Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group

Effect of traditional Chinese exercise on older patients with diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

Objective

This systematic review and meta-analysis aimed to evaluate the effects of traditional Chinese exercises (TCEs) on blood glucose, glycosylated hemoglobin (HbA1c), body mass index (BMI), and health-related quality of life in older patients with diabetes mellitus (DM).

Methods

Database searches were systematically conducted across multiple platforms. The review adhered to PRISMA guidelines, utilizing the Cochrane Risk of Bias Assessment Tool to gauge literature quality. Review Manager 5.3 was employed for data evaluation, calculating mean differences to ascertain pooled effect sizes.

Results

This study encompassed 11 randomized controlled trials involving 944 individuals. The results showed that TCEs reduced fasting blood glucose (-0.76, 95% CI [-1.14, -0.38], P = 0.0001), HbA1c (-2.64, 95% CI [-4.81, -0.47], P = 0.02), and BMI (-0.83, 95% CI [-1.42, -0.24], P = 0.006), and improved health-related quality of life. Among the various forms of TCEs, Baduanjin (BDJ) appeared particularly beneficial.

Conclusions

Traditional Chinese exercises can improve blood glucose levels, BMI and quality of life-related indicators to varying degrees in older diabetes patients, and may be a useful complementary therapy for this population.

Management of angina pectoris

Angina pectoris, a primary manifestation of ischemic heart disease, imposes a significant clinical and economic burden globally. This review highlights recent advancements in the management of angina, emphasizing a patient-centred approach that integrates pharmacological, interventional, and lifestyle strategies to reduce cardiovascular risk and improve patient outcomes. For obstructive coronary artery disease, optimal medical therapy represents the cornerstone of treatment. Individualized regimens should be tailored to clinical factors such as blood pressure, heart rate, left ventricular function, comorbidities like heart failure and diabetes, concomitant medications, patient preferences, and drug availability. Myocardial revascularization is reserved for select cases to alleviate symptoms or improve prognosis. For angina or ischemia with non-obstructive coronary arteries (ANOCA/INOCA), precise endotype classification, differentiating microvascular angina, vasospastic angina, mixed type and non-coronary chest pain, enables personalized treatment strategies. Lifestyle interventions, including smoking cessation, weight management, adherence to Mediterranean diet, and exercise therapy, are essential components of care, promoting improved cardiovascular outcomes and quality of life. Structured exercise programs, particularly within cardiac rehabilitation settings, have demonstrated efficacy in enhancing functional capacity and reducing adverse events. Emerging therapies, including pharmacological agents and novel interventional approaches such as the coronary sinus reducer, hold promise for addressing unmet needs in refractory angina and challenging ANOCA/INOCA cases. Future directions should prioritize the integration of precision medicine, digital health technologies, and multidisciplinary care to optimize outcomes and advance personalized angina management.

Exercise and Sinonasal Diseases: Key Interactions and Management Pearls

The nose filters, moistens, and warms inspired air at rest and during activity. Exercise is associated with an increase in nasal airflow and a decrease in resistance to that flow. Mechanistically, changes in the nasal mucosa during exercise may increase neutrophilic infiltration, impair olfaction, and prolong mucociliary transport time. The increased exposure to substances in the exercise environment may also produce rhinitis. Clinically, the prevalence of rhinitis and upper airway infections is increased in athletes. Allergic and non-allergic rhinitis, and rhinosinusitis may be diagnosed clinically, with other studies supporting the diagnosis; their main treatments are topical steroids, antihistamines, and saline.

Comparing arm-ergometry and treadmill exercise training on cardiovascular risk factors in peripheral artery disease: secondary analysis of the ARMEX trial

BACKGROUND

Peripheral artery disease (PAD), usually caused by atherosclerosis, is linked to high cardiovascular mortality. In this setting, a multidimensional cardiovascular rehabilitation program (CRP) comprising supervised exercise training can improve cardiovascular risk factors (CRF) control. This study compares the effects of an arm-ergometry supervised exercise training (AEx) with a standard treadmill protocol (TEx) on CRF.

METHODS

The ARMEX trial (ISRCTN54908548) was a single-center, single-blinded, parallel groups, noninferiority randomized clinical trial enrolling symptomatic PAD patients referred to a CRP. Participants were randomized (1:1) either to a 12-week AEx or TEx. Changes in blood pressure, lipid profile, glycated hemoglobin, body composition, physical activity levels, sedentary time and number of cigarettes smoked after the CRP were assessed.

RESULTS

Fifty-six patients (66±8.4 years; 87.5% male) were included: AEx (N.=28) and TEx (N.=28). Systolic and diastolic blood pressure decreased in both groups without significant between-group differences. Total cholesterol and low-density lipoprotein cholesterol decreased significantly only in the AEx group, without significant between-group differences. Weight, body mass index, waist circumference, waist/hip ratio and physical activity levels improved in both groups, without significant between-group differences. Smoking reduction was also similar between groups.

CONCLUSIONS

A multidimensional CRP, whether involving arm-ergometry or treadmill exercise, improved CRF control in symptomatic PAD patients. Both exercise modalities were equally effective, supporting their use as part of a comprehensive approach in this complex population.

Can Online Exercise Using Wearable Devices Improve Perceived Well-Being? A Study Among Patients with Coronary Artery Disease

Today, cardiovascular diseases contribute to approximately 17.9 million deaths annually worldwide. With reference to Europe, coronary artery disease (CAD) causes about 3.9 million deaths annually. Considering the positive physical and psychological outcomes of on-site exercise for CAD patients, this study aimed to expand the literature by examining the effects of a 6-month online exercise training program using wearable devices on CAD patients' perceived well-being, measured with the PERMA profiler. Individual well-being is considered today as an important prerequisite for healthy societies. Thirty patients with a recent myocardial infarction (i.e., <4 weeks) were randomly assigned to either the online home-based or the community-based exercise group. Both groups followed the same 24-week exercise-based cardiac rehabilitation program three times per week. Each session consisted of a 30-min aerobic, followed by a 15-min strength workout, and then a 15-min balance and flexibility training. The results of the Mann-Whitney U tests and the z scores indicated that the Meaning of Life, Health, Accomplishment, Engagement, and Positive Relationship dimensions of the PERMA were statistically improved, and Negative Emotions were decreased. These findings support the importance of cardiac telerehabilitation for patients' psychological health, demonstrating that online exercise using wearable devices can be a meaningful alternative to on-site exercise for patients with recent myocardial infarction. These results have policy implications as they provide arguments for providing online exercise for CAD patients as an alternative means for improving their psychological health.

A First Diastolic Function Evaluation in the Personalized Exercise Prescription Program for Solid Organs Transplanted Subjects: Is Atrial Strain Useful?

Background/Objectives: Solid organ transplant recipients (OTR) have been recently involved in exercise prescription programs in order to reduce the high prevalence of cardiovascular diseases. The normal systolic and diastolic cardiac function is fundamental to personalizing the prescription. Diastolic dysfunction can be associated to a higher risk of cardiovascular events and left atrial (LA) strain is an emerging parameter in the evaluation of diastolic compromising, especially in subjects with preserved ejection fraction. Left atrial (LA) strain has never been explored in this category. The study aimed to evaluate the contribution of the LA strain in the assessment of diastolic function of OTR and its potential contribution in the exercise program. Methods: 54 solid OTR (liver and kidney transplants) regularly trained for at least 12 months in a home-based, partially supervised model at moderate intensity estimated by cardiopulmonary exercise test, underwent a complete echocardiographic analysis. The measured variables included left ventricle systolic function (ejection fraction, EF), diastolic function (E/A and E/E'), LA indexed volumes, LA peak atrial longitudinal strain (PALS) and LA peak atrial contraction strain (PACS). The data were compared to those of 44 healthy subjects (HS). Results: The OTR showed an overweight condition (BMI: 25.79 ± 2.92 vs. 22.25 ± 2.95; p < 0.01). Both groups showed a preserved systolic function (EF: OTR 63.1 ± 3.5% vs. HS 66.9 ± 6.1; p < 0.001), while diastolic standard parameters were significantly different (E/A, 1.01 ± 0.4 vs. 1.96 ± 0.74; p < 0.001; E/E', 9.2 ± 2.7 vs. 6.9 ± 1.3; p < 0.001, in OTR and HS respectively) despite being normal. LA strain was significantly lower in OTR vs. HS (4C PALS, 33.7 ± 9.7 vs. 45.4 ± 14.19; p < 0.001; 4C PACS, 15.9 ± 6.7 vs. 11.6 ± 7.5; p = 0.006; 2C PALS, 35.3 ± 11.1 vs. 47.6 ± 14.9; p < 0.001; 2C PALS, 17.4 ± 4.9 vs. 13.2 ± 14.97; p = 0.001; in OTR and HS respectively). A specific correlation of two- and four-chamber PACs and PALs with BMI has been observed (R for 4C PALS -0.406 ** and 2C PALS -0.276 *). Conclusions: These findings suggest that the coexistence of increased bodyweight in asymptomatic OTR patients can exacerbate the impairment of LA strains. LA strain detection could be useful in the development of a personalized exercise program for OTRs, especially for asymptomatic subjects and those with elevated cardiovascular risk profile, to potentially manage the exercise program in the long term. Larger studies will confirm the role via an eventual structured clinical score index.

Exercise intensity and mortality in overweight and obese patients with chronic kidney disease: longitudinal analysis (1999-2016)

BACKGROUND

Chronic kidney disease (CKD) and overweight/obesity are significant global public health issues. Appropriate free-time physical activity (PA) is essential for overweight/obese patients with chronic kidney disease, but specific guidelines are lacking. The present study was conducted to determine the association between PA and all-cause mortality in these patients.

METHODS

Data from 3,434 overweight/obese adults with CKD from the 1999-2016 National Health and Nutrition Examination Surveys were analyzed. Associations between clinical/laboratory findings and PA intensity (moderate and vigorous) were investigated. The all-cause mortality of patients in different PA categories were compared by Kaplan-Meier analysis. Factors associated with all-cause mortality were determined using a Cox proportional hazards model. A restricted cubic spline was employed to obtain a more flexible and detailed representation of the relationship between PA intensity and all-cause mortality, with better predictive capability.

RESULTS

The Kaplan-Meier analysis revealed that greater all-cause mortality was associated with < 10 min/week moderate/vigorous PA (log-rank p < 0.001). A greater survival probability was associated with ≥ 150 min/week vigorous PA or 10-149 min/week moderate PA (log-rank p < 0.001). Age, gender, vigorous PA, smoking status, alcohol consumption, diabetes status, eGFR, serum albumin level, uric acid level, and blood urea nitrogen level were identified as factors associated independently with mortality in the Cox proportional hazards analysis. The restricted cubic splines revealed that these relationships were non-linear (all p < 0.05). Kaplan-Meier analysis of data from patients who engaged in 10-450 min/week moderate/vigorous PA revealed significant differences between the 0-74-min/week and other vigorous PA groups (all log-rank p < 0.001).

CONCLUSIONS

Extended durations of vigorous PA are associated with reduced all-cause mortality in overweight/obese patients with CKD. Clinicians should recommend vigorous free-time PA to these patients, and public health interventions should target this goal to maximize patient health.

Regular exercise ameliorates high-fat diet-induced depressive-like behaviors by activating hippocampal neuronal autophagy and enhancing synaptic plasticity

Exercise enhances synaptic plasticity and alleviates depression symptoms, but the mechanism through which exercise improves high-fat diet-induced depression remains unclear. In this study, 6-week-old male C57BL/6J mice were administered a high-fat diet (HFD, 60% kcal from fat) to a HFD model for 8 weeks. The RUN group also received 1 h of daily treadmill exercise in combination with the HFD. Depressive-like behaviors were evaluated by behavioral assessments for all groups. The key mediator of the effect of exercise on high-fat diet-induced depressive-like behaviors was detected by RNA-seq. The morphology and function of the neurons were evaluated via Nissl staining, Golgi staining, electron microscopy and electrophysiological experiments. The results showed that exercise attenuated high-fat diet-induced depressive-like behavior and reversed hippocampal gene expression changes. RNA-seq revealed Wnt5a, which was a key mediator of the effect of exercise on high-fat diet-induced depressive-like behaviors. Further work revealed that exercise significantly activated neuronal autophagy in the hippocampal CA1 region via the Wnt5a/CamkII signaling pathway, which enhanced synaptic plasticity to alleviate HFD-induced depressive-like behavior. However, the Wnt5a inhibitor Box5 suppressed the ameliorative effects of exercise. Therefore, this work highlights the critical role of Wnt5a, which is necessary for exercise to improve high-fat diet-induced depression.

Physical activity and exercise in chronic kidney disease: consensus statements from the Physical Exercise Working Group of the Italian Society of Nephrology

The Italian Society of Nephrology has tasked its Working Group on Physical Exercise with developing a consensus statement document on physical activity and exercise in patients with chronic kidney disease (CKD). This paper consists of 16 points that were discussed, and approved using the mini-Delphi method by 15 members of the working group. Each statement is based on a comprehensive review of the literature, clinical experience, and expert opinions. Overall, the statements affirm that regular physical activity and exercise training offer numerous benefits to CKD patients, including improved physical function, enhanced cardiometabolic and neuromuscular function, cognitive benefits, and an overall improvement in quality of life. Furthermore, exercise may provide nephroprotection and reduce mortality. These advantages are observed across all CKD stages, whether on conservative therapy or kidney replacement therapy (hemodialysis or peritoneal dialysis), and in kidney transplant recipients. Moreover, when physical activity and exercise training are implemented with appropriate precautions, they are safe in CKD patients. Gradual physical activity and customized exercise programs should be tailored to the patient's exercise tolerance, potentially enhancing compliance. Clinicians are encouraged to use a series of questionnaires and tests to assess the patient's level of physical activity and performance. However, exercise and physical activity are poorly implemented in clinical practice due to many barriers related to patients and healthcare staff. Overcoming these barriers requires the proactive role of the nephrologists, who should actively incorporate exercise training and promote physical activity within routine care plans. Adopting a multidisciplinary team approach, which includes nephrologists, nurses, exercise professionals, and dietitians, is crucial for providing comprehensive rehabilitation for CKD patients. Integrating new technologies and remote check ups could further enhance the effectiveness of these interventions.

Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice

Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).

Effect of blood flow-restrictive resistance training on metabolic disorder and body composition in older adults with type 2 diabetes: a randomized controlled study

Introduction

To explore whether blood flow-restrictive resistance exercise (BFRE) can be used as an alternative strategy to moderate-intensity resistance training (RT) to improve metabolic disorder and body composition in older adults with type 2 diabetes (T2DM).

Methods

This is a single-blind, randomized, controlled trial. Ninety-eight older adults with T2DM were randomly divided into three groups: BFRE group (n = 34), RT group (n = 31) and control group (n = 33). Two exercise groups received supervised collective training for a period of six months, each lasting 50 min, three times a week. The primary outcomes included fasting plasma glucose (FPG), Glycosylated hemoglobin (HbA1c), blood lipids, blood pressure, and body composition. The secondary outcome was muscle performance.

Results

After six months of intervention, the FPG, HbA1c, blood lipids, diastolic blood pressure, body composition, and muscle performance of the two exercise groups were significantly improved relative to the control group and baseline measurements (P < 0.05). There was no significant increase in lean mass between the two exercise groups compared to the control group and baseline (p > 0.05). There was no significant decrease in systolic blood pressure between the two exercise groups compared to the control group (p > 0.05), but it was significantly lower than their baseline (P < 0.05). There was no significant difference in all indicators between the two exercise groups at the baseline, third and sixth months of intervention (p > 0.05).

Discussion

BFRE can safely and effectively improve the metabolic disorder and body composition of older adults with T2DM. For elderly exercise beginners, BFRE can be used as an alternative strategy to moderate-intensity resistance training.

Clinical trial registration

https://www.chictr.org.cn/showproj.html?proj=178886, identifier ChiCTR2300074357.

The mitochondrial quality control system: a new target for exercise therapeutic intervention in the treatment of brain insulin resistance-induced neurodegeneration in obesity

Obesity is a major global health concern because of its strong association with metabolic and neurodegenerative diseases such as diabetes, dementia, and Alzheimer's disease. Unfortunately, brain insulin resistance in obesity is likely to lead to neuroplasticity deficits. Since the evidence shows that insulin resistance in brain regions abundant in insulin receptors significantly alters mitochondrial efficiency and function, strategies targeting the mitochondrial quality control system may be of therapeutic and practical value in obesity-induced cognitive decline. Exercise is considered as a powerful stimulant of mitochondria that improves insulin sensitivity and enhances neuroplasticity. It has great potential as a non-pharmacological intervention against the onset and progression of obesity associated neurodegeneration. Here, we integrate the current knowledge of the mechanisms of neurodegenration in obesity and focus on brain insulin resistance to explain the relationship between the impairment of neuronal plasticity and mitochondrial dysfunction. This knowledge was synthesised to explore the exercise paradigm as a feasible intervention for obese neurodegenration in terms of improving brain insulin signals and regulating the mitochondrial quality control system.

Lowering blood pressure by exercise: investigating the effect of sweating

High blood pressure (hypertension), is a common medical condition, affecting millions of people and is associated with significant health risks. Exercise has been suggested to manage hypertension by inducing sweating and the corresponding loss of sodium and water from the body.Thus, a variety of epidemiological and clinical studies have been conducted to investigate the relationship between sweating and exercise-induced blood pressure reduction and its impacts on hypertension. The mechanisms underlying exercise-induced blood pressure reduction are complex and still not fully understood. However, several pathways have been suggested, including the loss of sodium and water through sweat, a decrease in peripheral resistance, and an improvement in endothelial function in the blood vessels. The decrease in sodium and water content in the body associated with sweating may result in a reduction in blood volume and thus a decrease in blood pressure. Moreover, the reduction in peripheral resistance is thought to be mediated by the activation of the nitric oxide synthase pathway and the release of vasodilators such as prostacyclin and bradykinin, which lead to vasodilation and, thus, a reduction in blood pressure. In conclusion, exercise-induced sweating and consequent sodium and water loss appear to be a reliable biological link to the blood pressure-reducing effects of exercise in hypertensive individuals. Additionally, the mechanisms underlying exercise-induced blood pressure reduction are complex and involve several biological pathways in the cardiovascular system. Therefore, understanding the role of sweat production in blood pressure management is important for developing effective exercise interventions to prevent and manage hypertension.

Predicting the association of different levels of physical activity on postoperative pulmonary complications using the international physical activity questionnaire in patients undergoing thoracoscopic lung surgery under general anaesthesia: protocol for a prospective cohort study

INTRODUCTION

Postoperative pulmonary complications (PPCs) occur frequently in patients undergoing lung surgery under general anaesthesia and are strongly associated with longer postoperative hospital stays and increased mortality. The existing literature has shown that a higher level of preoperative physical activity (PA) plays a positive role in the low incidence of postoperative complications and the quality of life in patients undergoing lung surgery. However, the association between preoperative PA levels and the incidence of PPCs has rarely been studied, particularly in thoracoscopic lung surgery. This study aims to evaluate PA levels in patients undergoing thoracoscopic lung surgery using the International Physical Activity Questionnaire and to investigate the association between PA levels and the incidence of PPCs.

METHODS AND ANALYSIS

A total of 204 participants aged 18-80 years undergoing thoracoscopic lung surgery (thoracoscopic wedge resection, thoracoscopic segmentectomy and thoracoscopic lobectomy) will be included in the study. The primary outcome is the incidence of PPCs within the first 5 postoperative days. The secondary outcomes include the number of PPCs, the incidence of PPCs 1 month postoperatively, the arterial blood levels of inflammatory markers, the incidence of postoperative adverse events within the first 5 postoperative days, extubation time, unplanned admission to the intensive care unit, postoperative length of stay and mortality 1 month postoperatively.

ETHICS AND DISSEMINATION

The study was reviewed and approved by the Research Ethics Committee of the First Affiliated Hospital of Shandong First Medical University on 31 March 2022 (YXLL-KY-2022(014)) and is registered at ClinicalTrials.gov. We plan to disseminate the data and findings of this study in international and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

The trial has been prospectively registered at the clinicaltrials.gov registry (NCT05401253).

Are exercise prescriptions for patients with cardiovascular disease, made by physiotherapists, in agreement with European recommendations?

AIMS

Physiotherapists often treat patients with (elevated risk for) cardiovascular disease (CVD), and should thus be able to provide evidence-based exercise advice to these patients. This study, therefore, aims to examine whether exercise prescriptions by physiotherapists to patients with CVD are in accordance with European recommendations.

METHODS AND RESULTS

This prospective observational survey included forty-seven Belgian physiotherapists. The participants agreed to prescribe exercise intensity, frequency, session duration, program duration, and exercise type (endurance or strength training) for the same three patient cases. Exercise prescriptions were compared between physiotherapists and relations with their characteristics were studied. The agreement between physiotherapists' exercise prescriptions and those from European recommendations ('agreement score': based on a maximal score of 60/per case) was assessed. A wide inter-clinician variability was noticed for all exercise modalities, leading to a large variance for total peak-effort training minutes (from 461 up to 9000 over the three cases). The exercise frequency was prescribed fully out of range of the recommendations and the prescription of additional exercise modes was generally flawed. Exercise intensity and program duration were prescribed partially correct. The addition of strength exercises and session duration was prescribed correctly. This led to physiotherapist agreement scores of 25.3 ± 9.6, 23.2 ± 9.9, and 27.1 ± 10.6 (all out of 60), for cases one, two, and three, respectively. A greater agreement score was found in younger colleagues and those holding a Ph.D.

CONCLUSION

Exercise prescriptions for CVD patients vary widely among physiotherapists and often disagree with European recommendations.

REGISTRATION

ClinicalTrials.gov NCT05449652.

The Association between Objectively Measured Physical Activity and the Prevalence of Comorbidities in Lung Transplant Recipients

INTRODUCTION

Lung transplant recipients are often physically inactive and are at risk of developing comorbidities. We investigated whether objectively measured physical activity was associated with the prevalence of comorbidities.

METHODS

Physical activity (accelerometry) and the presence of cardiovascular disease, symptoms of depression and anxiety, diabetes, dyslipidaemia, hypertension, lower extremity artery disease, muscle weakness, obesity, and osteoporosis were assessed in 108 lung transplant recipients. Patients were divided into four groups based on daily step count.

RESULTS

A cohort of 108 patients (60 ± 7 years, 51% male, 20 ± 14 months since transplantation) was included. Active patients (>7,500 steps/day) had significantly fewer comorbidities (4 comorbidities) compared to severely inactive patients (<2,500 steps/day, 6 comorbidities), and muscle weakness and high symptoms of depression were less prevalent. Severely inactive patients had significantly more cardiovascular comorbidities compared to all other groups. No other significant differences were observed.

CONCLUSION

Physically active lung transplant recipients have fewer comorbidities, lower prevalence of muscle weakness, and fewer symptoms of depression compared to very inactive patients.

The Attitudes of Patients with Cardiovascular Diseases towards Online Exercise with the Mobile Monitoring of Their Health-Related Vital Signs

The health care cost of cardiovascular diseases (CVD) in the EU is estimated to be today over 282 billion euros. It is well documented today that exercise training is one of the main strategies for secondary disease prevention and the follow-up integration of these patients. This study aimed to examine patients' attitudes towards online exercise with mobile monitoring of their vital signs. More specifically, the research objectives were as follows: (a) to examine patients' attitudes and expectations of online exercise, (b) cluster patients in high- and low-attitude groups and examine their intention to participate in online exercise, and (c) to examine age and gender differences in terms of their intention to exercise online. The final goal of this project was to develop a real application that could be of use to patients and professionals. Data were collected from fifty patients in the city of Thessaloniki, Greece. The results revealed that most patients were positive about exercising online if the programs were perceived as fun and, especially, safe. The use of an online monitoring application with the distant supervision of health professionals could both motivate them and strengthen their feeling of safety.

Can different types of tree nuts and peanuts induce varied effects on specific blood lipid parameters? A systematic review and network meta-analysis

Tree nuts and peanuts have shown cardioprotective effects through the modulation of blood lipid levels. Despite the abundance of scientific evidence available, it remains uncertain whether the type of nut consumed influences these changes. The objective of this study was to evaluate and rank the effects of six types of nuts on total cholesterol (total-c), low-density lipoprotein (LDL-c), triglyceride (TG) and high-density lipoprotein (HDL-c) levels through a systematic search of randomized controlled trials (RCTs), a frequentist network meta-analysis (NMA), and the estimation of SUCRA values. A total of 76 RCTs were ultimately analyzed. The total c for pistachios, almond, and walnuts; LDL-c for cashews, walnuts, and almond; and TG for hazelnuts and walnuts significantly decreased, while only peanuts exhibited a significant increase in HDL-c levels. According to the rankings, the most effective type of nut for reducing total cholesterol was pistachio, cashew for LDL-c, hazelnut for TG, and peanut for increasing HDL-c levels. It should be noted that every type of nut analyzed exhibited a significant positive impact on some parameters, and specific types demonstrated enhanced advantages for particular blood lipids. These results endorse the use of personalized nutritional strategies to address and prevent dyslipidemia.Registration: PROSPERO database CRD42021270779.

Appropriate exercise prescription in primary and secondary prevention of cardiovascular disease: why this skill remains to be improved among clinicians and healthcare professionals. A call for action from the EXPERT Network†

In Europe alone, on a yearly basis, millions of people need an appropriate exercise prescription to prevent the occurrence or progression of cardiovascular disease (CVD). A general exercise recommendation can be provided to these individuals (at least 150 min of moderate-intensity endurance exercise, spread over 3-5 days/week, complemented by dynamic moderate-intensity resistance exercise 2 days/week). However, recent evidence shows that this one size does not fit all and that individual adjustments should be made according to the patient's underlying disease(s), risk profile, and individual needs, to maximize the clinical benefits of exercise. In this paper, we (i) argue that this general exercise prescription simply provided to all patients with CVD, or elevated risk for CVD, is insufficient for optimal CVD prevention, and (ii) show that clinicians and healthcare professionals perform heterogeneously when asked to adjust exercise characteristics (e.g. intensity, volume, and type) according to the patient's condition, thereby leading to suboptimal CVD risk factor control. Since exercise training is a class 1A intervention in the primary and secondary prevention of CVD, the awareness of the need to improve exercise prescription has to be raised among clinicians and healthcare professionals if optimized prevention of CVD is ambitioned.

Can postexercise hypotension also be observed in African and Asian populations: a systematic review and meta-analysis of randomized controlled trials

Worldwide, raised blood pressure (BP) or hypertension is the global leading risk factor for the development of cardiovascular diseases and all-cause mortality, with the highest prevalence found in Asian and African origin populations. Post-exercise hypotension (PEH), defined as a sustained reduction in BP after a single bout of exercise is an important physiological phenomenon in BP management. However, little is known about the hypotensive effect of a single bout of exercise in non-Caucasian populations. We systematically summarized the acute effects of a single bout of aerobic exercise on BP in a population of African or Asian origin. We searched the MEDLINE database identifying randomized controlled trials investigating the effect of a single bout of aerobic exercise on BP in African or Asian populations with optimal BP, high normal BP or hypertension published in a peer reviewed journal up to August 2021. A subsequent meta-analysis was performed using random-effect models fitted to estimate effect sizes. We identified 10 aerobic exercise trials performed in individuals of Asian origin (n = 136; mean age: 29.51 (21.2-69) years: 78% male; baseline systolic BP/diastolic BP: 118.9 ± 9.64/68.9 ± 2.69 mmHg) and 11 aerobic exercise trials involving individuals of African origin (n = 157; mean age: 41.05 (29.9-49) years; 59% male; baseline systolic BP/diastolic BP: 134.5 ± 8.65 mmHg/82.2 ± 3.24 mmHg). Non-significant reductions in office systolic BP and diastolic BP at 30 min post exercise (-2.25 [-6.38, 1.88] mmHg, p = 0.28/-1.02 [-2.51, 0.47] mmHg, p = 0.18) and 60 min post exercise (-2.80 [-7.90, 2.28], p = 0.27/-1.95, [-5.66, 1.75], p = 0.3) were observed compared to the control intervention. No statistically significant differences were found between both ethnic groups (p > 0.05). Ambulatory BP was reported only in a few African groups. No effect was found on 24h-systolic BP post exercise, but 24h-diastolic BP was statistically significantly reduced (-1.89 [-3.47, -0.31] mmHg, p < 0.01) after a bout of aerobic exercise compared to the control intervention. The available evidence is insufficient to recommend a single session of aerobic exercise as an efficient tool to lower BP in African and Asian populations. Though, the paucity of data in non-Caucasian populations underscores the need for additional efforts to establish the efficacy of single bouts of exercise, including isometric and dynamic resistance exercise, as a potential non-pharmacological adjunct to help lowering BP in the daily life of descendants of Asian or African origin.

Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group

Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.

Modulation of the Cardiovascular Effects of Polycyclic Aromatic Hydrocarbons: Physical Exercise as a Protective Strategy

Exposure to polycyclic aromatic hydrocarbons (PAHs) present in air pollution increases cardiovascular risk. On the contrary, physical exercise is a widely used therapeutic approach to mitigate cardiovascular risk, but its efficacy in an environment of air pollution, particularly with PAHs, remains unclear. This study investigates the effects of exercise on inflammation, endothelial dysfunction, and REDOX imbalance due to PAH exposure using a mouse model. Twenty male BALB/c mice were subjected to a mixture of PAHs (phenanthrene, fluoranthene, pyrene) in conjunction with aerobic exercise. The investigation evaluated serum levels of inflammatory cytokines, gene expression linked to inflammatory markers, endothelial dysfunction, and REDOX imbalance in aortic tissues. Furthermore, the study evaluated the expression of the ICAM-1 and VCAM-1 proteins. Exercise led to notable changes in serum inflammatory cytokines, as well as the modulation of genes associated with endothelial dysfunction and REDOX imbalance in aortic tissue. In turn, exercise produced a modulation in the protein expression of ICAM-1 and VCAM-1. The findings implicate the potential of exercise to counter PAH-induced damage, as demonstrated by changes in markers. In conclusion, exercise could mitigate the adverse effects related to exposure to PAHs present in air pollution, as evidenced by changes in inflammatory markers, endothelial dysfunction, and REDOX imbalance.

Rehabilitation contributes to lower readmission rates for individuals with peripheral arterial disease: A retrospective observational study

BACKGROUND

Non-pharmacological interventions, such as rehabilitation, are crucial for the treatment of people with peripheral arterial disease (PAD). Although several studies have shown rehabilitation is effective in improving the functional prognosis of PAD, there is currently insufficient evidence regarding its effect on readmission rates.

OBJECTIVES

To examine the impact of rehabilitation on readmission rates for people with PAD.

METHODS

A retrospective analysis of the JMDC hospital database was performed on data from two groups of people aged ≥20 years who were hospitalized between 2014 and 2020 with PAD, as based on a previous diagnosis. Participants were divided according to whether they did, or did not, receive any form of rehabilitation as part of their treatment in hospital. The primary outcome was readmission rates at 30, 60, 90, and 180 days after initial admission. A one-to-one propensity score matching was used to compare readmission rates between rehabilitation and non-rehabilitation groups.

RESULTS

We included 13,453 people with PAD, of whom 2701 pairs (5402 subjects) were selected after being matched in the rehabilitation and non-rehabilitation groups. The rehabilitation group participants had significantly lower mortality and readmission rates at 30, 60, 90, and 180 days. The odds ratios (95% confidence interval) for both groups were 0.79 (0.69-0.91; 30 days), 0.81 (0.71-0.91; 60 days), 0.78 (0.69-0.88; 90 days), and 0.79 (0.71-0.88; 180 days).

CONCLUSIONS

This large, nationwide study found that rehabilitation treatment during hospitalization was associated with lower readmission rates and mortality for people following hospitalization with PAD and supports its inclusion as a standard PAD treatment.

Data Informing Governing Body Resistance-Training Guidelines Exhibit Sex Bias: An Audit-Based Review

The objective of this review was to examine the ratio of female and male participants utilised in data informing consensus statements and position stands in the field of resistance training (RT). In order to achieve this objective, we conducted an 'audit' style review. We accessed three databases: SPORTDiscus, MEDLINE and Google Scholar utilising the following search terms: resistance or strength training AND consensus statements or position statements/stands. Eligibility criteria included consensus statements and position stands for RT in youth, adults and older adults. In this paper we have used the term 'female' to describe biological sex. Gender is a social construct and often describes roles and behaviours that society assigns to men or women. In this paper we have used the term 'women' to describe gender. Reference lists from each guideline were screened with the number of male and female participants extracted from each study. We also extracted data on the gender of the authors of the statements. We located 11 guidelines encompassing a total of 104,251,363 participants. Youth guidelines were comprised of 69% male participants. There were 287 studies that included both sexes, 205 male-only and 92 female-only studies. Adult guidelines were comprised of 70% male participants. There were 104 studies that included both sexes, 240 male-only and 44 female-only studies. Older adult guidelines were comprised of 54% female participants. There were 395 studies that included both sexes, 112 male-only and 83 female-only studies. Women authors comprised 13% of all authors of position stands and consensus statements. These results demonstrate an under-representation of females and women as both participants and as authors. It is imperative to ensure that data informing governing body guidelines and consensus statements are representative of the population they aim to inform. If this is not possible, guidelines should clearly state when their data and recommendations are based primarily upon one sex.

Physical activity and eating behaviors patterns associated with high blood pressure among Chinese children and adolescents

BACKGROUND

Physical activity and eating behavior are associated with hypertension in children and adolescents. Revealing the associations between physical activity patterns, eating behavior patterns and high blood pressure (HBP) could help improve the problem of hypertension from the actual children's physical activities and eating behaviors.

METHODS

A total of 687 students aged 8-15 years were selected from two nine-year primary and secondary schools using stratified cluster random sampling method. The students' body height, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and their physical activity time and eating behaviors were surveyed by using CLASS questionnaire and self-made eating behavior questionnaire, respectively. Exploratory factor analysis (EFA) was used to extract moderate to vigorous physical activity factor (MVPAF), sedentary activity factor (SAF), healthy eating behavior factor (HEBF), unhealthy eating behavior factor (UHEBF). MVPAF ≥ SAF was defined as moderate to vigorous physical activity pattern (MVPAP), MVPAF < SAF was defined as sedentary activity pattern (SAP). HEBF ≥ UHEBF was defined as healthy eating behavior pattern (HEBP), while the opposite was defined as unhealthy eating behavior pattern (UHEBP). Lifestyles includes physical activity patterns and eating behavior patterns.

RESULTS

The overall prevalence of hypertension was 5.8% (40/687), and was 5.69% (21/369) in boys and 5.97% (19/318) in girls, respectively. The MVPAF and UHEBF in boys were significantly higher than those in girls (P < 0.01), while the SAF in girls was significantly higher than that in boys (P < 0.05). The SAF was positively correlated with SBP in girls (β(SE) = 0.14 (0.50), P = 0.016), and was positively correlated with SBP (β(SE) = 0.21 (1.22), P = 0.000 and DBP (β(SE) = 0.14 (0.49), P = 0.006) in boys. The MVPAF was negatively correlated with DBP (β(SE)=-0.11 (0.40), P = 0.022) in boys. In boys, the SAP increased the risks of HBP (OR (95% CI):3.34 (1.30-8.63)) and high DBP (OR (95% CI):3.08 (1.02-9.34)) compared with MVPAP.

CONCLUSION

Compared with the boys with MVPAP, boys with SAP may increase the risks of HBP and high DBP. The SAF may be positively associated with SBP in boys and girls, while the MVPAF may be negatively associated with DBP in boys.

Exercise training improves blood pressure reactivity to stress: a systematic review and meta-analysis

Blood pressure (BP) reactivity to stress is associated with cardiovascular events and the incidence of hypertension, therefore, tolerance to stressors is important for better management of cardiovascular risks. Exercise training is among the strategies that have been investigated as blunting the peak response to stressors, however, its efficacy is poorly explored. The aim was to explore the effects of exercise training (at least four weeks) on BP responses to stressor tasks in adults. A systematic review was performed in five electronic databases (MEDLINE, LILACS, EMBASE, SPORTDiscus, and PsycInfo). Twenty-three studies and one conference abstract was included in the qualitative analysis, totaling 1121 individuals, and k = 17 and 695 individuals in the meta-analysis. Favorable results (random-effects) for exercise training were found, with attenuated peak responses in systolic (standardized mean difference (SMD) = -0.34 [-0.56; -0.11], representing average reductions of 2.5 ± 3.6 mmHg) and null effects on diastolic BP (SMD = -0.20 [-0.54; 0.14], representing average reductions of 2.0 ± 3.5 mmHg). The analysis removing outliers' studies improved the effects for diastolic (SMD = -0.21 [-0.38; -0.05]) but not systolic BP (SMD = -0.33 [-0.53; -0.13]). In conclusion, exercise training seems to lower stress-related BP reactivity, therefore has the potential to improve patients' ability to better respond to stressful situations.

Personalized remotely guided preventive exercise therapy for a healthy heart (PRIORITY): protocol for an assessor-blinded, multicenter randomized controlled trial

Aims

A key treatment for patients with varying stages of heart failure with preserved ejection fraction (HFpEF) is exercise. Yet, despite a Class 1A recommendation, only one-third of patients exercise sufficiently. A huge treatment gap exists between guidelines and clinical practice. PRIORITY aims to establish the feasibility, clinical effectiveness and cost-effectiveness of a hybrid centre and home-based personalized exercise and physical activity intervention for patients along the HFpEF continuum.

Methods

An assessor-blinded, multicenter randomized controlled trial will be conducted among 312 patients along the HFpEF continuum. Participants will be randomized (1:1) to the PRIORITY intervention or a comparator group receiving only a written exercise prescription. Participants in the PRIORITY group will receive 18 supervised centre-based exercise sessions during one year, supplemented with a remotely guided home-based physical activity program. Outcomes will be assessed at baseline, 4 months, one and two years. The primary outcome is the peak oxygen uptake (pVO2) at 1-year. Secondary outcomes include physical activity, other physical fitness parameters, cardiovascular health, echocardiographic parameters, health-related quality of life and costs at 1-year FU. Machine learning algorithms will analyse big data on physical activity collected during the 1-year intervention to develop models that can predict physical activity uptake and adherence as well as changes in fitness and health. A cost-utility analysis will be performed to evaluate the cost-effectiveness of the PRIORITY intervention compared to the control condition.

Discussion

We anticipate that participants in the supervised home-based exercise intervention group will have a greater increase in pVO2 compared to those receiving a written exercise prescription.

Trial registration number

This trial is registered at ClinicalTrials.gov (NCT04745013) and is currently in the recruitment stage.

Considerations after lockdown and overcoming Covid-19: A systematic review for returning to safe physical exercise practice

Objective

This systematic review aims to understand the problems associated with lockdown and the various conditions of Covid-19 infection and to help prepare athletes and exercise enthusiasts for the safe resumption of sport in a manner that promotes wellness, healthy competition, and a sports industry that survives the current situation. This systematic review was carried out, following the recommendations of the currently pre-established reporting elements for systematic reviews and meta-analyses. The following databases were consulted: ISI Web of Science (WOS), Scopus and Google Scholar. This review includes a total of 19 articles.

News

The results are presented based on three predominant themes: (1) psychological impact produced by SARS-CoV-2; (2) post-Covid-19 cardiac abnormalities and (3) protocols for an adequate return to physical practice.

Prospects and projects

Most of the protocols shown by the various papers are consistent in terms of duration and number of phases. Based on this, the safe return to practice protocol can be divided into four stages of seven days in each phase in order to progress according to the symptoms perceived. In each phase, the physiological demand and efforts necessary to cover the proposed activities are increased until optimal physical condition is recovered.

Impact of Exercise Training Interventions on Flow-Mediated Dilation in Adults: An Umbrella Review

BACKGROUND

Dysfunction of the endothelium is a key precursor of cardiovascular disease. Endothelial function, as assessed via the flow-mediated dilation test, is attenuated with chronic disease (e.g., type 2 diabetes mellitus, hypertension). Exercise training may mitigate this dysfunction and promote better vascular health.

OBJECTIVE

The main objective of this umbrella review was to determine the impact of exercise training on flow-mediated dilation in healthy adults and those with chronic disease.

METHODS

Studies were included if they conducted a systematic review and/or meta-analysis on flow-mediated dilation responses to exercise interventions in adults. Sources were searched in January 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier. National Institutes of Health quality assessment tools were used. The results were presented narratively.

RESULTS

Twenty-seven systematic reviews, including 19 meta-analyses, (total: 5464 unique participants, 2181 reported unique female individuals) met the inclusion criteria. The average overall quality of included reviews was 8.8/11. The quality of studies within each included review varied from low to moderate using a variety of quality assessment scales. Reviews were conducted in healthy adults (n = 9, meta-analyses = 6), as well as those with type 2 diabetes (n = 5, meta-analyses = 4), cardiovascular conditions [i.e., conditions that impact the cardiovascular system, but excluding samples of only type 2 diabetes] (n = 11, meta-analyses = 7), and other chronic conditions (n = 2, meta-analyses = 2). Overall, the included reviews provided evidence that the type of training to optimally improve FMD may vary based on disease condition. Specifically, the evidence suggests that healthy adults benefitted most from higher intensity aerobic training and/or more frequent low-to-moderate resistance training. In addition, adults with type 2 diabetes benefitted most from low-intensity resistance or aerobic exercise training, whereas those with cardiovascular conditions should consider engaging in high-intensity aerobic training to improve endothelial function.

CONCLUSIONS

This information may help guide the design of specific exercise programs or recommendations for adults with chronic conditions.

EXPERIMENTAL STUDY OF EXERCISE PRESCRIPTION INTERVENTION ON THE UNIVERSITY STUDENTS’ HEALTH

ABSTRACT Introduction Disparate to the development of society, health indices in Chinese college students have shown a pronounced decline in recent years. Government concern over this recent challenge has encouraged research for practical solutions, including optimized physical activity protocols. Objective Explore the effects of an exercise intervention on the health of Chinese university students. Methods Full-time university students (80 males and 55 females) were selected and randomly assigned into two groups. Before and after the experiment, the college students’ body composition scale and exercise experience were tested, focusing on the relationship between exercise prescription and changes in physical and mental health indicators. Results The body fat percentage of male and female students decreased significantly after the experiment. After eight weeks of the exercise prescription experiment, the weight of male and female college students was controlled or reduced. The suggested exercise prescription achieved a good moderating effect on the weight of the volunteers. There was a significant difference between the two groups, indicating that the experiment had a beneficial effect on vital capacity (p<0.01). Conclusion The suggested exercise prescription proved to be feasible to guide and intervene in the physical exercise of college students aiming at a beneficial impact on the physical health of college students. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Post-Acute Sequelae of COVID-19: The Potential Role of Exercise Therapy in Treating Patients and Athletes Returning to Play

Post-acute sequelae of coronavirus disease 19 (COVID-19) (PASC) describe a wide range of symptoms and signs involving multiple organ systems occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, representing a growing health problem also in the world of sport and the athletic population. Patients with PASC have new, returning, or persisting symptoms four or more weeks after the infection. Among the most frequent symptoms, patients complain of fatigue, dyspnea, exercise intolerance, and reduced functional capacity that interfere with everyday life activity. The role of exercise programs in PASC patients will be identified, and upcoming studies will establish the magnitude of their benefits. However, the benefits of exercise to counteract these symptoms are well known, and an improvement in cardiopulmonary fitness, functional status, deconditioning, and quality of life can be obtained in these patients, as demonstrated in similar settings. Based on this background, this review aims to summarise the current evidence about the PASC syndrome and the benefit of exercise in these patients and to provide a practical guide for the exercise prescription in PASC patients to help them to resume their functional status, exercise tolerance, prior activity levels, and quality of life, also considering the athletic population and their return to play and sports competitions.

The Effect of Exercise Training on Irisin Secretion in Patients with Type 2 Diabetes: A Systematic Review

INTRODUCTION

Irisin is a myokine considered to be a potential mediator of exercise-induced energy metabolism and its secretion is known to promote the browning of beige fat cells in white adipose tissue. However, it is currently not known which exercise protocol is the best to enhance irisin concentration in patients with type 2 diabetes (T2D).

OBJECTIVE

The purpose of this study is to provide a review investigating the irisin response to different exercise training modalities and intensities in T2D.

METHODS

A systematic literature search was performed in May 2022.

RESULTS

After the selection process from 938 articles, six studies were included. Selected papers presented different exercise training interventions regarding intensity and modality. One study reported no significant differences in serum irisin levels after exercise training, whereas the other five showed a higher increase in serum irisin levels after exercise training with higher differences in irisin secretion after high-intensity training (HIT). No consideration was possible on exercise modalities.

CONCLUSIONS

The impact of training intensity and modality was found to be partly discordant but data seem to suggest that HIT promotes greater irisin secretion. Despite the limited evidence, HIT, both in interval and continuous modalities, could be suggested as valid exercise training to increase circulating irisin in patients with T2D.

Circulating miR-29b decrease in response to sarcopenia in patients with cardiovascular risk factors in older Chinese

Introduction

Sarcopenia is a clinical syndrome characterized by a progressive and extensive decline in skeletal muscle mass, muscle strength, and function. Sarcopenia and cardiovascular diseases (CVDs) can coexist, which further decreases the quality of life of patients, and increases the mortality rate. MicroRNAs (miRNAs) are unique posttranscriptional regulators of gene expression whose function in aging-related sarcopenia and CVDs has recently begun to unravel. The aim of the present study is to investigate the relationship between sarcopenia and cardiovascular risk factors (CVRF) in the Chinese elderly and describe the circulating miRNAs in sarcopenia patients with the intention of identifying novel diagnostic and therapeutic tools.

Methods

The well-established CVRF of diabetes, hypertension, and dyslipidemia were assessed. Multiple logistic regression analyses and linear regressions were used to evaluate the components of CVRF and the number of CVRF in elderly patients with sarcopenia. Moreover, we used real-time RT-PCR to measure the abundance of the CVRF-related miRNAs in the plasma of a cohort of 93 control and sarcopenia individuals, including miR-29b, miR-181a, and miR-494.

Results

We found that CVRF was associated with a high prevalence of sarcopenia in elderly Chinese populations After adjusting for potential confounders. Furthermore, hypertension and dyslipidemia, but not diabetes, were found to be significantly associated with sarcopenia. A linear increase in the prevalence of sarcopenia was found to be associated with the number of CVRF components in the elderly population. We found that plasma miR-29b levels were significantly down-regulated in response to sarcopenia in the elderly with CVRF. In particular, there was a remarkable correlation between miR-29b and appendicular skeletal muscle mass (ASM)/height2. Collectively, knowledge of CVRF, particularly hypertension and dyslipidemia, may help predict the risk of sarcopenia in the elderly. Our data also show that circulating miR-29b can be considered as possible biomarkers for sarcopenia, which may also be used in the CVD assessment of these patients.

Discussion

We found that the prevalence of sarcopenia was significantly proportional to the number of CVRF components. In particular, hypertension and dyslipidemia were significantly associated with a higher risk of sarcopenia in the adjusted models. Moreover, our study has been proven that c-miRNAs may be considered as possible biomarkers for sarcopenia as a new diagnostic tool to monitor response to treatment. There is also a pressing need for further research on sarcopenia and CVRF to understand their relationship and mechanism. These can provide more evidence to develop potential interventions to improve clinical outcomes.

Epigenetics in the primary and secondary prevention of cardiovascular disease: influence of exercise and nutrition

Increasing evidence links changes in epigenetic systems, such as DNA methylation, histone modification, and non-coding RNA expression, to the occurrence of cardiovascular disease (CVD). These epigenetic modifications can change genetic function under influence of exogenous stimuli and can be transferred to next generations, providing a potential mechanism for inheritance of behavioural intervention effects. The benefits of exercise and nutritional interventions in the primary and secondary prevention of CVD are well established, but the mechanisms are not completely understood. In this review, we describe the acute and chronic epigenetic effects of physical activity and dietary changes. We propose exercise and nutrition as potential triggers of epigenetic signals, promoting the reshaping of transcriptional programmes with effects on CVD phenotypes. Finally, we highlight recent developments in epigenetic therapeutics with implications for primary and secondary CVD prevention.

A Bibliometric Analysis of High-Intensity Interval Training in Cardiac Rehabilitation

As global quality of life has improved, the risk factors for cardiovascular diseases have gradually increased in prevalence. People have consequently sought to improve their health through physical exercise. High-intensity interval training (HIIT) is a cardiac rehabilitation (CR) tool that has been of great interest for several years. However, its feasibility and safety remain controversial. This study aimed to explore hot research topics and new directions regarding the role of HIIT in CR and to describe the dynamic development of the field. We used the Web of Science Core Collection database to develop visualizations using CiteSpace software (v.6.1.R2). The number of articles published, institutional collaboration networks, author partnerships, and keyword co-occurrence and clustering were used to analyze the impact of HIIT on CR. Our results showed that Norway, Canada, and the United States were the most prominent contributors to this field. Articles by Nigam, A and Juneau, M had the highest number of citations. The Norwegian University of Science and Technology had performed the most in-depth research in this area. The European Journal of Preventive Cardiology had published the most articles. The United States had the highest number of publishing journals. Relevant issues focused on coronary artery disease, exercise capacity, heart failure, cardiorespiratory fitness, and physical activity. HIIT in heart transplantation may be at the forefront of research in this field and future studies should focus on this topic. HIIT-based CR can therefore improve the exercise capacity and quality of life of cardiovascular patients and improve patient compliance in a safe manner.

[Strength training education for physicians increases its prescription]

INTRODUCTION

Medical prescriptions have traditionally been focused on aerobic exercise. However, an increasing number of authors are pointing towards strength training as the healthiest exercise modality. The purpose of this study is to assess whether physicians increase their knowledge as well as their confidence to prescribe strength training after attending a physical training course.

MATERIALS AND METHODS

A prospective cohort study of 160 physicians was conducted, 80 physicians out of the 160 attended a physical training course, whereas the remaining 80 physicians did not. Personal and professional data was collected, as well as data regarding the type of exercise they were practising or prescribing and the confidence and knowledge for their prescription. Finally, differences between the two groups and the impact of attending the course where analysed.

RESULTS

Both groups were homogeneous in gender, age, medical speciality and practice of physical exercise, with very low rates of strength training and prescription for both groups. It was established that the group attending the course acquired knowledge and confidence for prescribing strength training. Moreover, this group considered that strength training was the exercise modality which should be encouraged (P<.001).

CONCLUSIONS

Education in strength training for physicians by means of a theoretical-practical course increases knowledge and confidence for its prescription.

The optimal exercise modality and intensity for hemodialysis patients incorporating Bayesian network meta-analysis and systematic review

Background: Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification.

Objective: We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients.

Design: Systematic review with network meta-analysis of randomized trials.

Data sources: Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0).

Result: We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate–vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo.

Conclusion: This network meta-analysis indicated that combined training and moderate–vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients.

Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].

Effects of a vegetarian diet combined with exercise on lipid profiles and blood pressure: A systematic review and meta-analysis

We aimed to evaluate the combined effects of a vegetarian diet (VD) and exercise on total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) parameters. A literature search was conducted in electronic databases from build to February 27, 2022. Data were synthesized using random effects model and were expressed as standardized mean difference (SMD)/weighted mean difference (WMD) and 95% confidence interval (CI). Overall, 27 trials with 9,251 participants were included. Pooled results indicated that the combination of a VD and exercise significantly reduced TC (SMD: -0.524; 95% CI: -0.602, -0.446; p < 0.001), LDL-C (SMD: -0.379; 95% CI: -0.471, -0.287; p < 0.001), HDL-C (SMD: -0.213; 95% CI: -0.299, -0.126; p < 0.001), TG (SMD: -0.090; 95% CI: -0.160, -0.020; p = 0.012), SBP (WMD: -7.664 mm Hg; 95% CI: -9.219, -6.109 mm Hg; p < 0.001), and DBP (WMD: -4.347 mm Hg; 95% CI: -5.099, -3.596 mm Hg; p < 0.001). These parameters were reduced more following a low-fat VD, or a mixed high-frequency exercise, especially under strict supervision. Surprisingly, the decreased HDL-C due to VD was observed to recover with the prolongation of exercise.

Pilot Feasibility Assessment of a Tailored Physical Activity Prescription in Overweight and Obese People in a Public Hospital

We aimed to evaluate the feasibility of a tailored physical activity (PA) prescription in overweight and obese people in a tertiary hospital in Lima, Peru. A feasibility pre-post-pilot study was conducted using mixed methods. Participants received a tailored prescription scheme for PA that lasted twelve weeks. It included two prescription sessions, three follow-up phone calls, and three evaluations. Primary feasibility outcomes were recruitment, visits, and phone call adherence. Primary intervention outcomes were self-reported PA levels and the 6 min walk test. Out of 228 people invited to participate, 30 were enrolled and received the first session of prescription, 11 went to the second session, and 21 went to the final evaluation; phone call participation decreased progressively during follow-up. There were no differences in the 6th week and the 12th week compared to the baseline for all the measures, except in the 6 min walk test. The participants considered the intervention was well designed, but they suggested complementing it with dietary instructions. The prescription of PA in overweight and obese people is feasible for promoting PA, but its implementation requires refinements to anticipate possible barriers to changing behavior.

Hepatic Steatosis Index and the Risk of Type 2 Diabetes Mellitus in China: Insights from a General Population-Based Cohort Study

Purpose

In the Chinese population, we looked at the relationship between the hepatic steatosis index (HSI) and the risk of type 2 diabetes mellitus (T2DM).

Methods

To evaluate the association between HSI and the risk of T2DM, Cox regression models were employed. Hazard ratios (HR) and 95 percent confidence intervals (CI) were computed. A stratified analysis with interaction testing was also carried out. Additionally, we evaluated the incremental predictive value of the HSI over the established risk factors using the C-statistic, the IDI, and the NRI.

Results

During a median follow-up period of 2.97 years, 433 (1.97%) participants developed new-onset T2DM. The smoothing curve fit plot showed a positive correlation between HSI and the risk of T2DM. After adjusting for all noncollinear variables, the risk of T2DM increased by 62% for every 1 standard deviation (SD) increase in HSI. Subgroup analysis indicated that higher HSI levels were associated with a higher risk of T2DM in those aged < 40 years. The addition of HSI enhanced the reclassification and discrimination of established risk factors, with an IDI of 0.027 and an NRI of 0.348 (both P < 0.001).

Conclusion

Our findings suggest that an elevated HSI is substantially associated with a greater risk of T2DM in the Chinese population. HSI has the potential to be an available and supplementary monitoring method for the management of T2DM risk stratification in the Chinese population.

Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes: a systematic review and meta-analysis

AIM

The benefits of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) are well established. However, the relative benefit of CR in those with comorbidities, including diabetes, is not well understood. This systematic review and meta-analysis examined the benefit of CR on exercise capacity and secondary outcomes in ACS patients with a co-diagnosis of diabetes compared to those without.

METHODS

Five databases were searched in May 2021 for randomised controlled trials (RCTs) and observational studies reporting CR outcomes in ACS patients with and without diabetes. The primary outcome of this study was exercise capacity expressed as metabolic equivalents (METs) at the end of CR and ≥ 12-month follow-up. Secondary outcomes included health-related quality of life, cardiovascular- and diabetes-related outcomes, lifestyle-related outcomes, psychological wellbeing, and return to work. If relevant/possible, studies were pooled using random-effects meta-analysis.

RESULTS

A total of 28 studies were included, of which 20 reported exercise capacity and 18 reported secondary outcomes. Overall, the studies were judged to have a high risk of bias. Meta-analysis of exercise capacity was undertaken based on 18 studies (no RCTs) including 15,288 patients, of whom 3369 had diabetes. This analysis showed a statistically significant smaller difference in the change in METs in ACS patients with diabetes (standardised mean difference (SMD) from baseline to end of CR: - 0.15 (95% CI: - 0.24 to - 0.06); SMD at the ≥ 12-month follow-up: - 0.16 (95% CI: - 0.23 to - 0.10, four studies)).

CONCLUSION

The benefit of CR on exercise capacity in ACS patients was lower in those with diabetes than in those without diabetes. Given the small magnitude of this difference and the substantial heterogeneity in the results of the study caused by diverse study designs and methodologies, further research is needed to confirm our findings. Future work should seek to eliminate bias in observational studies and evaluate CR based on comprehensive outcomes.

A nonrandomized controlled trial of individualized exercise prescription combined with remote exercise management in patients who are overweight or obese

Background

Between 2012 and 2020, the obesity rate increased among Chinese people aged 18 years and above, along with blood pressure, fasting blood glucose, serum total cholesterol, and triglycerides.

Purpose

Our objective was to compare the effects of a combined intervention, including individualized exercise prescription plus remote management versus individualized exercise prescription only, on cardiovascular risk factors in patients who are overweight or obese, with the aim of establishing a more effective remote model of health management than self-management.

Methods

This nonrandomized controlled trial (ChiCTR2100046307) studied patients who are overweight or obese at model labor health management centers from January 2019 to December 2019, including 55 people in the experimental group and 34 in the control group. The relevant indexes of all the research objects from both experimental group and control group were examined. Participants in the experimental group were given individualized exercise prescription combined with remote exercise management over a period of 3 months. The control group was prescribed exercise only at time of enrollment and taught about exercise once, followed by voluntary exercise and self-management for 3 months.

Result

After adjusting for baseline differences, the changes in weight (−2.72 ± 4.03 kg versus 0.32 ± 2.50 kg, P < 0.0001), body mass index (−0.99 ± 1.44 kg/m² versus 0.11 ± 0.92 kg/m², P < 0.0001), waist circumference (−2.98 ± 6.29 cm versus 0.60 ± 5.33 cm, P < 0.0001), visceral fat area (−9.75 ± 19.68 cm² versus −1.31 ± 12.37 cm², P = 0.028), body fat (− 2.65 ± 3.52 kg versus 0.54 ± 2.67 kg, P < 0.0001), body fat rate (−2.50 ± 3.32% versus 0.21 ± 3.30%, P < 0.0001), uric acid (−9.75 ± 19.68 µmol/L versus −1.31 ± 12.37 µmol/L, P = 0.028), serum total cholesterol (−0.11 ± 0.40 mmol/L versus −0.11 ± 0.59 mmol/L, P = 0.004), fasting insulin (− 2.36 ± 5.20 μU/mL versus 1.22 ± 7.34 μU/mL, P = 0.009), and homeostatic model assessment of insulin resistance (−0.62 ± 1.25 versus 0.14 ± 1.83, P = 0.022) were significantly better in the experimental group than in the control group after intervention.

Conclusion

Individualized exercise prescription combined with remote management in patients who are obese or overweight facilitated weight and fat loss, lowered blood pressure and serum total cholesterol, improved glucose metabolism and insulin resistance, and reduced cardiovascular risk factors. The intervention was superior to conventional education in terms of weight loss, fat reduction, total cholesterol reduction, fasting insulin reduction, and amelioration of insulin resistance.

Association of Hand Grip Strength with Mild Cognitive Impairment in Middle-Aged and Older People in Guangzhou Biobank Cohort Study

Background: Lower hand grip strength has been linked to cognitive impairment, but studies in older Chinese are limited. We examined the association of hand grip strength with cognitive function in a large sample of older Chinese. Methods: 6806 participants aged 50+ years from the Guangzhou Biobank Cohort Study (GBCS) were included. Relative grip strength was calculated by absolute handgrip strength divided by the body mass index (BMI). Cognitive function was assessed using the Delayed Word Recall Test (DWRT, from 0 to 10) and the Mini Mental State Examination (MMSE, from 0 to 30), with higher scores indicating better cognition. Results: After adjusting for multiple potential confounders, lower absolute grip strength and relative grip strength were significantly associated with lower DWRT (all p < 0.05) in all participants. No significant interaction effects between sex and handgrip strength on cognitive impairment were found (p from 0.27 to 0.87). No significant association between handgrip strength and total MMSE scores was found in the total sample or by sex (p from 0.06 to 0.50). Regarding the individual components of MMSE, lower absolute and relative grip strength were significantly associated with lower scores of the recall memory performance in all participants (p from 0.003 to 0.04). Conclusion: We have shown for the first time a positive association of grip strength with recall memory performance, but not general cognitive function in older people, which warrants further investigation.

Blood Pressure and Blood Glucose Responses to Combined Exercise Sessions of Different Intensities in Individuals with Cardiovascular Risk Factors

OBJECTIVE

The purpose of the present study was to verify the acute effects of blood pressure and blood glucose after two sessions of combined exercise sessions performed at two levels of intensity in trained individuals with cardiovascular risk factors.

METHODS

Eighteen individuals (66.22 ± 8.61 years) of both sexes (6 women/12 men) with cardiovascular risk factors performed two sessions of combined exercises at different levels of intensity: moderate (MOD) and high (HI). To control the intensity of the aerobic training, the Borg Rating of Perceived Exertion (RPE) Scale was used. For the strength training, the maximum number of repetitions was carried out within a predetermined duration of sets. Blood pressure and blood glucose measurements were collected before and 20 minutes after the sessions. The data were analyzed using Generalized Estimating Equations, α 5%.

RESULTS

Reductions were observed in systolic blood pressure (MOD - Δ = -4.95 mmHg; HI - Δ = -3.31 mmHg) and blood glucose (MOD - Δ = -16.06 mg/dL; HI - Δ = -29.45 mg/dL) after the two sessions, with no difference between sessions. Diastolic blood pressure did not change (p < .05).

CONCLUSION

Combined exercises sessions of moderate or high intensity can promote an acute reduction in systolic blood pressure and glycemia in individuals with cardiovascular risk factors.

Insulin and cancer: a tangled web

For a century, since the pioneering work of Otto Warburg, the interwoven relationship between metabolism and cancer has been appreciated. More recently, with obesity rates rising in the U.S. and worldwide, epidemiologic evidence has supported a link between obesity and cancer. A substantial body of work seeks to mechanistically unpack the association between obesity, altered metabolism, and cancer. Without question, these relationships are multifactorial and cannot be distilled to a single obesity- and metabolism-altering hormone, substrate, or factor. However, it is important to understand the hormone-specific associations between metabolism and cancer. Here, we review the links between obesity, metabolic dysregulation, insulin, and cancer, with an emphasis on current investigational metabolic adjuncts to standard-of-care cancer treatment.

Molecular Mechanisms of Exercise and Healthspan

Healthspan is the period of our life without major debilitating diseases. In the modern world where unhealthy lifestyle choices and chronic diseases taper the healthspan, which lead to an enormous economic burden, finding ways to promote healthspan becomes a pressing goal of the scientific community. Exercise, one of humanity's most ancient and effective lifestyle interventions, appears to be at the center of the solution since it can both treat and prevent the occurrence of many chronic diseases. Here, we will review the current evidence and opinions about regular exercise promoting healthspan through enhancing the functionality of our organ systems and preventing diseases.