considerable variability. Overall, most studies reported positive effects of exercise on vascular function outcomes, regardless of exercise characteristics. Different exercise interventions can be applied to improve vascular function in middle-aged and older adults. Studies on combined and stretching exercises reported encouraging results in improving vascular function. Stretching exercises rise as an effective alternative in promoting vascular function among older adults, while combined exercise delivered promising vascular benefits in both populations.

Effects of Combined Versus Multicomponent Training in Physically Active Women Aged 50-75 Years

Purpose: This study aimed to compare the effects of combined training (CT) and multicomponent training (MT) on different health parameters in physically active women aged between 50 and 75 years. Method: The participants were randomly divided into two training groups (CT and MT), lasting 180 min per week, for 14 consecutive weeks of training with the level of physical activity, anthropometric measurements, blood pressure, strength, cardiorespiratory skills, coordination, flexibility, agility, and quality of life. Results: Participants who underwent CT and MT training showed positive responses regarding the assessment of body mass, waist circumference, lower limb resistance and strength, upper limb strength, and mental domain related to the quality of life. However, only participants undergoing CT were able to increase agility and cardiorespiratory capacities. Conclusion: 14 weeks of CT were more efficient to improve physical capacities in physically active women aged between 50 and 75 years when compared to MT.

Impact of acute and chronic regular exercise on arterial stiffness and reflection measures in coronary artery disease patients: A Protocol for Randomized Clinical Trial

Vascular stiffness due to arteriosclerosis reduces arterial elasticity which is as an independent and non-invasive predictor of future incidence of coronary heart disease and stroke. There is limited evidence of the benefits of regular exercise on arterial stiffness in populations suffering from cardiovascular diseases (CVD) especially coronary artery disease (CAD).

Aim. To determine the acute and chronic effects of aerobic, resistance and combined exercise on arterial and hemodynamic function in patients with CAD.

Material and methods. This study will be a prospective, single-blind, randomized study examining the effects of exercise on arterial stiffness. The study will be conducted at a tertiary care hospital for a continuous period of one year. Patients with CAD (n=105) will be selected using systematic sampling techniques and allocated randomly to one of the four treatment groups using computer-generated, random number sequence for age, sex and health status of CAD (Group-I: aerobic exercise, Group-II: resistance exercise, Group-III: combined aerobic and resistance exercise, and Group-IV: control) as per the inclusion and exclusion criteria. All recruited subjects will be informed about the assessment and intervention procedure before getting the consent form filled. This project followed the guidelines of standard protocol for randomized clinical trials (spirit).

Perspective. It is expected that this study protocol shall through light and be helpful in better quality of life along with decline in drug dependency for the people suffering from CAD. Further this study will be valuable is designing exercise protocol for the people suffering from CAD.

Effect of Yijinjing combined with elastic band exercise on muscle mass and function in middle-aged and elderly patients with prediabetes: A randomized controlled trial

Introduction

This study investigated the effect of Yijinjing combined with elastic band exercise on muscle mass and muscle function in patients with prediabetes.

Methods

This study was a randomized controlled trial designed in parallel (Chinese Clinical Trial Registry: ChiCTR2000039049). Participants with prediabetes (n = 47) were randomly divided into control (n = 21, 63.5 ± 4.7 years,16 females) and exercise (n = 26, 62.0 ± 5.0 years, 20 females) groups. The former maintained their original lifestyle, and the latter received Yijinjing combined with elastic band exercise five times a week for 6 months. All the outcome measures were assessed immediately at baseline, after 3- and 6-month intervention.

Results

After 6-month of the exercise, the body weight, body mass index, leg fat mass, gynoid fat mass, and total body fat mass in exercise group were significantly decreased compared with those at baseline (p < 0.05). Compared with those at baseline, total lean mass decreased at 3 and 6 months in both groups. The total muscle mass loss in the exercise group was always less than that in control group at all time periods, but the difference was not statistically significant. Handgrip strength, gait speed, reaction time, leg power, eye-closed and single-legged standing, and sit-and-reach were significantly improved for the exercise group at 3 and 6 months (p < 0.05). Gait speed and reaction time between both groups at 3 and 6 months were significant different (p < 0.05), and leg power at 6 months (p < 0.05). Compared with baseline, the reaction time of control group at six months was significantly improved (p < 0.05), and no other significant changes were observed. Compared with those at baseline, fasting plasma glucose, 2-h post-meal plasma glucose, fasting insulin, total cholesterol, and insulin resistance index in exercise group gradually decreased, and growth hormone was gradually increased with significance at 6 months (p < 0.05). 25-hydroxyvitamin D gradually and significantly increased in both groups at 3 and 6 months (p < 0.05). But two groups’ testosterone levels weren’t significant change.

Conclusion

Yijinjing combined with elastic band exercise can substantially reduce the body weight and body fat content of middle-aged and elderly patients with Prediabetes, improve muscle function and growth hormone secretion, and delay muscle mass reduction and diabetes development.

Clinical trial registration

[http://www.chictr.org.cn/showproj.aspx?proj=62753], identifier [ChiCTR2000039049].

Effect of aquatic resistance interval training and dietary education program on physical and psychological health in older women: Randomized controlled trial

Due to demographic changes, the world’s population is progressively aging. The physiological deterioration of the older adult may lead to reduced balance capacity and increased risk of falls, among others, due to the prevalence of degenerative diseases. Physical exercise can be effective in reducing the risk of disease and slowing functional decline in older people. The aim of the research is to test the effects of aquatic resistance training and dietary education on health indicators, strength, balance, functional autonomy, perception of satisfaction with life. Thirty-four participants aged 69 ± 4 years were randomly assigned into two groups: experimental (aquatic resistance interval training) and control group (no intervention). The intervention consisted of resistance training in an aquatic environment carried out for 14 weeks (three sessions per week: 60 min each). All variables were analyzed twice; pre - post intervention. Aquatic resistance training has positive effects on strength (p &lt; 0.001), functional self-sufficiency (p &lt; 0.001) and aerobic capacity (p &lt; 0.001), however, no significant differences were observed in the perception of satisfaction with life and balance. Research results suggest that older women who engage in regular, scheduled aquatic resistance training have greater autonomy in performing activities of daily living, agility, gait control, and body composition variables (lower fat compartment and greater muscle mass).

Outcomes addressed in randomized controlled lifestyle intervention trials in community-dwelling older people with (sarcopenic) obesity-An evidence map

Obesity and sarcopenic obesity (SO) are characterized by excess body fat with or without low muscle mass affecting bio-psycho-social health, functioning, and subsequently quality of life in older adults. We mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community-dwelling older people with (sarcopenic) obesity. Systematic searches in Medline, Embase, Cochrane Central, CINAHL, PsycInfo, Web of Science were conducted. Two reviewers independently performed screening and extracted data on outcomes, outcome domains, assessment methods, units, and measurement time. A bubble chart and heat maps were generated to visually display results. Fifty-four RCTs (7 in SO) reporting 464 outcomes in the outcome domains: physical function (n = 42), body composition/anthropometry (n = 120), biomarkers (n = 190), physiological (n = 30), psychological (n = 47), quality of life (n = 14), pain (n = 4), sleep (n = 2), medications (n = 3), and risk of adverse health events (n = 5) were included. Heterogeneity in terms of outcome definition, assessment methods, measurement units, and measurement times was found. Psychological and quality of life domains were investigated in a minority of studies. There is almost no information beyond 52 weeks. This evidence map is the first step of a harmonization process to improve comparability of RCTs in older people with (sarcopenic) obesity and facilitate the derivation of evidence-based clinical decisions.

Effects of 12 weeks of aerobic exercise combined with resistance training on neurocognitive performance in obese women

Background/Objectives

To the best of our knowledge, there have been no previous studies conducted on the long-term effects of an exercise intervention on deficits in inhibitory control in obese individuals. The aim of this study was thus to examine the effect of 12 weeks of a combination of aerobic and resistance exercise on behavioral and cognitive electrophysiological performance involving cognitive interference inhibition in obese individuals.

Methods

Thirty-two qualified healthy obese women were randomly divided into either an exercise group (EG, age: 34.76 ± 5.52 years old; BMI: 29.35 ± 3.52 kg/m²) or a control group (CG, age: 33.84 ± 7.05 years old; BMI: 29.61 ± 4.31 kg/m²). All participants performed the Stroop task, with electrophysiological signals being collected simultaneously before and after a 12-week intervention. The estimated V̇O₂max, muscular strength, and body fat percentage (measured with dual-energy X-ray absorptiometry) were also assessed within one week before and after the intervention. Participants in the EG group engaged in 30 min of moderate-intensity aerobic exercise combined with resistance exercise, 5 sessions per week for 12 weeks, while the participants in the CG group maintained their regular lifestyle without engaging in any type of exercise.

Results

The results revealed that although a 12-week exercise intervention did not enhance the behavioral indices [e.g., accuracy rates (ARs) and reaction times (RTs)] in the EG group, significantly shorter N2 and P3 latencies and greater P2 and P3 amplitudes were observed. Furthermore, the fat percentage distribution (e.g. total body fat %, trunk fat %, and leg fat %) and level of physical fitness (e.g. estimated V̇O₂max and muscular strength) in the EG group were significantly improved. The changes prior to and after the intervention in the P3 amplitude and trunk fat percentage were significantly negatively correlated in the EG group (r = −0.521, p = 0.039).

Conclusions

These findings suggested that 12 weeks of aerobic exercise combined with resistance exercise in obese women affects cognitive function broadly, but not specifically in terms of inhibitory control. The percentage of decreased trunk fat may play a potential facilitating role in inhibition processing in obesity.

Implementation of exercise countermeasures during spaceflight and microgravity analogue studies: Developing countermeasure protocols for bedrest in older adults (BROA)

Significant progress has been made in the development of countermeasures to attenuate the negative consequences of prolonged exposure to microgravity on astronauts’ bodies. Deconditioning of several organ systems during flight includes losses to cardiorespiratory fitness, muscle mass, bone density and strength. Similar deconditioning also occurs during prolonged bedrest; any protracted time immobile or inactive, especially for unwell older adults (e.g., confined to hospital beds), can lead to similar detrimental health consequences. Due to limitations in physiological research in space, the six-degree head-down tilt bedrest protocol was developed as ground-based analogue to spaceflight. A variety of exercise countermeasures have been tested as interventions to limit detrimental changes and physiological deconditioning of the musculoskeletal and cardiovascular systems. The Canadian Institutes of Health Research and the Canadian Space Agency recently provided funding for research focused on Understanding the Health Impact of Inactivity to study the efficacy of exercise countermeasures in a 14-day randomized clinical trial of six-degree head-down tilt bedrest study in older adults aged 55–65 years old (BROA). Here we will describe the development of a multi-modality countermeasure protocol for the BROA campaign that includes upper- and lower-body resistance exercise and head-down tilt cycle ergometry (high-intensity interval and continuous aerobic exercise training). We provide reasoning for the choice of these modalities following review of the latest available information on exercise as a countermeasure for inactivity and spaceflight-related deconditioning. In summary, this paper sets out to review up-to-date exercise countermeasure research from spaceflight and head-down bedrest studies, whilst providing support for the proposed research countermeasure protocols developed for the bedrest study in older adults.

Effect of Exercise Training on Body Composition and Inflammatory Cytokine Levels in Overweight and Obese Individuals: A Systematic Review and Network Meta-Analysis

Objective

This study aimed to compare and rank the effectiveness of aerobic exercise (AE), resistance training (RT), combined aerobic and resistance training (CT), and high-intensity interval training (HIIT) on body composition and inflammatory cytokine levels in overweight and obese individuals by using network meta-analysis (NMA).

Methods

We searched the PubMed, Cochrane, Embase, Web of Science, and EBSCO databases to identify randomized controlled trials investigating the effects of exercise training on inflammatory cytokines in overweight and obese patients. The retrieval period was from inception to November 2021. Two reviewers independently screened the retrieved articles, extracted the pertinent data, and assessed the risk of bias of the included studies; then, they used Stata 16.0 and Review Manager 5.3 to perform an NMA.

Results

A total of 38 studies involving 1317 patients were included in this study. The results of the NMA indicated that AE had the greatest effect on weight loss (SUCRA=78.3; SMD=−0.51, 95% CI: −0.70, −0.33); CT had the greatest effect on reducing body mass index (SUCRA=70.7; SMD=−0.46, 95% CI: −0.81, −0.10), waist circumference (SUCRA=93.4; SMD=−1.86, 95% CI: −2.80, −0.93), percentage body fat (SUCRA=79.6; SMD=−1.38, 95% CI: −2.29, −0.48), interleukin-6 level (SUCRA=86.4; SMD=−1.98, 95% CI: −3.87, −0.09), and tumor necrosis factor-α level (SUCRA=79.4; SMD=−2.08, 95% CI: −3.75, −0.42); AE (SMD=0.51, 95% CI: −1.68, 2.69), RT (SMD=0.15, 95% CI: −3.01, 3.32), CT (SMD=1.78, 95% CI: −1.35, 4.92), and HIIT (SMD=2.29, 95% CI: −1.27, 5.86) did not significantly increase the adiponectin level.

Conclusion

The current results suggest that CT is the best exercise modality for improving body composition and inflammatory status in overweight and obese individuals. More rigorous randomized control trials are needed for further validation.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022303165.

Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests

Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges’ g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41–1.01; I² = 0%) and lower (effect size, 1.37; 95% CI, 0.84–1.91; I² = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20–1.01; I² = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06–0.87; I² = 31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42–0.63; I² = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up.

Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta-analysis

To systematically review and analyze the effects of resistance-based exercise programs on body composition, regional adiposity, and body weight in individuals with overweight/obesity across the lifespan. Using PRISMA guidelines, randomized controlled trials were searched in nine electronic databases up to December 2020. Meta-analyses were performed using random-effects model. One-hundred sixteen articles describing 114 trials (n = 4184 participants) were included. Interventions involving resistance training and caloric restriction were the most effective for reducing body fat percentage (ES = -3.8%, 95% CI: -4.7 to -2.9%, p < 0.001) and whole-body fat mass (ES = -5.3 kg, 95% CI: -7.2 to -3.5 kg, p < 0.001) compared with groups without intervention. Significant results were also observed following combined resistance and aerobic exercise (ES = -2.3% and -1.4 kg, p < 0.001) and resistance training alone (ES = -1.6% and -1.0 kg, p < 0.001) compared with no training controls. Resistance training alone was the most effective for increasing lean mass compared with no training controls (ES = 0.8 kg, 95% CI: 0.6 to 1.0 kg, p < 0.001), whereas lean mass was maintained following interventions involving resistance training and caloric restriction (ES = ~ - 0.3 kg, p = 0.550-0.727). Results were consistently observed across age and sex groups (p = 0.001-0.011). Reductions in regional adiposity and body weight measures were also observed following combined resistance and aerobic exercise and programs including caloric restriction (p < 0.001). In conclusion, this study provides evidence that resistance-based exercise programs are effective and should be considered within any multicomponent therapy program when caloric restriction is utilized in individuals with overweight or obesity.

Physical Exercise and Health: A Focus on Its Protective Role in Neurodegenerative Diseases

Scientific evidence has demonstrated the power of physical exercise in the prevention and treatment of numerous chronic and/or age-related diseases, such as musculoskeletal, metabolic, and cardiovascular disorders. In addition, regular exercise is known to play a key role in the context of neurodegenerative diseases, as it helps to reduce the risk of their onset and counteracts their progression. However, the underlying molecular mechanisms have not yet been fully elucidated. In this regard, neurotrophins, such as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glia cell line-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4), have been suggested as key mediators of brain health benefits, as they are involved in neurogenesis, neuronal survival, and synaptic plasticity. The production of these neurotrophic factors, known to be increased by physical exercise, is downregulated in neurodegenerative disorders, suggesting their fundamental importance in maintaining brain health. However, the mechanism by which physical exercise promotes the production of neurotrophins remains to be understood, posing limits on their use for the development of potential therapeutic strategies for the treatment of neurodegenerative diseases. In this literature review, we analyzed the most recent evidence regarding the relationship between physical exercise, neurotrophins, and brain health, providing an overview of their involvement in the onset and progression of neurodegeneration.

Effect of Exercise Training on Arterial Stiffness in Overweight or Obese Populations

The purpose was to analyze the effects of exercise training (ET) on arterial stiffness in all-age overweight or obese individuals. Sixty-one trials were included with ET improving flow-mediated dilation (FMD), pulse wave velocity (PWV), and intima-media thickness (IMT). In the subgroup analysis: (i) ET improved FMD in overweight or obese children and adolescents with a large effect size (SMD=0.83, 95% CI 0.42–1.25). PWV was decreased after ET regardless of age. IMT was decreased by ET in participants younger than 60, (ii) ET improved FMD, PWV, and IMT in participants whose BMI were smaller than 30 kg/m ² , but ET only improved PWV of participants whose BMI were larger than 30 kg/m ² . (iii) AE improved FMD, PWV, and IMT. High-intensity interval training (HIIT) decreased IMT. (iv) The increase of FMD only happened when training duration was longer than eight weeks. However, ET decreased PWV when the training duration was no longer than 12 weeks. IMT was decreased when the training duration was longer than eight weeks. ET instigated an improvement in endothelial function and arterial stiffness in overweight or obese populations, but depending on the different characteristics of exercise intervention and participants’ demographics.

Comparison of Vascular Function, Cardiometabolic Parameters, Hemorheological Function, and Cardiorespiratory Fitness Between Middle-Aged Korean Women With and Without Obesity—A Pilot Study

This study aimed to compare vascular function, cardiometabolic parameters, hemorheological function, and cardiorespiratory fitness in middle-aged Korean women according to obesity defined using body mass index (BMI). A total of 32 Korean women aged between 34 and 60 years (16 without obesity, mean age 46.31 ± 7.49 years and 16 with obesity, mean age 49.68 ± 6.69 years) participated in this study. Obesity was defined as BMI ≥ 25 kg/m2. The body composition, vascular function, cardiometabolic parameters, hemorheological function, and cardiorespiratory fitness of all participants were measured. Statistical differences in the dependent parameters between individuals with and without obesity were analyzed, and the correlations between BMI and the dependent variables were verified. The obese group showed significantly worse results (p &lt; 0.05) for body composition (significantly higher weight, BMI, fat mass, and percent body fat), vascular function [significantly higher branchial ankle pulse wave velocity (baPWV) and lower flow-mediated vasodilation (FMD)], cardiometabolic parameters [significantly higher insulin and homeostatic model assessment for insulin resistance (HOMA-IR)], hemorheological function (significantly lower erythrocyte deformability and higher aggregation), and cardiorespiratory fitness [significantly lower maximal oxygen uptake (VO2max)] compared to the non-obese group. In addition, BMI showed a significant positive correlation (p &lt; 0.05) with baPWV (r = 0.430); total cholesterol (r = 0.376), triglyceride (r = 0.411), low-density lipoprotein cholesterol (r = 0.462), and insulin (r = 0.477) levels; HOMA-IR (r = 0.443); and erythrocyte aggregation (r = 0.406), and a significant negative correlation (p &lt; 0.05) with VO2max (r = −0.482) and FMD (r = −0.412). Our study confirmed that obesity is a major determinant for deterioration of vascular function, cardiometabolic parameters, hemorheological function, and cardiorespiratory fitness.

Occupational Health Aspects with Special Focus on Physiological Differences between Office and Metalworkers

Physical workload adversely impacts inflammation, oxidative stress and mood in heavy workers. We compared these risk parameters between metalworkers (n = 20) and office workers (n = 30), including gender differences. Blood samples were analyzed with thirty parameters to overview endocrinology, inflammation, and psychological and oxidative stress. Despite an adequate antioxidative supply, oxidative stress occurred in metalworkers, as indicated by significantly increased peroxide and homocysteine (Hcy) levels. Moreover, increased concentrations were observed in this group regarding psychological stress and diet-related parameters. Sex-specific differences were determined for physical dimensions, dehydroepiandrosterone sulfate (DHEAS), Hcy, uric acid, triglycerides, osmolality, anti-Mullerian hormone (AMH) and testosterone. Age-associated differences were observed for DHEAS, glycosylated hemoglobin, adrenaline, AMH and testosterone. In male office workers, the body mass index was associated with increased LDL-HDL, cholesterol-HDL and homeostatic model assessment of insulin resistance (HOMA-IR). In conclusion, these results indicate increased oxidative stress and psychological stress in heavy workers independently of adequate antioxidant sustenance. The sedentary occupation of office workers, in turn, favored diseases of affluence. This might be particularly relevant for long-term occupied persons and older workers due to a hormonal shift coming along, given the risk for oxidative stress-related diseases such as cardiovascular disease, particularly in the case of males, based on their lifestyle habits.

The Impact of Aquatic Exercise Programs on the Intima-Media thickness of the Carotid Arteries, Hemodynamic Parameters, Lipid Profile and Chemokines of Community-Dwelling Older Persons: A Randomized Controlled Trial

Scientific evidence has shown that physical exercise is an effective way of improving several cardiovascular disease markers. However, few studies have tested its effectiveness when performed in aquatic environments. The purpose of this study was to test the impact of different aquatic exercise programs on the intima-media thickness of carotid arteries (IMT) and hemodynamic and biochemical markers of cardiovascular diseases in community-dwelling older persons. A total of 102 participants were randomly allocated into four groups: an aerobic exercise group (AerG) (n = 25, 71.44 ± 4.84 years); an aerobic interval group (IntG) (n = 28, 72.64 ± 5.22 years); a combined group (ComG) (n = 29, 71.90 ± 5.67 years); and a control group (CG) (n = 20, 73.60 ± 5.25 years). The AerG, IntG, and ComG participants took part in three different aquatic exercise programs for 28 weeks. The CG participants maintained their usual routines. All participants were evaluated for IMT, blood pressure, lipid profile, and MCP-1 and MIP-1α chemokines, pre- and post-intervention. Significant differences were found in the AerG for diastolic diameter (DD), in the IntG for peak systolic velocity (PSV), and in the ComG for DD and end-diastolic velocity (EDV). Regarding blood pressure, significant differences were found in AerG for systolic blood pressure (SBP) and diastolic blood pressure (DBP); in IntG for DBP; and in ComG for SBP, DBP, and heart rate (HR). Significant differences were found in the AerG and IntG for glucose (GLU). Lower plasma levels of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein (MIP-1α) were found in the AerG and in the ComG for MCP-1 after the intervention. Aquatic physical exercise appears to improve cardiovascular health, regardless of the type of the program adopted. Aerobic programs (combined and continuous aerobic exercises) seemed to have a more beneficial effect in reducing important cardiovascular risk markers.

Estimation of Behavior Change Stage from Walking Information and Improvement of Walking Volume by Message Intervention

Lifestyle-related diseases are a major problem all over the world although exercising can prevent them. Therefore, it is necessary to encourage users to exercise regularly and to support their exercises. The purpose of this study is to investigate whether the estimation of behavior change stages can be predicted from the gait information obtained from wearable devices, and whether message interventions created based on the behavior change stages are effective in improving the amount of walking. As for the estimation of the behavior change stages, we investigated whether the behavior change stages could be correctly estimated compared with the ones obtained from the questionnaire. As for the effect of the message, we compared the period of no intervention with that of intervention to examine whether there was any change in the amount of walking. As a result of the experiment, we could not properly estimate the behavior change stage of users, but we found that the message intervention improved the amount of walking for many subjects. This suggests that further research is needed to estimate the stage of behavior change. However, message intervention is confirmed as an effective means to improve walking volume.

Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness

Large artery stiffness (LAS) has proven to be an independent risk factor for cardiovascular disease and mortality. Nevertheless, the position of current hypertension guidelines regarding the usefulness of assessing LAS differs across different continents. In general, European Guidelines recognize pulse wave velocity (PWV) as a marker of target organ damage but do not recommend its systematic use in general population. Asian guidelines consider PWV as a recommended test at diagnosis of hypertension, in contrast to North American guidelines that do not state any position about its usefulness. However, PWV predicts cardiovascular events, and several studies have shown that it improves risk classification adjusting for established risk factors especially for intermediate-risk patients. Finally, some advances have been made related to treatments affecting LAS. Dietary interventions such as sodium restriction and exercise-based interventions have a modest effect in reducing LAS. Pharmacological interventions, such as statins, or more recent advances with mineralocorticoid blocker seem to have a beneficial effect. Last, controversial effects of renal denervation on LAS have been found. Our goal here is to update the reader on LAS on these areas since the 2015 American Heart Association Scientific Statement.

Multicomponent Exercise Program for Improvement of Functional Capacity and Lipidic Profile of Older Women with High Cholesterol and High Triglycerides

Background: Physical inactivity is a primary cause of most chronic diseases. In addition, the negative effects of aging, physical inactivity and dyslipidemia are risk factors for cardiovascular diseases of older women. Exercise is considered fundamental for the treatment and prevention due to the benefits in the health of this population, but detraining periods after exercise can reverse them. Multicomponent exercise (ME) is a combined method of aerobic and resistance training that can improve the lipidic profile of older women with high cholesterol and triglycerides. Methods: Seventeen older women (EG: 65.3 ± 4.7 years, 1.52 ± 4.12 m) followed a supervised ME program of nine months and three months of detraining (DT), and fifteen older women (CG: 66.4 ± 5.2 years, 1.54 ± 5.58 cm) continued their daily routine, without exercise. Total cholesterol (TC), triglycerides (TG), blood glucose (GL) and functional capacity (FC) were evaluated at the beginning and at the end of the program and after three months of DT. Results: ME program improved (p < 0.05) lipidic profile: GL (−15.6%), TC (−15.3%), TG (−19.3%) and FC: agility (−13.3%), lower body strength (27.78%), upper body strength (26.3%), cardiorespiratory capacity (11.2%), lower body flexibility (66.67%) and upper body flexibility (85.72%). DT declined the lipidic profile and FC (p < 0.05). Conclusion: Lipidic profile and functional capacity can be improved with nine months of ME. Besides the negative effects of DT, three months were not enough to reverse the benefits of exercise in older women with high values of TG and TC.

Effects of Combined Resistance and Aerobic Training on Arterial Stiffness in Postmenopausal Women: A Systematic Review

The aim of this systematic review was to investigate the effects of combined resistance and aerobic exercise on arterial stiffness in postmenopausal women. Two databases, PubMed and Google Scholar were searched to identify relevant studies. The methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) scale. Only seven studies met the eligibility criteria, and their outcomes were presented. Four studies demonstrated the effects of combined resistance and aerobic training, while three showed the effectiveness of exercise with both training components, aerobic and resistance. In all studies, arterial stiffness was measured by brachial–ankle pulse wave velocity (baPWV). Participants were middle-aged or older postmenopausal women of various health statuses (hypertensive, with comorbidities or healthy). The results unequivocally show that combined training reduces arterial stiffness. The most important finding of this review paper is that the applied type of exercise decreased baPWV in the range of 0.6–2.1 m/s. Moreover, combined resistance and aerobic exercise for 12 weeks, performed three times a week for about 60 min per training session, at a moderate intensity (40–60% HRR or HRmax), may be clinically meaningful to the cardiovascular system. In conclusion, we can say that combined resistance and aerobic training, or exercise with resistance and aerobic components, have important health implications for the prevention of cardiovascular disease and the maintenance or improvement of health in middle-aged and older postmenopausal women with different health conditions.

The Effect of a Mixed Circuit of Aerobic and Resistance Training on Body Composition in Older Adults-Retrospective Study

Ageing is inevitably associated with body composition changes, such as loss of muscle mass, increase in the total fat mass, and unfavorable reduction of subcutaneous fat. Physical activity exerts significant effects on the body composition. The aim of the study was to investigate the effects of two different weekly doses of resistance-aerobic training on the body composition in older people. The study consisted in a retrospective data analysis of fitness club members aged ≥60. The trainees participated in resistance-aerobic training sessions two or three times/week for a minimum of two months. A body composition analysis was performed before and after the training sessions. Group 1 (36 subjects) and Group 2 (28 subjects) had two and three training sessions/week, respectively. A higher skeletal muscle mass was found in Group 1 and lower waist-hip-ratio indices were observed in Group 2. No statistically significant differences were found in the body mass, skeletal muscle mass, fat mass, total body water, lean mass, body mass index, visceral fat area between both groups. The number of training session/week proved to be statistically insignificant for all investigated variables. Resistance-aerobic training with two sessions/week may be as effective in maintaining proper body composition in older people as the same training at the dose of three sessions/week.

Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest-Posttest Study

BACKGROUND

A scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring.

OBJECTIVE

The aim of this study was to investigate whether a year-long cloud platform-based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers' health outcomes.

METHODS

A total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest-posttest design. After being assessed in terms of physical activity, health-related lifestyle, history of chronic diseases and drug use, family history of disease and cardiovascular function, body composition, bone mineral density, and physical fitness through an eHealth promotion system, participants with relative contraindications for exercise were personally prescribed the health care exercise mode by an intelligent system, while those without relative contraindication and who had a regular exercise habit were prescribed the scientific fitness mode. Paired t tests were used for the analysis.

RESULTS

A total of 97 participants were classified into the health care mode, and the remaining 80 participants were assigned to the scientific fitness mode. Significant changes in heart rate (mean difference [MD] 2.97; 95% CI 1.1-4.84; P=.002), subendocardial viability ratio (MD -0.13; CI: -1.19 to -0.63; P<.001), weight (MD 0.99; CI 0.29-1.69; P=.006), BMI (MD 0.38; CI 0.11-0.64; P=.006), body fat rate (MD 0.88; CI 0.24-1.51; P=.007), fat mass (MD 0.92; CI 0.33-1.53; P=.003), and brachial-ankle pulse wave velocity (MD: -0.72; CI -1.17 to -0.27; P=.002) were observed among participants with the health care mode exercise prescriptions at the 12-month postintervention versus the baseline assessment, while no changes in systolic blood pressure, diastolic blood pressure, muscle mass, bone mineral density, t value, z value, balance, or ability were discerned. The results showed a functional decline in the physical fitness of both groups, including in handgrip strength (healthcare mode: MD 4.41; scientific fitness mode: MD 3.11), vital capacity (healthcare mode: MD 261.99; scientific fitness mode: MD 250.78), and agility (healthcare mode MD=-0.35; scientific fitness mode: MD=-0.39) with all P values <.001, except handgrip strength in the scientific fitness mode (P=.002). There were no significant differences in other parameters among participants with scientific fitness mode exercise prescriptions.

CONCLUSIONS

The observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.