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Restaino RM, Cradock K, Barlow MA. Effects of the Follicular Menstrual Phase on Forearm Vascular Conductance in Abdominal Obese Premenopausal Women During Graded Handgrip Exercise. Artery Res 2022. [DOI: 10.1007/s44200-022-00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose
Previous studies have reported a sympatholytic action of estrogen on the vasculature in response to increased sympathetic outflow, an effect most notable during exercise, providing for necessary increases in blood flow to working muscle. In contrast, elevated concentrations of progesterone can inhibit this action of estrogen, impairing increases in blood flow. We hypothesize that the peak concentration of estrogen during the proliferative portion of the follicular phase of the menstrual cycle in female humans will increase vascular conductance during exercise when the effects of progesterone are negligible. In addition, we hypothesize that overweight abdominally obese females will have an attenuated conductance response to dynamic exercise during the same menstrual phase.
Methods
Participants engaged in graded forearm exercise using an isotonic handgrip dynometer with sequential increases in resistance at a cadence of 30 contractions/minute until task failure. They performed exercise at time points of the menstrual cycle corresponding to low concentrations of both sex hormones and elevated estrogen, while progesterone remained low. Blood flow and vascular conductance were measured using Doppler ultrasound.
Results
This revealed a trend that abdominal obese women during a phase of low estrogen had a lower overall blood flow and vascular conductance response than healthy controls at matching resistance stages during rest and exercise. This group difference was attenuated during the proliferative phase with elevated circulating estrogen. There is not a statistically significant interaction between Ovarian Phase and Weight group (P = 0.778).
Conclusion
The results indicate that overweight women are at a disadvantage during exercise in increasing blood flow to working muscles, which can be detrimental to overall fitness improvement during the early and potentially late follicular phase of the menstrual cycle.
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Brugnara L, García AI, Murillo S, Ribalta J, Fernandez G, Marquez S, Rodriguez MA, Vinaixa M, Amigó N, Correig X, Kalko S, Pomes J, Novials A. Muscular carnosine is a marker for cardiorespiratory fitness and cardiometabolic risk factors in men with type 1 diabetes. Eur J Appl Physiol 2022; 122:1429-1440. [PMID: 35298695 DOI: 10.1007/s00421-022-04929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/04/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Muscle is an essential organ for glucose metabolism and can be influenced by metabolic disorders and physical activity. Elevated muscle carnosine levels have been associated with insulin resistance and cardiometabolic risk factors. Little is known about muscle carnosine in type 1 diabetes (T1D) and how it is influenced by physical activity. The aim of this study was to characterize muscle carnosine in vivo by proton magnetic resonance spectroscopy (1H MRS) and evaluate the relationship with physical activity, clinical characteristics and lipoprotein subfractions. METHODS 16 men with T1D (10 athletes/6 sedentary) and 14 controls without diabetes (9/5) were included. Body composition by DXA, cardiorespiratory capacity (VO2peak) and serum lipoprotein profile by proton nuclear magnetic resonance (1H NMR) were obtained. Muscle carnosine scaled to water (carnosineW) and to creatine (carnosineCR), creatine and intramyocellular lipids (IMCL) were quantified in vivo using 1H MRS in a 3T MR scanner in soleus muscle. RESULTS Subjects with T1D presented higher carnosine CR levels compared to controls. T1D patients with a lower VO2peak presented higher carnosineCR levels compared to sedentary controls, but both T1D and control groups presented similar levels of carnosineCR at high VO2peak levels. CarnosineW followed the same trend. Integrated correlation networks in T1D demonstrated that carnosineW and carnosineCR were associated with cardiometabolic risk factors including total and abdominal fat, pro-atherogenic lipoproteins (very low-density lipoprotein subfractions), low VO2peak, and IMCL. CONCLUSIONS Elevated muscle carnosine levels in persons with T1D and their effect on atherogenic lipoproteins can be modulated by physical activity.
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Affiliation(s)
- Laura Brugnara
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Ana Isabel García
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain.,Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Serafín Murillo
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Josep Ribalta
- Departament de Medicina i Cirugia, Universitat Rovira i Virgili/Unitat de Recerca en Lípids i Arteriosclerosi, IISRV, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Guerau Fernandez
- Bioinformatics Unit, Genetics and Molecular Medicine Service, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Susanna Marquez
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | | | - Maria Vinaixa
- Metabolomics Platform, Universitat Rovira i Virgili, IISRV, Reus, Spain
| | - Núria Amigó
- Metabolomics Platform, Universitat Rovira i Virgili, IISRV, Reus, Spain.,Biosfer Teslab, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Xavier Correig
- Metabolomics Platform, Universitat Rovira i Virgili, IISRV, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain
| | - Susana Kalko
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain.,Bioinformatics Core Facility (IDIBAPS), Barcelona, Spain
| | - Jaume Pomes
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Anna Novials
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain. .,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Madrid, Spain.
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3
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The Effect of Exercise on Cardiometabolic Risk Factors in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031386. [PMID: 35162403 PMCID: PMC8835550 DOI: 10.3390/ijerph19031386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 01/06/2023]
Abstract
Background: Polycystic Ovary Syndrome (PCOS), a common endocrine disorder in women of reproductive age, increases the risk for cardiometabolic morbidity. While regular exercise is effective in reducing cardiometabolic risk, women with PCOS may experience condition-specific barriers to exercise thereby limiting its efficacy. Aim: To determine the effect of exercise on cardiometabolic risk factors in women with PCOS. Methods: Five databases (Cochrane, EMBASE, Medline, Scopus and SPORTDiscus) were searched up to December of 2021. Eligible studies included: a randomised controlled design; participants with a diagnosis of PCOS; aerobic and/or resistance exercise intervention lasting ≥4 weeks; cardiometabolic outcomes. Meta-analyses were performed to determine the effect of exercise versus non-exercising control on cardiometabolic outcomes. Results: Of the 4517 studies screened, 18 studies were analysed involving 593 participants. When compared with control, exercise significantly improved cardiorespiratory fitness (weighted mean difference {WMD} = 4.00 mL/kg/min, 95% CI: 2.61 to 5.40, p < 0.001) and waist circumference (WMD = −1.48 cm, 95% CI: −2.35 to −0.62, p = 0.001). Systolic blood pressure, fasting blood glucose, insulin resistance, and lipid profiles remained unchanged. Conclusions: Regular exercise may improve cardiorespiratory fitness and waist circumference in women with PCOS. Further large-scale studies are required to determine whether exercise interventions improve various biochemical and anthropometric parameters in women with PCOS and more severe cardiometabolic abnormalities.
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4
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The Effects of Exercise on Lipid Biomarkers. Methods Mol Biol 2021; 2343:93-117. [PMID: 34473317 DOI: 10.1007/978-1-0716-1558-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The World Health Organization has declared obesity to be a global epidemic that increases cardiovascular disease (CVD) mortality risk factors, such as hypertension, diabetes, dyslipidemia, and atherosclerosis. The increasing ratio of time spent in sedentary activities to that spent performing physically demanding tasks increases the trends to obesity and susceptibility to these risk factors. Dyslipidemia is the foundation of atherosclerotic buildup and lipoproteins serve as cofactors to the inflammatory processes that destabilize plaques. Increasing cardiorespiratory fitness and muscular strength helps attenuate concentrations of low-density lipoproteins (LDLs), such as LDL cholesterol, and increase levels of high-density lipoprotein cholesterol, as well as reduce proprotein convertase subtilisin kexin type 9 expression. Effects of physical activity on the inflammatory pathways of atherosclerosis, specifically C-reactive protein, are more closely related to reducing the levels of adiposity in tandem with increasing fitness, than with exercise training alone. The purpose of this review is to describe the physiology of dyslipidemia and relate it to CVD and exercise therapies.
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5
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Fuller KNZ, Thyfault JP. Barriers in translating preclinical rodent exercise metabolism findings to human health. J Appl Physiol (1985) 2021; 130:182-192. [PMID: 33180643 PMCID: PMC7944931 DOI: 10.1152/japplphysiol.00683.2020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 01/03/2023] Open
Abstract
Physical inactivity and low aerobic capacity are primary drivers of chronic disease pathophysiology and are independently associated with all-cause mortality. Conversely, increased physical activity and exercise are central to metabolic disease prevention and longevity. Although these relationships are well characterized in the literature, what remains incompletely understood are the mechanisms by which physical activity/exercise prevents disease. Given methodological constraints of clinical research, investigators must often rely on preclinical rodent models to investigate these potential underlying mechanisms. However, there are several key barriers to applying exercise metabolism findings from rodent models to human health. These barriers include housing temperature, nutrient metabolism, exercise modality, exercise testing, and sex differences. Increased awareness and understanding of these barriers will enhance the ability to impact human health through more appropriate experimental design and interpretation of data within the context of these factors.
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Affiliation(s)
- Kelly N Z Fuller
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - John P Thyfault
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
- Research Service Kansas City Veterans Affairs Medical Center, Kansas City, Kansas
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, Missouri
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6
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Kowall B, Stang A, Erbel R, Moebus S, Petersmann A, Steveling A, Jöckel KH, Völzke H. Is the Obesity Paradox in Type 2 Diabetes Due to Artefacts of Biases? An Analysis of Pooled Cohort Data from the Heinz Nixdorf Recall Study and the Study of Health in Pomerania. Diabetes Metab Syndr Obes 2020; 13:1989-2000. [PMID: 32606858 PMCID: PMC7305936 DOI: 10.2147/dmso.s242553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/23/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS/HYPOTHESIS There is controversy on whether an obesity paradox exists in type 2 diabetes, ie, that mortality is lowest in overweight or obesity. We examined the role of potential biases in the obesity paradox. METHODS From two regional population-based German cohort studies - the Heinz Nixdorf Recall Study and the Study of Health in Pomerania (baseline examinations 2000-2003/1997-2001) - 1187 persons with diabetes at baseline were included (mean age 62.6 years, 60.9% males). Diabetes was ascertained by self-report of physician's diagnosis, antidiabetic medication, fasting/random glucose or haemoglobin A1c. Mortality data were assessed for up to 17.7 years. We used restricted cubic splines and Cox regression models to assess associations between body mass index (BMI) and mortality. Sensitivity analyses addressed, inter alia, exclusion of early death cases, of persons with cancer, kidney disease or with history of cardiovascular diseases, and of ever smokers. Furthermore, we examined the role of treatment bias and collider bias for the obesity paradox. RESULTS In spline models, mortality risk was lowest for BMI at about 31 kg/m2. Sensitivity analyses carried out one after another had hardly any impact on this result. In our cohort, persons with diabetes and BMI ≥30 kg/m2 did not have better treatment than non-obese patients, and we found that collider bias played only a minor role in the obesity paradox. CONCLUSION In a cohort of 1187 persons with diabetes, mortality risk was lowest in persons with moderate obesity. We cannot explain this result by a variety of sensitivity analyses.
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Affiliation(s)
- Bernd Kowall
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
- School of Public Health, Department of Epidemiology, Boston University, Boston, MA02118, USA
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Susanne Moebus
- Center for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Antje Steveling
- Department of Internal Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Henry Völzke
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- German Center for Diabetes Research, Site Greifswald, Greifswald, Germany
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Abushamat LA, McClatchey PM, Scalzo RL, Schauer I, Huebschmann AG, Nadeau KJ, Liu Z, Regensteiner JG, Reusch JEB. Mechanistic Causes of Reduced Cardiorespiratory Fitness in Type 2 Diabetes. J Endocr Soc 2020; 4:bvaa063. [PMID: 32666009 PMCID: PMC7334033 DOI: 10.1210/jendso/bvaa063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/04/2020] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) has been rising in prevalence in the United States and worldwide over the past few decades and contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Cardiorespiratory fitness (CRF) is a modifiable cardiovascular (CV) risk factor in the general population and in people with T2D. Young people and adults with T2D have reduced CRF when compared with their peers without T2D who are similarly active and of similar body mass index. Furthermore, the impairment in CRF conferred by T2D is greater in women than in men. Various factors may contribute to this abnormality in people with T2D, including insulin resistance and mitochondrial, vascular, and cardiac dysfunction. As proof of concept that understanding the mediators of impaired CRF in T2D can inform intervention, we previously demonstrated that an insulin sensitizer improved CRF in adults with T2D. This review focuses on how contributing factors influence CRF and why they may be compromised in T2D. Functional exercise capacity is a measure of interrelated systems biology; as such, the contribution of derangement in each of these factors to T2D-mediated impairment in CRF is complex and varied. Therefore, successful approaches to improve CRF in T2D should be multifaceted and individually designed. The current status of this research and future directions are outlined.
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Affiliation(s)
- Layla A Abushamat
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | | | - Rebecca L Scalzo
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Irene Schauer
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Amy G Huebschmann
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J Nadeau
- Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Zhenqi Liu
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Judith G Regensteiner
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jane E B Reusch
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional VA, Aurora, Colorado.,Center for Women's Health Research, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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8
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Ångström L, Hörnberg K, Sundström B, Jonsson SW, Södergren A. Aerobic capacity is associated with disease activity and cardiovascular risk factors in early rheumatoid arthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1833. [PMID: 31913553 PMCID: PMC7378948 DOI: 10.1002/pri.1833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 12/21/2022]
Abstract
Objectives The aim of this study was to investigate aerobic capacity and its associations with disease activity and risk factors for cardiovascular disease (CVD) in early rheumatoid arthritis (RA). Methods This cross‐sectional study included 67 patients with early RA. Aerobic capacity was estimated with the Åstrand submaximal test adjusted according to the Nord‐Tröndelag Health Study formula. The following were also assessed: subclinical atherosclerosis by carotid intima‐media thickness and pulse wave analysis; body composition by dual X‐ray absorptiometry; estimated CVD mortality risk by the Systematic Coronary Risk Evaluation; disease activity by the Disease Activity Score 28, C‐reactive protein and erythrocyte sedimentation rate; blood lipids by total cholesterol, low‐density lipoproteins, high‐density lipoproteins, and triglycerides; and functional ability by the Stanford health assessment questionnaire. Univariate and multiple linear regression analyses were performed to explore the associations between variables. Results The mean (SD) aerobic capacity was 31.6 (8.7) ml O2−1 kg min−1. Disease activity and risk factors for CVD were more favourable for patients with aerobic capacity above the median value. Aerobic capacity was associated with ESR and several CVD risk factors, independent of age and sex. In a multiple regression model that was adjusted for age and sex, aerobic capacity was significantly associated with per cent body fat (β = −0.502, 95% CI [−0.671, −0.333]) and triglycerides (β = −2.365, 95% CI [−4.252, −0.479]). Conclusions Disease activity and risk factors for CVD were in favour for patients with a higher aerobic capacity. Aerobic capacity was associated with disease activity and several risk factors for CVD, independent of age and sex. In RA, these findings may provide insights into the benefits of using aerobic capacity as a marker to prevent CVD.
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Affiliation(s)
- Lars Ångström
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Kristina Hörnberg
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Björn Sundström
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | | | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
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9
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Relationship of Cardiorespiratory Fitness and Body Mass Index with the Incidence of Dyslipidemia among Japanese Women: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234647. [PMID: 31766623 PMCID: PMC6926922 DOI: 10.3390/ijerph16234647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/10/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022]
Abstract
Low cardiorespiratory fitness (CRF) and obesity are independent risk factors for dyslipidemia. We investigated the synergistic effects of CRF and obesity on the incidence of dyslipidemia among Japanese women. Of 7627 participants, 927 normolipidemic Japanese women completed a submaximal exercise test, medical examination, and a questionnaire on smoking and alcohol drinking. The incidence of dyslipidemia was defined as having at least one of the following: high-density lipoprotein cholesterol < 40 mg/dL, low-density lipoprotein cholesterol ≥ 140 mg/dL, fasting triglyceride ≥ 150 mg/dL, or physician-diagnosed dyslipidemia. Multivariable hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using a Cox proportional hazard regression model. During the follow-up period of ≤16 years (median 1 year), 196 (21.1%) women developed dyslipidemia. Compared with those in the body mass index (BMI)-specific (< or ≥25.0 kg/m2) lowest CRF tertile, the multivariable HRs for dyslipidemia in the highest CRF tertile were 1.36 (95% CI, 0.75–2.48) for women with BMI ≥ 25 kg/m2 and 0.70 (95% CI, 0.45–1.09) for those with BMI < 25 kg/m2 (p < 0.01 for interaction). These results suggest that CRF and BMI are interdependent and, together, they affect the incidence of dyslipidemia among Japanese women. CRF is inversely related to a lower incidence of dyslipidemia with low BMI.
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10
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Karefylakis C, Särnblad S, Ariander A, Ehlersson G, Rask E, Rask P. Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men-a randomized controlled trial. Endocrine 2018; 61:388-397. [PMID: 29978375 PMCID: PMC6105237 DOI: 10.1007/s12020-018-1665-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/25/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Several observational studies have shown an association between vitamin D deficiency and non-skeletal major health issues including impaired cardiorespiratory fitness and adiposity. Only a few studies have examined the impact of vitamin D supplementation on these conditions and the results are ambiguous. The aim of this study was to examine the effect of vitamin D supplementation on body composition and cardiorespiratory fitness in overweight/obese men with vitamin D deficiency. METHODS This study was a prospective, placebo controlled, double blinded, randomized trial with a study period of 6 months. Forty overweight/obese men (BMI > 25 kg/m2) with vitamin D deficiency (25(OH)D ≤ 55 nmol/L) were randomized to receive either 2000 IU Cholecalciferol drops or the equivalent amount of drops of placebo. At baseline and follow up body composition and cardiorespiratory fitness were measured and blood samples were obtained. Body composition was measured using bioelectrical impedance analysis (BIA) and cardiorespiratory fitness using cardiopulmonary exercise test (CPET). The primary outcomes were changes in percentage body fat and in maximum oxygen uptake (VO2max). RESULTS No statistically significant difference between the placebo and the intervention group regarding changes in percentage body fat (p = 0.54) and VO2max (p = 0.90) was observed. Moreover, there was no statistically significant difference between the groups concerning changes in BMI (p = 0.26), maximum load (p = 0.89) and oxygen uptake at anaerobic threshold (AT) (p = 0.14). CONCLUSIONS We conclude that treatment with 2000 IU/d vitamin D for 6 months does not impact body composition or maximum oxygen uptake in overweight/obese men with vitamin D deficiency.
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Affiliation(s)
- Christos Karefylakis
- Department of Endocrinology, School of Medical Sciences, Örebro University, SE 70182, Örebro, Sweden.
| | - Stefan Särnblad
- Department of Pediatrics, School of Medical Sciences, Örebro University, SE 70182, Örebro, Sweden
| | | | - Gustaf Ehlersson
- School of Medical Sciences, Örebro University, SE 70182, Örebro, Sweden
| | - Eva Rask
- Department of Endocrinology, School of Medical Sciences, Örebro University, SE 70182, Örebro, Sweden
| | - Peter Rask
- Department of Clinical Physiology, Örebro University Hospital, SE 70185, Örebro, Sweden
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11
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Cree-Green M, Scalzo RL, Harrall K, Newcomer BR, Schauer IE, Huebschmann AG, McMillin S, Brown MS, Orlicky D, Knaub L, Nadeau KJ, McClatchey PM, Bauer TA, Regensteiner JG, Reusch JEB. Supplemental Oxygen Improves In Vivo Mitochondrial Oxidative Phosphorylation Flux in Sedentary Obese Adults With Type 2 Diabetes. Diabetes 2018; 67:1369-1379. [PMID: 29643061 PMCID: PMC6463751 DOI: 10.2337/db17-1124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
Type 2 diabetes is associated with impaired exercise capacity. Alterations in both muscle perfusion and mitochondrial function can contribute to exercise impairment. We hypothesized that impaired muscle mitochondrial function in type 2 diabetes is mediated, in part, by decreased tissue oxygen delivery and would improve with oxygen supplementation. Ex vivo muscle mitochondrial content and respiration assessed from biopsy samples demonstrated expected differences in obese individuals with (n = 18) and without (n = 17) diabetes. Similarly, in vivo mitochondrial oxidative phosphorylation capacity measured in the gastrocnemius muscle via 31P-MRS indicated an impairment in the rate of ADP depletion with rest (27 ± 6 s [diabetes], 21 ± 7 s [control subjects]; P = 0.008) and oxidative phosphorylation (P = 0.046) in type 2 diabetes after isometric calf exercise compared with control subjects. Importantly, the in vivo impairment in oxidative capacity resolved with oxygen supplementation in adults with diabetes (ADP depletion rate 5.0 s faster, P = 0.012; oxidative phosphorylation 0.046 ± 0.079 mmol/L/s faster, P = 0.027). Multiple in vivo mitochondrial measures related to HbA1c These data suggest that oxygen availability is rate limiting for in vivo mitochondrial oxidative exercise recovery measured with 31P-MRS in individuals with uncomplicated diabetes. Targeting muscle oxygenation could improve exercise function in type 2 diabetes.
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Affiliation(s)
- Melanie Cree-Green
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L Scalzo
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kylie Harrall
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Irene E Schauer
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Veterans Affairs Medical Center, Denver, CO
| | - Amy G Huebschmann
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shawna McMillin
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mark S Brown
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Orlicky
- Division of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Leslie Knaub
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kristen J Nadeau
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - P Mason McClatchey
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Timothy A Bauer
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Judith G Regensteiner
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E B Reusch
- Center for Women's Health Research, Anschutz Medical Campus, Aurora, CO
- Veterans Affairs Medical Center, Denver, CO
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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12
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Bakrania K, Edwardson CL, Khunti K, Henson J, Stamatakis E, Hamer M, Davies MJ, Yates T. Associations of objectively measured moderate-to-vigorous-intensity physical activity and sedentary time with all-cause mortality in a population of adults at high risk of type 2 diabetes mellitus. Prev Med Rep 2017; 5:285-288. [PMID: 28149710 PMCID: PMC5279862 DOI: 10.1016/j.pmedr.2017.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 11/30/2022] Open
Abstract
The relationships of physical activity and sedentary time with all-cause mortality in those at high risk of type 2 diabetes mellitus (T2DM) are unexplored. To address this gap in knowledge, we examined the associations of objectively measured moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time with all-cause mortality in a population of adults at high risk of T2DM. In 2010–2011, 712 adults (Leicestershire, U.K.), identified as being at high risk of T2DM, consented to be followed up for mortality. MVPA and sedentary time were assessed by accelerometer; those with valid data (≥ 10 hours of wear-time/day with ≥ 4 days of data) were included. Cox proportional hazards regression models, adjusted for potential confounders, were used to investigate the independent associations of MVPA and sedentary time with all-cause mortality. 683 participants (250 females (36.6%)) were included and during a mean follow-up period of 5.7 years, 26 deaths were registered. Every 10% increase in MVPA time/day was associated with a 5% lower risk of all-cause mortality [Hazard Ratio (HR): 0.95 (95% Confidence Interval (95% CI): 0.91, 0.98); p = 0.004]; indicating that for the average adult in this cohort undertaking approximately 27.5 minutes of MVPA/day, this benefit would be associated with only 2.75 additional minutes of MVPA/day. Conversely, sedentary time showed no association with all-cause mortality [HR (every 10-minute increase in sedentary time/day): 0.99 (95% CI: 0.95, 1.03); p = 0.589]. These data support the importance of MVPA in adults at high risk of T2DM. The association between sedentary time and mortality in this population needs further investigation. Objectively measured MVPA time was strongly associated with all-cause mortality. Objectively measured sedentary time was not associated with all-cause mortality. These data support the importance of MVPA in adults at high risk of T2DM.
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Affiliation(s)
- Kishan Bakrania
- Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care - East Midlands (CLAHRC - EM), Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care - East Midlands (CLAHRC - EM), Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - Emmanuel Stamatakis
- Charles Perkins Center, Prevention Research Collaboration, School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; Department of Epidemiology and Public Health, Institute of Epidemiology and Healthcare, University College London, London, WC1E 6BT, United Kingdom
| | - Mark Hamer
- National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom; National Institute for Health Research (NIHR) Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Diabetes Research Centre, Leicester General Hospital, Leicester, Leicestershire, LE5 4PW, United Kingdom
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Long Term Home-Based Exercise is Effective to Reduce Blood Pressure in Low Income Brazilian Hypertensive Patients: A Controlled Trial. High Blood Press Cardiovasc Prev 2016; 23:395-404. [PMID: 27658925 DOI: 10.1007/s40292-016-0169-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/08/2016] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Home-based exercise programs may increase adherence to physical activity among groups with poor access to exercise facilities. However, their effectiveness to lower blood pressure of hypertensive patients remains undefined. AIMS This controlled clinical trial investigated the influence of a home-based exercise program upon blood pressure, blood metabolic profile, and physical fitness in a Brazilian cohort of low income patients diagnosed with hypertension. METHODS Twenty-nine patients (22 women, age: 53 ± 11 years) underwent 16 months of home-based exercise, including 30 min of moderate intensity walking and stretching exercises. Fourteen patients (9 women, age: 48 ± 5 years) composed a non-exercise control group. Primary outcomes were assessed each two months. RESULTS Body mass (3.6 ± 0.2 kg; P = 0.03) and sum of skinfolds (3.0 ± 1.2 cm; P = 0.04) increased in controls vs. baseline. Mean compliance to home-based exercise was 83 ± 7 %, which induced significant improvements from baseline vs. controls in body mass (-5.4 ± 2.0 kg; P = 0.04), body fat (-4.7 ± 0.3 %; P = 0.03), waist circumference (-6.1 ± 1.2 cm; P = 0.03), sum of skinfolds (-14.8 ± 3.7; P = 0.02); aerobic efficiency reflected by slopes of relationships between heart rate and workload (-0.05 ± 0.01; P = 0.05), trunk flexibility (7.8 ± 1.7 cm; P = 0.02), HDL (1.8 ± 0.9 mg/dL; P = 0.04), triglycerides (-12.3 ± 1.0 mg/dL; P = 0.03), and glucose (-6.9 ± 2.9 mg/dL; P = 0.05). Systolic and diastolic BP decreased until the sixth month of intervention vs. baseline and controls, remaining stable at lower levels thereafter (systolic blood pressure: -4.5 ± 0.3 mmHg; P = 0.03; diastolic blood pressure: -2.5 ± 0.6 mmHg; P = 0.05). CONCLUSIONS Low income hypertensive patients complied with a long-term home-based exercise program, which was effective for improving their functional capacity, blood metabolic profile, and blood pressure.
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Liu T. A Comparison of Biological and Physical Risk Factors for Cardiovascular Disease in Overweight/Obese Individuals With and Without Prediabetes. Clin Nurs Res 2016; 26:674-693. [PMID: 27402725 DOI: 10.1177/1054773816658644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Compared with type 2 diabetes, evaluating the direct biological and physical risk factors for cardiovascular disease (CVD) in overweight/obese adults with and without prediabetes is less understood. Therefore, the aim of the study was to compare baseline biological and physical risk factors for CVD among overweight/obese adults with and without prediabetes. A secondary data analysis was performed. Three hundred forty-one overweight/obese participants were included in the analysis. Compared with non-prediabetics, prediabetics had higher fasting blood glucose, body mass index, waist-to-hip ratio, and triglycerides. Prediabetics were also more likely to be insulin resistant than non-prediabetics. Participants with prediabetes had much lower cardiorespiratory fitness than those without prediabetes. Findings from this study suggest that healthy overweight/obese adults with prediabetes were likely at higher biological and physical risk of CVD at baseline compared with those without prediabetes. Early intervention to improve CVD risk progression among persons with prediabetes is essential.
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Shin YS, Yang SM, Kim MY, Lee LK, Park BS, Lee WD, Noh JW, Kim JH, Lee JU, Kwak TY, Lee TH, Kim JY, Park J, Kim J. Analysis of the respirogram phase of Korean wrestling athletes compared with nonathletes for sports physiotherapy research. J Phys Ther Sci 2016; 28:392-8. [PMID: 27064260 PMCID: PMC4792979 DOI: 10.1589/jpts.28.392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/30/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Respiratory function is important for patients including athletes who require
physical therapy for respiratory dysfunction. The purpose of the present study was to
analyze the differences in the respirograms between Korean wrestling athletes and
nonathletes according to phase for the study of sports physiotherapy. [Subjects and
Methods] Respiratory function was measured using spirometry in both the athletes and
nonathletes while they were in a sitting position. [Results] Spirometry parameters in the
athletes were significantly higher than in the nonathletes. In respirogram phasic
analysis, the expiratory area and total area of forced vital capacity were significantly
increased in the athletes compared with the nonathletes. The slopes of the forced vital
capacity for athletes at slopes 1, 2, and 3 of the A area were significantly increased. In
correlative analysis, chest circumference was significantly correlated with slope 3 of the
A area of the forced vital capacity. [Conclusion] The results suggest that the differences
in changes in the phases of the respirogram between the Korean wrestling athletes and
nonathletes may in part contribute to our understanding of respiratory function in sports
physiotherapy research.
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Affiliation(s)
- Yong-Sub Shin
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea
| | - Seung-Min Yang
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea
| | - Mee-Young Kim
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea
| | - Lim-Kyu Lee
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea; Commercializations Promotion Agency for R&D Outcomes, Republic of Korea
| | - Byoung-Sun Park
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea
| | - Won-Deok Lee
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea
| | - Ji-Woong Noh
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yong In University, Republic of Korea
| | - Ju-Hyun Kim
- Department of Physical Therapy, College of Health Welfare, Wonkwang Health Science University, Republic of Korea
| | - Jeong-Uk Lee
- Department of Physical Therapy, College of Health Science, Honam University, Republic of Korea
| | - Taek-Yong Kwak
- Department of Taekwondo Instructor Education, College of Martial Arts, Yong In University, Republic of Korea
| | - Tae-Hyun Lee
- Department of Combative Martial Arts Training, College of Martial Arts, Yong In University, Republic of Korea
| | - Ju-Young Kim
- Department of Combative Martial Arts Training, College of Martial Arts, Yong In University, Republic of Korea
| | - Jaehong Park
- Department of Social Welfare, College of Public Health and Welfare, Yong In University, Republic of Korea
| | - Junghwan Kim
- Departments of Physical Therapy, College of Public Health and Welfare, Yong In University: Yongin 449-714, Republic of Korea
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Chang HW, Li YH, Hsieh CH, Liu PY, Lin GM. Association of body mass index with all-cause mortality in patients with diabetes: a systemic review and meta-analysis. Cardiovasc Diagn Ther 2016; 6:109-19. [PMID: 27054100 DOI: 10.21037/cdt.2015.12.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis. METHODS We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m(2)) levels: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method. RESULTS As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32-1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78-0.96, and 0.88, 95% CI: 0.78-1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84-1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74-0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons. CONCLUSIONS Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes. The significant heterogeneity among studies suggested that many confounders such as sex difference may affect the association.
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Affiliation(s)
- Hsiao-Wen Chang
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ; 3 Department of Public Health, Tzu-Chi University, Hualien, Taiwan ; 4 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 5 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Yi-Hwei Li
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ; 3 Department of Public Health, Tzu-Chi University, Hualien, Taiwan ; 4 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 5 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Chang-Hsun Hsieh
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ; 3 Department of Public Health, Tzu-Chi University, Hualien, Taiwan ; 4 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 5 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Pang-Yen Liu
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ; 3 Department of Public Health, Tzu-Chi University, Hualien, Taiwan ; 4 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 5 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
| | - Gen-Min Lin
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan ; 3 Department of Public Health, Tzu-Chi University, Hualien, Taiwan ; 4 Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; 5 Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan
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Sénéchal M, Johannsen NM, Swift DL, Earnest CP, Lavie CJ, Blair SN, Church TS. Association between Changes in Muscle Quality with Exercise Training and Changes in Cardiorespiratory Fitness Measures in Individuals with Type 2 Diabetes Mellitus: Results from the HART-D Study. PLoS One 2015; 10:e0135057. [PMID: 26252477 PMCID: PMC4529285 DOI: 10.1371/journal.pone.0135057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/17/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is associated with a reduction in muscle quality. However, there is inadequate empirical evidence to determine whether changes in muscle quality following exercise are associated with improvement in cardiorespiratory fitness (CRF) in individuals with T2DM. The objective of this study was to investigate the association between change in muscle quality following a 9-month intervention of aerobic training (AT), resistance training (RT) or a combination of both (ATRT) and cardiorespiratory fitness (CRF) in individuals with T2DM. Material and Methods A total of 196 participants were randomly assigned to a control, AT, RT, or combined ATRT for a 9-months intervention. The exposure variable was change in muscle quality [(Post: leg muscle strength/leg muscle mass)-[(Pre: leg muscle strength/leg muscle mass)]. Dependent variables were change in CRF measures including absolute and relative VO2peak, and treadmill time to exhaustion (TTE) and estimated metabolic equivalent task (METs). Results Continuous change in muscle quality was independently associated with change in absolute (β = 0.015; p = 0.019) and relative (β = 0.200; p = 0.005) VO2peak, and TTE (β = 0.170; p = 0.043), but not with estimated METs (p > 0.05). A significant trend was observed across tertiles of change in muscle quality for changes in absolute (β = 0.050; p = 0.005) and relative (β = 0.624; p = 0.002) VO2peak following 9 months of exercise training. No such association was observed for change in TTE and estimated METs (p > 0.05). Discussion The results from this ancillary study suggest that change in muscle quality following exercise training is associated with a greater improvement in CRF in individuals with T2DM. Given the effect RT has on increasing muscle quality, especially as part of a recommended training program (ATRT), individuals with T2DM should incorporate RT into their AT regimens to optimize CRF improvement. Trial Registration Clinicaltrials.gov NCT00458133
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Affiliation(s)
- Martin Sénéchal
- Faculty of Kinesiology, Fredericton, New Brunswick, Canada
- University of New Brunswick, Fredericton, New Brunswick, Canada
- * E-mail:
| | - Neil M. Johannsen
- Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
- The Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Damon L. Swift
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, United States of America
- Center for Health Disparities, East Carolina University, Greenville, North Carolina, United States of America
| | - Conrad P. Earnest
- Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, United States of America
| | - Steven N. Blair
- University of South Carolina, Columbia, South Carolina, United States of America
| | - Timothy S. Church
- Department of Preventive Medicine, Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States of America
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Arbeev KG, Akushevich I, Kulminski AM, Ukraintseva SV, Yashin AI. Joint Analyses of Longitudinal and Time-to-Event Data in Research on Aging: Implications for Predicting Health and Survival. Front Public Health 2014; 2:228. [PMID: 25414844 PMCID: PMC4222133 DOI: 10.3389/fpubh.2014.00228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/24/2014] [Indexed: 12/23/2022] Open
Abstract
Longitudinal data on aging, health, and longevity provide a wealth of information to investigate different aspects of the processes of aging and development of diseases leading to death. Statistical methods aimed at analyses of time-to-event data jointly with longitudinal measurements became known as the "joint models" (JM). An important point to consider in analyses of such data in the context of studies on aging, health, and longevity is how to incorporate knowledge and theories about mechanisms and regularities of aging-related changes that accumulate in the research field into respective analytic approaches. In the absence of specific observations of longitudinal dynamics of relevant biomarkers manifesting such mechanisms and regularities, traditional approaches have a rather limited utility to estimate respective parameters that can be meaningfully interpreted from the biological point of view. A conceptual analytic framework for these purposes, the stochastic process model of aging (SPM), has been recently developed in the biodemographic literature. It incorporates available knowledge about mechanisms of aging-related changes, which may be hidden in the individual longitudinal trajectories of physiological variables and this allows for analyzing their indirect impact on risks of diseases and death. Despite, essentially, serving similar purposes, JM and SPM developed in parallel in different disciplines with very limited cross-referencing. Although there were several publications separately reviewing these two approaches, there were no publications presenting both these approaches in some detail. Here, we overview both approaches jointly and provide some new modifications of SPM. We discuss the use of stochastic processes to capture biological variation and heterogeneity in longitudinal patterns and important and promising (but still largely underused) applications of JM and SPM to predictions of individual and population mortality and health-related outcomes.
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Affiliation(s)
| | - Igor Akushevich
- Center for Population Health and Aging, Duke University, Durham, NC, USA
| | | | | | - Anatoliy I. Yashin
- Center for Population Health and Aging, Duke University, Durham, NC, USA
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McAuley PA, Artero EG, Sui X, Lavie CJ, Almeida MJ, Blair SN. Fitness, fatness, and survival in adults with prediabetes. Diabetes Care 2014; 37:529-36. [PMID: 24062333 PMCID: PMC3898753 DOI: 10.2337/dc13-1347] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to examine independent and joint associations of cardiorespiratory fitness (CRF) and different adiposity measures with mortality risk in individuals with prediabetes (or impaired fasting glucose). RESEARCH DESIGN AND METHODS We examined associations of CRF and fatness with cardiovascular disease (CVD) and all-cause mortality in a cohort of 17,044 participants (89% men) with prediabetes (defined as 100 mg/dL ≤ fasting plasma glucose < 126 mg/dL), who did not have a history of diabetes, CVD, or cancer. RESULTS We identified 832 deaths (246 from CVD) during 13.9 ± 7.0 years (mean ± SD) follow-up. Normal-weight individuals who were unfit (lowest one-third) had a higher risk of all-cause (hazard ratio 1.70 [95% CI 1.32-2.18]) and CVD (1.88 [1.13-3.10]) mortality compared with the normal-weight and fit (upper two-thirds) reference group in a model adjusted for age, sex, examination year, and multiple risk factors. The mortality risk for fit individuals who were overweight or obese did not differ significantly from the reference group. Similar patterns were observed for sex-specific thirds of waist circumference and % body fat. CONCLUSIONS CRF markedly modifies the relationship between adiposity and mortality in persons with prediabetes. Unfit individuals have a higher and fit individuals have a lower mortality risk irrespective of adiposity level in this high-risk group.
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Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O'Keefe JH, Milani RV, Blair SN, Church TS. Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 2013; 77:281-92. [PMID: 23328449 DOI: 10.1253/circj.cj-13-0007] [Citation(s) in RCA: 219] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality. These data strongly support the routine referral of patients with CHD to CRET programs and that patients should be vigorously encouraged to attend CRET following major CHD events.
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Affiliation(s)
- Damon L Swift
- Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Sui X, Lavie CJ, Hooker SP, Lee DC, Colabianchi N, Lee CD, Blair SN. A prospective study of fasting plasma glucose and risk of stroke in asymptomatic men. Mayo Clin Proc 2011; 86:1042-9. [PMID: 21911559 PMCID: PMC3202993 DOI: 10.4065/mcp.2011.0267] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the association between levels of fasting plasma glucose (FPG) and incidence of stroke outcomes in a large cohort of asymptomatic men. PATIENTS AND METHODS Participants were 43,933 men (mean ± SD age, 44.3 ± 9.9 years) who were free of known cardiovascular disease at baseline and whose FPG levels were assessed during a preventive medical examination at the Cooper Clinic, Dallas, TX, between January 7, 1971, and March 11, 2002. Patients with diagnosed diabetes mellitus (DM) or low FPG (<80 mg/dL [to convert to mmol/L, multiply by 0.0555]) were excluded. Fatal stroke was identified through the National Death Index, and nonfatal stroke was ascertained from mail-back surveys. RESULTS A total of 595 stroke events (156 fatal and 456 nonfatal strokes; 17 men reported a nonfatal stroke before they died of stroke) occurred during 702,928 person-years of exposure. Age-adjusted fatal, nonfatal, and total stroke event rates per 10,000 person-years for normal FPG (80-109 mg/dL), impaired fasting glucose (110-125 mg/dL), and undiagnosed DM (≥ 126 mg/dL) were 2.1, 3.4, and 4.0 (P(trend)=.002); 10.3, 11.8, and 18.0 (P(trend)=.008); and 8.2, 9.6, and 12.4 (P(trend)=.008), respectively. After further adjusting for potential confounders, the direct association between FPG and fatal, nonfatal, or total stroke events remained significant (P(trend)=.02, .03, and .01, respectively). For FPG levels of 110 mg/dL or greater, each 10-unit increment of FPG was associated with a 6% higher risk of total stroke events (P=.05). CONCLUSION Hyperglycemia (FPG, ≥ 110 mg/dL), even below the DM threshold (such as with impaired fasting glucose), was associated with a higher risk of fatal, nonfatal, or total stroke events in asymptomatic men.
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Affiliation(s)
- Xuemei Sui
- Department of Exercise Science, Arnold Schoolof Public Health, University of South Carolina, Columbia, USA.
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22
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Artham SM, Lavie CJ, Milani RV, Ventura HO. Value of weight reduction in patients with cardiovascular disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 12:21-35. [PMID: 20842479 DOI: 10.1007/s11936-009-0056-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OPINION STATEMENT Obesity is an independent risk factor for cardiovascular (CV) disease and contributes markedly to individual CV risk factors, including hypertension, diabetes mellitus, dyslipidemia, and other chronic conditions, such as osteoarthritis, obstructive sleep apnea, and physical deconditioning. Obesity, defined as a body mass index ≥30 kg/m(2), is associated with increased morbidity and mortality, particularly in severely obese patients with a body mass index ≥35 kg/m(2). Physical activity, healthy eating and behavioral modification are three pivotal approaches to treating obesity. Some individuals may benefit from pharmacologic agents to achieve meaningful weight loss. Unfortunately, there are few such agents at present with proven efficacy and safety profiles. In this review, we discuss the obesity epidemic and its detrimental effects on the CV system, and focus on exercise training and on established pharmacologic agents as well as those on the horizon. We conclude by summarizing the surgical therapeutic options available to treat obesity and the evidence supporting the CV benefits of surgery, and discuss the potential adverse effects of both pharmacologic and surgical options.
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Affiliation(s)
- Surya M Artham
- Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Gander J, Lee DC, Sui X, Hébert JR, Hooker SP, Blair SN. Self-rated health status and cardiorespiratory fitness as predictors of mortality in men. Br J Sports Med 2011; 45:1095-100. [PMID: 21659563 DOI: 10.1136/bjsm.2010.079855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for all-cause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18 488 men who completed a health survey, clinical examination and a maximal exercise treadmill test during 1987-2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (p(trend) <0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, hypercholesterolaemia, cardiovascular disease, diabetes and cancer. Adjustment for fitness attenuated the association (p value =0.09). The authors also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (p(trend) = 0.006). The combined analysis of SRH and fitness showed that fit men with good or excellent SRH had a 58% lower risk of mortality than their counterparts. SRH and fitness were both associated with all-cause mortality in men. Fit men with good or excellent SRH live longer than unfit men with poor or fair SRH.
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Affiliation(s)
- Jennifer Gander
- University of South Carolina, Columbia, South Carolina 29208, USA.
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24
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Ardestani A, Parker B, Mathur S, Clarkson P, Pescatello LS, Hoffman HJ, Polk DM, Thompson PD. Relation of vitamin D level to maximal oxygen uptake in adults. Am J Cardiol 2011; 107:1246-9. [PMID: 21349488 DOI: 10.1016/j.amjcard.2010.12.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 12/15/2010] [Accepted: 12/15/2010] [Indexed: 12/17/2022]
Abstract
Low cardiorespiratory fitness and low serum 25-hydroxy vitamin D (25[OH]D) levels are associated with increased cardiovascular and all-cause mortality, but whether low 25(OH)D is independently associated with cardiorespiratory fitness in healthy adults is not known. We examined 25(OH)D levels and fitness in 200 healthy adults participating in a double-blind clinical trial investigating statins and muscle performance (STOMP study). Maximal aerobic exercise capacity (Vo₂(max)) was measured using metabolic gas analysis during graded treadmill exercise to exhaustion. 25(OH)D was measured using an enzyme-linked immunosorbent assay. Daily physical activity was assessed using the Paffenbarger Physical Activity Questionnaire. Serum 25(OH)D concentration was positively related to Vo₂(max) (r = 0.29, p = 0.0001), even after adjusting for relevant predictors (e.g., age, gender, and body mass index). There was also a significant interaction between 25(OH)D level and self-reported hours of moderate to vigorous physical activity (MVPA; p < 0.02). With each SD increase in 25(OH)D, Vo₂(max) increased by 2.6 ml/kg/min (p = 0.0001) when MVPA was low (16 hours/week) and 1.6 ml/kg/min (p <0.0004) when MVPA was moderate (35 hours/week) but only 0.01 ml/kg/min (p = 0.9) when MVPA was high (64 hours/week). In conclusion, serum 25(OH)D levels predict Vo₂(max) in adults; the effect is greatest in those with low levels of physical activity.
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Gatterer H, Ulmer H, Dzien A, Somavilla M, Burtscher M. High cardiorespiratory fitness is more beneficial in pre-diabetic men than women. Clinics (Sao Paulo) 2011; 66:747-51. [PMID: 21789375 PMCID: PMC3109370 DOI: 10.1590/s1807-59322011000500007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/07/2011] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate gender-specific relationships between cardiorespiratory fitness and factors that predict the development of diabetes and to identify the risk factors that predict fasting plasma glucose and 2-hour plasma glucose levels. INTRODUCTION Different risk factors (e.g., low cardiorespiratory fitness) may cause elevated plasma glucose levels in men compared to women. Therefore, gender-specific analyses are needed. METHODS Cardiorespiratory fitness (maximal power output achieved during a standard cycle ergometry test), resting blood pressure, total serum cholesterol, high-density lipoprotein cholesterol and triglyceride levels were measured in 32 pre-diabetic men (mean age: 57.2 ± 6.8 years; mean body mass index (BMI): 28.5 ± 3.0 kg/m²) and 40 pre-diabetic women (mean age: 55.0 ± 7.3 years, mean BMI: 30.4 ± 5.7 kg/m²). A stepwise regression with backward variable selection was performed to construct models that predict 2-hour and fasting plasma glucose levels. RESULTS Maximal power output was inversely related to the 2-hour plasma glucose level in the entire group (r= -0.237, p<0.05), but this relationship was significant only for males (r= -0.404, p<0.05). No significant correlation was found between female gender and cardiorespiratory fitness. Age and cardiorespiratory fitness were significant predictors of 2-hour plasma glucose levels in men. High-density lipoprotein cholesterol was predictive of 2-hour plasma glucose levels in women. Triglycerides in women and BMI in men were the only predictors of fasting plasma glucose levels. CONCLUSIONS These findings may have consequences for the development of gender-specific diabetes prevention programs. Whereas increasing cardiorespiratory fitness should be a key goal for men, improving the lipid profile seems to be more beneficial for women. However, the present results do not negate the positive effects of increasing cardiorespiratory fitness in women.
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Affiliation(s)
- Hannes Gatterer
- Department of Sport Science, Medical Section, University of Innsbruck, Austria.
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26
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Sundquist J, Hagströmer M, Johansson SE, Sundquist K. Effect of a primary health-care-based controlled trial for cardiorespiratory fitness in refugee women. BMC FAMILY PRACTICE 2010; 11:55. [PMID: 20678219 PMCID: PMC2921106 DOI: 10.1186/1471-2296-11-55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 08/02/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Refugee women have a high risk of coronary heart disease with low physical activity as one possible mediator. Furthermore, cultural and environmental barriers to increasing physical activity have been demonstrated. The aim of the study was to evaluate the combined effect of an approximate 6-month primary health care- and community-based exercise intervention versus an individual written prescription for exercise on objectively assessed cardiorespiratory fitness in low-active refugee women. METHODS A controlled clinical trial, named "Support for Increased Physical Activity", was executed among 243 refugee women recruited between November 2006 and April 2008 from two deprived geographic areas in southern Stockholm, Sweden. One geographic area provided the intervention group and the other area the control group. The control group was on a higher activity level at both baseline and follow-up, which was taken into consideration in the analysis by applying statistical models that accounted for this. Relative aerobic capacity and fitness level were assessed as the two main outcome measures. RESULTS The intervention group increased their relative aerobic capacity and the percentage with an acceptable fitness level (relative aerobic capacity > 23 O2 mlxkgxmin-1) to a greater extent than the control group between baseline and the 6-month follow-up, after adjusting for possible confounders (P = 0.020). CONCLUSIONS A combined primary health-care and community-based exercise programme (involving non-profit organizations) can be an effective strategy to increase cardiorespiratory fitness among low-active refugee women. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT00747942.
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Affiliation(s)
- Jan Sundquist
- Center for Primary Health Care Research, CRC, Lund University, Malmö, Sweden.
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Lyerly GW, Sui X, Church TS, Lavie CJ, Hand GA, Blair SN. Maximal exercise electrocardiographic responses and coronary heart disease mortality among men with metabolic syndrome. Mayo Clin Proc 2010; 85:239-46. [PMID: 20160139 PMCID: PMC2843111 DOI: 10.4065/mcp.2009.0509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the association between abnormal exercise electrocardiographic (E-ECG) test results and mortality (all-cause and that resulting from coronary heart disease [CHD] or cardiovascular disease [CVD]) in a large population of asymptomatic men with metabolic syndrome (MetS). PATIENTS AND METHODS A total of 9191 men (mean age, 46.9 years) met the criteria of having MetS. All completed a maximal E-ECG treadmill test (May 14, 1979, through April 9, 2001) and were without a previous CVD event or diabetes at baseline. Main outcomes were all-cause mortality, mortality due to CHD, and mortality due to CVD. Cox regression analysis was used to quantify the mortality risk according to E-ECG responses. RESULTS During a follow-up of 14 years, 633 deaths (242 CVD and 150 CHD) were identified. Mortality rates and hazard ratios (HRs) across E-ECG responses were the following: for all-cause mortality: HR, 1.36; 95% confidence interval (CI), 1.09-1.70 for equivocal responses and HR, 1.41; 95% CI, 1.12-1.77 for abnormal responses (P(trend)<.001); for mortality due to CVD: HR, 1.29; 95% CI, 0.88-1.88 for equivocal responses and HR, 2.04; 95% CI, 1.46-2.84 for abnormal responses (P(trend)<.001); and for mortality due to CHD: HR, 1.62; 95% CI, 1.02-2.56 for equivocal responses and HR, 2.45; 95% CI, 1.62-3.69 for abnormal responses (P(trend)<.001). A positive gradient for CHD, CVD, and all-cause mortality rates across E-ECG categories within 3, 4, or 5 MetS components was observed (P<.001 for all). CONCLUSION Among men with MetS, an abnormal E-ECG response was associated with higher risk of all-cause, CVD, and CHD mortality. These findings underscore the importance of E-ECG tests to identify men with MetS who are at risk of dying.
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Affiliation(s)
- G William Lyerly
- Department of Kinesiology, School of Health, Kinesiology, and Sport Studies, Coastal Carolina University, PO Box 261954, Conway, SC 29528, USA.
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Franklin BA, McCullough PA. Cardiorespiratory fitness: an independent and additive marker of risk stratification and health outcomes. Mayo Clin Proc 2009; 84:776-9. [PMID: 19720774 PMCID: PMC2735426 DOI: 10.1016/s0025-6196(11)60486-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Barry A. Franklin
- Address correspondence to Barry A. Franklin, PhD, Director, Cardiac Rehabilitation and Exercise Laboratories, Beaumont Health Center, Preventive Cardiology, 4949 Coolidge Hwy, Royal Oak, MI 48073 ().
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