Evidence for sex differences in cardiovascular aging and adaptive responses to physical activity

Sex-Specific Patterns in Blood Pressure and Vascular Parameters: The MUJER-EVA Project

Recent evidence suggests that sex-related differences in cardiovascular health extend beyond traditional risk factors, affecting vascular structure and function. This study aimed to examine sex differences in vascular parameters, including central and peripheral blood pressure, pulse wave velocity (PWv), augmentation index at 75 bpm (AIx75), cardiac output, stroke volume, and peripheral vascular resistance, using harmonized data from three population-based cohorts (EVasCu, VascuNET, and ExIC-FEp) as part of the MUJER-EVA project. A total of 669 adult participants were included in this pooled cross-sectional analysis. Sex-stratified comparisons were conducted using multiple linear regression models adjusted for anthropometric, sociodemographic, and clinical covariates. The results showed that men had significantly higher values for central and peripheral blood pressure (p < 0.001), PWv (p = 0.003), cardiac output (p < 0.001), and stroke volume (p < 0.001), whereas women presented higher values of AIx75 (p < 0.001) and peripheral vascular resistance (p = 0.002). These differences remained statistically significant after full adjustment for potential confounders. These findings highlight the need to consider sex as a key biological variable in cardiovascular research and clinical decision-making. Incorporating sex-specific reference values and personalized treatment strategies could improve vascular health assessment and the effectiveness of cardiovascular disease prevention.

Sex-specific molecular drivers of cardiac fibrosis in aging hearts

The aging population, defined as individuals 65 years or older, is rapidly increasing, with age as the most significant and independent risk factor for cardiovascular diseases (CVD). Older women show greater susceptibility to cardiac remodeling and dysfunction compared to men. Despite this, the specific molecular drivers of sex differences in cardiac aging remain poorly understood. In this study, cardiac fibrosis and gene expression profiles were investigated in left atrial appendage samples obtained from 24 consecutive patients undergoing cardiac surgery. Using Masson's trichrome staining, we found that cardiac fibrosis significantly increased with age in females (p = 0.02) but not in males (p = 0.27). A subsequent medium-throughput gene expression analysis targeting approximately 800 cardiovascular genes revealed no differences in overall cardiac gene expression between sexes based on principal component analyses (PCA). However, pathway-specific analyses identified the thrombosis and hemostasis pathway as prominently dysregulated in females. Specifically, older females showed significant upregulation of PTPN1, PTPN11, and RAPGEF4, genes implicated in cardiac remodeling and metabolic health, compared to younger females, while males exhibited no significant changes across the age range. Correlation analyses confirmed significant positive associations between PTPN1, PTPN11, and RAPGEF4 expression and age in females but not in males. These findings suggest that aging in females is associated with cardiac fibrosis, which is likely driven by the sex-specific upregulation of key genes within the thrombosis and hemostasis pathway.

Sex Differences in Cardiovascular Adaptations Following Aerobic Exercise Training Programs: A Systematic Review and Meta-analysis

BACKGROUND

The influence of aerobic exercise training on cardiovascular adaptations in healthy males vs. females is unclear. This systematic review and meta-analysis summarized sex-based differences in cardiac adaptations following aerobic exercise training interventions in healthy adults.

METHODS

Five electronic databases were searched from inception to June 2024. Cardiac adaptation data included peak oxygen uptake, heart rate, arteriovenous oxygen difference, systolic and diastolic blood pressure, stroke volume, cardiac output, left ventricular (LV) mass, LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), and LV ejection fraction (LVEF). Meta-analyses were conducted in RevMan 5.4.

RESULTS

Meta-analyses were conducted on 4 outcomes: LV mass, LVEDV, LVESV, and LVEF. The meta-analysis revealed no sex differences in LV mass (standardized mean difference = -0.01, 95% confidence interval [CI]: -0.29, 0.27, P = 0.97), LVESV (mean difference [MD] = 1.85, 95% CI: -3.45, 7.10, P = 0.5), or LVEF (MD = -0.9, 95% CI: -3.26, 1.46, P = 0.45) following aerobic exercise interventions. Meta-analyses revealed a sex difference in LVEDV: males show a greater improvement in LVEDV (MD = 7.67, 95% CI: 2.75, 12.59, P = 0.002) than females after aerobic exercise training. No other sex differences were observed in any of the other outcomes. The overall risk of bias was low, and the quality of evidence was moderate.

CONCLUSIONS

Aerobic exercise interventions were associated with a larger increase in LVEDV in men relative to women, yet no sex differences were found in cardiac morphology (LV mass) or functional indices (LVEF).

The Acquisition of Cardiovascular Adaptation to Aerobic Exercise: When Does It Begin and How Does It Evolve Depending on Intrinsic and Extrinsic Factors?

The acquisition and evolution of cardiovascular (CV) adaptation to physical activity or exercise training are critical in enhancing cardiorespiratory fitness and reducing CV disease (CVD) risk. CV adaptations to exercise occur through structural, functional, and molecular changes that enhance cardiac efficiency. These adaptations, such as increased stroke volume, improved blood pressure regulation, and enhanced endothelial function, collectively reduce CVD morbidity and mortality. In this review we explore how CV adaptations vary across different demographic characteristics, and highlight the importance of exercise timing, intensity, and recovery periods. We delve into the immediate physiological responses to physical activity, such as increased heart rate and cardiac output, and the longer-term adaptations, including cardiac hypertrophy and improved vascular function. The influence of age, sex, and preexisting health conditions on CV responses to exercise is also discussed, emphasizing the need for tailored exercise interventions. Finally, the review highlights the significance of recovery periods in optimizing CV adaptations and how insufficient recovery might lead to adverse outcomes. Overall, understanding the timing and evolution of CV adaptations can inform exercise prescriptions to improve CV health across populations for the primary and secondary prevention of CVD.

Sex differences in associations of daily stair climbing, genetic predisposition, and risk of cardiovascular disease among 389,973 UK adults

OBJECTIVES

This study aimed to determin the sex differences in associations between daily stair climbing with cardiovascular disease (CVD) risk, and the role of genetic predisposition.

STUDY DESIGN

This study is a prospective cohort study from the UK Biobank.

METHODS

A total of 389,973 adults (mean age of 55.7 years, 45.2 % men) from the UK Biobank were analyzed. The frequency of daily stair climbing was self-reported via questionnaires, and the polygenetic risk score (PRS) of CVD was measured to assess genetic predisposition. Cox proportional hazards regression was used to predict CVD risk.

RESULTS

During a median follow-up of 13.7 years, 57,704 cases were recorded. Compared with the no stair climbing group, both sexes achieved a peak CVD benefit at 11-15 times/day of stair climbing (hazard ratio (HR) 95 % confidence intervals (CI) 0.92 [0.88-0.98] for male, HR 95 % CI 0.86 [0.82-0.90] for female). In the joint analyses, 11-15 times/day of stair climbing was significantly associated with a 12 % lower CVD risk even in the high PRS group of women. For males, 11-15 times/day of stair climbing was significantly associated with CVD risk only in intermediate and high PRS groups, but not in the low PRS group. Results were consistent in subgroup analyses stratified by age.

CONCLUSIONS

Our study demonstrated the negative associations of daily stair climbing with CVD risk were more pronounced in females than in males, and these associations were independent of disease susceptibility to CVD only in females. These findings highlight stair climbing as a low-cost intervention strategy for preventing CVD, especially in females.

Sex-specific responses of central artery stiffness to cold pressor test-mediated sympathetic activation

Considerable attention has been devoted to investigating whether acute activation of the sympathetic nervous system, triggered by daily life stressors, increases central artery stiffness (CAS). Overt sex differences in sympathetic neurovascular transduction lead to distinct cardiovascular responses to sympathoexcitation in men versus women. Our study aimed to determine if the cold pressor test (CPT), chosen to simulate highly painful stressors individuals encounter daily, would induce CAS augmentation in a sex-balanced cohort of young individuals and whether any observed CAS increase would differ between sexes. Twenty-eight participants (14 men, 14 women) provided baseline and CPT measurements of carotid-femoral pulse wave velocity (cf-PWV), mean arterial pressure (MAP), cardiac output (CO), total peripheral resistance (TPR), and heart rate (HR). CPT involved immersing participants' feet in 5 °C ice-water slurry. Data were analyzed using 2-way analysis of variance and post hoc testing, where applicable. CPT significantly increased (p < 0.01) cf-PWV values in our population, with women showing lower collective CAS values compared to men across baseline and CPT conditions. CPT augmented (p < 0.01) MAP, HR, and CO without altering stroke volume (SV), but increased (p = 0.002) TPR only in men. Men collectively exhibited higher (p < 0.01) CO and SV values across baseline and CPT conditions, as well as lower (p < 0.01) TPR values compared to women. These results support the notion that CPT increases CAS in a healthy young population. Despite observed sex differences in peripheral vascular responses to CPT, these variances did not differently impact the central pressor response or central artery stiffening between sexes. Given the well-documented sex differences in cardiovascular risk and incidence, these findings deepen understanding of how cardiocirculatory responses differ between sexes under stress. These findings support sex-specific approaches in cardiovascular medicine and prevention, including tailored coping strategies for managing stress.

Effect of Prior Moderate Aerobic Exercise to Prolonged Sitting on Peripheral and Central Cardiovascular Measures in Young Women

BACKGROUND

Prolonged sitting is a risk factor for cardiovascular disease (CVD). We examined whether moderate aerobic exercise prior to prolonged sitting (EX + SIT) has protective effects on peripheral and central cardiovascular and autonomic measures.

METHODS

Young women (n = 26; 23.4 ± 4.3 years old; BMI = 23.1 ± 4.3) completed two sessions in random order: (1) EX + SIT, which consisted of 25 min of moderate aerobic exercise followed by a 3 h prolonged sitting bout, and (2) a 3 h prolonged sitting bout only (SIT-only). Seated peripheral and central blood pressure (BP), pulse wave velocity (PWV), and heart rate variability (HRV) were measured at baseline and after 1 h, 2 h, and 3 h of sitting. Generalized linear mixed models with random effects examined the effects of conditions (i.e., EX + SIT vs. SIT) on BP, PWV, and HRV while adjusting for baseline values.

RESULTS

Only peripheral and central diastolic BP (β = 2.18; p = 0.016 and β = 1.99; p = 0.034, respectively) were significantly lower in the EX + SIT condition compared to the SIT-only condition. No differences were detected in other BP, PWV, or HRV variables between the two conditions (p > 0.05 for all).

CONCLUSIONS

Performing moderate aerobic exercise in the morning before engaging in prolonged sitting bouts may reduce some of the prolonged-sitting-induced cardiovascular impairments in young women. Further research is needed to confirm these findings in males and middle-aged/older adults.

Exercise training alters skeletal muscle microvascular endothelial cell properties in recent postmenopausal females

The present study examined and compared the impact of exercise training on redox and molecular properties of human microvascular endothelial cells derived from skeletal muscle biopsies from sedentary recent (RPF, ≤ 5 years as postmenopausal) and late (LPF, ≥ 10 years as postmenopausal) postmenopausal females. Resting skeletal muscle biopsies were obtained before and after 8 weeks of intense aerobic exercise training for isolation of microvascular endothelial cells and determination of skeletal muscle angiogenic proteins and capillarisation. The microvascular endothelial cells were analysed for mitochondrial respiration and production of reactive oxygen species (ROS), glycolysis and proteins related to vascular function, redox balance and oestrogen receptors. Exercise training led to a reduced endothelial cell ROS formation (∼50%; P = 0.009 and P = 0.020 for intact and permeabilized cells (state 3), respectively) in RPF only, with no effect on endothelial mitochondrial capacity in either group. Basal endothelial cell lactate formation was higher (7%; P = 0.028), indicating increased glycolysis, after compared to before the exercise training period in RPF only. Baseline endothelial G protein-coupled oestrogen receptor (P = 0.028) and muscle capillarisation (P = 0.028) was lower in LPF than in RPF. Muscle vascular endothelial growth factor protein was higher (32%; P = 0.002) following exercise training in LPF only. Exercise training did not influence endothelial cell proliferation or skeletal muscle capillarisation in either group, but the CD31 level in the muscle tissue, indicating endothelial cell content, was higher (>50%; P < 0.05) in both groups. In conclusion, 8 weeks of intense aerobic exercise training reduces ROS formation and enhances glycolysis in microvascular endothelial cells from RPF but does not induce skeletal muscle angiogenesis. KEY POINTS: Late postmenopausal females have been reported to achieve limited vascular adaptations to exercise training. There is a paucity of data on the effect of exercise training on isolated skeletal muscle microvascular endothelial cells (MMECs). In this study the formation of reactive oxygen species in MMECs was reduced and glycolysis increased after 8 weeks of aerobic exercise training in recent but not late postmenopausal females. Late postmenopausal females had lower levels of G protein-coupled oestrogen receptor in MMECs and lower skeletal muscle capillary density at baseline. Eight weeks of intense exercise training altered MMEC properties but did not induce skeletal muscle angiogenesis in postmenopausal females.

Metabolic flexibility in postmenopausal women: Hormone replacement therapy is associated with higher mitochondrial content, respiratory capacity, and lower total fat mass

AIM

To investigate effects of hormone replacement therapy in postmenopausal women on factors associated with metabolic flexibility related to whole-body parameters including fat oxidation, resting energy expenditure, body composition and plasma concentrations of fatty acids, glucose, insulin, cortisol, and lipids, and for the mitochondrial level, including mitochondrial content, respiratory capacity, efficiency, and hydrogen peroxide emission.

METHODS

22 postmenopausal women were included. 11 were undergoing estradiol and progestin treatment (HT), and 11 were matched non-treated controls (CONT). Peak oxygen consumption, maximal fat oxidation, glycated hemoglobin, body composition, and resting energy expenditure were measured. Blood samples were collected at rest and during 45 min of ergometer exercise (65% VO2peak). Muscle biopsies were obtained at rest and immediately post-exercise. Mitochondrial respiratory capacity, efficiency, and hydrogen peroxide emission in permeabilized fibers and isolated mitochondria were measured, and citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HAD) activity were assessed.

RESULTS

HT showed higher absolute mitochondrial respiratory capacity and post-exercise hydrogen peroxide emission in permeabilized fibers and higher CS and HAD activities. All respiration normalized to CS activity showed no significant group differences in permeabilized fibers or isolated mitochondria. There were no differences in resting energy expenditure, maximal, and resting fat oxidation or plasma markers. HT had significantly lower visceral and total fat mass compared to CONT.

CONCLUSION

Use of hormone therapy is associated with higher mitochondrial content and respiratory capacity and a lower visceral and total fat mass. Resting energy expenditure and fat oxidation did not differ between HT and CONT.

Metabolic equivalents intensity thresholds for physical activity classification in older adults

BACKGROUND

Although the metabolic equivalents (METs) system is a common procedure to quantify the intensity of physical activity in older adults, it remains unclear whether the conventional METs intensity thresholds (CTs) used for this purpose are appropriate in this population. Therefore, this study aimed (i) to derive overall and fitness-specific METs intensity thresholds in older adults ≥ 60 years old (OATs) expressed both in standard METs (VO2/3.5 mL O2·kg-1·min-1) and older adults METs60+ (VO2/2.7 mL O2·kg-1·min-1), and (ii) to compare them with the CTs.

METHODS

A total of 93 subjects were assessed for cardiorespiratory fitness. Graded exercise test protocols using indirect calorimetry were performed to calculate individual VO2max and categorize subjects as "very poor/fair" or "good/superior" fitness. Overall and fitness-specific OATs expressed in standard METs (OATsstandard) and METs60+ (OATs60+) were derived based on the %VO2max and the ventilatory thresholds (VTs) physical intensity categories.

RESULTS

Significantly higher VO2max, VO2 at VT1 and VO2 at VT2 (p < 0.001) were obtained in the "good/superior" subgroup compared to the "very poor/fair" fitness subgroup. Accordingly, OATs were approximately 69% higher in individuals with a "good/superior" fitness compared to those with a "very poor/fair" fitness. Furthermore, this study showed that OATsstandard were approximately 21-24% lower than OATs60+, and 10-22% higher OATs were observed when following the VTs intensity categories (heavy-intensity physical activity [HPA] and severe-intensity physical activity [SPA]) compared to the %VO2max categories (moderate-intensity physical activity [MPA] and vigorous-intensity physical activity [VPA]). When compared with the CTs, similar or higher OATsstandard and OATs60+ for MPA, and HPA were obtained compared to the conventional MPA threshold (3.0 METs). Conversely, for VPA and SPA, lower, similar, or higher OATs were obtained depending on the METs derivation approach (OATsstandard or OATs60+) or the intensity categories (VO2max or VTs), compared to the conventional VPA threshold (6.0 METs).

CONCLUSIONS

None of the derived OATs were concurrently similar to the CTs, suggesting that fitness-specific METs intensity thresholds adapted to the METs derivation approach should be used in older adults.

TRIAL REGISTRATION

FenotipAGING (Non-health-care intervention study), PRO-Training (NCT05619250).

Combined cardiovascular effects of ovariectomy and high-intensity interval training in female spontaneously hypertensive rats

Hypertensive postmenopausal women are more likely to develop adverse cardiac remodeling and respond less effectively to drug treatment than men. High-intensity interval exercise (HIIE) is a nonpharmacological strategy for the treatment of hypertension; however, the effectiveness in women remains uncertain. This study was designed to evaluate 1) the effects of HIIE training upon morphological and functional markers of cardiovascular health in female SHR and 2) to determine whether the hormonal shift induced by ovariectomy could influence cardiovascular responses to HIIE. Thirty-six SHR were randomly assigned to four groups: ovariectomized sedentary, ovariectomized trained, sham-operated sedentary, and sham-operated trained. The trained rats performed HIIE 5 days/wk for 8 wk. Blood pressure and echocardiographic measurements were performed before and after training in animals. Cardiac response to β-adrenergic stimulation and the expression of calcium regulatory proteins and estrogen receptors in heart samples were assessed. Endothelium-dependent vasorelaxation in response to acetylcholine was evaluated in aortic rings as well as the expression of nitric oxide synthase isoforms (eNOS and P-eNOS) by Western blotting. In both groups of trained SHR, HIIE induced eccentric cardiac remodeling with greater inotropic and chronotropic effects, as well as an increase in SERCA and β1AR expression. However, although the trained rats showed improved endothelial function and expression of eNOS and P-eNOS in the aorta, there was no demonstrated effect on blood pressure. In addition, the responses to HIIE training were not affected by ovariectomy. This work highlights the importance of assessing the cardiovascular efficacy and safety of different exercise modalities in women.NEW & NOTEWORTHY This study reports the effects of high-intensity interval exercise (HIIE) training on cardiac and endothelial function in female hypertensive rats. Despite a lack of effect on blood pressure (BP), HIIE training induces eccentric cardiac remodeling with greater functionals effects. Furthermore, training has beneficial effects on endothelial function. However, ovarian hormones do not seem to modulate cardiac and aortic adaptations to this training modality. All this underlines the need to consider training modalities on the cardiovascular system in women.

Acute inspiratory resistance training enhances endothelium-dependent dilation and retrograde shear rate in healthy young adults

Inspiratory resistance training (IRT) yields significant reductions in resting blood pressure and improves vascular endothelial function. Our objective was to quantify the acute effects of IRT on brachial artery flow-mediated dilation (FMD) and shear rates (SRs) in healthy men and women. Twenty young adults (22.9 ± 3.4 years; 10 male, 10 female) completed a single bout of IRT or Rest condition in a randomized crossover design. Brachial artery FMD was performed before, 10 min after, and 40 min after the assigned condition. Brachial artery blood flow velocities were collected during IRT, separated by breathing cycle phase, and converted into SRs. FMD improved 10 min post-IRT (+1.86 ± 0.61%; p = 0.025) but returned to baseline by 40 min post-IRT (p = 0.002). Anterograde SR decreased by 10% and retrograde SR increased 102% during resisted inspiration, relative to baseline SR (p < 0.001). Anterograde SR increased by 7% in men and women (p < 0.001) and retrograde SR decreased by 12% in women but not men (p = 0.022) during unresisted expiration, relative to baseline SR. A single bout of IRT elicits a transient enhancement in FMD in both men and women. Acute IRT-related enhancements in SRs may contribute to sustained improvements in FMD that have been reported previously.

Development of an interpretable machine learning-based intelligent system of exercise prescription for cardio-oncology preventive care: A study protocol

Background

Cardiovascular disease (CVD) and cancer are the first and second causes of death in over 130 countries across the world. They are also among the top three causes in almost 180 countries worldwide. Cardiovascular complications are often noticed in cancer patients, with nearly 20% exhibiting cardiovascular comorbidities. Physical exercise may be helpful for cancer survivors and people living with cancer (PLWC), as it prevents relapses, CVD, and cardiotoxicity. Therefore, it is beneficial to recommend exercise as part of cardio-oncology preventive care.

Objective

With the progress of deep learning algorithms and the improvement of big data processing techniques, artificial intelligence (AI) has gradually become popular in the fields of medicine and healthcare. In the context of the shortage of medical resources in China, it is of great significance to adopt AI and machine learning methods for prescription recommendations. This study aims to develop an interpretable machine learning-based intelligent system of exercise prescription for cardio-oncology preventive care, and this paper presents the study protocol.

Methods

This will be a retrospective machine learning modeling cohort study with interventional methods (i.e., exercise prescription). We will recruit PLWC participants at baseline (from 1 January 2025 to 31 December 2026) and follow up over several years (from 1 January 2027 to 31 December 2028). Specifically, participants will be eligible if they are (1) PLWC in Stage I or cancer survivors from Stage I; (2) aged between 18 and 55 years; (3) interested in physical exercise for rehabilitation; (4) willing to wear smart sensors/watches; (5) assessed by doctors as suitable for exercise interventions. At baseline, clinical exercise physiologist certificated by the joint training program (from 1 January 2023 to 31 December 2024) of American College of Sports Medicine and Chinese Association of Sports Medicine will recommend exercise prescription to each participant. During the follow-up, effective exercise prescription will be determined by assessing the CVD status of the participants.

Expected outcomes

This study aims to develop not only an interpretable machine learning model to recommend exercise prescription but also an intelligent system of exercise prescription for precision cardio-oncology preventive care.

Ethics

This study is approved by Human Experimental Ethics Inspection of Guangzhou Sport University.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR2300077887.

Effects of aging and endurance exercise training on cardiorespiratory fitness and cardiac structure and function in healthy midlife and older women

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in women in developed societies. Unfavorable structural and functional adaptations within the heart and central blood vessels with sedentary aging in women can act as the substrate for the development of debilitating CVD conditions such as heart failure with preserved ejection fraction (HFpEF). The large decline in cardiorespiratory fitness, as indicated by maximal or peak oxygen uptake (V̇o2max and V̇o2peak, respectively), that occurs in women as they age significantly affects their health and chronic disease status, as well as the risk of cardiovascular and all-cause mortality. Midlife and older women who have performed structured endurance exercise training for several years or decades of their adult lives exhibit a V̇o2max and cardiac and vascular structure and function that are on par or even superior to much younger sedentary women. Therefore, regular endurance exercise training appears to be an effective preventative strategy for mitigating the adverse physiological cardiovascular adaptations associated with sedentary aging in women. Herein, we narratively describe the aging and short- and long-term endurance exercise training adaptations in V̇o2max, cardiac structure, and left ventricular systolic and diastolic function at rest and exercise in midlife and older women. The role of circulating estrogens on cardiac structure and function is described for consideration in the timing of exercise interventions to maximize beneficial adaptations. Current research gaps and potential areas for future investigation to advance our understanding in this critical knowledge area are highlighted.

Physical activity during early life and the risk of all-cause mortality in midlife: findings from a birth cohort study

BACKGROUND

The objective of this study was to examine the association between physical activity during childhood and adolescence and the risk of all-cause mortality in midlife. We analyzed data from a birth cohort (The 1958 National Child Development Survey), including births in England, Wales and Scotland.

METHODS

Physical activity was assessed using questionnaires at ages 7, 11 and 16. Death certificates defined all-cause mortality. Cumulative exposure, sensitive and critical periods, and physical activity trajectory from childhood to adolescence were tested using multivariate Cox proportional hazard models. The sweep the death was confirmed was defined as the time event.

RESULTS

From age 23 to 55, 8.9% of participants (n = 9398) died. Physical activity in childhood and adolescence affected the risk of all-cause mortality in midlife. In men, physical activity at ages 11 [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.60-0.98] and 16 (HR: 0.60; 95% CI: 0.46-0.78) was associated with reduced risk of all-cause mortality. In women, physical activity at age 16 (HR: 0.68; 95% CI: 0.48-0.95) was associated with reduced risk of all-cause mortality. Physical activity in adolescence eliminated the risk of all-cause mortality associated with physical inactivity in adulthood in women.

CONCLUSIONS

Physical activity during childhood and adolescence was associated with reduced risk of all-cause mortality with different effects by sex.

Neighbourhood greenness moderates the association between physical activity and geriatric-relevant health outcomes: an analysis of the CLSA

BACKGROUND

The purpose of this analysis was to evaluate the relationship between baseline physical activity levels of older adults and geriatric-relevant health outcomes at 3-year follow-up, and to determine whether baseline neighbourhood characteristics alter this association.

METHODS

Data from the Canadian Longitudinal Study on Aging (CLSA) were used to assess geriatric-relevant outcomes of physical impairment, medication use, severity of daily pain, and depressive symptoms. Data from the Canadian Active Living Environments (Can-ALE) and the Normalized Difference Vegetative Index (NDVI) were used to determine neighbourhood walkability and greenness, respectively. The analytic sample included adults who were 65 years or older at baseline [Formula: see text]. Adjusted odds ratios and 95% confidence intervals for the base relationships were calculated using proportional odds logistic regression (physical impairment, pain, medication use), and linear regression (depressive symptoms). Moderation effects of environmental factors were assessed using greenness and walkability.

RESULTS

The base relationships showed protective associations between each additional hour per week of total physical activity and physical impairment [Formula: see text] daily pain severity [Formula: see text] medication use [Formula: see text], and depressive symptoms [Formula: see text]. Additive moderation effects were seen when greenness was added to physical impairment [Formula: see text], daily pain severity [Formula: see text], and depressive symptoms [Formula: see text] but no moderation was seen with walkability. Sex differences were observed. For example, greenness moderation was found in severity of daily pain in males but not in females.

CONCLUSION

Future research investigating geriatric-relevant health outcomes and physical activity should consider neighbourhood greenness as a potential moderator.

Association of Temperature Thresholds with Heat Illness- and Cardiorespiratory-Related Emergency Visits during Summer Months in Alaska

BACKGROUND

Recent record-breaking hot temperatures in Alaska have raised concerns about the potential human health implications of heat exposure among this unacclimated population.

OBJECTIVES

We estimated cardiorespiratory morbidity associated with days above summer (June-August) heat index (HI, apparent temperature) thresholds in three major population centers (Anchorage, Fairbanks, and the Matanuska-Susitna Valley) for the years 2015-2019.

METHODS

We implemented time-stratified case-crossover analyses of emergency department (ED) visits for International Classification of Diseases, 10^th Revision codes indicative of heat illness and major cardiorespiratory diagnostic codes using data from the Alaska Health Facilities Data Reporting Program. Using conditional logistic regression models, we tested maximum hourly HI temperature thresholds between 21.1°C (70°F) and 30°C (86°F) for a single day, 2 consecutive days, and the absolute number of previous consecutive days above the threshold, adjusting for the daily average concentration of particulate matter ≤2.5μg.

RESULTS

There were increased odds of ED visits for heat illness above a HI threshold as low as 21.1°C (70°F) [odds ratio (OR)=13.84; 95% confidence interval (CI): 4.05, 47.29], and this increased risk continued for up to 4 d (OR=2.43; 95% CI: 1.15, 5.10). Asthma and pneumonia were the only respiratory outcomes positively associated with the HI: ED visits for both were highest the day after a heat event (Asthma: HI>27°C(80°F) OR=1.18; 95% CI: 1.00, 1.39; Pneumonia: HI>28°C(82°F) OR=1.40; 95% CI: 1.06, 1.84). There was a decreased odds of bronchitis-related ED visits when the HI was above thresholds of 21.1-28°C (70-82°F) across all lag days. We found stronger effects for ischemia and myocardial infarction (MI) than for respiratory outcomes. Multiple days of warm weather were associated with an increased risk of health impacts. For each additional preceding day above a HI of 22°C (72°F), the odds of ED visits related to ischemia increased 6% (95% CI: 1%, 12%); for each additional preceding day above a HI of 21.1°C (70°F), the odds of ED visits related to MI increased 7% (95% CI: 1%, 14%).

DISCUSSION

This study demonstrates the importance of planning for extreme heat events and developing local guidance for heat warnings, even in areas with historically mild summertime climates. https://doi.org/10.1289/EHP11363.

Gender Differences in the Association between Physical Activity and Mortality in Chronic Kidney Disease: Results from the National Health and Nutrition Examination Survey (2011-2018)

BACKGROUND

Physical activity is indispensable in the management of chronic kidney disease (CKD). The aim of this study was to investigate gender difference in the association of physical activity with mortality among the CKD population.

METHODS

In total, 3701 participants with CKD from the 2011 to 2018 NHANES with linked mortality data were classified into different groups based on the intensity of self-reported physical activity. Multivariable-adjusted Cox proportional hazards models were used to examine the associations between physical activity and mortality.

RESULTS

During the median follow-up of 53.7 months, 694 all-cause deaths and 226 cardiovascular deaths were recorded. Patients were categorized into extremely highly active (>1500 MET-min/week), highly active (>600, ≤1500 MET-min/week), low-active (>0, ≤600 MET-min/week), or inactive (0 MET-min/week) groups. Among males, the multivariable Cox regression showed that the low-active group (HR, 0.67; 95% CI, 0.48-0.93) and highly active group (HR, 0.60; 95% CI, 0.41-0.88) were independently associated with lower risks for all-cause mortality, compared to the inactive group. The risks of all-cause mortality did not further decrease once physical activity surpassed 1500 MET-min/week, indicating a U-shaped association in males. In females, only the extremely highly active group (>1500 MET-min/week) was significantly associated with a mortality risk compared to inactivity (HR, 0.59; 95% CI, 0.39-0.89).

CONCLUSIONS

Any amount of physical activity is associated with reduced all-cause mortality in male CKD participants, while in female patients, only the extremely highly active group shows the significant association.

Associations between Self-Perceived and Desired Health-Related Physical Fitness in Spanish Children

Health-related physical fitness (HRPF) has emerged as an important marker of health among children. It is usually defined as a multidimensional construct consisting of cardiorespiratory endurance; muscular strength and endurance; and flexibility. Currently, health policies are aimed at getting children to increase their HRPF levels. Understanding the relationship between the perceived and the desired levels of fitness can be important to avoid the abandoning of physical activity practice. We analyzed the associations between the self-perceived and the desired health-related physical fitness. A modified version of the self-perceived HRPF questionnaire was completed by 330 children (148 girls, mean age: 10.78 ± 0.67 years, and 182 boys, mean age: 10.82 ± 0.61 years). Fitness was measured through tests selected from the Eurofit battery. The questions regarding desired HRPF showed moderate internal consistency (Cronbach’s α: 0.671) and good test–retest reliability (ICC: 0.761). In general, children shared a desire to improve their self-perceived HRPF. Those who perceived themselves as already being fit were the ones who showed the strongest desire for achieving higher HRPF levels.

Quantile Differences in the Age-Related Decline in Cardiorespiratory Fitness Between Sexes in Adults Without Type 2 Diabetes Mellitus in the United States

Objective

To comprehensively assess the extent to which the decline in cardiorespiratory fitness (CRF) with age differs between sexes.

Participants and Methods

This study used data from the Aerobics Center Longitudinal Study, conducted between September 1974 and August 2006, consisting primarily of White adults from middle-to-upper socioeconomic strata restricted to adults without type 2 diabetes mellitus (33,742 men and 9,415 women). Quantile regression models were used to estimate the differences in age-associated changes in CRF between the sexes, estimated using a maximal treadmill test.

Results

For adults aged up to 45 years, significant differences in slopes relating to age and CRF between men and women were observed for all adjusted percentiles of CRF other than the 90th percentile; women reported significantly greater declines in CRF per year. For those aged 45-60 years and those older than 60 years, no significant differences in age-related declines in CRF were observed between the sexes.

Conclusion

This study found that compared with men, the onset of decline in CRF was found to occur earlier and at lower CRF percentiles in women. This is of particular concern, given that compared with men, women already tend to have lower CRF levels. These findings suggest that maintaining the levels of physical activity sufficient to maintain moderate-to-high levels of fitness is particularly important for women earlier during adulthood.

Sympathetic vasomotor outflow during low-intensity leg cycling in healthy older males

NEW FINDINGS

What is the central question of this study? Sympathetic vasomotor outflow is reduced during low-intensity dynamic leg exercise in younger individuals: does ageing influence the sympathoinhibitory effect during low-intensity leg cycling? What is the main finding and its importance? Muscle sympathetic nerve activity during low-intensity cycling decreased in older males, as seen in young males. It is possible that cardiopulmonary baroreflex-mediated inhibition of sympathetic vasomotor outflow during dynamic leg exercise is preserved in healthy older males.

ABSTRACT

Muscle sympathetic nerve activity (MSNA) is reduced during low-intensity dynamic leg exercise in young males. It is suggested that this inhibition is mediated by loading of the cardiopulmonary baroreceptors. The purpose of this study was to clarify the impact of age on MSNA during dynamic leg exercise. Nine younger males (YM, mean ± SD, 20 ± 1 years) and nine older males (OM, 72 ± 3 years) completed the study. The subjects performed two 4-min cycling exercises at 10% of their heart rate reserve using a cycle ergometer in a semirecumbent position (MSNA and estimated central venous pressure (eCVP) trials). MSNA was recorded via microneurography of the left radial nerve. The CVP was estimated based on peripheral venous pressure, which was monitored using a cannula in the right large antecubital vein. The magnitude of the increase in mean arterial blood pressure during leg cycling was larger in OM (+9.3 ± 5.5 mmHg) compared with YM (+2.8 ± 4.7 mmHg). MSNA burst frequency was decreased during cycling in both YM (-8.1 ± 3.8 bursts/min) and OM (-10.6 ± 3.3 bursts/min), but no significant difference was found between the two groups. The eCVP increased during exercise in both groups, and there was no difference in the changes in eCVP between YM (+1.1 ± 0.4 mmHg) and OM (+1.2 ± 0.7 mmHg). These data indicate that inhibition of sympathetic vasomotor outflow during low-intensity cycling appears in OM as seen in YM. It is possible that the muscle pump-induced loading of the cardiopulmonary baroreflex is preserved during cycling in healthy older males.

A single dose of dietary nitrate supplementation protects against endothelial ischemia-reperfusion injury in early postmenopausal women

The onset of menopause and accompanying changes to ovarian hormones often precedes endothelial dysfunction in women. In particular, accelerated impairments in macrovascular and microvascular function coincide with the loss of estrogen, as does impaired endothelial responses to ischemia-reperfusion (IR) injury. In healthy, early postmenopausal women (n = 12; 3.9 ± 1.5 years since menopause) we tested the hypothesis that acute dietary nitrate (NO3-) supplementation would improve endothelial function and attenuate the magnitude of endothelial dysfunction following whole-arm IR in comparison with placebo. In this randomized, double-blind, placebo-controlled, crossover study we tested participants before and after NO3--rich (BRnitrate) and NO3--depleted (BRplacebo) beetroot juice (BR) consumption, as well as following IR injury, and 15 min after IR to assess recovery. Analyses with repeated-measures general linear models revealed a condition × time interaction for brachial artery flow-mediated dilation (FMD; P = 0.04), and no interaction effect was found for the near-infrared spectroscopy-derived reperfusion slope (P = 0.86). Follow-up analysis showed a significant decline in FMD following IR injury with BRplacebo in comparison with all other timepoints (all, P < 0.05), while this decline was not present with BRnitrate (all, P > 0.05). Our findings demonstrate that a single dose of dietary NO3- minimizes IR-induced macrovascular endothelial dysfunction in healthy, early postmenopausal women, but does not improve resting macrovascular and microvascular function. Trial registration number: NCT03644472. Novelty: In healthy, early postmenopausal women, a single dose of NO3--rich BR can protect against IR-induced endothelial dysfunction. This protection may be due to nitric oxide bioactivity during IR rather than improved endothelial function prior to the IR protocol per se.

A Systematic Review and Meta-Analysis of Tai Chi Training in Cardiorespiratory Fitness of Elderly People

Objectives

The purpose of this study was to investigate the influence of Tai Chi on cardiorespiratory fitness (CRF) in elderly people using meta-analysis.

Methods

This study used seven electronic databases and data retrieved from randomized controlled trials (RCTs) investigating the role of Tai Chi on CRF in the elderly. All these 24 RCTs were screened and selected from 7 literature databases. The Stata 11.2 software (StataCorp, USA) was used for the meta-analysis, subgroup analysis, and bias test, while the Cochrane Collaboration's tool was used for the assessment of the risk of bias (RoB). 4 researchers independently participated in sample selection, data extraction, and RoB assessment.

Results

Following the inclusion criteria, 24 eligible studies were included in our analysis. The meta-analysis indicated that Tai Chi practice significantly increased the maximum rate of oxygen consumption (VO_{2 max}) (weighted mean difference (WMD)  = 3.76, 95% CI: 1.25 to 6.26, P < 0.1), leading to an overall reduction in the heart rate (HR) (WMD  = −1.84, 95% CI: −2.04 to −1.63, P  ≤ 0.001) and an increase in the O_{2 pulse} (WMD = 0.94, 95% CI: 0.60 to 1.28, P ≤ 0.001) in individuals who practiced Tai Chi regularly compared with those who did not. The subgroup analysis suggested that overall in those who practiced Tai Chi, males (WMD = 1.48, 95% CI: 0.85 to 2.12, P ≤ 0.001) had higher O_{2 pulse} than females (WMD = 0.73, 95% CI: 0.33 to 1.12, P ≤ 0.001). The subgroup analysis also showed an increase in the vital capacity (VC) (WMD = 316.05, 95% CI: 239.74 to 392.35, P ≤ 0.001) in individuals practicing Tai Chi. When the samples were further stratified by Tai Chi practicing time, the subgroup analysis suggested that individuals practicing Tai Chi over a period of 24 weeks showed no significant difference in VC (WMD = 82.95, 95% CI: -98.34 to 264.23, P=0.370), while those practicing Tai Chi over a period of 48 weeks showed a significant increase (WMD = 416.62, 95% CI: 280.68 to 552.56, P ≤ 0.001). Furthermore, the subgroup analysis demonstrated that the increase in VC is significantly correlated with the Tai Chi practicing time (WMD = 344.97, 95% CI: 227.88 to 442.06, P ≤ 0.001).

Conclusion

Regular Tai Chi practice could improve the CRF in the elderly, as indicated by significant improvement in indicators including VO_2max, O_2pulse, VC, and HR. However, gender and practice time might influence the overall beneficial outcomes.

Sex Differences in Peripheral Artery Disease

Peripheral artery disease (PAD) is a prevalent condition that confers substantial morbidity and mortality and remains underdiagnosed as well as undertreated in the overall population. Although PAD prevalence is similar or higher in women compared with men, associations of traditional and nontraditional risk factors with PAD and clinical manifestations of PAD differ by sex and may contribute to delayed or lack of diagnosis in women. Such sex-based differences in the manifestation of PAD may arise from sexual dimorphism in the vascular substrate in health as well as sex variation in the responses to vascular stressors. Despite the availability of proven therapies for improving symptoms and reducing risk of ischemic cardiovascular and limb events among patients with diagnosed PAD, important sex differences in treatment and outcomes have been observed. We provide an overview of current knowledge regarding sex differences in the epidemiology, pathophysiology, clinical presentation, and management of PAD.

Association of physical activity trajectories with major cardiovascular diseases in elderly people

Introduction

Cardiovascular benefits deriving from physical activity are well known, but it is unclear whether physical activity trajectories in late life are associated with different risks of cardiovascular diseases.

Methods

Progetto Veneto Anziani (Pro.V.A.) is a cohort study of 3099 Italians aged ≥65 years with baseline assessment in 1995–1997 and follow-up visits at 4 and 7 years. Surveillance was extended to 2018 by linkage with hospital and mortality records. Prevalent and incident cardiovascular diseases (coronary heart disease, heart failure and stroke) were identified through clinical examination, questionnaire, or hospital records. Moderate to vigorous physical activity was considered as a time-varying variable. Physical activity trajectories were categorised as: stable-low, high-decreasing, low-increasing and stable-high. Exposure was also assessed at 70, 75, 80 and 85 years.

Results

Overall, physical activity was associated with lower rates of incident cardiovascular diseases. A significant risk reduction was present among men and was stronger earlier in late life (70–75 years). Trajectories of stable-high physical activity were associated with a significantly lower risk of cardiovascular outcomes among men (HR 0.48, 95% CI 0.27 to 0.86) compared with those with stable-low trajectories (p for trend 0.002). No significant association was found with stroke. The greatest cardiovascular risk reduction was observed for >20 min/day of physical activity, and was more marked at 70 years.

Conclusion

Increasingly active trajectories of physical activity were associated with lower rates of cardiovascular diseases and overall mortality. Promoting at least 20 min/day of physical activity early in late life seems to provide the greatest cardiovascular benefits.

Long-Term Enrollment in Cardiac Rehabilitation Benefits of Cardiorespiratory Fitness and Skeletal Muscle Strength in Females with Cardiovascular Disease

Background: The benefits of short-term cardiac rehabilitation (CR) for improving fitness are well known, but the effects of long-term maintenance-phase CR are less well established. Moreover, changes in cardiorespiratory fitness (CRF) and muscle strength with long-term CR have never been examined specifically in females, a population that is under-researched and under-represented in cardiovascular research. The objective of this retrospective pilot study was to estimate changes in CRF and muscle strength in females enrolled in a long-term CR program. Methods: Data from 39 females (mean ± standard deviation age 65 ± 9 years) enrolled for at least 1 year in a maintenance-phase CR program were analyzed. The program consisted of aerobic and resistance training, and data were collected annually for CRF (peak oxygen consumption [VO₂peak, mL/kg/min]) and skeletal muscle strength (one-repetition maximum tests for chest press, seated row, and knee extension, kg). Mixed-model analyses were used to determine changes in CRF over the 5-year follow-up (203 observations) and muscle strength over 6 years (108 observations). Results: The CRF increased in females by 1.8%/year over 5 years of CR enrollment, and muscle strength increased by 0.6%-2.1%/year over 6 years. These findings are in contrast to the expected age-related declines in fitness over time. Conclusion: The positive long-term benefits on CRF and muscle strength in females provide initial preliminary support for maintenance-based CR, especially given that this population is commonly under-researched and under-represented in the CR literature.

Observational study of an inpatient program for musculoskeletal disorders: The effects of gender and physical activity

A new inpatient secondary preventive program for patients with musculoskeletal health problems was introduced throughout Austria. The aim of the current work was to evaluate this "Health Prevention Active" program and its possible influences on the quality of medical results upon hospital discharge.This observational study presents monocentric data for 7448 patients (48.99 ± 6.15 years; 53.7% women) with chronic musculoskeletal disorders who completed a 3-week health program. The focus was placed on measuring medical quality outcomes such as BMI, blood pressure, heart rate, pain, subjective ratings, and achieved power output in cycle ergometer exercise testing. We describe pre-post changes before and after the inpatient program and the results of a follow-up survey conducted after 1 year to identify moderating factors related to health outcomes.The medical baseline showed obvious deficits regarding obesity, hypertension, and subjective symptoms. Of all patients, 36.5% were completely inactive. The patient's gender and physical activity had a high impact on the medical baseline status. In total, the majority of patients (86.2%; SMD = -0.78 ± 0.59) responded well to the health prevention program, independent of their ages and lifestyles.Requirements for secondary prevention programs are high. The results of the study reflect the general problems presented by inactivity, obesity, and subjective symptoms like pain. Physical activity was specifically identified as a major factor for the observed medical baseline status.

Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation

This pre-post study examined sex-differences in peak aerobic power (V̇O2peak) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HRpeak)) and lower- (3×3 minutes 60-70% HRpeak) intensity intervals twice weekly for 10 weeks. V̇O2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇O2peak did not differ between sexes (interaction: p = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇O2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇O2peak, BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇O2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇O2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).

Low-volume cycling training improves body composition and functionality in older people with multimorbidity: a randomized controlled trial

Physical exercise, when practiced regularly and in adequate doses, is a proven nonpharmacological measure that helps to prevent and reverse noncommunicable diseases, as well as reduce mortality rates from any cause. In general, older adults perform insufficient physical activity and do not meet the doses recommended by the World Health Organization for the improvement of health through physical activity. However, there is little evidence on adequate doses of exercise in older people, especially in those with multimorbidity. Our main aim was to evaluate the effect of a 6-week intervention on health-related outcomes (body composition, hemodynamic and functionality changes) in 24 individuals aged 65 and older with multimorbidity in a randomized controlled trial. The intervention consisted of a very low volume (60 min per week) of low-to-moderate intensity exercise training (perception of effort from 3 to 6 on an 11-point scale). After the intervention, blood pressure was significantly (p = 0.038) reduced in the exercise group (EG), with a higher reduction in men. Furthermore, the EG decreased their waist circumference (p = 0.005), a proxy of abdominal adiposity, and demonstrated an increased likelihood (73%) that a randomly selected change in muscle mass score from the EG would be greater than a randomly selected change score from the control group. The exercise intervention was particularly effective in enhancing the functionality of older adults with multimorbidity, especially in walking speed and balance skills. Perceptually regulated intensity during exercise training seemed to be a very interesting strategy to train individuals with low physical fitness and comorbidities. This study is registered with Clinicaltrials.gov (NCT04842396).

Aerobic High-Intensity Exercise Training Improves Cardiovascular Health in Older Post-menopausal Women

The aim of this study was to determine the effect of a period of aerobic high intensity training on central- and peripheral cardiovascular parameters in older post-menopausal women. Eleven healthy post-menopausal (>10 years after menopause) women (mean age: 64 years; BMI: 25.3 kg m⁻²) completed an 8-week period of supervised, high intensity cycle training, with sessions conducted three times per week. Before and after the training period maximal oxygen uptake, body composition, popliteal artery flow mediated dilation, exercise hyperemia, arterial blood pressure, and plasma lipids were assessed. In addition, levels of estrogen related receptor α (ERRα) and vasodilator enzymes were determined in muscle biopsy samples. Training induced an 18% increase (P < 0.001) in maximal oxygen uptake. Plasma High-density lipoprotein (HDL) was higher (P < 0.05) after than before the training period. Fat mass was reduced (4.9%; P < 0.01), whereas lean body mass was unaltered. Mean arterial blood pressure was unchanged (91 vs. 88 mmHg; P = 0.058) with training. Training did not induce a change in popliteal flow mediated dilation. Exercise hyperemia at submaximal exercise was lower (P < 0.01; 11 and 4.6% at 10 and 16 W, respectively) after compared to before training. Muscle ERRα (~1.7-fold; P < 0.01) and eNOS (~1.4-fold; P < 0.05) were higher after the training intervention. The current study demonstrates that, in older post-menopausal women, a period of aerobic high intensity training effectively increases maximal oxygen uptake and improves the cardiovascular health profile, without a parallel improvement in conduit artery function.

Beetroot supplementation in women enjoying exercise together (BEE SWEET): Rationale, design and methods

Background

Postmenopausal women exhibit higher rates of disability and cardiovascular disease (CVD) with aging compared to men. Whereas habitual exercise training is a known strategy to enhance physiologic function in men and premenopausal women, exercise-related adaptations are often modest in postmenopausal women. We propose dietary nitrate (beetroot juice) administered prior to exercise training may be a feasible approach to improve mobility and cardio-metabolic health outcomes in postmenopausal women.

Methods

Our randomized, placebo-controlled study aims to determine preliminary effects sizes for changes in functional mobility and endothelium-dependent vasodilation across three study arms: exercise only (EX), exercise + placebo (EX + PL), and exercise + beetroot (EX + BR). Thirty-six postmenopausal women are recruited in small cohorts wherein group exercise is implemented to facilitate social support and adherence to an 8-week training progression. Participants are randomized to one of three study arms (n = 12 per group) following baseline assessments. Post-intervention assessments are used to determine pre-post changes in outcome measures including distance covered during a 6 min walk test, walking economy, muscle speed and power, and endothelial-dependent vasodilation as determined by flow-mediated dilation. Measures of feasibility include recruitment, retention, adherence to exercise prescription, perceived exercise session difficulty, and adverse event rates.

Discussion

Evidence-based, translational strategies are needed to optimize exercise training-related adaptations in postmenopausal women. Findings will inform larger randomized clinical trials to determine if pre-exercise consumption of beetroot juice is an efficacious strategy to promote mobility and attenuate CVD disease risk.

Acute Cardiopulmonary Response to Interval and Continuous Exercise in Older Adults: A Randomized Crossover Study

ABSTRACT

Linares, AM, Goncin, N, Stuckey, M, Burgomaster, KA, and Dogra, S. Acute cardiopulmonary response to interval and continuous exercise in older adults: a randomized crossover study. J Strength Cond Res XX(X): 000-000, 2020-The purpose of this study was to compare the cardiopulmonary response with different exercise protocols in healthy older adults. Subjects (n = 30; 15 women, age: 69.6 ± 6.2 years) completed an exercise test (MAX) on a cycle ergometer to determine maximal oxygen consumption (V[Combining Dot Above]O2max) and peak power output (PPO). Exercise sessions were randomized: high-intensity interval exercise (HIIE, 1 minute 90% PPO followed by 1 minute 10% PPO, ×10), moderate-intensity continuous exercise (MOD, 20 minutes at 50% PPO), and sprint-interval exercise (SPRT, 20 seconds "all-out" sprints followed by 2 minutes at 50 W, ×3). V[Combining Dot Above]O2max was highest during MAX in men (MAX: 28.2 ± 6.3; MOD: 22.6 ± 4.5; HIIE: 26.7 ± 5.7; SPRT: 26.0 ± 4.3; F(2.1) = 28.6, p = 0.0001, = 0.67), whereas similar peaks were observed between HIIE, SPRT, and MAX in women (MAX: 21.9 ± 6.1; MOD: 18.9 ± 4.5; HIIE: 21.6 ± 5.3; SPRT: 21.7 ± 3.9; F(2.2) = 10.2, p = 0.0001, = 0.42). The peak heart rate (b·min-1) was similar across all exercise sessions in both men (MAX: 148.1 ± 17.1; MOD: 132.6 ± 21.8; HIIE: 144.9 ± 16.6; SPRT: 148.6 ± 14.2; F(1.9) = 9.1, p = 0.001, = 0.41) and women (MAX: 148.1 ± 13.1; MOD: 136.3 ± 18.2; HIIE: 147.0 ± 16.4; SPRT: 148.5 ± 18.0; F(2.0) = 5.3, p = 0.011, = 0.27). The %V[Combining Dot Above]O2 at which sessions were performed varied significantly across individual subjects. In conclusion, older women work at near maximal V[Combining Dot Above]O2 when performing HIIE and SPRT; this has implications for exercise testing and prescription protocols in older adults.

Long-term incidence of cardiovascular outcomes in the middle-aged and elderly with different patterns of physical activity: Tehran lipid and glucose study

Background

Following the global upward trend of cardiovascular diseases (CVD/CHD), much attention has been paid to lifestyle behaviors such as physical activity (PA). However, most of previous studies were conducted in developed countries and with just one measurement of physical activity. The aim of the current study is to assess the effect of changes in the PA on the incidence of CVD/CHD in middle-aged and older men and women in an Eastern-Mediterranean population, over a decade follow-up.

Methods

This study has been conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) including 4073 (57% women) participants without CVD/CHD at baseline. The participants were followed up for an average period of 12 years. The Iranian version of Modified Activity Questionnaire (MAQ) was used to measure PA at baseline and at the closest follow-up to the outcome. Subsequently, participants were categorized as “compliers”, “non-compliers”, “adopters” and “relapsers”, based on their adherence to the PA guideline recommendations. All analysis has been conducted in two separate age groups including middle-aged and elderly in both men and women. The effect of PA patterns on incidence of CVD/CHD was investigated using Cox proportional hazard model. Variables including marital status, job status, education, smoking, and family history of CVD/CHD were adjusted in the models.

Results

Adherence to guideline recommendation increased from 63.5 to 66.6% between the two measurements. At the second measurement of PA, the percentages of compliers, non-compliers, adopters and relapsers were 48.4, 18.3, 18.2, and 15.1%, respectively. In fully adjusted models, HRs of CVD and CHD for men aged 40–60 years in the complier group were 0.58 (95% CI: 0.38–0.87, P = 0.008) and 0.58 (95% CI: 0.38–0.89, P = 0.01), respectively. HRs of CVD and CHD for men aged 40–60 years in adopter group were 0.61 (95% CI: 0.38–0.96, P = 0.03) and 0.60 (95% CI: 0.37–0.97, P = 0.04) respectively. The corresponding values were not significant in women.

Conclusions

Adhering to established PA recommendations have a protective effect on the incidence of CVD/CHD among middle-aged men; findings which need to be considered in reducing cardiovascular outcomes in this population.

Difference in Housing Temperature-Induced Energy Expenditure Elicits Sex-Specific Diet-Induced Metabolic Adaptations in Mice

OBJECTIVE

The aim of this study was to test whether increased energy expenditure (EE), independent of physical activity, reduces acute diet-induced weight gain through tighter coupling of energy intake to energy demand and enhanced metabolic adaptations.

METHODS

Indirect calorimetry and quantitative magnetic resonance imaging were used to assess energy metabolism and body composition during 7-day high-fat/high-sucrose (HFHS) feeding in male and female mice housed at divergent temperatures (20°C vs. 30°C).

RESULTS

As previously observed, 30°C housing resulted in lower total EE and energy intake compared with 20°C mice regardless of sex. Interestingly, housing temperature did not impact HFHS-induced weight gain in females, whereas 30°C male mice gained more weight than 20°C males. Energy intake coupling to EE during HFHS feeding was greater in 20°C versus 30°C housing, with females greater at both temperatures. Fat mass gain was greater in 30°C mice compared with 20°C mice, whereas females gained less fat mass than males. Strikingly, female 20°C mice gained considerably more fat-free mass than 30°C mice. Reduced fat mass gain was associated with greater metabolic flexibility to HFHS, whereas fat-free mass gain was associated with diet-induced adaptive thermogenesis.

CONCLUSIONS

These data reveal that EE and sex interact to impact energy homeostasis and metabolic adaptation to acute HFHS feeding, altering weight gain and body composition change.

Does menopausal status have an effect on body mass index and blood pressure?

Aim of the study was to understand the relationship of menopausal status with BMI and blood pressure. The study area was selected through multistage sampling technique covering six districts of West Bengal, a state located at the eastern part of India. 1400 participants were selected for the study. The participants were divided into four groups on the basis of menopausal status: early and late perimenopausal; early and late postmenopausal. Results shows that menopausal status was significantly associated with Body Mass Index (BMI) and Mean Arterial Pressure (MAP), after controlling the effect of covariates such as participants' age, reproductive behavior, diet and addiction to tobacco use.

Mitochondrial Dysfunction and Inflammaging in Heart Failure: Novel Roles of CYP-Derived Epoxylipids

Age-associated changes leading to a decline in cardiac structure and function contribute to the increased susceptibility and incidence of cardiovascular diseases (CVD) in elderly individuals. Indeed, age is considered a risk factor for heart failure and serves as an important predictor for poor prognosis in elderly individuals. Effects stemming from chronic, low-grade inflammation, inflammaging, are considered important determinants in cardiac health; however, our understanding of the mechanisms involved remains unresolved. A steady decline in mitochondrial function is recognized as an important biological consequence found in the aging heart which contributes to the development of heart failure. Dysfunctional mitochondria contribute to increased cellular stress and an innate immune response by activating the NLRP-3 inflammasomes, which have a role in inflammaging and age-related CVD pathogenesis. Emerging evidence suggests a protective role for CYP450 epoxygenase metabolites of N-3 and N-6 polyunsaturated fatty acids (PUFA), epoxylipids, which modulate various aspects of the immune system and protect mitochondria. In this article, we provide insight into the potential roles N-3 and N-6 PUFA have modulating mitochondria, inflammaging and heart failure.

Determinant Factors of Intraocular Pressure Responses to a Maximal Isometric Handgrip Test: Hand Dominance, Handgrip Strength and Sex

PURPOSE

To assess the mediating role of strength levels, hand dominance and participants´ sex on the intraocular pressure (IOP) behaviour during the execution of a maximal isometric handgrip test.

METHODS

One hundred and seventy-six sport science students (102 men and 74 women) performed a maximal isometric handgrip test with the dominant and non-dominant hands. A rebound tonometer was used to measure IOP before effort, during effort, and immediately after performing the handgrip test. Men and women were divided based on their handgrip strength in low- and high-strength groups using a median split analysis.

RESULTS

There was an acute IOP rise during effort, returning to baseline levels immediately after exercise cessation (P < .001, η_p ² = 0.79). A greater increase in IOP during the execution of the handgrip test was observed for the dominant-hand compared to the non-dominant hand (P = .004, d = 0.30) and for men compared to women (P = .001, d = 0.90). The main effect of strength level did not reach statistical significance (P = .266).

CONCLUSIONS

The IOP rise associated with a maximal isometric handgrip effort is affected by the participants´ sex (men > women) and hand dominance (dominant hand > non-dominant hand), but not on strength levels. These findings need to be corroborated in glaucoma patients.

Age matters: differences in exercise-induced cardiovascular remodelling in young and middle aged healthy sedentary individuals

AIMS

Remodelling of the cardiovascular system (including heart and vasculature) is a dynamic process influenced by multiple physiological and pathological factors. We sought to understand whether remodelling in response to a stimulus, exercise training, altered with healthy ageing.

METHODS

A total of 237 untrained healthy male and female subjects volunteering for their first time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent tests including 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided by age into under or over 35 years (U35, O35).

RESULTS

Injury and completion rates were similar among the groups; 138 runners (U35: n = 71, women 49%; O35: n = 67, women 51%) completed the race. On average, U35 were faster by 37 minutes (12%). Training induced a small increase in left ventricular mass in both groups (3 g/m2, P < 0.001), but U35 also increased ventricular cavity sizes (left ventricular end-diastolic volume (EDV)i +3%; left ventricular end-systolic volume (ESV)i +8%; right ventricular end-diastolic volume (EDV)i +4%; right ventricular end-systolic volume (ESV)i +5%; P < 0.01 for all). Systemic aortic compliance fell in the whole sample by 7% (P = 0.020) and, especially in O35, also systemic vascular resistance (-4% in the whole sample, P = 0.04) and blood pressure (systolic/diastolic, whole sample: brachial -4/-3 mmHg, central -4/-2 mmHg, all P < 0.001; O35: brachial -6/-3 mmHg, central -6/-4 mmHg, all P < 0.001).

CONCLUSION

Medium-term, unsupervised physical training in healthy sedentary individuals induces measurable remodelling of both heart and vasculature. This amount is age dependent, with predominant cardiac remodelling when younger and predominantly vascular remodelling when older.

Age and Sex Differences in Hearts of Soluble Epoxide Hydrolase Null Mice

Biological aging is an inevitable part of life that has intrigued individuals for millennia. The progressive decline in biological systems impacts cardiac function and increases vulnerability to stress contributing to morbidity and mortality in aged individuals. Yet, our understanding of the molecular, biochemical and physiological mechanisms of aging as well as sex differences is limited. There is growing evidence indicating CYP450 epoxygenase-mediated metabolites of n-3 and n-6 polyunsaturated fatty acids (PUFAs) are active lipid mediators regulating cardiac homeostasis. These epoxy metabolites are rapidly hydrolyzed and inactivated by the soluble epoxide hydrolase (sEH). The current study characterized cardiac function in young and aged sEH null mice compared to the corresponding wild-type (WT) mice. All aged mice had significantly increased cardiac hypertrophy, except in aged female sEH null mice. Cardiac function as assessed by echocardiography demonstrated a marked decline in aged WT mice, notably significant decreases in ejection fraction and fractional shortening in both sexes. Interestingly, aged female sEH null mice had preserved systolic function, while aged male sEH null mice had preserved diastolic function compared to aged WT mice. Assessment of cardiac mitochondria demonstrated an increased expression of acetyl Mn-SOD levels that correlated with decreased Sirt-3 activity in aged WT males and females. Conversely, aged sEH null mice had preserved Sirt-3 activity and better mitochondrial ultrastructure compared to WT mice. Consistent with these changes, the activity level of SOD significantly decreased in WT animals but was preserved in aged sEH null animals. Markers of oxidative stress demonstrated age-related increase in protein carbonyl levels in WT and sEH null male mice. Together, these data highlight novel cardiac phenotypes from sEH null mice demonstrating a sexual dimorphic pattern of aging in the heart.

Aerobic exercise training and vascular function with ageing in healthy men and women

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in both men and women in developed societies. Age is the greatest risk factor for CVD due largely to adverse changes to arteries that include stiffening of the large elastic arteries (aortic and carotid arteries) and endothelial dysfunction. Vascular ageing is driven by oxidative stress, which reduces nitric oxide (NO) bioavailability and stimulates changes in the extracellular matrix. In women, reductions in circulating oestrogens with menopause interact with ageing processes to induce vascular dysfunction. Regular aerobic exercise is the most evidence-based strategy for reducing CVD risk with ageing in both men and women. Much of this cardiovascular-protective effect of aerobic exercise is likely due to its vascular health-enhancing influence. Large elastic artery stiffening with advancing age is attenuated in healthy adults engaged in aerobic exercise training, and aerobic exercise interventions improve arterial stiffness in previously sedentary middle-aged and older men and postmenopausal women. Regular aerobic exercise also enhances endothelial function with ageing in men (by reducing oxidative stress and preserving NO bioavailability), but not consistently in oestrogen-deficient postmenopausal women. In postmenopausal women, treatment with oestradiol appears to restore the ability of aerobic exercise to improve NO-mediated endothelial function by reducing oxidative stress. Several research gaps exist in our understanding of potential sex differences in the vascular adaptations to regular aerobic exercise. More information is needed on the factors that are responsible for sex differences, including the role of circulating oestrogens in transducing the aerobic exercise training 'stimulus'.

Constitutive PGC-1α overexpression in skeletal muscle does not protect from age-dependent decline in neurogenesis

Aerobic exercise prevents age-dependent decline in cognition and hippocampal neurogenesis. The transcription factor peroxisome proliferator-activated receptor gamma co-activator 1-alpha (PGC-1α) mediates many of the exercise-induced benefits in skeletal muscle, including the release of factors into the circulation with neurotrophic effects. We use a transgenic mouse model with muscle-specific overexpression of PGC-1α to study the contribution of chronic muscle activation on exercise-induced effects on hippocampal neurogenesis in aging. Young and old transgenic and wild type animals of both sexes displayed a robust age-related reduction in newborn BrdU⁺-cells, immature neurons (DCX⁺-cells) and new mature BrdU⁺/NeuN⁺-neurons in the dentate gyrus. No differences were detected between genotypes or sexes. Analysis of serum proteins showed a tendency towards increased levels of myokines and reduced levels of pro-inflammatory cytokines for transgenic animals, but only musclin was found to be significantly up-regulated in transgenic animals. We conclude that constitutive muscular overexpression of PGC-1α, despite potent systemic changes, is insufficient for mimicking exercise-induced effects on hippocampal neurogenesis in aging. Continued studies are required to investigate the complex molecular mechanisms by which circulating signals could mediate exercise-induced effects on the central nervous system in disease and aging, with the aim of discovering new therapeutic possibilities for patients.

Sex Moderates the Effect of Aerobic Exercise on Some Aspects of Cognition in Cognitively Intact Younger and Middle-Age Adults

We recently reported the results of a randomized, parallel-group, observer-masked, community-based clinical trial of 132 cognitively normal individuals aged 20–67 with below median aerobic capacity who were randomly assigned to one of two 6-month, four-times-weekly conditions: aerobic exercise and stretching/toning. We now assessed potential sex moderation on exercise-related changes in aerobic capacity, BMI and cognitive function. There was no sex moderation of the effect of aerobic exercise on aerobic capacity or BMI. We had previously reported an effect of aerobic exercise on executive function that was moderated by age. We found additional moderation by sex, such that in any age range men improved more than women. Processing speed showed significant sex moderation but not significant age moderation. In men, processing speed significantly improved by week 12 (b = 0.35, p = 0.0051), but the effect was diminished relative to week 12 at week 24 (b = 0.24, p = 0.0578). In women, there was no exercise effect at either time point (week 12: b = −0.06, p = 0.4156; week 24: b = −0.11, p = 0.1841). Men benefited cognitively more than women from aerobic exercise. This study highlights the importance of using sex-disaggregated analyses when assessing the impact of physical exercise intervention, and the need to ascertain the underlying mechanisms for differential cognitive benefit by sex.

Investigating the Immediate and Cumulative Effects of Isometric Squat Exercise for Different Weight Loads on Intraocular Pressure: A Pilot Study

BACKGROUND

The execution of resistance exercise against heavy loads promotes an acute intraocular pressure (IOP) rise, which has detrimental effects on ocular health. However, the effect of load on the IOP behavior during exercise remains unknown due to technical limitations.

HYPOTHESES

IOP monitoring during isometric squat exercise permits assessment of IOP behavior during physical effort. Second, greater loads will induce a higher IOP rise.

STUDY DESIGN

Randomized cross-sectional study.

LEVEL OF EVIDENCE

Level 2.

METHODS

Twenty-six young adults (13 women, 13 men) performed an isometric squat exercise against 3 loads relative to their maximum capacity (low, medium, and high). IOP was measured before, during (1 measurement every 6 seconds), and after exercise (10 seconds of recovery).

RESULTS

There was a progressive IOP rise during exercise, which was dependent on the load applied (Bayes factor₁₀ >100). Higher IOP values were found in the high load condition in comparison with the medium (mean IOP difference = 1.5 mm Hg) and low (mean IOP difference = 3.1 mm Hg) conditions, as well as when the medium load was compared with the low load condition (mean IOP difference = 1.6 mm Hg). Men reached higher IOP values in comparison with women during the last measurements in the high load condition. Ten seconds of recovery were enough to obtain IOP values similar to baseline levels.

CONCLUSION

Isometric squat exercise induces an immediate and cumulative IOP elevation, which is positively associated with the load applied. These IOP increments return to baseline values after 10 seconds of recovery, and men demonstrate a more accentuated IOP rise in comparison with women when high levels of effort are accumulated.

CLINICAL RELEVANCE

These findings may help in better management of different ocular conditions and highlight the importance of an individualized exercise prescription in clinical populations.

Sex differences in the relationship between cardiorespiratory fitness and brain function in older adulthood

We investigated sex differences in the association between a measure of physical health, cardiorespiratory fitness (CRF), and brain function using resting-state functional connectivity fMRI. We examined these sex differences in the default, frontoparietal control, and cingulo-opercular networks, assemblies of functionally connected brain regions known to be impacted by both age and fitness level. Healthy older adults ( n = 49; 29 women) were scanned to obtain measures of intrinsic connectivity within and across these 3 networks. We calculated global efficiency (a measure of network integration) and local efficiency (a measure of network specialization) using graph theoretical methods. Across all three networks combined, local efficiency was positively associated with CRF, and this was more robust in male versus female older adults. Furthermore, global efficiency was negatively associated with CRF, but only in males. Our findings suggest that in older adults, associations between brain network integrity and physical health are sex-dependent. These results underscore the importance of considering sex differences when examining associations between fitness and brain function in older adulthood. NEW & NOTEWORTHY We examined the association between cardiorespiratory fitness and resting state functional connectivity in several brain networks known to be impacted by age and fitness level. We found significant associations between fitness and measures of network integration and network specialization, but in a sex-dependent manner, highlighting the interplay between sex differences, fitness, and aging brain health. Our findings underscore the importance of considering sex differences when examining associations between fitness and brain function in older adulthood.

Physical Activity, Sedentary Time, and Cardiovascular Disease Biomarkers at Age 60 to 64 Years

Background We examined associations of objectively measured physical activity ( PA ) and sedentary time with cardiovascular disease biomarkers at age 60 to 64 years. This included investigation of sex differences and the extent to which associations may be mediated by adiposity. Methods and Results Participants were 795 men and 827 women aged 60 to 64 years from the Medical Research Council National Survey of Health and Development. Combined heart rate and movement sensors worn for 5 consecutive days were used to derive overall PA energy expenditure, kJ /kg per day) and time spent sedentary (<1.5 metabolic equivalent of tasks), in light PA (1.5-3 metabolic equivalent of tasks) and moderate-to-vigorous intensity PA (>3 metabolic equivalent of tasks). Linear regression models were used to relate each PA parameter to inflammatory (C-reactive protein, interleukin-6), endothelial (tissue-plasminogen activator, E-selectin) and adipokine (leptin, adiponectin) markers extracted from fasting blood samples. Greater time in light PA and moderate-to-vigorous intensity PA and less sedentary time were associated with more favorable biomarker levels. For C-reactive protein, interleukin-6, and leptin, these differences were greater among women than men. For example, % differences (95% confidence intervals) in leptin for men and women per SD increases in sedentary time: 7.9 (2.7, 13.0) and 20.6 (15.3, 25.8); light intensity PA : -3.8 (-8.9, 12.7) and -17.7 (-23.1, -12.4), moderate-to-vigorous intensity PA : -12.9 (-17.9, -8.0) and -18.3 (-23.4, -13.1). Fat mass mediated a greater proportion of these associations in women than men. Conclusions Greater light PA and moderate-to-vigorous intensity PA and less sedentary time in early old age were associated with more favorable cardiovascular biomarker profiles. Fat mass partially mediated these associations but more strongly in women than men, which explained sex differences.

Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis

BACKGROUND

Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality.

OBJECTIVES

This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions.

METHODS

Major electronic databases were searched systematically. A meta-analysis calculating Hedges' g statistic was undertaken.

RESULTS

Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p < 0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges' g = -1.01, 95 % CI -1.18 to -0.85, p < 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (β = 6.6, 95 % CI 0.6-12.6) and inpatient (β = 5.3, 95 % CI 1.6-9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges' g = 0.33, 95 % CI = 0.21-0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists).

CONCLUSION

The multidisciplinary treatment of people with SMI should include a focus on improving fitness to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.

Prognostic value of exercise capacity among patients with treated depression: The Henry Ford Exercise Testing (FIT) Project

BACKGROUND

Exercise capacity is associated with survival in the general population. Whether this applies to patients with treated depression is not clear.

HYPOTHESIS

High exercise capacity remains associated with lower risk of all-cause mortality (ACM) and nonfatal myocardial infraction (MI) among patients with treated depression.

METHODS

We included 5128 patients on antidepressant medications who completed a clinically indicated exercise stress test between 1991 and 2009. Patients were followed for a median duration of 9.4 years for ACM and 4.5 years for MI. Exercise capacity was estimated in metabolic equivalents of tasks (METs). Cox proportional hazards regression models were used.

RESULTS

Patients with treated depression who achieved ≥12 METs (vs those achieving <6 METs) were younger (age 46 ± 9 vs 61 ± 12 years), more often male (60% vs 23%), less often black (10% vs 27%), and less likely to be hypertensive (51% vs 86%), have DM (9% vs 38%), or be obese (11% vs 36%) or dyslipidemic (45% vs 54%). In the fully adjusted Cox proportional hazard regression model, exercise capacity was associated with a lower ACM (HR per 1-MET increase in exercise capacity: 0.82, 95% CI: 0.79-0.85, P < 0.001) and nonfatal MI (HR: 0.92, 95% CI: 0.87-0.97, P = 0.004).

CONCLUSIONS

Exercise capacity had an inverse association with both ACM and nonfatal MI in patients with treated depression, independent of cardiovascular risk factors. These results highlight the potential impact of assessing exercise capacity to identify risk, as well as promoting an active lifestyle among treated depression patients.