The effects of aerobic exercise training at two different intensities in obesity and type 2 diabetes: implications for oxidative stress, low-grade inflammation and nitric oxide production

Exploring the key role of DNA methylation as an epigenetic modulator in oxidative stress related islet cell injury in patients with type 2 diabetes mellitus: a review

Type 2 diabetes mellitus (T2DM) is a multifactorial metabolic disorder characterised by impaired insulin secretion and action, often exacerbated by oxidative stress. Recent research has highlighted the intricate involvement of epigenetic mechanisms, particularly DNA methylation, in the pathogenesis of T2DM. This review aims to elucidate the role of DNA methylation as an epigenetic modifier in oxidative stress-mediated beta cell dysfunction, a key component of T2DM pathophysiology. Oxidative stress, arising from an imbalance between reactive oxygen species (ROS) production and antioxidant defence mechanisms, is a hallmark feature of T2DM. Beta cells, responsible for insulin secretion, are particularly vulnerable to oxidative damage due to their low antioxidant capacity. Emerging evidence suggests that oxidative stress can induce aberrant DNA methylation patterns in beta cells, leading to altered gene expression profiles associated with insulin secretion and cell survival. Furthermore, studies have identified specific genes involved in beta cell function and survival that undergo DNA methylation changes in response to oxidative stress in T2DM. These epigenetic modifications can perpetuate beta cell dysfunction by dysregulating key pathways essential for insulin secretion, such as the insulin signalling cascade and mitochondrial function. Understanding the interplay between DNA methylation, oxidative stress, and beta cell dysfunction holds promise for developing novel therapeutic strategies for T2DM. Targeting aberrant DNA methylation patterns may offer new avenues for restoring beta cell function and improving glycemic control in patients with T2DM. However, further research is needed to elucidate the complex mechanisms underlying epigenetic regulation in T2DM and to translate these findings into clinical interventions.

The analysis of the skeletal muscle metabolism is crucial for designing optimal exercise paradigms in type 2 diabetes mellitus

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that commonly results from a high-calorie diet and sedentary lifestyle, leading to insulin resistance and glucose homeostasis perturbation. Physical activity is recommended as one first-line treatment in T2DM, but it leads to contrasted results. We hypothesized that, instead of applying standard exercise protocols, the prescription of personalized exercise programs specifically designed to reverse the potential metabolic alterations in skeletal muscle could result in better results.

METHODS

To test this hypothesis, we drew the metabolic signature of the fast-twitch quadriceps muscle, based on a combined unbiased NMR spectroscopy and RT-qPCR study, in several T2DM mouse models of different genetic background (129S1/SvImJ, C57Bl/6J), sex and aetiology (high-fat diet (HFD) or HFD/Streptozotocin (STZ) induction or transgenic MKR (FVB-Tg Ckm-IGF1R*K1003R)1Dlr/J) mice. Three selected mouse models with unique muscular metabolic signatures were submitted to three different swimming-based programs, designed to address each metabolic specificity.

RESULTS

We found that depending on the genetic background, the sex, and the mode of T2DM induction, specific muscular adaptations occurred, including depressed glycolysis associated with elevated PDK4 expression, shift to β-oxidation, or deregulation of amino-acid homeostasis. Interestingly, dedicated swimming-based exercises designed to restore specific metabolic alterations in muscle were found optimal in improving systemic T2DM hallmarks, including a significant reduction in insulin resistance, the improvement of glucose homeostasis, and a delay in sensorimotor function alterations.

CONCLUSION

The muscle metabolism constitutes an important clue for the design of precision exercises with potential clinical implications for T2DM patients.

Type 1 and Type 2 Diabetes Mellitus: Commonalities, Differences and the Importance of Exercise and Nutrition

Diabetes mellitus represents a group of physiological dysfunctions characterized by hyperglycaemia resulting directly from insulin resistance (in the case of type 2 diabetes mellitus-T2DM), inadequate insulin secretion/production, or excessive glucagon secretion (in type 1 diabetes mellitus-T1DM) [...].

Oxidative Stress in Type 2 Diabetes: Impacts from Pathogenesis to Lifestyle Modifications

Oxidative stress is a critical factor in the pathogenesis and progression of diabetes and its associated complications. The imbalance between reactive oxygen species (ROS) production and the body's antioxidant defence mechanisms leads to cellular damage and dysfunction. In diabetes, chronic hyperglycaemia and mitochondrial dysfunction contribute to increased ROS production, further exacerbating oxidative stress. This oxidative burden adversely affects various aspects of diabetes, including impaired beta-cell function and insulin resistance, leading to disrupted glucose regulation. Additionally, oxidative stress-induced damage to blood vessels and impaired endothelial function contribute to the development of diabetic vascular complications such as retinopathy, nephropathy, and cardiovascular diseases. Moreover, organs and tissues throughout the body, including the kidneys, nerves, and eyes, are vulnerable to oxidative stress, resulting in diabetic nephropathy, neuropathy, and retinopathy. Strategies to mitigate oxidative stress in diabetes include antioxidant therapy, lifestyle modifications, and effective management of hyperglycaemia. However, further research is necessary to comprehensively understand the underlying mechanisms of oxidative stress in diabetes and to evaluate the efficacy of antioxidant interventions in preventing and treating diabetic complications. By addressing oxidative stress, it might be possible to alleviate the burden of diabetes and improve patient outcomes.

[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia]

Introduction

Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.

Decreased inflammatory gene expression accompanies the improvement of liver enzyme and lipid profile following aerobic training and vitamin D supplementation in T2DM patients

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) is one of the health issues causing untoward low-grade systemic inflammation. Aerobic Training (AT) and Vitamin D (Vit D) supplementation are among the approaches that improve lipid profile and liver enzymes in T2DM. However, the mechanisms responsible for these improvements are not fully elucidated.

OBJECTIVES

This study aimed to evaluate the effects of AT and Vit D supplementation on lipid profile, liver enzymes, Interleukin-6 (IL-6), Interleukin-10 (IL-10), Cluster of differentiation 27 (CD27), Chemokine (C-X-C motif) Ligand 13 (CXCL13), Interferon-Gamma (IFN-γ) and Transforming Growth Factor-Beta 1 (TGF-β1) gene expressions in patients with T2DM.

METHODS

In this study, 40 male T2DM patients aged 35-50 years were randomly selected and assigned into four groups (n = 10 for each); AT+vitamin D supplementation (AT+Vit D), AT+placebo (AT), Vit D supplementation (Vit D), and control+placebo (C). The intervention consisted of 8 weeks of 20-40 minutes AT protocol at 60-75% HR_max 3 sessions/week and taking 50,000 IU of Vit D supplement once a week. Serum levels of lipid profile and liver enzymes and gene expression of IL-6, IL-10, CD27, CXCL13, IFN-γ, and TGF-β1 in Peripheral Blood Mononuclear Cells (PBMCs) were measured. One-way analysis of variance (ANOVA), Tukey's post hoc, and paired sample t-test at P-values less than 0.05 were used to analyze the data using SPSS software.

RESULTS

AT+Vit D, AT, and Vit D significantly decreased TC, TG, LDL, AST, ALT, and GGT while increased HDL after 8 weeks in favor of AT+Vit D. Also, gene expressions of IL-6, IL-10, CD27, CXCL13, IFN-γ, and TGF-β1 were downregulated significantly in AT+Vit D, AT, and Vit D, while upregulated in C. Furthermore, compared to individual AT or Vit D, AT+Vit D significantly downregulated IL-6 (P = 0.013; P = 0.025), IL-10 (P = 0.012; P = 0.026), CD27 (P = 0.023; P = 0.041), CXCL13 (P = 0.014; P = 0.025), IFN-γ (P = 0.017; P = 0.026), and TGF-β1 (P = 0.001; P = 0.028).

CONCLUSION

In comparison to individual AT or Vit D, AT+Vit D may enhance lipid profile, and liver enzymes and drive the balance to favor inhibition of inflammation by downregulating gene expression of inflammation-related factors. As a result, AT+Vit D may be considered appropriate therapy for managing T2DM.

Effect of exercise training on nitric oxide and nitrate/nitrite (NOx) production: A systematic review and meta-analysis

Background: Exercise and physical activity can improve circulation through various mechanisms, such as the increment of nitric oxide (NO) production, by affecting vascular endothelial nitric oxide synthase, and reducing reactive oxygen species (ROS). Although, theoretically, this mechanism is well known, studies in living subjects have made controversial findings regarding the association of NO production and its metabolites [nitrate/nitrite (NOx)] with physical activity. Hence, this systematic review and meta-analysis was designed to gather all these studies and evaluate the effects of exercise training, and physical activity duration and length on the mean change of serum/plasma NO and NOx.

Method: We searched all available bibliographic electronic databases from inception through to May 2022 to include all randomized controlled trials (RCT) and quasi-experimental trials which assessed the effect of exercise and training on NO and NOx levels. Random-effects meta-analysis was used to pool the standardized mean difference (SMD) and 95% confidence interval (CI) of included RCT studies which assessed the effect of training. Stratified meta-analysis was performed according to the type of exercise (high-intensity interval training (HIIT), aerobic training (AT), the duration of exercise (≤8 and > 8 weeks), and length of exercise in each session ≥40 and 40 < minutes).

Results: Overall, 15 and 10 studies were included in the systematic review and meta-analysis, respectively. According to the random-effects meta-analysis, exercise significantly increased the mean change of NO and NOx compared to control (SMD: 1.82, 95%CI: 1.14 to 2.49. In the stratified meta-analysis, the mean change of NO and NOx in the intervention group was significantly higher than in the control group in the AT (SMD: 1.36, 95%CI: 0.55–2.18), HIIT (SMD: 2.55, 95%CI: 1.14–3.96), duration of ≤8 (SMD: 2.29, 95%CI: 1.24–3.35) and > 8 weeks (SMD: 1.19, 95%CI: 0.52–1.86), length of ≥40 (SMD: 1.61, 95%CI: 1.04–2.18), and 40 < minutes in each session (SMD: 2.07, 95%CI: 0.79–3.35).

Conclusion: The findings of this study indicate that, regardless of exercise duration, length, and type (AT or HIIT), exercise can significantly increase serum NO and NOx levels.

Effects of Multicomponent Exercise Training Program on Biochemical and Motor Functions in Patients with Alzheimer’s Dementia

The aim of this study was to examine the effects of a multicomponent exercise training program on motor function and biochemical markers in patients with Alzheimer’s-type dementia. Twenty patients with Alzheimer disease, divided into the intervention group (IG; aged 84 ± 3.1 years) and the control group (CG; aged 86 ± 2.6 years) were included in this study. The intervention group was enrolled into an exercise training program for three months (two sessions of 60 min per week). The CG was instructed to follow their daily rhythm of life (e.g., rest, reading) without a physical training program. After 3 months of participation in a multicomponent exercise program, gait speed, balance and walking parameters were all improved in the intervention group as measured with the Berg Balance Scale, the Tinetti test, the 6-min walking test and the timed up and go test (p < 0.05 for all; percentage range of improvements: 3.17% to 53.40%), except the walking while talking test, and biochemical parameters were not affected (p > 0.05). Our results demonstrate that exercise improves postural control, aerobic capacity and mobility functions in patients with Alzheimer disease. Physical exercise is a safe and effective method for treating physical disorders in patients with Alzheimer’s disease and can easily be integrated in various programs for the management of Alzheimer disease.

HSP70 as a biomarker of the thin threshold between benefit and injury due to physical exercise when exposed to air pollution

Physical exercise has acute and chronic effects on inflammatory balance, metabolic regulation, and redox status. Exercise-induced adaptations are mediated by enhanced 70-kDa heat shock protein (HSP70) levels and an improved heat shock response (HSR). Therefore, exercise could be useful against disease conditions [obesity, diabetes mellitus (DM), and exposure to atmospheric pollutants] marked by an impaired HSR. However, exercise performed by obese or diabetic subjects under pollution conditions might also be dangerous at certain intensities. Intensity correlates with an increase in HSP70 levels during physical exercise until a critical point at which the effort becomes harmful and impairs the HSR. Establishing a unique biomarker able to indicate the exercise intensity on metabolism and cellular fatigue is essential to ensure adequate and safe exercise recommendations for individuals with obesity or DM who require exercise to improve their metabolic status and live in polluted regions. In this review, we examined the available evidence supporting our hypothesis that HSP70 could serve as a biomarker for determining the optimal exercise intensity for subjects with obesity or diabetes when exposed to air pollution and establishing the fine threshold between anti-inflammatory and pro-inflammatory exercise effects.

Six weeks of high intensity cycle training reduces H2O2 emission and increases antioxidant protein levels in obese adults with risk factors for type 2 diabetes

Obesity has been associated with increased production of reactive oxygen species (ROS), which may be involved in the development of cardiovascular disease and type 2 diabetes (T2D). Endurance exercise lowers ROS production and increases antioxidant capacity in muscle cells, but it is currently unknown whether high intensity interval training (HIT) elicits the same effects. Twelve sedentary obese subjects at risk of developing T2D took part in a six-week intervention, performing three HIT sessions per week (five 1-min sets of high-intensity cycling (125% of VO₂peak), with 90 s recovery in between sets). Muscle biopsies were obtained for assessment of ROS production (H₂O₂ emission), mitochondrial respiratory capacity, and antioxidant protein levels before and after the intervention. H₂O₂ emission decreased 60.4% after the intervention (Succinate 3 mmol･l^-1), concurrent with a 35.1% increase in protein levels of the antioxidant manganese superoxide dismutase (MnSOD) and a trend towards increased levels of the antioxidant catalase (p = 0.06, 72.9%). These findings were accompanied by a 19% increased mitochondrial respiratory capacity (CI + II), a 6.9% increased VO₂peak and a 1.7% lower body fat percentage. These effects were achieved after just 15 min of high-intensity work and 40 min of total time spent per week. Overall, this suggests that a relatively small amount of HIT is sufficient to induce beneficial effects on ROS production and antioxidant status in muscle cells, which may lower oxidative stress and potentially protect against the development of cardiovascular disease.

Reactive oxygen species in exercise and insulin resistance: Working towards personalized antioxidant treatment

Reactive oxygen species (ROS) are well known for their role in insulin resistance and the development of cardiometabolic disease including type 2 diabetes mellitus (T2D). Conversely, evidence supports the notion that ROS are a necessary component for glucose cell transport and adaptation to physiological stress including exercise and muscle contraction. Although genetic rodent models and cell culture studies indicate antioxidant treatment to be an effective strategy for targeting ROS to promote health, human findings are largely inconsistent. In this review we discuss human research that has investigated antioxidant treatment and glycemic control in the context of health (healthy individuals and during exercise) and disease (insulin resistance and T2D). We have identified key factors that are likely to influence the effectiveness of antioxidant treatment: 1) the context of treatment including whether oxidative distress or eustress is present (e.g., hyperglycemia/lipidaemia or during exercise and muscle contraction); 2) whether specific endogenous antioxidant deficiencies are identified (redox screening); 3) whether antioxidant treatment is specifically designed to target and restore identified deficiencies (antioxidant specificity); 4) and the bioavailability and bioactivity of the antioxidant which are influenced by treatment dose, duration, and method of administration. The majority of human research has failed to account for these factors, limiting their ability to robustly test the effectiveness of antioxidants for health promotion and disease prevention. We propose that a modern "redox screening" and "personalized antioxidant treatment" approach is required to robustly explore redox regulation of human physiology and to elicit more effective antioxidant treatment in humans.

The metabolic-epigenetic nexus in type 2 diabetes mellitus

The prevalence of type 2 diabetes mellitus (T2DM) continues to rise globally. Yet the aetiology and pathophysiology of this noncommunicable, polygenic disease, is poorly understood. Lifestyle factors, such as poor dietary intake, lack of exercise, and abnormal glycaemia, are purported to play a role in disease onset and progression, and these environmental factors may disrupt specific epigenetic mechanisms, leading to a reprogramming of gene transcription. The hyperglycaemic cell per se, alters epigenetics through chemical modifications to DNA and histones via metabolic intermediates such as succinate, α-ketoglutarate and O-GlcNAc. To illustrate, α-ketoglutarate is considered a salient co-factor in the activation of the ten-eleven translocation (TET) dioxygenases, which drives DNA demethylation. On the contrary, succinate and other mitochondrial tricarboxylic acid cycle intermediates, inhibit TET activity predisposing to a state of hypermethylation. Hyperglycaemia depletes intracellular ascorbic acid, and damages DNA by enhancing the production of reactive oxygen species (ROS); this compromised cell milieu exacerbates the oxidation of 5-methylcytosine alongside a destabilisation of TET. These metabolic connections may regulate DNA methylation, affecting gene transcription and pancreatic islet β-cell function in T2DM. This complex interrelationship between metabolism and epigenetic alterations may provide a conceptual foundation for understanding how pathologic stimuli modify and control the intricacies of T2DM. As such, this narrative review will comprehensively evaluate and detail the interplay between metabolism and epigenetic modifications in T2DM.

Effects of Cardiovascular, Resistance and Combined Exercise Training on Cardiovascular, Performance and Blood Redox Parameters in Coronary Artery Disease Patients: An 8-Month Training-Detraining Randomized Intervention

It is well-documented that chronic/regular exercise improves the cardiovascular function, decreases oxidative stress and enhances the antioxidant capacity in coronary artery disease (CAD) patients. However, there is insufficient evidence regarding the chronic effects of different types of training and detraining on cardiovascular function and the levels of oxidative stress and antioxidant status in these patients. Therefore, the present study aimed at investigating the effects of cardiovascular, resistance and combined exercise training followed by a three-month detraining period, on cardiovascular function, physical performance and blood redox status parameters in CAD patients. Sixty coronary artery disease patients were randomly assigned to either a cardiovascular training (CVT, N = 15), resistance training (RT, N = 11), combined cardiovascular and resistance training (CT, N = 16) or a control (C, N = 15) group. The training groups participated in an 8-month supervised training program (training three days/week) followed by a 3-month detraining period, while the control group participated only in measurements. Body composition, blood pressure, performance-related variables (aerobic capacity (VO_2max), muscle strength, flexibility) and blood redox status-related parameters (thiobarbituric acid reactive substances (TBARS), total antioxidant capacity (TAC), reduced glutathione (GSH), oxidized glutathione (GSSG), catalase activity (CAT), protein carbonyls (PC)) were assessed at the beginning of the study, after 4 and 8 months of training as well as following 1, 2 and 3 months of detraining (DT). CVT induced the most remarkable and pronounced alterations in blood pressure (~9% reduction in systolic blood pressure and ~5% in diastolic blood pressure) and redox status since it had a positive effect on all redox-related variables (ranging from 16 to 137%). RT and CT training affected positively some of the assessed (TAC, CAT and PC) redox-related variables. Performance-related variables retained the positive response of the training, whereas most of the redox status parameters, for all training groups, restored near to the pre-exercise values at the end of the DT period. These results indicate that exercise training has a significant effect on redox status of CAD. Three months of detraining is enough to abolish the exercise-induced beneficial effects on redox status, indicating that for a better antioxidant status, exercise must be a lifetime commitment.

Endocrinopathies and cancer cachexia

PURPOSE OF REVIEW

Cancer cachexia cannot be easily reversed by standard nutritional support and interventions directed at underlying metabolic derangements may be needed to prevent or reverse cachexia and maintain healthy body composition. The following review will highlight the contribution and potential therapeutic interventions for insulin resistance, alterations in ghrelin signaling, and hypogonadism in cancer patients.

RECENT FINDINGS

In addition to decreased caloric intake, chronic inflammation, and altered metabolism of glucose, proteins and lipids, endocrine abnormalities can propagate weight loss or changes in body composition in cancer patients.

SUMMARY

Cancer cachexia, loss of muscle mass with or without the loss of fat mass, is a multifactorial syndrome, which is associated with increased morbidity and mortality. Currently, limited therapeutic options for the treatment of weight loss in cancer patients exist, which lead to clinically meaningful improvements in weight gain and performance status. Treatment directed at underlying insulin resistance, low testosterone, and altered ghrelin sensitivity, in the future, may lead to potential therapeutic options for loss of lean body mass and cancer cachexia.

Effects of Aerobic Exercise Protocol on Genes Related to Insulin Resistance and Inflammation in the Pancreas of ob/ob Mice with NAFLD

PURPOSE

To evaluate the effect of 8 weeks of aerobic training on insulin resistance and inflammatory response in obese mice (ob/ob) with NAFLD.

MATERIALS AND METHODS

Male ob/ob mice were randomly divided into sedentary (n=7) and trained (n=7) groups. Aerobic training consisted of 5 weekly sessions, 60 min per session at 60% of the maximum speed of the running test. Hepatic and pancreatic samples were collected to evaluate histological features and gene expression associated with insulin resistance and inflammatory response after 8-week experiment protocol. RNA was performed by TRIzol®. PCR experiments were performed using the Rotor-Gene RG-3000. Parametric data were assessed by t-test, one-way ANOVA and Bonferroni test for multiple comparisons. Non-parametric data were assessed by the Mann-Whitney tests with Dunn's post-test of multiple comparisons. Histological analysis was assessed by chi-square test with Fisher's exact test. Significant variables were considered when p<0.05. All the analyses were performed by GraphPad Prism V6.0 software (GraphPad Software Inc.).

RESULTS

Reductions in bodyweight (p = 0.008), weight evolution (p = 0.03), food intake (p <0.0001) and fat content were observed in trained group. Moreover, the trained group showed better results in peak velocity (p=0.03) physical effort tolerance (p=0.006) and distance (p=0.01). Gene expression showed differences in IL-10 (p=0.03) and GLUT-2 (p=0.03) in hepatic analysis, between groups. Pancreatic gene expression showed difference between groups in IRS-2 (p=0.004), GLUT-2 (p=0.03) and IL-10 (p=0.008) analysis. Also, the trained group showed lower values for interlobular fat and inflammatory infiltrate in histological analysis when compared to sedentary animals.

CONCLUSION

An 8-week physical training protocol was able to attenuate bodyweight gain, food intake and generate positive effects on gene expression related to insulin resistance and inflammation in both liver and pancreas of ob/ob mice.

Capillary facilitation of skeletal muscle function in health and disease

Skeletal muscle is highly vascularized, with perfusion being tightly regulated to meet wide-ranging metabolic demands. For decades, the capillary supply has been explored mainly in terms of evaluating the capillary numbers and their function in the supply of oxygen and substrates and the removal of metabolic byproducts. This review will focus on recent discoveries concerning the role played by capillaries in facilitating other aspects of cell regulation and maintenance, in health and disease, as well as alterations during the aging process.

Novelty Capillaries play a central role in the coordination of the vascular response that controls blood flow during contraction and the cellular responses to which they feed into. Nitric oxide is an important regulatory compound within the cardiovascular system, and a significant contributor to skeletal muscle capillary angiogenesis and vasodilatory response to agonists. The microvascular network between muscle fibres may play a critical role in the distribution of signalling factors necessary for optimal muscle satellite cell function.

Effects of exercise training and detraining on atheromatous matrix metalloproteinase activity in mice

BACKGROUND AND AIMS

Exercise training (ET) helps treat atherosclerosis. However, many patients stop regular ET for various reasons. The effect of detraining on atherosclerosis is not well studied. We examined the effects of ET vs. short-term detraining on atheromatous matrix-metalloproteinase (MMP) activity in preexisting plaque and circulating cytokines/lipids.

METHODS AND RESULTS

Eighteen-week-old apolipoprotein-E^-/- mice (n = 56) on a Western diet underwent: 1) ET for 6-weeks (ET5+1), 2) ET for 5-weeks and detraining for 1-week (ET5+0), 3) ET for the last 1-week (ET0+1), or 4) no treadmill ET at all for 6-weeks (ET0+0). Atheromatous MMP-activity was visualized using molecular imaging with an MMP-2/9-activatable near-infrared-fluorescent probe. Compared with no ET (ET0+0), regular ET (ET5+1) decreased carotid atheromatous MMP activity, but this protective effect was significantly blunted by short-term detraining (ET5+0). Short-term detraining after longer-term ET showed a reduction in MMP-activity similar to short-term ET (ET0+1). Blood levels of lipids and cytokines paralleled the molecular imaging results: exercise caused higher levels of high-density lipoprotein, adiponectin, and interleukin-10 and lower levels of vascular cell adhesion molecule, monocyte chemoattractant protein-1, interleukin-1β, and low-density lipoprotein. However, this beneficial effect was short-lived, with the ET5+0 group being similar to the ET0+0 group, and the ET0+1 group being similar to the ET5+1 group. The effect of exercise can be modeled with an exponential-decay of the protective factor of about 15%/day.

CONCLUSIONS

Even short-term detraining reduces atheroprotective effects, and tips the balance towards atherosclerosis. This suggests that ET, to be effective, needs to be prolonged and regular, and that detraining should be avoided.

Aerobic Training Down-Regulates Pentraxin 3 and Pentraxin 3/Toll-Like Receptor 4 Ratio, Irrespective of Oxidative Stress Response, in Elderly Subjects

Reactive oxygen and nitrogen species-mediated cellular aging has been linked to diseases such as atherothrombosis and cancer. Although pentraxin 3 (PTX3) is associated with aging-related diseases via TLR4-dependent anti-inflammatory effects, its relationship with oxidative stress in aging remains to be elucidated. Exercise is proposed as the key intervention for health maintenance in the elderly. This study aimed to examine the association of PTX3 levels with changes in oxidative stress in both plasma and peripheral blood mononuclear cells (PBMCs), following aerobic training in elderly adults. Nine trained and five controls participated in an eight-week aerobic training protocol. Enzyme-linked immunosorbent assay (ELISA) and Western blot analyses were used to determine PTX3, toll-like receptor 4 (TLR4), and levels of oxidative stress biomarkers [3-nitrotyrosine (3NT), 4-hydroxynonenal (4-HNE), glutathione (GSH), protein carbonyl (PC), reactive oxygen/ nitrogen species (ROS/RNS), and trolox equivalent antioxidant capacity (TEAC)] in plasma and/or PBMCs. Results showed a down-regulation of PTX3 expression in PBMCs following aerobic training, along with decreased PTX3/TLR4 ratios. Oxidative stress responses in PBMCs remained unchanged with the exercise protocol. Comparable levels of plasma PTX3 and oxidative stress biomarkers were observed in trained vs. control groups. No correlation was found between PTX3 and any oxidative stress biomarkers following training. These findings demonstrated the down-regulation of PTX3 and PTX3/TLR4 ratio, irrespective of oxidative stress response, in elderly adults following eight weeks of aerobic training.

Comparing High-Intensity Interval Training (HIIT) and Continuous Training on Apelin, APJ, NO, and Cardiotrophin-1 in Cardiac Tissue of Diabetic Rats

BACKGROUND AND AIMS

Exercise activity is an important method for managing type 2 diabetes. This investigation examined the HIIT and continuous training on apelin, APJ receptor, NO, and cardiotrophin-1 in the cardiac tissue of diabetic rats.

METHODS

The animals were categorized into 3 groups of HIIT, continuous (CO), and control (C) (all animals were sacrificed immediately and 2 days after exercise training period). Rats underwent the treadmill exercise program either HIIT (12 bouts at 90-95% of VO₂ max with 60 s rest at 50% of VO₂ max) or CO (60-65% VO₂ max for 40 min). Protocols performed 5 days per week for 8 weeks. Apelin, APJ receptor, NO, and cardiotrophin-1 protein expressions were measured using the Western blotting method in the left ventricle.

RESULTS

Immediately after HIIT and CO exercise protocols, apelin and CT-1 protein showed a significant difference in contrast by the C-0 group (p < 0.01). However, NO values were substantially higher in HIIT-0 compared to C-0 and CO-0 groups rats (p < 0.01). After two days of exercise protocols, apelin and NO protein showed a significant increase in HIIT and CO groups in contrast to the C animals (p < 0.01). Moreover, APJ and CT-1 protein significantly upregulated in CO-2 and HIIT-2 compared to the other groups (p < 0.01).

CONCLUSIONS

This study indicates that exercise training, despite the type, is an efficient method to modify apelin, APJ receptor, NO, and cardiotrophin-1 values in animals with type 2 diabetes.

Exercise-Induced Regulation of Redox Status in Cardiovascular Diseases: The Role of Exercise Training and Detraining

Although low levels of reactive oxygen species (ROS) are beneficial for the organism ensuring normal cell and vascular function, the overproduction of ROS and increased oxidative stress levels play a significant role in the onset and progression of cardiovascular diseases (CVDs). This paper aims at providing a thorough review of the available literature investigating the effects of acute and chronic exercise training and detraining on redox regulation, in the context of CVDs. An acute bout of either cardiovascular or resistance exercise training induces a transient oxidative stress and inflammatory response accompanied by reduced antioxidant capacity and enhanced oxidative damage. There is evidence showing that these responses to exercise are proportional to exercise intensity and inversely related to an individual’s physical conditioning status. However, when chronically performed, both types of exercise amplify the antioxidant defense mechanism, reduce oxidative stress and preserve redox status. On the other hand, detraining results in maladaptations within a time-frame that depends on the exercise training intensity and mode, as high-intensity training is superior to low-intensity and resistance training is superior to cardiovascular training in preserving exercise-induced adaptations during detraining periods. Collectively, these findings suggest that exercise training, either cardiovascular or resistance or even a combination of them, is a promising, safe and efficient tool in the prevention and treatment of CVDs.

Heat shock response to exercise in pancreatic islets of obese mice

Chronic obesity imposes an organismal state of low-grade inflammation because the physiological resolution of inflammation is progressively repressed giving rise to cellular senescence and its accompanying Senescence-Associated Secretory Phenotype (SASP), which avoids apoptosis but perpetuates the relay of inflammatory signals from adipose tissue toward the rest of the body. Conversely, resolution of inflammation depends on the integrity of heat shock response (HSR) pathway that leads to the expression of cytoprotective and anti-inflammatory protein chaperones of the 70 kDa family (HSP70). However, chronic exposure to the aforementioned injuring factors leads to SASP, which, in turn, suppresses the HSR. A main metabolic tissue severely jeopardized by obesity-related dysfunctions is the endocrine pancreas, particularly β-cells of the islets of Langerhans. Because exercise is a powerful inducer of HSR and predicted to alleviate negative health outcomes of obesity, we sought whether obesity influence HSP70 expression in pancreatic islets and other metabolic tissues (adipose tissue and skeletal muscle) of adult B6.129SF2/J mice fed on a high-fat diet (HFD) for 13 weeks since the weaning and whether acute exercise as well as moderate-intensity exercise training (8 weeks) could interfere with this scenario. We showed that acute exercise of moderate intensity protects pancreatic islets against cytokine-induced cell death. In addition, acute exercise challenge time-dependently increased islet HSP70 that peaked at 12 h post-exercise in both trained and untrained mice fed on a control diet, suggesting an adequate HSR to exercise training. Unexpectedly, however, neither exercise training nor acute exercise challenges were able to increase islet HSP70 contents in trained mice submitted to HFD, but only in untrained HFD animals. In parallel, HFD disrupted glycemic status which is accompanied by loss of muscular mass resembling sarcopenic obesity that could not be rescued by exercise training. These results suggest that exercise influences HSR in pancreatic islets but obesity undermines islet, muscle and adipose tissue HSR, which is associated with metabolic abnormalities observed in such tissues.

Insulin resistance and body composition in cancer patients

Cancer cachexia, weight loss with altered body composition, is a multifactorial syndrome propagated by symptoms that impair caloric intake, tumor byproducts, chronic inflammation, altered metabolism, and hormonal abnormalities. Cachexia is associated with reduced performance status, decreased tolerance to chemotherapy, and increased mortality in cancer patients. Insulin resistance as a consequence of tumor byproducts, chronic inflammation, and endocrine dysfunction has been associated with weight loss in cancer patients. Insulin resistance in cancer patients is characterized by increased hepatic glucose production and gluconeogenesis, and unlike type 2 diabetes, normal fasting glucose with high, normal or low levels of insulin. Cancer cachexia results in altered body composition with the loss of lean muscle mass with or without the loss of adipose tissue. Alteration in visceral adiposity, accumulation of intramuscular adipose tissue, and secretion of adipocytokines from adipose cells may play a role in promoting the metabolic derangements associated with cachexia including a proinflammatory environment and insulin resistance. Increased production of ghrelin, testosterone deficiency, and low vitamin D levels may also contribute to altered metabolism of glucose. Cancer cachexia cannot be easily reversed by standard nutritional interventions and identifying and treating cachexia at the earliest stage of development is advocated. Experts advocate for multimodal therapy to address symptoms that impact caloric intake, reduce chronic inflammation, and treat metabolic and endocrine derangements, which propagate the loss of weight. Treatment of insulin resistance may be a critical component of multimodal therapy for cancer cachexia and more research is needed.

Oxidative Stress and Inflammation, Key Targets of Atherosclerotic Plaque Progression and Vulnerability: Potential Impact of Physical Activity

Atherosclerosis, a complex cardiovascular disease, is a leading cause of mortality and morbidity worldwide. Oxidative stress and inflammation are both involved in the development of atherosclerotic plaque as they increase the biological processes associated with this pathology, such as endothelial dysfunction and macrophage recruitment and adhesion. Atherosclerotic plaque rupture leading to major ischemic events is the result of vulnerable plaque progression, which is a result of the detrimental effect of oxidative stress and inflammation on risk factors for atherosclerotic plaque rupture, such as intraplaque hemorrhage, neovascularization, and fibrous cap thickness. Thus, both are key targets for primary and secondary interventions. It is well recognized that chronic physical activity attenuates oxidative stress in healthy subjects via the improvement of antioxidant enzyme capacities and inflammation via the enhancement of anti-inflammatory molecules. Moreover, it was recently shown that chronic physical activity could decrease oxidative stress and inflammation in atherosclerotic patients. The aim of this review is to summarize the role of oxidative stress and inflammation in atherosclerosis and the results of therapeutic interventions targeting them in both preclinical and clinical studies. The effects of chronic physical activity on these two key processes are then reviewed in vulnerable atherosclerotic plaques in both coronary and carotid arteries.

Aerobic exercise training prevents obesity and insulin resistance independent of the renin angiotensin system modulation in the subcutaneous white adipose tissue

We investigate the effects of aerobic exercise training (AET) on the thermogenic response, substrate metabolism and renin angiotensin system (RAS) in the subcutaneous white adipose tissue (SC-WAT) of mice fed cafeteria diet (CAF). Male C57BL/6J mice were assigned into groups CHOW-SED (chow diet, sedentary; n = 10), CHOW-TR (chow diet, trained; n = 10), CAF-SED (CAF, sedentary; n = 10) and CAF-TR (CAF, trained; n = 10). AET consisted in running sessions of 60 min at 60% of maximal speed, five days per week for eight weeks. The CAF-SED group showed higher body weight and adiposity, glucose intolerance and insulin resistance (IR), while AET prevented such damages in CAF-TR group. AET reduced the p-AKT/t-AKT ratio and increased ATGL expression in CHOW-TR and CAF-TR groups and increased t-HSL and p-HSL/t-HSL ratio in CAF-TR. AET prevented adipocyte hypertrophy in CAF-TR group and increased UCP-1 protein expression only in CHOW-TR. Serum ACE2 increased in CHOW-TR and CAF-TR groups, and Ang (1–7) increased in the CHOW-TR group. In the SC-WAT, CAF-TR group increased the expression of AT1, AT2 and Mas receptors, whereas CHOW-TR increased Ang (1–7) and Ang (1–7)/Ang II ratio in SC-WAT. No changes were observed in ACE and Ang II. Positive correlations were observed between UCP-1 and kITT (r = 0.6), between UCP-1 and Ang (1–7) concentration (r = 0.6), and between UCP-1 and Ang (1–7)/Ang II ratio (r = 0.7). In conclusion, the AET prevented obesity and IR, reduced insulin signaling proteins and increased lipolysis signaling proteins in the SC-WAT. In addition, the CAF diet precludes the AET-induced thermogenic response and the partial modulation of the RAS suggests that the protective effect of AET against obesity and IR could not be associated with SC-WAT RAS.

Aspalathus linearis (Rooibos) - a functional food targeting cardiovascular disease

Increasing consumer bias toward natural products and the considerable wealth of indigenous knowledge has precipitated an upturn in market-driven research into potentially beneficial medicinal plants. In this context, Aspalathus linearis (Rooibos) has been identified to be a promising candidate which may impact cardiovascular disease (CVD), which is one of the most widely studied chronic diseases of modern times. Despite these efforts, ischemic heart disease remains the number one cause of mortality globally. Apart from genetic predisposition and other aetiological mechanisms specific to particular types of CVD, co-factors from interlinked systems contribute significantly to disease development and the severity of its clinical manifestation. The bioactivity of Rooibos is directed towards multiple therapeutic targets. Experimental data to date include antioxidant, anti-inflammatory and anti-diabetic effects, as well as modulatory effects in terms of the immune system, adrenal steroidogenesis and lipid metabolism. This review integrates relevant literature on the therapeutic potential of Rooibos in the context of CVD, which is currently the most common of non-communicable diseases. The therapeutic value of whole plant extracts versus isolated active ingredients are addressed, together with the potential for overdose or herb-drug interaction. The body of research undertaken to date clearly underlines the benefits of Rooibos as both preventative and complementary therapeutic functional food in the context of CVD.

Association of l-Arginine Supplementation with Markers of Endothelial Function in Patients with Cardiovascular or Metabolic Disorders: A Systematic Review and Meta-Analysis

l-Arginine supplementation is a potential therapy for treating cardiovascular and metabolic diseases. However, the use of distinct l-arginine sources, intervened populations, and treatment regimens may have yielded confusion about their efficacy. This research constitutes a systematic review and meta-analysis summarizing the effects of l-arginine supplementation compared to placebo in individuals with cardiovascular disease (CVD), obesity, or diabetes. Eligibility criteria included randomized clinical trials and interventions based on oral supplementation of l-arginine with a minimum duration of three days; comparison groups consisted of individuals with the same disease condition receiving an oral placebo substance. The primary outcome was flow-mediated dilation, and secondary outcomes were nitrite/nitrate (NOx) rate and asymmetric dimethylarginine (ADMA). Statistical heterogeneity among studies included in the meta-analyses was assessed using the inconsistency index (I2). Fifty-four full-text articles from 3761 retrieved references were assessed for eligibility. After exclusions, 13 studies were included for data extraction. There was no difference in blood flow after post-ischemic hyperemia between the supplementation of l-arginine and placebo groups before and after the intervention period (standardized mean difference (SMD) = 0.30; 95% confidence intervals (CIs) = −0.85 to 1.46; I2 = 96%). Sensitivity analysis showed decreased heterogeneity when the studies that most favor arginine and placebo were removed, and positive results in favor of arginine supplementation were found (SMD = 0.59; 95% CIs = 0.10 to 1.08; I2 = 75%). No difference was found in meta-analytical estimates of NOx and ADMA responses between arginine or placebo treatments. Overall, the results indicated that oral l-arginine supplementation was not associated with improvements on selected variables in these patients (PROSPERO Registration: CRD42017077289).

Glycemic, inflammatory and oxidative stress responses to different high-intensity training protocols in type 1 diabetes: A randomized clinical trial

AIMS

To investigate the effects of high-intensity interval training (HIIT) and/or strength training (ST) on inflammatory, oxidative stress (OS) and glycemic parameters in type 1 diabetes (T1DM) patients.

METHODS

After a 4-week control period, volunteers were randomly assigned to 10-week HIIT, ST or ST + HIIT protocol, performed 3×/week. Blood biochemistry, anthropometric, strength and cardiopulmonary fitness variables were assessed. Outcomes were analyzed via generalized estimating equations (GEE), with Bonferroni post hoc analysis.

RESULTS

ST, HIIT and ST + HIIT improved glycemic (HbA_1c and fasting glucose) and antioxidant parameters (total antioxidant capacity, catalase and superoxide dismutase activities), but not plasma inflammatory (C-reactive protein, TNF-α and IL-10) or OS markers (thiobarbituric acid-reactive substances, 8-hydroxy-2-deoxyguanosine and oxLDL) levels. Noteworthy, interventions reduced soluble receptors for advanced glycation end products levels. However, intracellular heat shock protein 70 content increased only after HIIT. While daily insulin dosage decreased only in the ST + HIIT group, all training models induced anthropometric and functional benefits.

CONCLUSIONS

Similar benefits afforded by ST, HIIT or ST + HIIT in T1DM people are associated with enhanced antioxidant systems and glucose-related parameter, even in a few weeks. From a practical clinical perspective, the performance of ST + HIIT may be advised for additional benefits regarding insulin dosage reduction.

Effects of dancing compared to walking on cardiovascular risk and functional capacity of older women: A randomized controlled trial

INTRODUCTION

Aging is characterized by reductions in lean mass simultaneously to increases in visceral adipose tissue, elevating cardiovascular risk (CVR) and physical dependence. Dancing has been recommended for improving fall-risk and CVR, however, comparisons with traditional exercises are limited. This study aimed to compare the effects of dancing with walking on CVR and functionality of older women.

METHODS

Thirty sedentary women (65 ± 5 years, BMI 27 ± 4 kg/m²) were randomized into three groups (n = 10/group): dancing, walking or stretching (active control). All interventions lasted 8 weeks (60 min sessions): dancing/walking 3×/week, stretching 1×/week. Dancing: several styles, no partner. Walking: treadmill, 60% peak oxygen consumption (VO₂peak). Stretching: large muscle groups, no discomfort. Before and after interventions assessments: VO₂peak (primary outcome), total cholesterol, HDL-C, LDL-C, glucose, insulin, CRP, TNF-α, waist and hip circumferences, visceral adipose tissue (VAT), muscle thickness, maximal muscle strength/power, static and dynamic balance, gait ability, flexibility, chair-raise and level of physical activity (PA).

STATISTICS

generalized estimating equations, post-hoc LSD (p < 0.05), SPSS 22.0.

RESULTS

(Mean-CI): (before vs after): group vs time interaction showed increases in VO₂peak (mL·kg^-1·min^-1) for dancing 23.3 (20.8-25.8) vs 25.6 (23.4-27.8), and walking 23.4 (21.3-25.5) vs 27.0 (25.4-28.6), with no differences for stretching 23.5 (21.3-25.7) vs 23.0 (21.0-24.9). Lower body muscle power and static balance also improved for dancing and walking, but not for stretching. Main time effect showed improvements in CRP, TNF-α, LDL-C, HDL-C, VAT, waist, hip, chair raise, flexibility and level of daily PA for all groups.

CONCLUSION

Dancing induced similar increases in VO₂peak, lower body muscle power and static balance as walking, while the stretching group remained unchanged. Pooled effects showed improvements in body composition, lipid and inflammatory profile, which are supported by increased PA levels.

TRIAL REGISTRATION

NCT03262714.

Aerobic Exercise Training and Inducible Inflammation: Results of a Randomized Controlled Trial in Healthy, Young Adults

Background Consensus panels regularly recommend aerobic exercise for its health-promoting properties, due in part to presumed anti-inflammatory effects, but many studies show no such effect, possibly related to study differences in participants, interventions, inflammatory markers, and statistical approaches. This variability makes an unequivocal determination of the anti-inflammatory effects of aerobic training elusive. Methods and Results We conducted a randomized controlled trial of 12 weeks of aerobic exercise training or a wait list control condition followed by 4 weeks of sedentary deconditioning on lipopolysaccharide (0, 0.1, and 1.0 ng/mL)-inducible tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and on toll-like receptor 4 in 119 healthy, sedentary young adults. Aerobic capacity by cardiopulmonary exercise testing was measured at study entry (T1) and after training (T2) and deconditioning (T3). Despite a 15% increase in maximal oxygen consumption, there were no changes in inflammatory markers. Additional analyses revealed a differential longitudinal aerobic exercise training effect by lipopolysaccharide level in inducible TNF -α ( P=0.08) and IL-6 ( P=0.011), showing T1 to T2 increases rather than decreases in inducible (lipopolysaccharide 0.1, 1.0 versus 0.0 ng/mL) TNF- α (51% increase, P=0.041) and IL-6 (42% increase, P=0.11), and significant T2 to T3 decreases in inducible TNF- α (54% decrease, P=0.007) and IL-6 (55% decrease, P<0.001). There were no significant changes in either group at the 0.0 ng/mL lipopolysaccharide level for TNF- α or IL-6. Conclusions The failure to support the primary hypotheses and the unexpected post hoc findings of an exercise-training-induced proinflammatory response raise questions about whether and under what conditions exercise training has anti-inflammatory effects. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01335737.

Self-directed exercise programmes in sedentary middle-aged individuals in good overall health; a systematic review

Many chronic diseases and illnesses are caused by the lifestyle, including the physical activity habits, of an individual. As such, consistent high levels of exercise should be encouraged across the lifespan, to limit the risk of developing one of these conditions and allowing for healthy aging to occur. Exercise prescriptions that encourage high completion and adherence rates in an independent manner and improve health related outcomes should be provided to individuals. To date, no review has identified optimal prescriptions of exercise to achieve this in sedentary middle-aged adults and this is important, given the higher risk of developing illnesses in this population as they age. This review examines the effects prescriptions of self-directed (SD) exercise has on adherence and health related outcomes in sedentary middle-aged individuals in good general health currently and aims to identify the most suitable forms of planned SD exercise that can be carried out independently. A systematic search of the electronic database PubMed was conducted. Randomised controlled trials published in English between February 2007 and February 2017 examining healthy, sedentary middle-aged participants only were included. Studies were critically appraised using the PEDro scale and data were presented on standardised tables. Twenty-one articles examining different aerobic activities, combined training and non-traditional exercise prescriptions were included. This review summarised in detail the effects SD exercise interventions had on sedentary middle-aged individuals alongside the adherence to the prescriptions. SD exercise was seen to be beneficial for improving metabolic outcomes physical characteristics, cardiorespiratory fitness and functional measures.

Effects of acute ingestion of whey protein with or without prior aerobic exercise on postprandial glycemia in type 2 diabetics

PURPOSE

Acute protein co-ingestion or a single bout of aerobic exercise can attenuate postprandial glycemia, but their combined effect has not been investigated in type 2 diabetics.

METHODS

Using a randomised crossover design, male type 2 diabetics (n = 8) [mean (95% CI); age, 55.0 (45.2, 64.8) year; BMI, 33.7 (25.6, 41.8) kg·m^- 2; 2 h glucose 14.0 (12.5, 15.5) mM] completed (1) 75 g oral glucose tolerance test (OGTT) (CON); (2) OGTT supplemented with 0.33 g·kg BM^- 1 of whey protein concentrate (PRO); or OGTT supplemented with PRO but preceded by a bout of aerobic cycling exercise (PRO + EX). Postprandial venous blood samples were collected for glucose, insulin, C-peptide and glucagon.

RESULTS

Despite a fold-increase of 1.90 (1.26, 2.56; p < 0.05) in postprandial insulin compared to CON, PRO failed to attenuate postprandial glycemia measured by 2 h glucose area under the curve. During PRO + EX, plasma glucose was elevated by 1.51 (0.5, 2.5) mM and 1.3 (0.3, 2.3) mM at 15 and 30 min, respectively, compared to CON, but was lower by 1.60 (0.6, 2.6) mM and 1.5 (0.5, 2.5) mM at 90 and 120 min, respectively (all p < 0.01). The additive effect of exercise and protein ingestion resulted in a fold-increase of 1.67 (1.35, 2.00; p < 0.05) in postprandial glucagon compared to CON.

CONCLUSION

In type 2 diabetics, prior aerobic exercise altered the humoral response to co-ingestion of whey protein with a carbohydrate load, but neither protein ingestion alone nor when preceded by prior exercise attenuated postprandial glycemia.

Induction chemotherapy reduces extracellular heat shock protein 72 levels, inflammation, lipoperoxidation and changes insulin sensitivity in children and adolescents newly diagnosed with acute lymphoblastic leukemia

Background

Acute lymphoblastic leukemia (ALL) is associated with higher levels of pro-inflammatory cytokines and oxidative stress. Recently, the levels of extracellular heat shock protein 72 (eHSP72) were found to be elevated in ALL, and its elevation associated with poor prognosis. Therefore, considering the possible role of eHSP72 as a modulator of the immunological system and metabolism, the aim of this study was to describe the response of eHSP72 to the induction phase of chemotherapy, along with metabolic, inflammatory and oxidative stress markers, in children and adolescents newly diagnosed with ALL.

Methods

Nineteen patients were recruited and analysed before and after the induction phase of chemotherapy (with 28 days of duration). Blood samples were taken for the analysis of C-reactive protein (CRP), levels of lipoperoxidation, insulin (and HOMA-IR), cortisol, glucose, lipid profile and eHSP72.

Results

We found that induction phase of chemotherapy leads to a drop in glucose levels (from 101.79±19 to 75.8±9.7 mg/dL), improvements on inflammation (CRP levels, p<0.01) and oxidative stress (TBARS levels, p<0.01), reduction on eHSP72 (p=0.03) and improved insulin sensitivity (HOMA-IR, p=0.02).

Conclusion

Our results indicate that eHSP72 may have an immune and metabolic role and could be used as a marker of the treatment success and metabolic changes in children with ALL.

Exercise and Diabetes: A Narrative Review

Persons with diabetes might experience significant benefits through regular exercise. Not unlike the general population, those with diabetes could also lack motivation to participate in an exercise program. Often, those treating persons with diabetes lack training and/or interest in exercise prescription and are therefore unable to provide the needed information and encouragement. In many cases, reluctance to exercise could result from an inability to find an enjoyable exercise activity. Attempts to find activities that, not only provide effective aerobic challenges, but are also enjoyable to participate in are fraught with difficulty. Three electronic databases were searched in January 2017. Evidence for the merits of exercise for those with diabetes was robust. Numerous reports have addressed the degree of noncompliance to exercise recommendations and the barriers reported for this nonadherence. Additional studies concluded that most medical providers are deficient in formal training in the prescription of an exercise program. Newer studies are evaluating the effects of exercise and vitamin D supplementation and their interplay with diabetic peripheral neuropathy and ulceration. Exercise confers remarkable benefits to those with diabetes; however, the challenges to compelling patients with diabetes to exercise are formidable. An improved focus on exercise prescription and related motivation during provider training must be undertaken.

Effects of High-Intensity Interval and Moderate-Intensity Continuous Exercise on Inflammatory, Leptin, IgA, and Lipid Peroxidation Responses in Obese Males

Purpose: To compare the effects of a single high-intensity interval exercise session (HIIE) with a moderate-intensity continuous exercise session (MICE) on the inflammatory profile, IgA levels, and lipid peroxidation in sedentary obese males.

Methods: Ten sedentary obese men (age 28.5 ± 2.7 years; BMI 35.9 ± 4.9 kg/m²; body fat 40.6 ± 2.0%) performed three experimental sessions, on separate days with 1 week wash-out period between interventions, according to a randomized order: (1) HIIE: 10 × 60 s at 90% of the HR_max alternated by 60 s of active recovery; (2) MICE: 20 min at 70% of the HR_max; (3) Rest—control. Blood and saliva samples were collected before, immediately after and 60 min after the end of each session in order to analyse serum levels of cytokines, IgA, and lipoperoxidation markers.

Results: Leptin levels decreased immediately after HIIE (P = 0.033) and was different from the MICE (P = 0.025). IFN-γ levels were reduced immediately after (P = 0.032) and 60 min after HIIE (P = 0.003) compared to baseline, and it also increased IL-4 levels immediately after exercise (P = 0.007) compared to resting values. MICE promoted an increase in IFN-γ levels immediately after exercise (P = 0.025) and 60 min after exercise (P = 0.004) in relation to baseline. Both exercise conditions increased IL-6 levels up to 60 min after exercise (P < 0.05). The IFN-γ/IL-4 ratio decreased immediately after (P = 0.002) and 60 min after HIIE (P = 0.005) in relation to pre-exercise. No changes were found for IgA-S and TBARS for any of the conditions.

Conclusion: A single HIIE session is able to decrease IFN-γ/IL-4 ratio, indicating an anti-inflammatory response, without alterations in the function of the mucosal immune system and lipoperoxidation. On the other hand, a brief session of MICE induced changes in the pattern of cytokines associated with increased cellular immune function.

White matter pathways as both a target and mediator of health behaviors

Health behaviors arise from the dynamics of highly interconnected networks in the brain and variability in these networks drives individual differences in behavior. In this review, we show how many factors that predict the physical health of the body also correlate with variability of the myelinated fascicles, called white matter, that connect brain regions together. The general pattern present in the literature is that as predictors of physical health decline, there is often a coincident reduction in the integrity of major white matter pathways. We also highlight a plausible mechanism, inflammatory pathways, whereby health-related activation of the immune system can impact the myelin sheath, a protective tissue that facilitates long range communication in the brain. The growing body of evidence supports the hypothesis that degrading health in the periphery may disrupt the communication efficiency of the macroscopic neural circuits that mediate complex behaviors, which can in turn contribute to poorer physical health.

How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies

Aim

To assess the relationship between time spent in light physical activity and cardiometabolic health and mortality in adults.

Design

Systematic review and meta-analysis.

Data sources

Searches in Medline, Embase, PsycInfo, CINAHL and three rounds of hand searches.

Eligibility criteria for selecting studies

Experimental (including acute mechanistic studies and physical activity intervention programme) and observational studies (excluding case and case–control studies) conducted in adults (aged ≥18 years) published in English before February 2018 and reporting on the relationship between light physical activity (<3 metabolic equivalents) and cardiometabolic health outcomes or all-cause mortality.

Study appraisal and synthesis

Study quality appraisal with QUALSYST tool and random effects inverse variance meta-analysis.

Results

Seventy-two studies were eligible including 27 experimental studies (and 45 observational studies). Mechanistic experimental studies showed that short but frequent bouts of light-intensity activity throughout the day reduced postprandial glucose (−17.5%; 95% CI −26.2 to −8.7) and insulin (−25.1%; 95% CI −31.8 to –18.3) levels compared with continuous sitting, but there was very limited evidence for it affecting other cardiometabolic markers. Three light physical activity programme intervention studies (n ranging from 12 to 58) reduced adiposity, improved blood pressure and lipidaemia; the programmes consisted of activity of >150 min/week for at least 12 weeks. Six out of eight prospective observational studies that were entered in the meta-analysis reported that more time spent in daily light activity reduced risk of all-cause mortality (pooled HR 0.71; 95% CI 0.62 to 0.83).

Conclusions

Light-intensity physical activity could play a role in improving adult cardiometabolic health and reducing mortality risk. Frequent short bouts of light activity improve glycaemic control. Nevertheless, the modest volume of the prospective epidemiological evidence base and the moderate consistency between observational and laboratory evidence inhibits definitive conclusions.

Effects of n-3 fatty acids and exercise on oxidative stress parameters in type 2 diabetic: a randomized clinical trial

Background

The relationship between diabetes and oxidative stress has been previously reported. Exercise represents a useful non-pharmacological strategy for the treatment in type 2 diabetic (T2DM) patients, but high intensity exercise can induce a transient inflammatory state and increase oxidative stress. Nutritional strategies that may contribute to the reduction of oxidative stress induced by acute exercise are necessary. The aim of this study was to examine if n-3 PUFA supplementation intervention can attenuate the inflammatory response and oxidative stress associated with high intensity exercise in this population. As a primary outcome, lipoperoxidation measurements (TBARS and F2-isoprostanes) were selected.

Methods

Thirty T2DM patients, without chronic complications, were randomly allocated into two groups: placebo (gelatin capsules) or n-3 PUFA (capsules containing 180 mg of eicosapentaenoic acid and 120 mg of docosahexaenoic acid). Blood samples were collected fasting before and after 8 weeks supplementation. In the beginning and at the end of protocol, an acute exercise was performed (treadmill), and new blood samples were collected before and immediately after the exercise for measurements of oxidative stress and high-sensitivity C-reactive protein (hs-CRP).

Results

After the supplementation period, a decrease in triglycerides levels was observed only in n-3 PUFA supplementation group (mean difference and 95% CI of 0.002 (0.000–0.004), p = 0.005). Supplementation also significantly reduced TRAP levels after exercise (mean difference and 95% CI to 9641 (− 20,068–39,351) for − 33,884 (− 56,976 - -10,793), p = 0.004, Cohen’s d effect size = 1.12), but no significant difference was observed in n-3 PUFA supplementation group in lipoperoxidation parameters as TBARS (mean difference and 95% CI to − 3.8 (− 10–2.4) for − 2.9 (− 1.6–7.4) or F2-isoprostanes (mean difference and 95% CI -0.05 (− 0.19–0.10) for − 0.02 (− 0.19–0.16), p > 0.05 for both.

Conclusion

PUFA n-3 supplementation reduced triglycerides as well as TRAP levels after exercise, without a significant effect on inflammatory and oxidative stress markers.

This study is registered at ClinicalTrials.gov with the registration number of NCT03182712.

Morning bright light exposure has no influence on self-chosen exercise intensity and mood in overweight individuals - A randomized controlled trial

Overweight is a worldwide increasing public health issue. Physical exercise is a useful countermeasure. Overweight individuals choose rather low exercise intensities, but especially high exercise intensities lead to higher energy expenditure and show beneficial health effects compared to lower exercise intensities. However, especially in the morning higher exercise intensities are likely to be avoided due to higher subjective effort. Bright light exposure has shown to increase maximum performance. The aim of this study was to investigate if bright light exposure can also increase self-chosen exercise intensity. We hypothesized that morning bright light exposure increases self-chosen exercise intensity of subsequent exercise through increased mood and reduced sleepiness in overweight individuals. In this randomized controlled single-blind parallel group design, 26 overweight individuals (11 males, 15 females; age 25 ± 5.7 years; body mass index 28.9 ± 2.1 kg/m²) underwent three measurement appointments. On the first appointment, subjects performed a cardiopulmonary exercise test to measure maximum oxygen uptake (VO2max). Two days later a 30-min exercise session with self-chosen exercise intensity was performed for familiarization. Then subjects were randomly allocated to bright light (~4400 lx) or a control light (~230 lx) condition. Three to seven days later, subjects were exposed to light for 30 min starting at 8:00 am, immediately followed by a 30-min exercise session with persisting light exposure. Multidimensional mood questionnaires were filled out before and after the light exposure and after the exercise session. The primary outcome was the mean power output during the exercise session and the secondary outcome the rating on the three domains (i.e. good-bad; awake-tired; calm-nervous) of the multidimensional mood questionnaire. Mean power output during the exercise session was 92 ± 19 W in bright light and 80 ± 37 W in control light, respectively. In the multivariate analysis adjusted for VO2max, the mean power output during the exercise session was 8.5 W higher (95% confidence interval -12.7, 29.7; p = 0.416) for participants in bright light compared to control light. There were no significant differences between the groups for any of the three domains of the questionnaire at any time point. This is in contrast to longer lasting intervention studies that show positive influences on mood and suggests that bright light therapy requires repetitive sessions to improve mood in overweight individuals. In conclusion bright light exposure does not acutely increase self-chosen exercise intensity or improve mood in a 30-min exercise session starting at 08:30. However, regarding the fact that overweight is a worldwide and rapidly increasing public health issue even small increases in exercise intensity may be relevant. The trend toward superiority of bright light over control light implicates that further studies may be conducted in a larger scale.

ABBREVIATIONS

VO2max: maximum oxygen uptake; 95% CI: 95% confidence interval; SD: standard deviation.

Fitness attenuates the prevalence of increased coronary artery calcium in individuals with metabolic syndrome

Background

The association between cardiorespiratory fitness, physical activity and coronary artery calcium (CAC) is unclear, and whether higher levels of fitness attenuate CAC prevalence in subjects with metabolic syndrome is not fully elucidated. The present study aims to: a) investigate the independent association of fitness on the prevalence of CAC, after adjustment for moderate-to-vigorous physical activity and sedentary time, and b) study the possible attenuation of increased CAC by higher fitness, in participants with metabolic syndrome.

Design

Cross-sectional.

Methods

In total 678 participants (52% women), 50–65 years old, from the SCAPIS pilot study were included. Fitness (VO2max) was estimated by submaximal cycle ergometer test and moderate-to-vigorous physical activity and sedentary time were assessed using hip-worn accelerometers. CAC score (CACS) was quantified using the Agatston score.

Results

The odds of having a significant CACS (≥100) was half in participants with moderate/high fitness compared with their low fitness counterparts. Further consideration of moderate-to-vigorous physical activity, sedentary time and number of components of the metabolic syndrome did only slightly alter the effect size. Those with metabolic syndrome had 47% higher odds for significant CAC compared with those without metabolic syndrome. However, moderate/high fitness seems to partially attenuate this risk, as further joint analysis indicated an increased odds for having significant CAC only in the unfit metabolic syndrome participants.

Conclusions

Being fit is associated with a reduced risk of having significant CAC in individuals with metabolic syndrome. While still very much underutilized, fitness should be taken into consideration in everyday clinical risk prediction in addition to the traditional risk factors of the metabolic syndrome.

The Effects of Chronic Aerobic Exercise on Cardiovascular Risk Factors in Persons with Diabetes Mellitus

PURPOSE OF REVIEW

Aerobic exercise training is a component of diabetes mellitus (DM) care guidelines due to its favorable effects on glycemic control and cardiovascular disease (CVD) risk factors. The purpose of this review is to outline the recent evidence regarding the clinical effects of chronic aerobic exercise on CVD risk factors in persons with DM and to compare the effects of varying intensities and types of exercise.

RECENT FINDINGS

Among individuals with DM, all types of aerobic exercise training can impact positively on some traditional and non-traditional risk factors for CVD. Training programs with a higher volume or intensity induce greater improvements in vascular function, cardiorespiratory fitness (CRF), and lipid profiles. The beneficial outcomes of aerobic training include improvements in glycemic control, endothelial function, oxidative stress, dyslipidemia, myocardial function, adiposity, and CRF. Findings regarding markers of inflammation are discrepant and further research should focus on the role of exercise to impact upon the chronic inflammation associated with DM.

Concurrent Aerobic and Resistance Training Has Anti-Inflammatory Effects and Increases Both Plasma and Leukocyte Levels of IGF-1 in Late Middle-Aged Type 2 Diabetic Patients

Type 2 diabetes (T2D) is an age-related chronic disease associated with metabolic dysregulation, chronic inflammation, and activation of peripheral blood mononuclear cells (PBMC). The aim of this study was to assess the effects of a concurrent exercise training program on inflammatory status and metabolic parameters of T2D patients. Sixteen male patients (age range 55–70) were randomly assigned to an intervention group (n = 8), which underwent a concurrent aerobic and resistance training program (3 times a week; 16 weeks), or to a control group, which followed physicians' usual diabetes care advices. Training intervention significantly improved patients' body composition, blood pressure, total cholesterol, and overall fitness level. After training, plasma levels of adipokines leptin (−33.9%) and RBP4 (−21.3%), and proinflammatory markers IL-6 (−25.3%), TNF-α (−19.8%) and MCP-1 (−15.3%) decreased, whereas anabolic hormone IGF-1 level increased (+16.4%). All improvements were significantly greater than those of control patients. Plasma proteomic profile of exercised patients showed a reduction of immunoglobulin K light chain and fibrinogen as well. Training also induced a modulation of IL-6, IGF-1, and IGFBP-3 mRNAs in the PBMCs. These findings confirm that concurrent aerobic and resistance training improves T2D-related metabolic abnormalities and has the potential to reduce the deleterious health effects of diabetes-related inflammation.