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High-Intensity Interval Training is Safe, Feasible and Efficacious in Nonalcoholic Steatohepatitis: A Randomized Controlled Trial. Dig Dis Sci 2022; 68:2123-2139. [PMID: 36538276 PMCID: PMC9763796 DOI: 10.1007/s10620-022-07779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND High-Intensity Interval Training (HIIT) involves bursts of high-intensity exercise interspersed with lower-intensity exercise recovery. HIIT may benefit cardiometabolic health in people with nonalcoholic steatohepatitis (NASH). AIMS We aimed to examine the safety, feasibility, and efficacy of 12-weeks of supervised HIIT compared with a sham-exercise control (CON) for improving aerobic fitness and peripheral insulin sensitivity in biopsy-proven NASH. METHODS Participants based in the community [(n = 14, 56 ± 10 years, BMI 39.2 ± 6.7 kg/m2, 64% male), NAFLD Activity Score 5 (range 3-7)] were randomized to 12-weeks of supervised HIIT (n = 8, 4 × 4 min at 85-95% maximal heart rate, interspersed with 3 min active recovery; 3 days/week) or CON (n = 6, stretching; 3 days/week). Safety (adverse events) and feasibility determined as ≥ 70% program completion and ≥ 70% global adherence (including session attendance, interval intensity adherence, and duration adherence) were assessed. Changes in cardiorespiratory fitness (V̇O2peak), exercise capacity (time-on-test) and peripheral insulin sensitivity (euglycemic hyperinsulinemic clamp) were assessed. Data were analysed using ANCOVA with baseline value as the covariate. RESULTS There were no HIIT-related adverse events and HIIT was globally feasible [program completion 75%, global adherence 100% (including adherence to session 95.4 ± 7.3%, interval intensity 95.3 ± 6.0% and duration 96.8 ± 2.4%)]. A large between-group effect was observed for exercise capacity [mean difference 134.2 s (95% CI 19.8, 248.6 s), ƞ2 0.44, p = 0.03], improving in HIIT (106.2 ± 97.5 s) but not CON (- 33.4 ± 43.3 s), and for peripheral insulin sensitivity [mean difference 3.4 mg/KgLegFFM/min (95% CI 0.9,6.8 mg/KgLegFFM/min), ƞ2 0.32, p = 0.046], improving in HIIT (1.0 ± 0.8 mg/KgLegFFM/min) but not CON (- 3.1 ± 1.2 mg/KgLegFFM/min). CONCLUSIONS HIIT is safe, feasible and efficacious for improving exercise capacity and peripheral insulin sensitivity in people with NASH. CLINICAL TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (anzctr.org.au) identifier ACTRN12616000305426 (09/03/2016).
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Lendeckel F, Zylla S, Markus MRP, Ewert R, Gläser S, Völzke H, Albrecht D, Friedrich N, Nauck M, Felix SB, Dörr M, Bahls M. Association of Cardiopulmonary Exercise Capacity and Adipokines in the General Population. Int J Sports Med 2022; 43:616-624. [PMID: 35114706 DOI: 10.1055/a-1699-2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adipokines and cardiorespiratory fitness (CRF) are associated with the (patho)physiology of cardiometabolic diseases. Whether CRF and adipokines are related is unclear. We investigated associations of CRF with leptin, adiponectin, chemerin, resistin and vaspin. Data from the population-based Study of Health in Pomerania was used (n=1,479; median age 49 years; 51% women). Cardiopulmonary exercise testing was used to measure CRF. Circulating adipokine concentrations were measured by enzyme-linked immunosorbent assay. The association between CRF and adipokines was assessed using multivariable sex-specific quantile regression models. Higher maximum oxygen uptake was significantly associated with lower leptin (men:-0.11 ng/ml; 95%-confidence interval [CI]:-0.18 to-0.03 ng/ml; p<0.005; women:-0.17 ng/ml; 95%-CI:-0.33 to-0.02 ng/ml; p<0.05) and chemerin (men:-0.26 ng/ml; 95%-CI:-0.52 to-0.01 ng/ml; p<0.05; women:-0.41 ng/ml; 95%-CI:-0.82 to-0.01 ng/ml; p<0.05) as well as higher adiponectin concentrations (men: 0.06 µg/ml; 95%-CI: 0.02 to 0.11 µg/ml; p<0.05; women: 0.03 µg/ml; 95%-CI:-0.05 to 0.10 µg/ml; p=0.48). We found that CRF was inversely associated with leptin and chemerin in both sexes and positively associated with adiponectin only in men.
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Affiliation(s)
- Frederik Lendeckel
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany.,Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Stephanie Zylla
- Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany.,Institute for Clinical Chemistry and Laboratory Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany.,Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany.,Institute of Community Medicine, Universitatsmedizin Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sven Gläser
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany.,Clinic for Internal Medicine, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Henry Völzke
- Institute of Community Medicine, Universitatsmedizin Greifswald, Greifswald, Germany.,Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Berlin, Germany
| | - Diana Albrecht
- Institute of Community Medicine, Universitatsmedizin Greifswald, Greifswald, Germany.,Leibniz Institute Greifswald, Leibniz Institute for Plasma Science and Technology eV, Greifswald, Germany
| | - Nele Friedrich
- Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany.,Institute for Clinical Chemistry and Laboratory Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany.,Institute for Clinical Chemistry and Laboratory Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany.,Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Marcus Dörr
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany.,Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
| | - Martin Bahls
- Department for Internal Medicine B, Universitätsmedizin Greifswald, Greifswald, Germany.,Partner-site Greifswald, Deutsches Zentrum für Herz-Kreislauf-Forschung eV, Greifswald, Germany
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Duruturk N. Telerehabilitation intervention for type 2 diabetes. World J Diabetes 2020; 11:218-226. [PMID: 32547696 PMCID: PMC7284018 DOI: 10.4239/wjd.v11.i6.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/02/2020] [Accepted: 04/19/2020] [Indexed: 02/05/2023] Open
Abstract
Diabetes has become an increasingly important health problem worldwide due to its prevalence. Although effective treatments for diabetes management have been developed, many patients have difficulty in achieving their therapeutic goals. Regular exercise training is suggested to prevent or delay the symptoms and complications of type 2 diabetes along with other medical treatments. It has become necessary to develop new rehabilitation models and practices in order to cope with the changing needs of the population. Treatment models using technology can be effective in disease management. Telerehabilitation may be effective as part of the rehabilitation program in the home environment, especially for patients who are unable to participate in conventional center-based rehabilitation due to transport difficulties or work resumption. Telerehabilitation is defined as the delivery of rehabilitation services via telecommunication technology, including phone, internet, and videoconference communications between the patient and health care provider. It is possible that telerehabilitation may benefit people with type 2 diabetes in similar ways with telemonitoring and interactive health communication systems. Although the applicability of telehealth methods has been proven in previous studies, telerehabi-litation studies in type 2 diabetes are inadequate in the literature. With larger, multi-centered randomized controlled studies, established clinical guidelines can be developed that will ultimately improve patient outcomes.
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Affiliation(s)
- Neslihan Duruturk
- Department of Physiotherapy and Rehabilitation, Baskent University, Faculty of Health Sciences, Ankara 06790, Turkey
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Nambu H, Takada S, Fukushima A, Matsumoto J, Kakutani N, Maekawa S, Shirakawa R, Nakano I, Furihata T, Katayama T, Yamanashi K, Obata Y, Saito A, Yokota T, Kinugawa S. Empagliflozin restores lowered exercise endurance capacity via the activation of skeletal muscle fatty acid oxidation in a murine model of heart failure. Eur J Pharmacol 2020; 866:172810. [DOI: 10.1016/j.ejphar.2019.172810] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023]
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Bonaventura A, Carbone S, Dixon DL, Abbate A, Montecucco F. Pharmacologic strategies to reduce cardiovascular disease in type 2 diabetes mellitus: focus on SGLT-2 inhibitors and GLP-1 receptor agonists. J Intern Med 2019; 286:16-31. [PMID: 30888088 DOI: 10.1111/joim.12890] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients with type 2 diabetes mellitus (T2D) present an increased risk for cardiovascular (CV) complications. In addition to improvement in glycaemic control, glucose-lowering therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-dependent glucose cotransporter (SGLT)-2 inhibitors, have been shown to significantly reduce CV events. In 2008, the US Food and Drug Administration mandated that all new glucose-lowering drugs undergo CV outcomes trials (CVOTs) to determine their CV safety. These trials have largely demonstrated no major CV safety concerns. Most notably, the GLP-1RAs and SGLT-2 inhibitors have been found to be not only safe, but also cardioprotective compared to placebo. The SGLT-2 inhibitors have opened a new perspective for clinicians treating patients with T2D and established CV disease in light of their 'pleiotropic' effects, specifically on heart failure, while GLP-1RAs seem to present more favourable effects on atherosclerotic events. In this review, we discuss the role of GLP-1RAs and SGLT-2 inhibitors to reduce CV risk in T2D patients and suggest an individualized therapeutic approach in this population based on the presence of metabolic and CV comorbidities.
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Affiliation(s)
- A Bonaventura
- the First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - S Carbone
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - D L Dixon
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - A Abbate
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia, USA
| | - F Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino -Italian Cardiovascular Network, Genoa, Italy
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