Markers of inflammation are inversely related to physical activity and fitness in sedentary men with treated hypertension

Metabolic and inflammatory health in SARS-CoV-2 and the potential role for habitual exercise in reducing disease severity

Introduction

The rapid emergence and spread of SARS-CoV-2 in late 2019 has infected millions of people worldwide with significant morbidity and mortality with various responses from health authorities to limit the spread of the virus. Although population-wide inoculation is preferred, currently, there is large variation and disparity in the acquisition, development, and deployment of vaccination programs in many countries. Even with availability of a vaccine, achieving herd immunity does not guarantee against reinfection from SARS-CoV-2. Emerging evidence indicates that vaccines do not eliminate infection but protect against severe disease and potential hospitalisation. Therefore, additional strategies which strengthen the immune system should be strongly considered to assist in reducing the overall health care burden and stem the rate of infection. There is now substantial evidence that SARS-CoV-2 disease severity and death are linked to existing comorbidities such as cardiovascular disease, obesity, and metabolic disorders.

Purpose

In this review, we discuss the potential medium-to-long-term strategy of habitual exercise and its relationship to targeted comorbidities and underlying inflammation as a protective mechanism against SARS-CoV-2 disease severity.

Conclusion

We conclude that engagement in habitual physical activity and exercise could be a strategy to mitigate the development of comorbidities and improve the response of the immune system, potentially reducing the risk of symptoms and life-threatening complications if infected.

Unveiling the role of exercise training in targeting the inflammatory paradigm of heart failure with preserved ejection fraction: a narrative review

Heart failure with preserved ejection fraction (HFpEF) is currently lacking an effective pharmacological treatment with impact on major outcomes such as hospitalization and mortality. Exercise training (EXT) is recognized as an important nonpharmacological tool, capable of improving exercise capacity and quality of life, and has even been associated with a reduction in hospitalization and cardiovascular mortality risk. However, this positive impact largely lacks a physiological explanation. The aim of this narrative review was to provide an overview of the available data supporting the hypothesis that the beneficial role of EXT in HFpEF might be due to its effects on targeting the inflammatory paradigm described for this disease. A comprehensive literature search was conducted using the PubMed-NCBI database. We reviewed the effects of EXT throughout each step of the pathophysiological pathway leading to HFpEF and found clinical and/or preclinical evidence supporting the reduction of systemic inflammation, endothelial dysfunction, microvascular rarefaction, and myocardial stiffness. We also highlighted some gaps in the knowledge or topics that deserve further clarification in future studies. In conclusion, despite the scarcity of clinical studies in this population, there is compelling evidence suggesting that EXT modulates crucial aspects of the inflammatory pathway described for HFpEF and future investigation on cellular and molecular mechanisms are encouraged.

Does Higher Self-Reported Cardiorespiratory Fitness Reduce the Odds of Hospitalization From COVID-19?

BACKGROUND

Regular physical activity and higher cardiorespiratory (CR) fitness enhance immune function, possibly reducing coronavirus disease 2019 (COVID-19) infection severity. The aim was to assess the association between physical activity and self-reported CR fitness on COVID-19 infection characteristics.

METHODS

Participants formerly testing positive for COVID-19 completed an online questionnaire measuring COVID-19 infection characteristics and complications, self-reported CR fitness level, physical activity, and sociodemographic and health-related characteristics. Self-reported CR fitness was determined as the pace to cover 4.8 km without becoming overly fatigued (with slow walking, brisk walking, jogging, and running corresponding to low, moderate, good, and excellent levels of fitness, respectively).

RESULTS

A total of 263 individuals completed the survey. Compared with the lowest level of self-reported CR fitness, the odds of hospitalization significantly decreased by 64% (odds ratio = 0.36; 95% confidence interval, 0.13-0.98; P = .04) in individuals reporting the ability to maintain a brisk walk. In individuals reporting the ability to maintain a jogging pace, the further reduction in hospitalization was not significant (odds ratio = 0.22; 95% confidence interval, 0.05-1.04; P = .05). For COVID-19 symptom severity and number, there were no significant associations with self-reported CR fitness or physical activity levels.

CONCLUSIONS

For individuals with low self-reported CR fitness, improving CR fitness represents a strategy to reduce the risk of hospitalization from COVID-19.

Characterization of the Progression From Ambulatory to Hospitalized Heart Failure With Preserved Ejection Fraction

BACKGROUND

Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Some patients develop elevated filling pressures exclusively during exercise and never require hospitalization, whereas others periodically develop congestion that requires inpatient treatment. The features differentiating these cohorts are unclear.

METHODS

We performed a secondary analysis of 7 National Institutes of Health-sponsored multicenter trials of HFpEF (EF ≥ 50%, N = 727). Patients were stratified by history of hospitalization because of HF, comparing patients never hospitalized (HFpEF_NH) to those with a prior hospitalization (HFpEF_PH). Currently hospitalized (HFpEF_CH) patients were included to fill the spectrum. Clinical characteristics, cardiac structure, biomarkers, quality of life, functional capacity, activity levels, and outcomes were compared.

RESULTS

As expected, HFpEF_CH (n = 338) displayed the greatest severity of congestion, as assessed by N-terminal pro B-type natriuretic peptide levels, edema and orthopnea. As compared to HFpEF_NH (n = 109), HFpEF_PH (n = 280) displayed greater comorbidity burden, with more lung disease, renal dysfunction and anemia, along with lower activity levels (accelerometry), poorer exercise capacity (6-minute walk distance and peak exercise capacity), and more orthopnea. Patients with current or prior hospitalization displayed higher rates of future HF hospitalization, but quality of life was similarly impaired in all patients with HFpEF, regardless of hospitalization history.

CONCLUSIONS

A greater burden of noncardiac organ dysfunction, sedentariness, functional impairment, and higher event rates distinguish patients with HFpEF and prior HF hospitalization from those never hospitalized. Despite lower event rates, quality of life is severely and similarly limited in patients with no history of hospitalization. These data suggest that the 2 clinical profiles of HFpEF may require different treatment strategies.

The inflammatory biomarker YKL-40 decreases stepwise after exercise stress test

Background

Serum YKL-40 is an inflammatory biomarker associated with disease activity and mortality in diseases characterized by inflammation such as coronary artery disease (CAD). Exercise has a positive effect on CAD, possibly mediated by a decreased inflammatory activity. This study aimed to compare serial measurements of serum YKL-40 before and after exercise in patients with stable CAD versus controls.

Materials and methods

Eleven patients with stable CAD verified by coronary angiography (>70% stenosis) and 11 patients with a computer tomography angiography with no stenosis or calcification (calcium score=0) (controls) performed a standard clinical maximal exercise test. Serum YKL-40 was measured before exercise, immediately after exercise, and every hour for 6 h.

Results

Cardiovascular risk factors were more prevalent among the CAD patients compared with the controls. CAD patients had higher serum concentration of YKL-40 at baseline compared with controls, median (interquartile range) 94 (52–151) versus 57 (45–79) μg/l. Serum YKL-40 decreased stepwise after exercise, with a median decrease of 16 (13–39) μg/l for the CAD patients and 13 (10–22) μg/l for the controls from baseline to the lowest value. Thereafter, values increased again toward baseline level. Time after exercise was a significant factor for decrease in serum YKL-40 (P<0.0001), but no difference in YKL-40 decrease over time could be demonstrated between the groups (P=0.12).

Conclusion

Serum YKL-40 is elevated in patients with documented CAD compared with controls, and it decreases stepwise after exercise in both groups, indicating an anti-inflammatory effect of exercise independent of the presence of coronary atherosclerosis.

Does physical activity increase or decrease the risk of sickle cell disease complications?

Sickle cell disease (SCD) is the most common inherited disease in the world. Red blood cell sickling, blood cell-endothelium adhesion, blood rheology abnormalities, intravascular haemolysis, and increased oxidative stress and inflammation contribute to the pathophysiology of SCD. Because acute intense exercise may alter these pathophysiological mechanisms, physical activity is usually contra-indicated in patients with SCD. However, recent studies in sickle-cell trait carriers and in a SCD mice model show that regular physical activity could decrease oxidative stress and inflammation, limit blood rheology alterations and increase nitric oxide metabolism. Therefore, supervised habitual physical activity may benefit patients with SCD. This article reviews the literature on the effects of acute and chronic exercise on the biological responses and clinical outcomes of patients with SCD.

Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men

BACKGROUND

Fitness level and obesity have been associated with death in older populations. We investigated the relationship between aerobic fitness in late adolescence and early death, and whether a high fitness level can compensate the risk of being obese.

METHODS

The cohort comprised 1 317 713 Swedish men (mean age, 18 years) that conscripted between 1969 and 1996. Aerobic fitness was assessed by an electrically braked cycle test. All-cause and specific causes of death were tracked using national registers. Multivariable adjusted associations were tested using Cox regression models.

RESULTS

During a mean follow-up period of 29 years, 44 301 subjects died. Individuals in the highest fifth of aerobic fitness were at lower risk of death from any cause [hazard ratio (HR), 0.49; 95% confidence interval (CI), 0.47-0.51] in comparison with individuals in the lowest fifth, with the strongest association seen for death related to alcohol and narcotics abuse (HR, 0.20; 95% CI, 0.15-0.26). Similar risks were found for weight-adjusted aerobic fitness. Aerobic fitness was associated with a reduced risk of death from any cause in normal-weight and overweight individuals, whereas the benefits were reduced in obese individuals (P < 0.001 for interaction). Furthermore, unfit normal-weight individuals had 30% lower risk of death from any cause (HR, 0.70; 95% CI, 0.53-0.92) than did fit obese individuals.

CONCLUSIONS

Low aerobic fitness in late adolescence is associated with an increased risk of early death. Furthermore, the risk of early death was higher in fit obese individuals than in unfit normal-weight individuals.

Early mobilization in the critical care unit: A review of adult and pediatric literature

Early mobilization of critically ill patients is beneficial, suggesting that it should be incorporated into daily clinical practice. Early passive, active, and combined progressive mobilizations can be safely initiated in intensive care units (ICUs). Adult patients receiving early mobilization have fewer ventilator-dependent days, shorter ICU and hospital stays, and better functional outcomes. Pediatric ICU data are limited, but recent studies also suggest that early mobilization is achievable without increasing patient risk. In this review, we provide a current and comprehensive appraisal of ICU mobilization techniques in both adult and pediatric critically ill patients. Contraindications and perceived barriers to early mobilization, including cost and health care provider views, are identified. Methods of overcoming barriers to early mobilization and enhancing sustainability of mobilization programs are discussed. Optimization of patient outcomes will require further studies on mobilization timing and intensity, particularly within specific ICU populations.

Effects of exercise training on chronic inflammation in obesity : current evidence and potential mechanisms

Chronic, systemic inflammation is an independent risk factor for several major clinical diseases. In obesity, circulating levels of inflammatory markers are elevated, possibly due to increased production of pro-inflammatory cytokines from several tissues/cells, including macrophages within adipose tissue, vascular endothelial cells and peripheral blood mononuclear cells. Recent evidence supports that adipose tissue hypoxia may be an important mechanism through which enlarged adipose tissue elicits local tissue inflammation and further contributes to systemic inflammation. Current evidence supports that exercise training, such as aerobic and resistance exercise, reduces chronic inflammation, especially in obese individuals with high levels of inflammatory biomarkers undergoing a longer-term intervention. Several studies have reported that this effect is independent of the exercise-induced weight loss. There are several mechanisms through which exercise training reduces chronic inflammation, including its effect on muscle tissue to generate muscle-derived, anti-inflammatory 'myokine', its effect on adipose tissue to improve hypoxia and reduce local adipose tissue inflammation, its effect on endothelial cells to reduce leukocyte adhesion and cytokine production systemically, and its effect on the immune system to lower the number of pro-inflammatory cells and reduce pro-inflammatory cytokine production per cell. Of these potential mechanisms, the effect of exercise training on adipose tissue oxygenation is worth further investigation, as it is very likely that exercise training stimulates adipose tissue angiogenesis and increases blood flow, thereby reducing hypoxia and the associated chronic inflammation in adipose tissue of obese individuals.

Short-term bed rest increases TLR4 and IL-6 expression in skeletal muscle of older adults

Bed rest induces significant loss of leg lean mass in older adults. Systemic and tissue inflammation also accelerates skeletal muscle loss, but it is unknown whether inflammation is associated to inactivity-induced muscle atrophy in healthy older adults. We determined if short-term bed rest increases toll-like receptor 4 (TLR4) signaling and pro-inflammatory markers in older adult skeletal muscle biopsy samples. Six healthy, older adults underwent seven consecutive days of bed rest. Muscle biopsies (vastus lateralis) were taken after an overnight fast before and at the end of bed rest. Serum cytokine expression was measured before and during bed rest. TLR4 signaling and cytokine mRNAs associated with pro- and anti-inflammation and anabolism were measured in muscle biopsy samples using Western blot analysis and qPCR. Participants lost ∼4% leg lean mass with bed rest. We found that after bed rest, muscle levels of TLR4 protein expression and interleukin-6 (IL-6), nuclear factor-κB1, interleukin-10, and 15 mRNA expression were increased after bed rest (P < 0.05). Additionally, the cytokines interferon-γ, and macrophage inflammatory protein-1β, were elevated in serum samples following bed rest (P < 0.05). We conclude that short-term bed rest in older adults modestly increased some pro- and anti-inflammatory cytokines in muscle samples while systemic changes in pro-inflammatory cytokines were mostly absent. Upregulation of TLR4 protein content suggests that bed rest in older adults increases the capacity to mount an exaggerated, and perhaps unnecessary, inflammatory response in the presence of specific TLR4 ligands, e.g., during acute illness.

Contributions of body mass index and exercise habits on inflammatory markers: a cohort study of middle-aged adults living in the USA

OBJECTIVES

Determine whether body mass index (BMI) and physical activity (PA) above, at or below MET minute per week (MMW) levels recommended in the 2008 Physical Activity Guidelines interact or have additive effects on interleukin (IL)-6, C reactive protein (CRP), fibrinogen, interleukin6 (IL-6) soluble receptor (IL-6sr), soluble E-selectin and soluble intracellular adhesion molecule (sICAM)-1.

DESIGN

Archived cohort data (n=1254, age 54.5±11.7 year, BMI 29.8±6.6 kg/m(2)) from the National Survey of Midlife Development in the USA (MIDUS) Biomarkers Study were analysed for concentrations of inflammatory markers using general linear models. MMW was defined as no regular exercise, <500 MMW, 500-1000 MMW, >1000 MMW and BMI was defined as <25, 25-29.9, ≥30 kg/m(2). Analyses were adjusted for age, sex, smoking and relevant medication use.

SETTING

Respondents reported to three centres to complete questionnaires and provide blood samples.

PARTICIPANTS

Participants were men and women currently enroled in the MIDUS Biomarker Project (n=1254, 93% non-Hispanic white, average age 54.5 years).

PRIMARY OUTCOME MEASURES

Concentration of serum IL-6, CRP, fibrinogen, IL-6sr, sE-selectin and sICAM.

RESULTS

Significant interactions were found between BMI and MMW for CRP and sICAM-1 (p<0.05). CRP in overweight individuals was similar to that in obese individuals when no PA was reported, but it was similar to normal weight when any level of regular PA was reported. sICAM-1 was differentially lower in obese individuals who reported >1000 MMW compared to obese individuals reporting less exercise.

CONCLUSIONS

The association of exercise with CRP and sICAM-1 differed by BMI, suggesting that regular exercise may buffer weight-associated elevations in CRP in overweight individuals while higher levels of exercise may be necessary to reduce sICAM-1 or CRP in obese individuals.

Effects of physical activity on cardiovascular disease

Much attention has been directed toward lifestyle modifications as effective means of reducing cardiovascular disease risk. In particular, physical activity has been heavily studied because of its well-known effects on metabolic syndrome, insulin sensitivity, cardiovascular disease risk, and all-cause mortality. However, data regarding the effects of exercise on various stages of the atherosclerosis pathway remain conflicting. The investigators review previously published reports for recent observational and interventional trials investigating the effects of physical activity on markers of (or causal factors for) atherosclerotic burden and vascular disease, including serum lipoproteins, systemic inflammation, thrombosis, coronary artery calcium, and carotid intima-media thickness. In conclusion, the data show a correlation between physical activity and triglyceride reduction, apolipoprotein B reduction, high-density lipoprotein increase, change in low-density lipoprotein particle size, increase in tissue plasminogen activator activity, and decrease in coronary artery calcium. Further research is needed to elucidate the effect of physical activity on inflammatory markers and intima-media thickness.

Effect of prolonged standardized bed rest on cystatin C and other markers of cardiovascular risk

Background

Sedentary lifestyle is associated with coronary artery disease but even shorter periods of physical inactivity may increase cardiovascular risk. Cystatin C is independently associated with cardiovascular disease and our objective was to investigate the relation between this novel biomarker and standardized bed rest. Research of immobilization physiology in humans is challenging because good biological models are in short supply. From the Women International Space simulation for Exploration study (WISE) we studied markers of atherosclerosis and kidney function, including cystatin C, in a standardized bed rest study on healthy volunteers. Fifteen healthy female volunteers participated in a 20-day ambulatory control period followed by 60 days of bed rest in head-down tilt position (-6°) 24 h a day, finalized by 20 days of recovery. The subjects were randomized into two groups during bed rest: a control group (n = 8) that remained physically inactive and an exercise group (n = 7) that participated in both supine resistance and aerobic exercise training.

Results

Compared to baseline values there was a statistically significant increase in cystatin C in both groups after bed rest (P < 0.001). Glomerular filtration rate (GFR), calculated by both cystatin C and Cockcroft-Gault equation, decreased after bed rest while there were no differences in creatinine or creatine kinase levels. CRP did not change during bed rest in the exercise group, but there was an increase of CRP in the control group during recovery compared to both the baseline and the bed rest periods. The apo-B/apo-Ai ratio increased during bed rest and decreased again in the recovery period. Subjects experienced a small but statistically significant reduction in weight during bed rest and compared to baseline weights remained lower at day 8 of recovery.

Conclusion

During and following prolonged standardized bed rest the concentrations of several clinically relevant cardiovascular risk markers change.

Moderate Intensities of Leisure-Time Physical Activity Are Associated With Lower Levels of High-Sensitivity C-Reactive Protein in Healthy Middle-Aged Men

Circulating C-reactive protein (CRP), reflective of systemic chronic low-grade inflammation, is a marker associated with cardiovascular disease (CVD). One of the mechanisms through which physical activity might promote cardiovascular health is by preventing changes in inflammation biomarkers, such as CRP. The present study examined the association of self-reported physical activity with an inflammation biomarker, high-sensitivity CRP (hs-CRP), in a population-based cohort of clinically healthy 58-year-old men. Compared with a sedentary lifestyle both moderate (1.81 [0.94-3.69] vs 1.28 [0.55-2.90] mg/L; P < .05) and vigorous physical activity (1.81 [0.94-3.69] vs 0.88 [0.42-1.81] mg/L; P < .001) were associated with decrease in hs-CRP levels. In summary, we identified an association between self-reported leisure time physical activity and hs-CRP in a cross-sectional study of healthy 58-year-old men, with decreased levels of CRP by increased intensities of physical activity.

Low lifetime recreational activity is a risk factor for peripheral arterial disease

BACKGROUND

The relationship between lifetime physical activity and the risk of developing peripheral arterial disease (PAD) is not known.

METHODS

We studied 1381 patients referred for elective coronary angiography in a point prevalence analysis. PAD was defined as ankle-brachial index (ABI) <0.9 at the time or a history of revascularization of the lower extremities regardless of ABI measure. We used a validated physical activity questionnaire to retrospectively measure each patient's lifetime recreational activity (LRA). Multivariate and logistic regression analyses were used to assess the independent association of LRA to ABI and the presence of PAD.

RESULTS

PAD was present in 19% (n = 258) of all subjects. Subjects reporting no regular LRA had greater diastolic blood pressure and were more likely to be female. They had lower average ABI, and a higher proportion had PAD (25.6%). In a regression model, including traditional risk factors and LRA, multivariate analysis showed that age (P < .001), female gender (P < .001), systolic blood pressure (P = .014), fasting glucose (P < .001), serum triglycerides (P = .02), and cumulative pack years (P < .001) were independent negative predictors of ABI, and LRA was a positive predictor of ABI (P < .001). History of sedentary lifestyle independently increased the odds ratio for PAD (odds ratio, 0.46; 95% confidence interval, 1.01-2.10) when assessed by logistic regression. Intriguingly, there is a correlation between physical activity and gender, such that women with low LRA are at greatest risk.

CONCLUSION

Recalled LRA is positively correlated to ABI and associated with PAD. Whereas the mechanism for this effect is not clear, LRA may be a useful clinical screening tool for PAD risk, and strategies to increase adult recreational activity may reduce the burden of PAD later in life.

The relationship between serum C-reactive protein and daily physical activity in Japanese hypertensive patients

Hypertension (HT) and C-reactive protein (CRP) are risk factors of cardiovascular diseases (CVD). The current study's purpose was to investigate the relationship between serum CRP levels and daily lifestyles, including physical activity, in Japanese HT patients. Lifestyle factors, blood pressure (BP), blood cholesterol, glucose, and CRP were measured in a total of 312 HT patients (153 men/159 women, mean age: 62.6 y). Women with physical activity of ≥ 1 time/week showed significantly lower CRP levels than those without it (p < 0.05). The data suggest that regular physical activity could reduce the CRP levels in HT patients, thereby maybe preventing CVD.

Effect of exercise training on chronic inflammation

Persistent, sub-clinical inflammation, as indicated by higher circulating levels of inflammatory mediators, is a prominent risk factor for several chronic diseases, as well as aging-related disability. As such, the inflammatory pathway is a potential therapeutic target for lifestyle interventions designed to reduce disease and disability. Physical exercise is well recognized as an important strategy for reducing the risk of chronic disease, and recent research has focused on its role in the improvement of the inflammatory profile. This review summarizes the evidence for and against the role of increasing physical activity in the reduction of chronic inflammation. Large population-based cohort studies consistently show an inverse association between markers of systemic inflammation and physical activity or fitness status, and data from several small-scale intervention studies support that exercise training diminishes inflammation. However, data from large, randomized, controlled trials designed to definitively test the effects of exercise training on inflammation are limited, and results are inconclusive. Future studies are needed to refine our understanding of the effects of exercise training on systemic low-grade inflammation, the magnitude of such an effect, and the amount of exercise necessary to elicit clinically meaningful changes in the deleterious association between inflammation and disease.

Dairy consumption and circulating levels of inflammatory markers among Iranian women

Objective

Although recent studies have shown an inverse relationship between dairy consumption and metabolic abnormalities, we are aware of no study evaluating the association between dairy consumption and circulating levels of inflammatory markers. The current study was undertaken to assess the association between the consumption of high-fat and low-fat dairy products and circulating levels of inflammatory markers among Tehrani women aged 40–60 years.

Design

In a cross-sectional study of 486 apparently healthy women aged 40–60 years, we assessed usual dietary intakes by means of an FFQ. Anthropometric measurements were made and fasting blood samples were taken for measuring inflammatory markers.

Results

The reported mean (sd) daily intake of low- and high-fat dairy consumption was 85 (sd 23) and 101 (sd 29) g/d, respectively. After control for age, BMI, waist circumference and other potential confounders, low-fat dairy consumption was inversely associated with C-reactive protein (β = −0.04), IL-6 (β = −0.02) and soluble vascular cell adhesion molecule-1 (β = −0.06); with further adjustment for dietary intakes, the associations remained significant just for soluble vascular cell adhesion molecule-1 (β = −0.03). High-fat dairy intake was positively associated with log-transformed values of serum amyloid A (β = 0.08) and soluble vascular cell adhesion molecule-1 (β = 0.05), both before and after adjustment for all potential confounding variables. No overall significant associations were found between total dairy consumption and inflammation.

Conclusions

The current study indicates an independent relationship between high-fat as well as low-fat dairy consumption, not total dairy intake, and some markers of inflammation and endothelial dysfunction. Further studies are required to identify responsible components of dairy products and related mechanisms of action.

Managing erectile dysfunction in hypertension: the effects of a continuous training programme on biomarker of inflammation

OBJECTIVE

To determine the effect of a continuous training programme on C-reactive protein (CRP) levels, and in the management of erectile dysfunction (ED) in older men with hypertension.

PATIENTS AND METHODS

In all, 22 men with hypertension and ED (mean age 61.8 years, sd 7.79) were involved in continuous training (35-59% of heart rate maximum reserve) for 8 weeks for 45-60 min, while 21 age-matched control hypertensives (mean age 64 years, sd 8.53) remained sedentary during this period. The International Index of Erectile Function (IIEF) questionnaire was used to assess the outcome of ED. The Mann-Whitney U-test and Spearman correlation were used to analyse the results of the changes in IIEF and CRP.

RESULTS

There was a significant effect of continuous exercise training on erectile function and CRP levels in hypertensive men with ED (P < 0.05).

CONCLUSIONS

A continuous training programme decreases CRP levels and is an effective means of noninvasive and nonpharmacological management of ED in men with hypertension.

Serum level of soluble intercellular adhesion molecule-1 correlates with pulmonary arterial pressure in children with congenital heart disease

BACKGROUND

Endothelial activation and vascular inflammation are thought to be the mechanisms of pulmonary hypertension. Increased expression of the intercellular adhesion molecule (ICAM-1) and raised serum level of its soluble form (sICAM-1) are found in various conditions associated with endothelial activation.

METHODS

Serum samples from 31 children (14 boys and 17 girls; age, 4.9 +/- 4.6 years) with congenital heart disease (CHD) collected at the time of cardiac catheterization were analyzed for sICAM-1 level. Uni- and multivariable stepwise linear regression analyses were performed for the following variables against the sICAM-1 level: age, hemoglobin, serum creatinine, systemic arterial pressure (SAP), pulmonary arterial pressure (PAP), pulmonary blood flow (Qp) and resistance (Rp), systemic blood flow (Qs) and resistance (Rs), Qp/Qs, Rp/Rs, and pulmonary and systemic oxygen saturation.

RESULTS

The sICAM-1 levels in children who had CHD with and without pulmonary hypertension were 411 +/- 110 and 344 +/- 81 ng/ml, respectively (p = 0.11). In the univariable models, age, serum creatinine, systolic PAP, mean PAP, diastolic PAP, Rp, and Rp/Rs were significantly correlated with sICAM-1 level. In the multiple stepwise regression model, only mean PAP remained as an independent predictor of sICAM-1 level (r = 0.55; p = 0.002).

CONCLUSION

Children with CHD and pulmonary hypertension had a trend toward elevated sICAM-1 compared with CHD children who had no pulmonary hypertension. A linear correlation was found between mean pulmonary arterial pressure and sICAM-1 level.

Calorie restriction modulates inactivity-induced changes in the inflammatory markers C-reactive protein and pentraxin-3

CONTEXT

Energy balance and physical activity potentially influence systemic inflammation.

OBJECTIVE

Our objective was to test the hypothesis that moderate energy restriction may prevent activation of inactivity-induced inflammatory response.

DESIGN

Participants were studied four times at the end of 14-d periods of experimental bed rest or controlled ambulation, after receiving eucaloric or hypocaloric diets.

SETTING

The study was conducted at the clinical research center of the German Space Agency.

SUBJECTS

Nine healthy young volunteers participated.

INTERVENTIONS

Energy intake was calibrated to physical activity and decreased by about 20% in hypocaloric conditions.

MAIN OUTCOME MEASURES

Changes in body fat by dual-energy x-ray absorptiometry as well as plasma inflammatory markers and cytokine mRNA levels in blood cells were measured.

RESULTS

Fat mass did not change significantly in eucaloric conditions and decreased in hypocaloric periods (-1.0 +/- 0.3 and -1.0 +/- 0.3 kg in ambulatory and bed rest, respectively). Bed rest in eucaloric conditions increased plasma C-reactive protein (CRP) (+143 +/- 53%) and both the ratios between plasma IL-6 and IL-10 (4+/-1 times) and white blood cell IL-6 and IL-10 mRNAs (5 +/- 1 times). Energy restriction prevented bed-rest-mediated increases in CRP and the IL-6 to IL-10 ratio. Bed rest increased (P = 0.03) long pentraxin-3 (PTX3) plasma concentration, without significant activity-by-diet interaction. In all conditions (n = 36), CRP and PTX3 were inversely correlated (r = -0.61; P < 0.001). Changes in fat mass, leptin, and IL-6 directly correlated with CRP and inversely correlated with PTX3. IL-10 inversely correlated with CRP and directly correlated with PTX3 (r = 0.52; P < 0.01).

CONCLUSIONS

Calorie restriction prevents the inflammatory response induced by 14 d of bed rest. We suggest an inverse regulation of CRP and PTX3 in response to changes in energy balance.

Low-grade inflammation and arterial wave reflection in patients with chronic fatigue syndrome

Some of the symptoms reported by people with CFS (chronic fatigue syndrome) are associated with various cardiovascular phenomena. Markers of cardiovascular risk, including inflammation and oxidative stress, have been demonstrated in some patients with CFS, but little is known about the relationship between these and prognostic indicators of cardiovascular risk in this patient group. In the present study, we investigated the relationship between inflammation and oxidative stress and augmentation index, a measure of arterial stiffness, in 41 well-characterized patients with CFS and in 30 healthy subjects. AIx@75 (augmentation index normalized for a heart rate of 75 beats/min) was significantly greater in patients with CFS than in control subjects (22.5+/-1.7 compared with 13.3+/-2.3% respectively; P=0.002). Patients with CFS also had significantly increased levels of CRP (C-reactive protein) (2.58+/-2.91 compared with 1.07+/-2.16 mug/ml respectively; P<0.01) and 8-iso-prostaglandin F(2alpha) isoprostanes (470.7+/-250.9 compared with 331.1+/-97.6 pg/ml respectively; P<0.005). In patients with CFS, AIx@75 correlated significantly with logCRP (r=0.507, P=0.001), isoprostanes (r=0.366, P=0.026), oxidized LDL (low-density lipoprotein) (r=0.333, P=0.039) and systolic blood pressure (r=0.371, P=0.017). In a stepwise multiple regression model, including systolic and diastolic blood pressure, body mass index, CRP, tumour necrosis factor-alpha, interleukin-1, oxidized LDL, high-density lipoprotein-cholesterol levels, isoprostanes, age and gender, AIx@75 was independently associated with logCRP (beta=0.385, P=0.006), age (beta=0.363, P=0.022) and female gender (beta=0.302, P=0.03) in patients with CFS. The combination of increased arterial wave reflection, inflammation and oxidative stress may result in an increased risk of future cardiovascular events. Assessment of arterial wave reflection might be useful for determining cardiovascular risk in this patient group.

Exercise training for cardiometabolic adaptation after stroke

Patients with stroke are severely deconditioned, leading to metabolic abnormalities that significantly increase risk for myocardial infarction and recurrent stroke. This review characterizes the nature of the metabolic decline, the underlying causes, and the potential for progressive aerobic exercise to address metabolic impairment following disabling stroke. Although exercise training has previously been shown to improve peak aerobic capacity and sensorimotor function after stroke, establishing safe and effective exercise programs in this population presents unique challenges stemming from neurological deficit complexities and comorbid conditions. Thus, recommendations for application to practice are provided that include proper preexercise evaluation, guidelines for symptom-limited maximal effort exercise testing, as well as evidence-based suggestions for initiation and progression of an exercise program. Implementing regular, progressive exercise therapy is critical on the basis of the devastating impact of physical inactivity on overall metabolic heath. Prevalence of impaired or diabetic glucose metabolism may be as high as 80% in chronic stroke, predicting 2- and 3-fold increased risk for recurrent stroke, respectively. Tragically, nearly one third of patients with stroke experience recurrent stroke within 5 years, and comorbid cardiovascular conditions represent the leading cause of death in this population. Recent evidence showing the positive impact of exercise training on hyperinsulinemia and glucose tolerance in survivors of stroke is presented, given the central importance of these factors to overall cardiovascular risk. On the basis of these and other findings, structured exercise programs should be considered for all survivors of stroke.

The potential anti-inflammatory benefits of improving physical fitness in hypertension

Hypertension is associated with an increased risk of stroke and atherosclerosis. In addition to elevated blood pressure, hypertension is characterized by neuroendocrine and immune activation, including elevated levels of C-reactive protein, inflammatory cytokines, and soluble adhesion molecules, which are predictive of morbidity and mortality outcomes. Pharmacological treatment for hypertension reduces blood pressure, but has limited effectiveness in reducing the accompanying inflammation and its associated morbidity and mortality. Exercise and diet interventions regularly show reductions in blood pressure in hypertensive individuals. Similar interventions in other populations show reductions in many inflammatory markers, but these effects have not been routinely examined in hypertensive individuals. The mechanisms through which exercise might exert an anti-inflammatory action include the sympathetic nervous system, the hypothalamic-pituitary-adrenal axis, as well as direct effects of blood pressure. Here, exercise is promoted as a potentially effective treatment for both the elevated blood pressure and chronic inflammation found in hypertension.