Exercise in the prevention of coronary heart disease

Exercise addiction in team sports: A systematic literature review

While regular exercise should be part of the contemporary lifestyle, many people overindulge in it to the point of losing control over their behavior. This condition is known as exercise addiction (EA). Although addiction is an individual phenomenon, and most of the over 1,000 published studies on EA look at individual exercisers, there are studies on team sports athletes, too. Theoretically, these athletes should not manifest exercise addiction, but some studies are projecting the contrary. Therefore, in this literature review, we analyze EA in team athletes. Based on four databases (PsycINFO, SPORTDiscus, Web of Science, and Google Scholar), we located 22 articles conforming to inclusion criteria. These studies suggest a high risk of exercise addiction among team sports participants. While the figures are lower than for individual exercisers, they are in discord with the concept of addiction as a dysfunction, and the lack of a single case of exercise addiction reported (to date) in team sports athletes in the academic literature. In agreement with a recent position paper, we conclude that there are substantial conceptual and measurement errors in exercise addiction research.

Exercise and Experiments of Nature

In this article, we highlight the contributions of passive experiments that address important exercise-related questions in integrative physiology and medicine. Passive experiments differ from active experiments in that passive experiments involve limited or no active intervention to generate observations and test hypotheses. Experiments of nature and natural experiments are two types of passive experiments. Experiments of nature include research participants with rare genetic or acquired conditions that facilitate exploration of specific physiological mechanisms. In this way, experiments of nature are parallel to classical "knockout" animal models among human research participants. Natural experiments are gleaned from data sets that allow population-based questions to be addressed. An advantage of both types of passive experiments is that more extreme and/or prolonged exposures to physiological and behavioral stimuli are possible in humans. In this article, we discuss a number of key passive experiments that have generated foundational medical knowledge or mechanistic physiological insights related to exercise. Both natural experiments and experiments of nature will be essential to generate and test hypotheses about the limits of human adaptability to stressors like exercise. © 2023 American Physiological Society. Compr Physiol 13:4879-4907, 2023.

The innovative role of Olympic sports and exercise in the promotion of health, gender equality and sustainability: past achievements and future challenges

Olympic sports represent, through their athletes, an iconic source of inspiration and ambition for everyone. During every Olympiad we are reminded of the astonishing achievements that can be reached through hard work and dedication. Nevertheless, these performances are very far from the reality of those being physically active to improve their health and fitness. The technological development that humanity has gone through in the last couple of centuries, has engineered physical activity out of our lives and dramatically altered our lifestyle, leading to the development of diseases that were not so prevalent. Exercise has become an integral part of our lives and it is now regarded as a medicine to prevent and counteract chronic conditions that are associated with a sedentary lifestyle. In this context Olympic sports can play a key role in attracting people to be physically active as well as leveraging on city governments to allow, not only sport participation, but a global active lifestyle. Therefore, International Sports Federations (ISF) have a central position in ensuring sports are in line with the changes occurring in society as well as fostering its natural evolution. Examples of this evolution are gender equality and sustainability, topics that finally are becoming central in ISFs as they have been in society for decades. Therefore, Olympic sports should acknowledge the prominent role they have in society and contribute to its further development by promoting socially relevant actions.

Long-term effects of exercise in postmenopausal women: 16-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS)

OBJECTIVE

Multimorbidity related to menopause and/or increased age will put healthcare systems in western nations under ever-greater strain. Effective strategies to prevent diseases are thus of high priority and should be started earlier in life. The purpose of the study was to evaluate the long-term effect of exercise on different important health parameters in initially early postmenopausal women over a 16-year period.

METHODS

In 1998, 137 early postmenopausal women with osteopenia living in Erlangen-Nürnberg were included in the study. Eighty-six women joined the exercise group (EG) and conducted two supervised group and two home training sessions per week, whereas the control group (CG: n = 51) maintained their physical activity level. Primary outcome parameters were clinical overall fractures incidence; secondary study endpoint was Framingham study-based 10-year risk of coronary death/myocardial infarction and low back pain.

RESULTS

In 2014, 59 women of the EG and 46 women of the CG were included in the 16-year follow-up analysis. Framingham study-based 10-year risk of myocardial infarction/coronary death increased significantly (P < 0.001) in both groups; however, changes were significantly more favorable in the EG (5.00% ± 2.94% vs CG: 6.90% ± 3.98%; P = 0.02). The ratio for clinical "overall" fractures was 0.47 (95% CI: 0.24-0.92; P = 0.03), and thus significantly lower in the EG. Although we focused on a high-intensity exercise strategy, low back pain was favorably affected in the EG.

CONCLUSIONS

Multipurpose exercise programs demonstrated beneficial effects on various relevant risk factors and diseases of menopause or/and increased age, and should thus be preferentially applied for primary or secondary prevention in postmenopausal women.

The Lactate Minimum Test: Concept, Methodological Aspects and Insights for Future Investigations in Human and Animal Models

In 1993, Uwe Tegtbur proposed a useful physiological protocol named the lactate minimum test (LMT). This test consists of three distinct phases. Firstly, subjects must perform high intensity efforts to induce hyperlactatemia (phase 1). Subsequently, 8 min of recovery are allowed for transposition of lactate from myocytes (for instance) to the bloodstream (phase 2). Right after the recovery, subjects are submitted to an incremental test until exhaustion (phase 3). The blood lactate concentration is expected to fall during the first stages of the incremental test and as the intensity increases in subsequent stages, to rise again forming a "U" shaped blood lactate kinetic. The minimum point of this curve, named the lactate minimum intensity (LMI), provides an estimation of the intensity that represents the balance between the appearance and clearance of arterial blood lactate, known as the maximal lactate steady state intensity (iMLSS). Furthermore, in addition to the iMLSS estimation, studies have also determined anaerobic parameters (e.g., peak, mean, and minimum force/power) during phase 1 and also the maximum oxygen consumption in phase 3; therefore, the LMT is considered a robust physiological protocol. Although, encouraging reports have been published in both human and animal models, there are still some controversies regarding three main factors: (1) the influence of methodological aspects on the LMT parameters; (2) LMT effectiveness for monitoring training effects; and (3) the LMI as a valid iMLSS estimator. Therefore, the aim of this review is to provide a balanced discussion between scientific evidence of the aforementioned issues, and insights for future investigations are suggested. In summary, further analyses is necessary to determine whether these factors are worthy, since the LMT is relevant in several contexts of health sciences.

Beyond Blood Pressure Screening: A Rationale for Promoting the Primary Prevention of Hypertension

High blood pressure is a major public health problem in the United States. However, the underlying reasons for the chronic elevation of blood pressure (BP) are unknown in most cases of hypertension (HT), and medical care has focused on lowering already elevated BP, primarily by pharmacologic means. Although an important factor in the development of HT appears to be a genetic predisposition, other potentially modifiable lifestyle risk factors associated with elevated BP have been identified. This article describes the scientific rationale for encouraging health promotion specialists to focus on the primary prevention of abnormally elevated blood pressure. Nonbehavioral risk factors such as increasing age, history of HT, Black ancestry, and consistent BP readings in the higher range of normality, and behavioral factors including dietary excesses and deficiencies, excessive body fat, a sedentary life style, and frequent episodes of unmanageable emotional stress are addressed. Recommendations are made based on scientific evidence supporting the relationships between these risk factors and the development of HT.

Biological mechanisms underlying the role of physical fitness in health and resilience

Physical fitness, achieved through regular exercise and/or spontaneous physical activity, confers resilience by inducing positive psychological and physiological benefits, blunting stress reactivity, protecting against potentially adverse behavioural and metabolic consequences of stressful events and preventing many chronic diseases. In this review, we discuss the biological mechanisms underlying the beneficial effects of physical fitness on mental and physical health. Physical fitness appears to buffer against stress-related disease owing to its blunting/optimizing effects on hormonal stress responsive systems, such as the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. This blunting appears to contribute to reduced emotional, physiological and metabolic reactivity as well as increased positive mood and well-being. Another mechanism whereby regular exercise and/or physical fitness may confer resilience is through minimizing excessive inflammation. Chronic psychological stress, physical inactivity and abdominal adiposity have been associated with persistent, systemic, low-grade inflammation and exert adverse effects on mental and physical health. The anti-inflammatory effects of regular exercise/activity can promote behavioural and metabolic resilience, and protect against various chronic diseases associated with systemic inflammation. Moreover, exercise may benefit the brain by enhancing growth factor expression and neural plasticity, thereby contributing to improved mood and cognition. In summary, the mechanisms whereby physical fitness promotes increased resilience and well-being and positive psychological and physical health are diverse and complex.

A Research Agenda to Examine the Efficacy and Relevance of the Transtheoretical Model for Physical Activity Behavior

Regular physical activity (PA) decreases the risk of several chronic diseases including some cancers, type II diabetes, obesity, and cardiovascular disease; however, the majority of US adults are not meeting the recommended levels to experience these benefits. To address this public health concern, the underlying mechanisms for behavior change need to be understood, translated and disseminated into appropriately tailored interventions. The Transtheoretical Model (TTM) provides a framework for both the conceptualization and measurement of behavior change, as well as facilitating promotion strategies that are individualized and easily adapted. The purpose of this manuscript is to present the constructs of the TTM as they relate to PA behavior change. We begin with a brief synopsis of recent examinations of the TTM constructs and their application. Subsequent to its introduction, we specifically present the TTM within the PA context and discuss its application and usefulness to researchers and practitioners. Criticisms of the TTM are also noted and presented as opportunities for future research to enhance the valid application of the TTM. We offer general study design recommendations to appropriately test the hypothesized relationships within the model. With further examinations using appropriate study design and statistical analyses, we believe the TTM has the potential to advance the public health impact of future PA promotion interventions.

Recent trends and socio-demographic determinants of exercise participation in Australia

Although sentiments about the positive health benefits of regular exercise have been expressed for many centuries, it is only in the past three decades that epidemiologic evidence has provided scientific support for the health benefits of being physically active. The evidence for the protective effect of physical activity is particularly strong with reference to cardiovascular disease, with the relative risk of being "inactive" compared to 'active' estimated to typically lie between 1.5 and 2.0. Despite the popular view that exercise participation has increased in recent years, estimates of trends in physical activity in Australian (and other) populations have been difficult to interpret because of the different measurements and surveys used. We examined data from population surveys using well validated, standardised methods to assess exercise participation, through National surveys between 1984 and 1987 conducted by the Commonwealth Department of the Arts, Sport, the Environment, Tourism and Territories (DASETT). Over the period in which the surveys were conducted, there appears to have been a slight increase in the proportion of Australians who participated in regular physical activity. There was a significant decline in the proportion who reported being totally sedentary--from 32.9 per cent in 1984 to 25.4 per cent in 1987. The data from all of the surveys were then pooled to give an overall sample size of 17053, and socio-demographic variables were examined in relation to exercise participation. Women, older people, the less well educated, and those on lower incomes were less likely to perform regular physical activity. Inequalities in the social distribution of exercise participation parallel those found for other health risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

10-year trends in physical activity in the eastern Finnish adult population: relationship to socioeconomic and lifestyle characteristics

In a large, community-based cardiovascular disease prevention study in Eastern Finland, independent random population samples were surveyed in 1972, 1977 and 1982. The leisure-time physical activity (LTPA), occupational physical activity (OPA), and socioeconomic and lifestyle characteristics were assessed. In men and women aged 30-59, the proportion with high LTPA increased from 1972 to 1982 by approximately one half (p less than 0.001), whereas that of high OPA decreased during the same period (p less than 0.001). In both sexes, high overall physical activity fell from 1972 to 1977 (p less than 0.001), but no more from 1977 to 1982. The proportion of entirely sedentary remained stable. Education, income and younger age showed a positive, body mass index, smoking and OPA a graded, negative association with high LTPA in 1972 and 1982. Significant (p less than 0.001) differences in 10-year trends of changes in LTPA were observed: men and women with low education or income increased LTPA more than those with high education and income. Socioeconomic factors, such as income and education, appear to have lost importance as determinants of population-wide exercise, whereas the clustering of low physical activity with overweight and smoking has increased.

Population strategies to enhance physical activity: the Minnesota Heart Health Program

A population-wide, community-based program in cardiovascular disease prevention, the Minnesota Heart Health Program (MHHP), has been designed to promote more frequent and vigorous physical activity in North American communities, along with improved eating and smoking patterns. The physical activity component of this broad-based education strategy is based on the facilitation which physical activity provides to lowering of other risk characteristics for heart disease and its enhancement of other healthy behaviors and on the potential for prevention of elevated risk in the first place. The rationale for a population strategy to complement medical approaches to prevention is that exercise patterns are largely socially learned and culturally determined. The MHHP Physical Activity Program is implemented through three major education strategies: direct education, community organization, and mass communications. Early results from this 10-year project indicate that it is feasible to enter U.S. communities and to involve their leadership actively in MHHP activities of health promotion. Moreover, attitudes, knowledge, awareness, participation, and behaviors related to exercise and eating patterns appear to be changed by the program. Nevertheless, there are problems in the design, implementation, analysis and interpretation of population changes in physical activity and other health behaviors in community demonstration programs. These issues, along with their solutions, should provide useful information for medical science and for the public health about population strategies of disease prevention and health promotion.

Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease

Substantial data have established a sedentary lifestyle as a major modifiable risk factor for coronary heart disease (CHD). Increased levels of physical activity, exercise training, and overall cardiorespiratory fitness have provided protection in the primary and secondary prevention of CHD. This review surveys data from observational studies supporting the benefits of physical activity, exercise training, and overall cardiorespiratory fitness in primary prevention. Clearly, cardiac rehabilitation/secondary prevention (CRSP) programs have been greatly underused by patients with CHD. We review the benefits of CRSP programs on CHD risk factors, psychological factors, and overall CHD morbidity and mortality. These data support the routine referral of patients with CHD to CRSP programs. Patients should be vigorously encouraged to attend these programs.

Enhanced removal from the plasma of LDL-like nanoemulsion cholesteryl ester in trained men compared with sedentary healthy men

The objective of this study was to evaluate the effects of exercise training on plasma removal of a cholesterol-rich nanoemulsion (LDE) that mimics low-density lipoprotein (LDL) lipid structure and binds to LDL receptors. LDE-derived cholesteryl ester plasma kinetics was studied in 24 exercise-trained and 20 sedentary male subjects. LDE labeled with [14C]cholesteryl ester was injected intravenously, and plasma samples were collected over a 24-h period to determine radioisotope decay curves. LDL cholesterol concentration was similar in both groups. Fractional clearance rate (FCR) of the nanoemulsion label was greater in the exercise-trained group compared with the sedentary group (0.138 ± 0.152 and 0.0261 ± 0.023 h−1, respectively). A positive correlation was found ( r = 0.60, P < 0.01) between FCR and peak O2consumption in trained subjects. Circulating oxidized LDL levels were lower in trained subjects compared with the sedentary group (9.0 ± 2.0 and 16.0 ± 3.0 mU/l). LDE was also injected into control and LDL receptor gene knockout mice submitted and not submitted to training. Muscle LDE uptake percentage was increased in the trained mice compared with the untrained mice (1.1 ± 0.8 and 0.2 ± 0.1, respectively, P < 0.0001) in the control group but not in the knockout animals, indicating that the LDL receptor is involved in the increased uptake elicited by exercise. These results show that exercise training increases LDE plasma removal, which in turn suggests that it also increases LDL receptors or LDL receptor activity.

Heart disease risk perception in college men and women

The authors sought to assess the perception of risks for coronary heart disease (CHD) in college men and women. They surveyed 470 undergraduates from 2 major 4-year institutions who completed a questionnaire that measured perceived risks for heart disease. Sixty-eight percent of the respondents rated their risks as lower or much lower than those of their peers, indicating a clear optimistic bias. The research also revealed that the students who exercised regularly rated their risk of coronary disease lower than those who did not do so. In addition, women perceived a number of risk markers to be more potent or causative factors than men did. A significant number of participants did not comprehend commonly understood causal relationships associated with heart disease risk. The findings in this preliminary investigation suggest that college men and women do not accurately perceive their risks for developing heart disease.

Physical activity and functional capacity measurement in women: a report from the NHLBI-sponsored WISE study

Physical activity and functional capacity have not been assessed by questionnaire for criterion validity in women. We wished to evaluate the ability of a physical activity and a functional capacity assessment questionnaire to predict functional capacity measured by treadmill exercise stress testing, as well as correlate with cardiac risk factors and angiographic coronary artery disease (CAD) in women. In a National Heart, Lung and Blood Institute (NHLBI)-sponsored cross-sectional population study involving four academic medical centers, 476 women with cardiac risk factors undergoing coronary angiography for evaluation for suspected myocardial ischemia were enrolled in the Women's Ischemia Syndrome Evaluation (WISE). The main outcome measures were functional capacity measured during symptom-limited exercise treadmill testing, cardiac risk factors, and CAD, using core laboratory-determined measures. Physical activity measured by the Postmenopausal Estrogen and Progesterone Intervention physical activity questionnaire (PEPI-Q) and functional capacity measured by the Duke Activity Status Index (DASI) questionnaire, correlated with functional capacity measured in metabolic equivalents (METS), as estimated during symptom-limited exercise treadmill testing (r = 0.27, p = 0.001 and r = 0.31, p = 0. 0002, respectively). The DASI was a significant independent predictor of functional capacity even after adjustment for cardiac risk factors, and the PEPI-Q was not. The DASI and PEPI-Q scores were inversely associated with higher numbers and levels of cardiac risk factors, as well as angiographic CAD. The DASI questionnaire is a reasonable correlate of functional capacity achieved during symptom-limited treadmill exercise testing in women with suspected myocardial ischemia. Lower functional capacity or physical activity measured by the DASI and PEPI-Q, respectively, is associated with more prevalent cardiac risk factors and angiographic CAD. These findings suggest that the DASI and, to a lesser extent, the PEPI-Q have criterion validity for use in health-related research in women.

Field evaluation of the Computer Science and Applications, Inc. physical activity monitor

PURPOSE

The purpose of this study was to evaluate the Computer Science and Applications, Inc. (CSA) activity monitor to quantify physical activity in free living subjects using an activity diary as the criterion measure.

METHODS

Subjects also completed a 7-d physical activity recall at the end of the monitoring period. Nine male and 10 female subjects (mean, SD) (25.0, 3.6 yr) wore the CSA monitor for 7 consecutive days. On 3 of those days, subjects completed an activity diary (2 weekdays and 1 weekend day). Total kcal per day (Dkcal(tot)) was calculated from the self-reported diary classifications of the subject's activities. For the 3 days that coincided with the diary, total number of counts accumulated per day (cnt(tot)) was obtained from the monitor.

RESULTS

The amount of activity per day recorded by the CSA monitor followed the same pattern of change as the activity diary. The cnt(tot) and Dkcal(tot) were significantly (P < or = 0.05) correlated on day 1 (r = 0.65), day 2 (r = 0.49), day 3 (r = 0.55), and for the 3 days pooled (r = 0.51). Subjects were classified as low, moderate, or highly active based on tertiles of kcal from the diary and counts from the CSA monitor. The percentage agreement between the CSA and the activity diary was 68.4% (Kappa = 0.53, P < 0.01). The number of minutes spent in the various activity categories were compared between instruments using an ANOVA model. The results of these analyses suggest that the CSA overestimated light activity and underestimated vigorous activity compared with the diary.

CONCLUSION

In conclusion, the CSA monitor may be useful in a field situation where total physical activity and patterns of physical activity are the desired outcomes.

Aerobic fitness of Tasmanian secondary school children using the 20-m shuttle run test

The aim of this study was to determine the aerobic fitness of Tasmanian secondary school children aged 11 to 16 years. A random sample of Tasmanian secondary schools was undertaken and then all children within each grade in the school were tested. In all, 6061 children undertook the test, 2981 boys and 3080 girls. The test consisted of a 20-m shuttle run in time to a prerecorded timing sequence. Each child had to complete as many shuttles as possible while staying in time with the beep. The test ceased for each child when they could no longer reach the marker at the same time or prior to the generated sound. The analyses indicated that there was a significant main effect of grade and sex. Children in lower grades completed fewer shuttles than the children in higher grades, and boys completed more shuttles than girls within each grade. Students in government-run schools completed significantly fewer shuttles than their nongovernment school counterparts (p < .0001). On a regional basis, there were no differences between children in the north and south of Tasmania as each completed 5.7 +/- 0.1 shuttles but children in the northwestern region of the state completed a significantly greater number of shuttles. An estimation of mean VO2max based upon shuttle stages completed indicated that these values ranged from a low of 40.6 ml.kg-1.min-1 in 13-, 14-, and 15-yr-old girls to a high of 50.4 ml.kg-1.min.-1 in 16-yr-old boys. Comparisons between this and similar data suggest that Tasmanian school children are less fit than their counterparts around the world. In conclusion, normative data for Tasmanian school children were developed and distributed to schools throughout Tasmania for use by teachers in evaluating the fitness of their students.

Self-reported exercise frequency and personality: a population-based study in Japan

This study of relationships between personality and exercise frequency was based on 22,448 residents (40 to 64 years old) in Miyagi, Japan. They completed the self-administered questionnaires on their exercise frequency and the Japanese version of the short form Eysenck Personality Questionnaire-Revised. Higher scores on Extraversion were positively related to exercising and higher scores on Neuroticism and Psychoticism were positively related to "not exercising" in a general population for both sexes. These observed relationships were consistent even when an analysis of covariance was conducted with controlling for possible confounding factors of age, marital status, and education.

The Fitness Facility Membership Questionnaire: a measure of reasons for joining

This study describes the development of the Fitness Facility Membership Questionnaire of 43 items, designed to identify reasons for joining a fitness facility. Items were generated from responses to an open-ended questionnaire. A 50-item version of the questionnaire was completed by 152 members of five community-based fitness facilities. Principal components analysis with varimax rotation yielded 8 factors, accounting for 63.8% of the variance. The factors were labeled Socialization, Aquatic-related Facilities, Extrinsic Motivation, Recreational Facilities, Intrinsic Motivation, Resistance Equipment, Aerobic Equipment, and Amenities. The internal consistency of the eight factors was acceptable with Cronbach coefficients alpha ranging from .72 to .89. Discriminant analysis of responses is also presented.

Modification of physical activity 5 months after myocardial infarction: relevance of biographic and personality characteristics

The relation between modification of physical activity, a risk factor for coronary heart disease, and personality characteristics was assessed in 166 survivors of a first myocardial infarction (MI). Physical activity was assessed before MI in retrospect and again 5 months after MI. Patients were divided into 3 categories according to their current daily-life physical activities: less active than before MI (n=24), equally active as before MI (n=82), or more active than before MI (n=60). A significant differentiation was found between patients who became less physically active than before MI and the other 2 categories. This less active category was characterized by feelings of disability, a low level of vigor, and feelings of anxiety. In addition, this patient group was on average older and more often female. The results were adjusted for participation in a cardiac rehabilitation program. Finally, the discussion recommends involving psychological intervention in the exercise program for the less active category of patients to diminish feelings of anxiety and disability and to improve vigor.

Physical activity assessment: a review of methods

In order to determine the actual threshold level of habitual physical activity necessary to obtain protective effects against degenerative diseases, valid, reliable, nonreactive, and precise instruments are needed. Because regular, low-intensity exercise provides prophylactic effects, the ability to distinguish activity patterns should be a primary consideration when choosing an instrument to assess activity in the field. Although self-report methods in the form of questionnaires are the instruments of choice when large populations are to be assessed, they are somewhat limited in their objectivity. The doubly labeled water (DLW) technique is a highly accurate and objective technique for assessing total daily energy expenditure that should be utilized more as a criterion measure for validating questionnaires that assess energy expenditure. However, the DLW technique remains too costly to be considered practical for large-scale studies. Supplementing questionnaires with a personal interview does elicit more detailed data, but activity monitors provide a more objective measure of activity that can be used as an adjunct to questionnaires. Several models of activity monitors are capable of collecting and storing data for many days, weeks, or even months. More importantly, the internal real-time clocks of these monitors allow the discrimination of activity patterns. Future studies should combine the use of these monitors with a suitable questionnaire.

Cardiac rehabilitation in the United Kingdom: guidelines and audit standards. National Institute for Nursing, the British Cardiac Society and the Royal College of Physicians of London

This paper summarises a multidisciplinary workshop convened to prepare clinical guidelines and audit standards in cardiac rehabilitation in the United Kingdom. The workshop developed a three element model of the rehabilitation process and identified needs relating to medical and psychosocial care and the potential contributions of exercise, education, secondary prevention, and vocational advice. Draft clinical standards are proposed as a basis for locally developed guidelines and further research.

Physical-strength tests and mortality among visitors to health-promotion centers in Japan

A follow-up study was conducted to clarify the relationship between physical-strength level and risk of death from all causes and from cancer and cardiovascular disease. The 7286 persons who were examined at seven health-promotion centers throughout Japan between 1982 and 1987 were followed up. By January 1992, 6259 persons (85.9%) had been contacted by questionnaire. They included 3117 men (49.8% of all subjects studied) (average age 53.6 years at baseline, SD = 9.0 years, range 40-84 years), and 3142 women (50.2%) (average age 54.5 years at baseline, SD = 8.5 years, range 40-85 years). The follow-up period for each person averaged 6.1 years, for a total of 38,253 person-years. During this period, 155 deaths were reported. At baseline, five physical-strength tests (grip strength, side step, vertical jump, standing trunk flexion, and sit-ups) were performed. Five clinical laboratory tests (thickness of skinfold, blood sugar, total serum cholesterol, percent vital lung capacity, and blood pressure) were also conducted. The examinees were questioned about smoking status (current smoker, nonsmoker, and ex-smoker). Men with thicker skinfold [relative risk (RR) = 2.11] and higher levels of blood sugar (RR = 1.89) had an excess risk of death from all causes. Men with higher serum cholesterol (RR = 5.08), thicker skinfold (RR = 4.54), and elevated blood pressure (RR = 2.33) had an excess risk of death from cardiovascular disease. In women, no relationship was seen between clinical laboratory tests and an excess risk of death. Men exhibiting lower values for side step (RR = 2.43), vertical jump (RR = 2.37), sit-ups (RR = 1.93) and grip strength (RR = 1.92) also had an excess risk of death from all causes. Furthermore, men with lower heights for vertical jump (RR = 5.51) had an excess risk of death from cardiovascular disease. After adjustment for skinfold thickness, blood sugar, total serum cholesterol, blood pressure, percent vital lung capacity and smoking status, men with a lower level of side step, vertical jump, and grip strength had an excess risk of death from all causes. No such relationship was seen between physical-strength level and an excess risk of death in women. It is concluded that a low level of physical strength might be significantly correlated with subsequent health outcomes in men.

The role of exercise in the patient with post-polio syndrome

Recent studies have shown that judicious exercise can improve muscle strength, cardiorespiratory fitness, and the efficiency of ambulation in post-polio patients. It may also add to the patient's sense of well-being. These benefits appear to occur when the patients stay within reasonable bounds while exercising in order to avoid overuse problems. In particular, the patients should be instructed to avoid activities that cause increasing muscle or joint pain or excessive fatigue, either during or after their exercise program. The literature indicates that exercise within these constraints leads to a number of beneficial physiologic and psychologic adaptations in patients with post-polio syndrome. Judicious exercise should be viewed as important adjuvant in the overall therapeutic program of the patient. Patients seen in post-polio clinics frequently complain of new fatigue, weakness, muscle pain, and/or joint pain. The most frequent complaints involving activities of daily living include new difficulties with walking and stair climbing. The therapeutic benefit of exercise in these patients to minimize or reverse decline in function is an important question frequently asked by patients with post-polio syndrome. In the general population, physical activity is known to be an important adjunct to good health, bestowing both physiologic and psychologic benefits leading to a reduction in the risk to develop a number of serious ailments as well as leading to better psychological adjustment. On the other hand, limitation in physical activity results in a number of deleterious effects. Patients with post-polio syndrome have unique problems, however, which need to be considered when prescribing an exercise program for an individual patient. A number of functional etiologies for declining function have been hypothesized including disuse weakness, overuse weakness, weight gain, and chronic weakness. Because of the variability in which the motor neurons to different muscle groups may have been affected in a particular patient, both asymmetric and scattered weakness may be present. The challenge in prescribing exercise for the patient with post-polio syndrome comes in recognizing these unique factors in each patient and modifying the prescription accordingly. One must protect muscles and joints experiencing the adverse effects of overuse or body areas with very significant chronic weakness (in general, in areas where the muscles have less than antigravity strength on manual muscle testing) while exercising those body areas experiencing the deleterious effects of disuse. Weight gain is to be avoided if at all possible in this population, because increased weight only leads to further difficulty in the performance of daily activities.(ABSTRACT TRUNCATED AT 400 WORDS)

Aging and Exercise: A Health Perspective

Habitual exercise provides protection against fatal coronary heart disease, extends longevity, and enhances quality of life. National surveys show less physical activity in older men and women compared with middle-aged and younger persons; older women are particularly sedentary. Although there are still few longitudinal studies on exercise and physical activity in older individuals, the data support a positive relationship between physical activity and health and function in older individuals. The data further show that with regular physical activity, health and physical fitness are maintained or even increased over time in older individuals. Studies on physical activity requirements for beneficial health effects in the elderly are reviewed and presented, and exercise recommendations for older individuals are given.

Physical activity and 23-year incidence of coronary heart disease morbidity and mortality among middle-aged men. The Honolulu Heart Program

BACKGROUND

The purpose of the study was to examine the association between physical activity and 23-year incidence of coronary heart disease morbidity and mortality. This cohort study continues to follow 8006 Japanese-American men who were 45 to 68 years of age and living on Oahu, Hawaii, in 1965, for the development of coronary heart disease morbidity and mortality.

METHODS AND RESULTS

The Framingham physical activity index was calculated by summing the product of average hours spent at each activity level and a weighting factor based on oxygen consumption. Study subjects were divided into tertiles of physical activity index at baseline. Relative risks and 95% confidence intervals (CI) for incidence of coronary heart disease morbidity and mortality were obtained using the Cox model. After age adjustment and using the lowest physical activity index tertile as a reference group, the relative risk for coronary heart disease incidence for the highest tertile of physical activity was 0.83 (CI, 0.70 to 0.99). After adjusting for age, hypertension, smoking, alcohol intake, diabetes, cholesterol, and body mass index, the relative risk was 0.95 and CI included 1 (CI, 0.80 to 1.14). For coronary heart disease mortality, the age-adjusted relative risk was 0.74 (CI, 0.56 to 0.97) and 0.85 (CI, 0.65 to 1.13) after risk factor adjustment.

CONCLUSIONS

The results suggest that the impact of physical activity index on coronary heart disease is mediated through its effects on hypertension, diabetes, cholesterol, and body mass index. These findings support the hypothesis that physical activity is inversely associated with coronary heart disease morbidity and mortality and suggest that physical activity interventions in middle-aged men, by improving cardiovascular risk factor levels, may have significant public health implications in the prevention of coronary heart disease.

The prevention of cardiovascular disease. Emphasis on secondary prevention

Atherosclerosis is a progressive disease affecting all major arteries. Clinical evidence of atherosclerosis increases the risk of subsequent morbid and mortal events fivefold to sevenfold over the next 5 to 10 years. The same risk factors contribute to the initial development of CVD events as to their recurrence. Both coronary and noncoronary events, such as stroke or PAD, reflect the severity of the underlying atherosclerotic process and strongly predict future excess CVD morbidity and mortality. Short-term and long-term survival depends on modifying the risk factors that contribute to CVD events. Although absolute proof of benefit for secondary prevention does not exist for all risk factors, the data from primary prevention trials and the secondary prevention trials that have been done argue strongly for aggressive intervention. Benefit has been demonstrated for smoking cessation, cholesterol reduction, and blood pressure control. Selected patients may benefit from additional medical, procedural, or surgical interventions to prolong life, such as beta-blocking agents, aspirin, or carotid endarterectomy. Many secondary prevention measures are a cost-effective way to reduce the substantial morbidity and mortality due to CVD. Contrary to primary prevention, even modest treatment effects from secondary prevention efforts can benefit large numbers of patients. Finally, secondary prevention may be more successful because patients with clinical evidence of CVD may be more highly motivated than their healthy counterparts to make and maintain lifestyle changes.

Physical activity and risk of peripheral arterial disease in the general population: Edinburgh Artery Study

STUDY OBJECTIVE

To determine associations between physical activity at age 35-45 years with peripheral arterial disease and cardiovascular risk factors at age 55-74 years.

DESIGN

Cross sectional survey of the general population--Edinburgh Artery Study. The presence of peripheral arterial disease was determined using the WHO/Rose questionnaire on intermittent claudication, and the ankle brachial pressure index at rest and during reactive hyperaemia. Levels of physical activity undertaken at the time of the survey and at the times the subjects were aged 35-45 years were measured by self administered recall questionnaire.

SETTING

City of Edinburgh, Scotland.

PARTICIPANTS

Altogether 1592 men and women aged 55 to 74 years, selected from the age-sex registers of 10 general practices spread geographically and socioeconomically throughout the city.

MAIN RESULTS

Participation in moderate or strenuous activity when aged 35-45 years was reported by 66% of men and 40% of women. In men, but not in women, less peripheral arterial disease (measured by an increasing trend in the ankle brachial pressure index) was found with increasing amounts of exercise at age 35-45 years (p < 0.001). Higher levels of exercise at age 35-45 years were associated with lower blood viscosity (p < 0.05) and plasma fibrinogen levels (p < 0.05) in men and women aged 55-74 years, and also with higher current alcohol intake (p < 0.001) and high density lipoprotein cholesterol concentrations (p < 0.01) in women aged 55-74 years. After adjustment for age, sex, life-time smoking, social class, body mass index, and alcohol intake, the association between leisure activity aged 35-45 years and the ankle brachial pressure index aged 55-74 years remained highly significant in men who had at some time smoked (p < 0.001) but not in men or women who had never smoked (p > 0.05).

CONCLUSION

The risk of peripheral arterial disease, particularly among male smokers, is inversely related to previous physical activity in early middle age, suggesting a protective effect of exercise.

Parental influences on childhood fitness and activity patterns

The purpose of this study was to determine the effect of parental attitudes and self-reported exercise habits on the fitness and activity levels of their children. One parent from each of 1,253 families was asked about exercise habits and completed the Exercise Benefits and Barriers Scale (EBBS) to determine their personal attitudes toward exercise. The children completed a self-reported activity questionnaire (SRA) and had their aerobic power predicted using a cycle ergometer test. Multiple regression indicated that the parents' EBBS scores were weakly associated with the child's maximal oxygen uptake (VO2max); the mothers' association was significant, but the fathers was not. The children's SRA scores were not correlated with parents' attitudes or exercise habits. These results suggest either that factors other than parental attitudes and exercise habits are more influential in determining the fitness and activity levels of children or that the instruments lack precision. Thus, to improve the cardiovascular fitness of children, we need to examine factors in the child's environment that may be more influential than parental attitudes and examples.

Prevention of running injuries by warm-up, cool-down, and stretching exercises

The purpose of this study was to evaluate the effect of a health education intervention on running injuries. The intervention consisted of information on, and the subsequent performance of, standardized warm-up, cool-down, and stretching exercises. Four hundred twenty-one male recreational runners were matched for age, weekly running distance, and general knowledge of preventing sports injuries. They were randomly split into an intervention and a control group: 167 control and 159 intervention subjects participated throughout the study. During the 16-week study, both groups kept a daily diary on their running distance and time, and reported all injuries. In addition, the intervention group was asked to note compliance with the standardized program. At the end of the study period, knowledge and attitude were again measured. There were 23 injuries in the control group and 26 in the intervention group. Injury incidence for control and intervention subjects was 4.9 and 5.5 running injuries per 1000 hours, respectively. The intervention was not effective in reducing the number of running injuries; it proved significantly effective (P < 0.05) in improving specific knowledge of warm-up and cool-down techniques in the intervention group. This positive change can perhaps be regarded as a first step on the way to a change of behavior, which may eventually lead to a reduction of running injuries.

Reduced plasma fibrinogen, serum peroxides, lipids, and apolipoproteins after a 3-week vegetarian diet

The influence of a 3-week vegetarian diet and fasting on serum concentration of peroxides, lipids, apolipoproteins, and plasma fibrinogen was studied in ten middle-aged fibromyalgia/fibrositis patients (eight women, two men). Mean serum peroxide concentration (estimated as thiobarbituric acid reacting substances) was reduced from 3.60 +/- 0.14 to 2.82 +/- 0.15 umol/l (p = 0.01) and plasma fibrinogen from 3.33 +/- 0.25 to 2.74 +/- 0.15 g/l (p = 0.02). Serum total cholesterol fell from 6.61 +/- 0.50 to 4.83 +/- 0.35 mmol/l (p < 0.0001), apolipoprotein B from 1.77 +/- 0.14 to 1.31 +/- 0.11 g/l (p < 0.0001), and apolipoprotein A from 1.41 +/- 0.09 to 1.23 +/- 0.05 g/l (p = 0.03). High density lipoprotein cholesterol concentration also decreased somewhat (from 1.26 +/- 0.09 to 1.07 +/- 0.04 mmol/l, p = 0.03) An atherogenic index, reflecting the balance between low and high density lipoproteins, was reduced by 31% (from 5.74 +/- 0.79 to 3.97 +/- 0.60, p = 0.02). The results suggest that vegetarian diet/fasting may have a beneficial influence on the concentration of serum peroxides and plasma fibrinogen concentration, and on the serum level of several lipoprotein-related coronary risk factors.

Coronary risk factors in middle-aged men as related to smoking, coffee intake and physical activity

The relationship between lifestyle and coronary risk factors in blood was investigated in 165 middle-aged men. Plasma fibrinogen, serum triacylglycerols (TG), and apolipoprotein B (apo B) were higher, and high density lipoprotein cholesterol (HDLc) lower in smokers (n = 69) than in non-smokers (n = 96). By linear regression analysis there was a significant positive association between degree of smoking and either total cholesterol (TC), apo B, or plasma fibrinogen, whereas smoking was inversely related to HDLc. Smoking and coffee intake were positively correlated with an atherogenic index, reflecting the balance between low and high density lipoproteins. Sedentary men (n = 59) had higher mean TC, apo B, and atherogenic index than physically active men (n = 104). Smokers used salt more often than non-smokers. Physically active men used vegetables more often than sedentary men. Combining several habits into a "bad habit" score gave a high level of significance for its association with TC, apo B, and the atherogenic index. The results indicate that lifestyle may influence several blood factors involved in atherosclerosis development.