Effects of diet and/or low-intensity resistance exercise training on arterial stiffness, adiposity, and lean mass in obese postmenopausal women

The Effect of Diet on Vascular Aging: A Narrative Review of the Available Literature

Early vascular aging is related to various cardiovascular diseases including hypertension, coronary heart disease, and stroke. Healthful lifestyle practices and interventions, including dietary regimens and consistent aerobic exercise, exert favorable modulation on these processes, thereby diminishing the risk of cardiovascular disease with advancing age. The principal objective of this review was to conduct a comprehensive evaluation and synthesis of the available literature regarding the effectiveness of different diets on vascular health, such as arterial stiffness and endothelial function. To conduct this review, a thorough search of electronic databases including PubMed, Scopus, and Web of Science Core Collection was carried out. Based on the existing evidence, the Mediterranean, Dietary Approaches to Stop Hypertension, and low-calorie diets may have a beneficial effect on vascular health. However, more randomized controlled trials with sufficient sample sizes, longer follow-ups, rigorous methodologies, and, possibly, head-to-head comparisons between the different diets are needed to shed light on this topic.

Effect of exercise on inflammatory markers in postmenopausal women with overweight and obesity: A systematic review and meta-analysis

IMPORTANCE

Postmenopausal women affected by overweight and obesity are susceptible to a variety of diseases due to inflammation. Exercise may reduce the risk of disease by attenuating low-grade chronic inflammation.

OBJECTIVE

We conducted a systematic review and meta-analysis to investigate the effects of exercise on inflammatory markers in postmenopausal women struggling with overweight and obesity.

METHOD

Literature as of May 2023 was searched from databases such as Cochrane, Embase, Pubmed, Web of Science, and EBSCO and English-language randomized controlled trials (RCTs) that meet the inclusion criteria were selected. Studies were included based on the following criteria: (A) Written in English; (B) RCTs; (C) Postmenopausal women impacted by overweight and obesity as research objects; (D) Outcome measurements include CRP, TNF-α, IL-6, and adiponectin; (E) Duration of the exercise intervention is eight weeks.

RESULTS

A total of 34 articles and 2229 participants were included. Exercise can significantly reduce the level of C-reactive protein (CRP) (MD: -0.59, 95 % CI: -0.87 to -0.31, p < 0.00001), tumor necrosis factor-α (TNF-α) (MD: -0.65, 95 % CI: -0.94 to -0.35, p < 0.00001), interleukin-6 (IL-6) (MD: -0.48, 95 % CI: -0.75 to -0.21, p < 0.00001), and exercise can significantly increase the level of adiponectin (MD: 0.33, 95 % CI: 0.02 to 0.65, p = 0.04) in women impacted by overweight and obesity.

CONCLUSION

These results suggest that exercise may be an effective intervention for reducing pro-inflammatory markers and increasing adiponectin in postmenopausal women impacted by overweight and obesity. The findings may provide clinicians and healthcare professionals with insights into the implementation of exercise programs for postmenopausal women living with overweight and obesity.

Vascular function in hypertension: does gender dimension matter?

Blood pressure and vascular ageing trajectories differ between men and women. These differences develop due to sex-related factors, attributable to sex chromosomes or sex hormones, and due to gender-related factors, mainly related to different sociocultural behaviors. The present review summarizes the relevant facts regarding gender-related differences in vascular function in hypertension. Among sex-related factors, endogenous 17ß-estradiol plays a key role in protecting pre-menopausal women from vascular ageing. However, as vascular ageing (preceding and inducing hypertension) has a steeper increase in women than in men starting already from the third decade, it is likely that gender-related factors play a prominent role, especially in the young. Among gender-related factors, psychological stress (including that one related to gender-based violence and discrimination), depression, some psychological traits, but also low socioeconomic status, are more common in women than men, and their impact on vascular ageing is likely to be greater in women. Men, on the contrary, are more exposed to the vascular adverse consequences of alcohol consumption, as well as of social deprivation, while "toxic masculinity" traits may result in lower adherence to lifestyle and preventive strategies. Unhealthy diet habits are more prevalent in men and smoking is equally prevalent in the two sexes, but have a disproportional negative effect on women's vascular health. In conclusion, given the major and complex role of gender-related factors in driving vascular alterations and blood pressure patterns, gender dimension should be systematically integrated into future research on vascular function and hypertension and to tailor cardiovascular prevention strategies.

The Effects of Obesity on the Inflammatory, Cardiovascular, and Neurobiological Responses to Exercise in Older Adults

Obesity with advancing age leads to increased health complications that are involved in various complex physiological processes. For example, inflammation is a critical cardiovascular disease risk factor that plays a role in the stages of atherosclerosis in both aging and obesity. Obesity can also induce profound changes to the neural circuitry that regulates food intake and energy homeostasis with advancing age. Here we discuss how obesity in older adults impacts inflammatory, cardiovascular, and neurobiological functions with an emphasis on how exercise mediates each topic. Although obesity is a reversible disorder through lifestyle changes, it is important to note that early interventions are crucial to prevent pathological changes seen in the aging obese population. Lifestyle modifications such as physical activity (including aerobic and resistance training) should be considered as a main intervention to minimize the synergistic effect of obesity on age-related conditions, such as cerebrovascular disease.

Aerobic and resistance exercises affect the BDNF/TrkB signaling pathway, and hippocampal neuron density of high-fat diet-induced obese elderly rats

Obesity, caused by a high-fat diet (HFD) in elderly, is a risk factor for insulin resistance and a precursor to diabetes and can lead to impaired cognitive function. Physical exercise has positive effects on decrease obesity and improvement brain function. We investigated which type of aerobic (AE) or resistance (RE) exercise can be more effective in reducing HFD-induced cognitive dysfunction in obese elderly rats. 48 male Wistar rats (19-monthold) were divided into six groups: Healthy control (CON), CON+AE, CON+RE, HFD, HFD+AE, and HFD+RE. Obesity was induced by 5 months of HFD feeding in older rats. After obesity confirmation, RT (with a range of 50% to 100%1RM/3 days/week) and AE (running at 8-m/min for 15-min to 26-m/min for 60-min /5 days/week) was performed for 12-weeks. Morris water maze Test was used to evaluate cognitive performance. All data were analyzed using two-way statistical test of variance. The results showed that obesity had a negative effect on glycemic index, increased inflammation, decreased antioxidant levels, decreased BDNF/TrkB and decreased nerve density in hippocampal tissue. The Morris water maze results clearly showed cognitive impairment in the obesity group. But 12 weeks after AE and RE, all the measured variables were on the improvement path, and in general, no difference was observed between the two exercise methods. Two mods of exercise (AE and RE) may be having same effects on nerve cell density, inflammatory, antioxidant and functional status of hippocampus of obese rats. Each of the AE and RE can create beneficial effects on the cognitive function of the elderly.

Long-term effects of different exercise training modes on cytokines and adipokines in individuals with overweight/obesity and cardiometabolic diseases: A systematic review, meta-analysis, and meta-regression of randomized controlled trials

The present study aimed to investigate the evidence on the effects of different long-term training interventions (aerobic [AeT], resistance [RT], and combined [COMB]) and spontaneous physical activity (PA) in modifying cytokines and adipokines in individuals with overweight or obesity with or without cardiometabolic diseases while considering potential confounders. Although exercise interventions have become a potentially effective tool for preventing and treating metabolic diseases, the evidence provided by previous systematic reviews is inconclusive since several potential confounders have yet to be addressed. Therefore, we conducted a systematic literature search in Medline, Cochrane, and Embase databases from January 2000 to July 2022 and performed a meta-analysis. Inclusion criteria retrieved 106 full texts comprising 8,642 individuals with a range BMI of 25.1-43.8 kg m^-2 . We found that independently of the training mode, exercise had a beneficial effect on diminishing Adiponectin, C-reactive protein (CRP), IL-6, IL-18, IL-20, Leptin, sICAM, and TNF-α levels circulating levels. Furthermore, by subsequent analysis, we detected differential effects of AeT, RT, and COMB, with sex, age, body composition, and trial length acting as moderators. The comparison of training modes revealed a difference favoring COMB over AeT for regulating the increase in CRP with no differences in the remaining biomarkers. Meta-regression analysis revealed an effect of change in maximal oxygen uptake (VO_2max ) on CRP, IL-6, and TNF-α, while IL-10 was influenced by the change in body fat. The results suggest that all interventions, except PA, are effective in lessening this population's inflammatory status, provided that exercise results in an increase of VO_2max .

The Influence of Dietary Interventions on Arterial Stiffness in Overweight and Obese Subjects

Arterial stiffness is often increased in overweight/obese subjects before the development of hypertension. It is also one of the earliest indicators of increased cardiovascular disease risk and can be considered a good predictor of the development of subclinical cardiovascular dysfunction. Arterial stiffness is a significant prognostic factor influencing cardiovascular risk, which dietary habits can modify. Obese patients should use the caloric-restricted diet because it augments aortic distensibility, diminishes pulse wave velocity (PWV), and increases the activity of endothelial nitric oxide synthases. High intake of saturated fatty acids (SFA), trans fats, and cholesterol, typical for the Western diet, impairs endothelial function and raises brachial-ankle PMV. The replacement of SFA with monounsaturated (MUFA) or polyunsaturated fatty acids (PUFA) derived from seafood and plants diminishes the risk of arterial stiffness. The dairy product intake (excluding butter) decreases PWV in the general population. The high-sucrose diet causes toxic hyperglycemia and increases arterial stiffness. Complex carbohydrates with a low glycemic index (including isomaltose) should be recommended to keep vascular health. The high sodium intake (>10 g/day), particularly associated with low potassium consumption, has a deleterious effect on arterial stiffness (↑ baPWV). Since vegetables and fruits are good sources of vitamins and phytochemicals, they should be recommended in patients with high PMV. Thus, the dietary recommendation to prevent arterial stiffness should be similar to the Mediterranean diet, which is rich in dairy products, plant oils, and fish, with a minimal red meat intake and five servings of fruits and vegetables daily.

The impact of exercise and dietary interventions on circulating leptin and adiponectin in individuals who are overweight and those with obesity: A systematic review and meta-analysis

The effects of exercise training (Ex), dietary interventions (DIs), and a combination of Ex and DI (Ex + DI) on leptin and adiponectin have been established. However, less is known regarding the comparisons of Ex with DI and of Ex + DI with either Ex or DI alone. The aim of the present meta-analysis is to compare the effects of Ex with those of DI and those of Ex + DI with those of either Ex or DI alone on circulating leptin and adiponectin in individuals who are overweight and those with obesity. PubMed, Web of Science, and MEDLINE were searched to identify original articles, published through June 2022, that compared the effects of Ex with those of DI and/or the effects of Ex + DI with those of Ex and/or DI on leptin and adiponectin in individuals with BMIs (in kg/m²) of ≥25 and aged 7-70 y. Standardized mean differences (SMDs), weighted mean differences, and 95% CIs were calculated using random-effect models for outcomes. Forty-seven studies, comprising 3872 participants who were overweight and those with obesity, were included in the current meta-analysis. DI reduced the concentration of leptin (SMD: -0.30; P = 0.001) and increased the concentration of adiponectin (SMD: 0.23; P = 0.001) compared with Ex, as did Ex + DI (leptin: SMD: -0.34; P = 0.001; adiponectin: SMD: 0.37; P = 0.004) compared with Ex alone. However, Ex + DI did not affect the concentration of adiponectin (SMD: 0.10; P = 0.11) and led to inconsistent and nonsignificant changes in the concentration of leptin (SMD: -0.13; P = 0.06) compared with DI alone. Subgroup analyses showed that age, BMI, duration of intervention, type of supervision, quality of the study, and magnitude of energy restriction are sources of heterogeneity. Our results suggest that Ex alone was not as effective as DI or Ex + DI for decreasing leptin and increasing adiponectin in individuals with overweight and obesity. However, Ex + DI was not more effective than DI alone, suggesting that diet plays a critical role in beneficially altering the concentrations of leptin and adiponectin. This review was registered at PROSPERO as CRD42021283532.

The influence of resistance training on adipokines in post-menopausal women: A brief review

The onset of menopause elicits changes in body composition that negatively influence adipokine levels. Consequently, various health risk factors (e.g., cardiovascular disease, osteoporosis, physical inactivity, obesity, arterial hypertension, hypercholesterolemia, sarcopenia) are influenced by adipokines due to changes in body composition after menopause. Thus, improvements in body composition are considered the primary influencer of adipokines. Though several therapeutic interventions (e.g., medication, diet, meditation, exercise) are employed to target changes in body composition, resistance training appears to be more effective in positively improving body composition through changes in lean-muscle mass/fat-mass ratio. However, due to the lack of research, very little is known about adipokines' anti/inflammatory response in postmenopausal women after completing resistance training. Most resistance training studies in postmenopausal women have focused on leptin, adiponectin, and resistin, with limited research assessing other adipokines that are important in metabolic regulation and inflammatory processes. Additionally, the consistency of resistance training protocols as an intervention is not standardized or fully recognized. Therefore, the focus of this review is to establish a more comprehensive understanding of the benefits of resistance training on influencing adipokine levels based on changes to total body composition in postmenopausal women.

Aerobic Versus Resistance Training: Leptin and Metabolic Parameters Improvement in Type 2 Diabetes Obese Men

Purpose: The purpose of the research was to determine the changes in metabolic parameters, leptin, and irisin levels after aerobic and resistance training in type-2 diabetes obese men. Methods: Forty-five participants in the age range of 17-25 years were randomized into three groups: aerobic training (AT), resistance training (RT), and control (CO). All training sessions were fulfilled 4 days per week for two months. The aerobic training began with intensity of 65% of the maximum aerobic power and finished with 90%. The resistance program started with 50% of one-repetition maximum and reached 70% in the 8th week. Results: Factorial analysis of variance and Bonferroni post-hoc test revealed significant decreases in leptin (p = .043), fasting blood sugar (FBS) (p = .023), insulin (p = .001), homeostasis model assessment for insulin resistance (HOMA-IR) (p = .022) in AT compared with CO and insulin (p = .006) in AT compared with RT. The change of percent body fat (PBF) was positively correlated only with change of HOMA-IR in AT group (p = .032) at p < .05. Conclusion: The result suggests that, compared to resistance training, aerobic training can control metabolic situations such as insulin resistance through the leptin hormone function, and not irisin in type-2 diabetes obese men.

Effect of Exercise Training on Arterial Stiffness in Overweight or Obese Populations

The purpose was to analyze the effects of exercise training (ET) on arterial stiffness in all-age overweight or obese individuals. Sixty-one trials were included with ET improving flow-mediated dilation (FMD), pulse wave velocity (PWV), and intima-media thickness (IMT). In the subgroup analysis: (i) ET improved FMD in overweight or obese children and adolescents with a large effect size (SMD=0.83, 95% CI 0.42–1.25). PWV was decreased after ET regardless of age. IMT was decreased by ET in participants younger than 60, (ii) ET improved FMD, PWV, and IMT in participants whose BMI were smaller than 30 kg/m ² , but ET only improved PWV of participants whose BMI were larger than 30 kg/m ² . (iii) AE improved FMD, PWV, and IMT. High-intensity interval training (HIIT) decreased IMT. (iv) The increase of FMD only happened when training duration was longer than eight weeks. However, ET decreased PWV when the training duration was no longer than 12 weeks. IMT was decreased when the training duration was longer than eight weeks. ET instigated an improvement in endothelial function and arterial stiffness in overweight or obese populations, but depending on the different characteristics of exercise intervention and participants’ demographics.

A comparison of the impact of exercise training with dietary intervention versus dietary intervention alone on insulin resistance and glucose regulation in individual with overweight or obesity: a systemic review and meta-analysis

PURPOSE

Obesity is associated with the development of insulin resistance (IR) and type 2 diabetes for which exercise training (Ex) and dietary interventions (DI) are effective interventions that can improve IR. We therefore performed a systematic meta-analysis to compare the effect of Ex + DI compared with DI on IR and glucose homeostasis.

METHODS

PubMed and Cochrane Library were conducted up to May 2021. Meta-analyses were conducted to compare the effect of Ex + DI compared with DI on fasting glucose and insulin, IR and body weight. Standardized mean differences (SMDs), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were computed using random or fixed effect models.

RESULTS

Fifty studies involving 2864 participants with overweight or obesity were included in the meta-analysis. Ex + DI caused a larger decrease in fasting glucose (p = 0.001, 62 trials) and IR (p = 0.01, 29 trials) when compared with DI alone. There was no significant evidence, however, for a greater effect of Ex + DI on fasting insulin (p = 0.07, 48 trials) and body weight (p = 0.12, 58 trials), compared with DI alone.

CONCLUSION

Our results suggest that a combination of Ex and DI may be more effective than DI alone at improving IR and fasting glucose in individuals with overweight and obesity.

Energy deficiency impairs resistance training gains in lean mass but not strength: A meta-analysis and meta-regression

Short-term energy deficits impair anabolic hormones and muscle protein synthesis. However, the effects of prolonged energy deficits on resistance training (RT) outcomes remain unexplored. Thus, we conducted a systematic review of PubMed and SportDiscus for randomized controlled trials performing RT in an energy deficit (RT+ED) for ≥3 weeks. We first divided the literature into studies with a parallel control group without an energy deficit (RT+CON; Analysis A) and studies without RT+CON (Analysis B). Analysis A consisted of a meta-analysis comparing gains in lean mass (LM) and strength between RT+ED and RT+CON. Studies in Analysis B were matched with separate RT+CON studies for participant and intervention characteristics, and we qualitatively compared the gains in LM and strength between RT+ED and RT+CON. Finally, Analyses A and B were pooled into a meta-regression examining the relationship between the magnitude of the energy deficit and LM. Analysis A showed LM gains were impaired in RT+ED vs RT+CON (effect size (ES) = -0.57, p = 0.02), but strength gains were comparable between conditions (ES = -0.31, p = 0.28). Analysis B supports the impairment of LM in RT+ED (ES: -0.11, p = 0.03) vs RT+CON (ES: 0.20, p < 0.001) but not strength (RT+ED ES: 0.84; RT+CON ES: 0.81). Finally, our meta-regression demonstrated that an energy deficit of ~500 kcal · day^-1 prevented gains in LM. Individuals performing RT to build LM should avoid prolonged energy deficiency, and individuals performing RT to preserve LM during weight loss should avoid energy deficits >500 kcal day^-1 .

Effects of Combined Resistance and Aerobic Training on Arterial Stiffness in Postmenopausal Women: A Systematic Review

The aim of this systematic review was to investigate the effects of combined resistance and aerobic exercise on arterial stiffness in postmenopausal women. Two databases, PubMed and Google Scholar were searched to identify relevant studies. The methodological quality was assessed with the Physiotherapy Evidence Database (PEDro) scale. Only seven studies met the eligibility criteria, and their outcomes were presented. Four studies demonstrated the effects of combined resistance and aerobic training, while three showed the effectiveness of exercise with both training components, aerobic and resistance. In all studies, arterial stiffness was measured by brachial–ankle pulse wave velocity (baPWV). Participants were middle-aged or older postmenopausal women of various health statuses (hypertensive, with comorbidities or healthy). The results unequivocally show that combined training reduces arterial stiffness. The most important finding of this review paper is that the applied type of exercise decreased baPWV in the range of 0.6–2.1 m/s. Moreover, combined resistance and aerobic exercise for 12 weeks, performed three times a week for about 60 min per training session, at a moderate intensity (40–60% HRR or HRmax), may be clinically meaningful to the cardiovascular system. In conclusion, we can say that combined resistance and aerobic training, or exercise with resistance and aerobic components, have important health implications for the prevention of cardiovascular disease and the maintenance or improvement of health in middle-aged and older postmenopausal women with different health conditions.

Effect of an Acute Resistance Training Bout and Long-Term Resistance Training Program on Arterial Stiffness: A Systematic Review and Meta-Analysis

Resistance training (RT) and exercise is useful for preventing cardiovascular disease, systolic hypertension and stroke, which are associated with the stiffening of the larger central arterial system. The aim of this systematic review was to (a) understand the changes in arterial stiffness (AS) in various parts of the body measurement after acute RT bout and long-term RT, and (b) to determine the impact of exercise intensity on these changes in healthy individuals. A systematic computerized search was performed according to the PRISMA in PubMed, Scopus and Google Scholar with final selection of 23 studies. An acute RT bout led to a temporary increase in pulse wave velocity (PWV) regardless of the measurement method or intensity. A long-term RT at above an 80% repetition maximum (RM) have an ambiguous effect on PWV. A low-intensity RT or whole-body vibration training program decreased carotid-femoral PWV and brachial-ankle PWV (d = 1.02) to between 0.7 ± 1.4 ms-1 (p < 0.05) and 1.3 ± 1.07 ms-1 (p < 0.05) and improved other cardiac functions. A long-term RT of moderate (60-80% 1RM) or low intensity (<60% one-repetition maximum (1RM)) can decrease AS. Low and moderate intensity RT is beneficial to reduce high AS to prevent cardiovascular diseases.

The effect of exercise training on blood pressure in menopause and postmenopausal women: A systematic review of randomized controlled trials

The prevalence of hypertension is higher in postmenopausal than in premenopausal women. Regular exercise training has been shown to be effective in addressing hypertension. The aim of this systematic review was to synthesize the effect of exercise training on systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) in menopausal and postmenopausal women. This review was reported according to the PRISMA statement and registered in PROSPERO. The literature search was done in MEDLINE, Embase, Cochrane CENTRAL and ClinicalTrials. Randomized controlled trials involving menopausal and postmenopausal women undergoing exercise training were included. Two blinded reviewers assessed risk of bias in the included studies by using the Cochrane Risk of Bias tool. A random-effects model was used for all analyses. Significance was set at P < 0.05. Compared with the control group, exercise training resulted in clinically significant reductions on SBP (MD -3.43 mmHg; 95% CI, -5.16, -1.71; P < 0.0001), DBP (MD, -2.25 mmHg; 95% CI, -3.40, -1.11; P = 0.0001) and MAP (MD, -3.48 mmHg; 95% CI, -5.84, -1.11; P = 0.004). Aerobic training (AT) did not produce a significant reduction in SBP, DBP and MAP (P >0.05). Combined training (CT) generated larger reductions. Exercise training generated small but clinically relevant reductions in SBP, DBP and MAP in menopausal and postmenopausal women, younger or older than 65 years, with prehypertension or hypertension. AT did not lead to a clinically relevant improvement in blood pressure (BP) in this population. In addition, CT showed the largest reductions in SBP, DBP and MAP.

Effects of Acute Stretching Exercise and Training on Heart Rate Variability: A Review

ABSTRACT

Wong, A and Figueroa, A. Effects of acute stretching exercise and training on heart rate variability: A review. J Strength Cond Res 35(5): 1459-1466, 2021-Stretching (ST), an exercise modality widely used for flexibility improvement, has been recently proposed as an effective adjunct therapy for declines in cardiovascular health, warranting research into the effects of ST exercise on cardiac autonomic function (CAF). Heart rate (HR) variability (HRV) is a reliable measure of CAF, mainly the sympathetic and parasympathetic modulations of HR. A low HRV has been associated to increased risk of cardiovascular events and mortality. Exercise interventions that enhance HRV are therefore seen as beneficial to cardiovascular health and are sought after. In this review, we discuss the effect of ST both acute and training on HRV. Stretching training seems to be a useful therapeutic intervention to improve CAF in different populations. Although the mechanisms by which ST training improves CAF are not yet well understood; increases in baroreflex sensitivity, relaxation, and nitric oxide bioavailability seem to play an important role.

Pilates for Overweight or Obesity: A Meta-Analysis

Background: Evidence for the efficacy of Pilates for the modulation of body weight and body composition is unclear. Objective: This meta-analysis aimed to evaluate the effects of Pilates on body weight and body composition in adults with overweight or obesity. Data Sources: The PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and EMBASE databases were systematically searched from the inception dates to 12 November 2020 for relevant randomized controlled trials (RCTs). Study Selection: Randomized controlled trials comparing Pilates with other physical exercises or without any intervention were included. Data Extraction and Synthesis: Three reviewers independently performed the data extraction and assessed study quality. The mean differences (MDs) and 95% confidence intervals (CIs) for pooled data were calculated. Main Outcomes and Measures: Outcome measures were body weight, body mass index (BMI), body fat percentage, lean body mass, and waist circumference. Results: Eleven RCTs with 393 subjects were included. This study revealed that Pilates dramatically reduces body weight (MD = -2.40, 95% CI: [-4.04, -0.77], P = 0.004, I ² = 51%), BMI (MD = -1.17, 95% CI: [-1.85, -0.50], P = 0.0006, I ² = 61%), and body fat percentage (MD = -4.22, 95% CI: [-6.44, -2.01], P = 0.0002, I ² = 88%) in adults with overweight or obesity. The reduction in body weight and body fat percentage appears to be more pronounced in studies including participants with obesity only, and the efficacy of Pilates for the improvement of body weight and BMI appears to be more evident in longer intervention duration. However, Pilates has no significant effect on waist circumference (MD = -2.65, 95% CI: [-6.84, 1.55], P = 0.22, I ² = 0%) and lean body mass (MD = -0.00, 95% CI: [-1.40, 1.40], P = 1.00, I ² = 23%). Conclusions: Pilates dramatically reduces body weight, BMI, and body fat percentage in adults with overweight or obesity. Large-scale and well-designed RCTs with improved methodology and reporting are urgently needed to further confirm these results.

Effects of resistance training combined with a ketogenic diet on body composition: a systematic review and meta-analysis

We evaluated the effects of ketogenic diets (KDs) on body mass (BM), fat mass (FM), fat-free mass (FFM), body mass index (BMI), and body fat percentage (BFP) compared to non-KDs in individuals performing resistance training (RT). Online electronic databases including PubMed, the Cochrane Library, Web of Science, Embase, SCOPUS, and Ovid were searched to identify initial studies until February 2021. Data were pooled using both fixed and random-effects methods and were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Out of 1372 studies, 13 randomized controlled trials (RCTs) that enrolled 244 volunteers were included. The pooled results demonstrated that KDs significantly decreased BM [(WMD = -3.67 kg; 95% CI: -4.44, -2.90, p < 0.001)], FM [(WMD = -2.21 kg; 95% CI: -3.09, -1.34, p < 0.001)], FFM [(WMD = -1.26 kg; 95% CI: -1.82, -0.70, p < 0.001)], BMI [(WMD = -1.37 kg.m^-2; 95% CI: -2.14, -0.59, p = 0.022)], and BFP [(WMD = -2.27%; 95% CI: -3.63, -0.90, p = 0.001)] compared to non-KDs. We observed beneficial effects of KDs compared to non-KDs on BM and body fat (both FM and BFP) in individuals performing RT. However, adherence to KDs may have a negative effect on FFM, which is not ameliorated by the addition of RT.

Resistance training leads to large improvements in strength and moderate improvements in physical function in adults who are overweight or obese: a systematic review

QUESTIONS

What are the effects of resistance training on muscle strength, physical function and muscle power in adults who are overweight or obese? Which factors moderate the effects?

DESIGN

Systematic review of randomised controlled trials, with random effects meta-analyses and meta-regressions.

PARTICIPANTS

Adults who are overweight or obese.

INTERVENTION

Resistance training lasting ≥ 4 weeks.

OUTCOME MEASURES

Muscle strength, muscle power and physical function.

RESULTS

Thirty trials with 1,416 participants met the eligibility criteria. Pooled analyses indicated that resistance training has a large beneficial effect on muscle strength (SMD 1.39, 95% CI 1.05 to 1.73, I² = 85%) and a moderate effect on physical function (SMD 0.67, 95% CI 0.25 to 1.08, I² = 71%) in adults who are overweight or obese. However, the effect of resistance training on muscle power was unclear (SMD 0.42, 95% CI -3.3 to 4.2, I² = 46%). The effect of resistance training on strength was greatest for the upper body (versus lower/whole body: β = 0.35, 95% CI 0.05 to 0.66) and in dynamic strength tests (versus isometric/isokinetic: β = 1.20, 95% CI 0.60 to 1.81), although trials judged to have good methodological quality reported statistically smaller effects (versus poor/fair quality: β = -1.21, 95% CI -2.35 to -0.07). Concomitant calorie restriction did not modify strength gains but reduced the effect of resistance training on physical function (β = -0.79, 95% CI -1.41 to -0.17). Small study effects were evident for strength outcomes (β = 5.9, p < 0.001).

CONCLUSIONS

Resistance training has a large positive effect on muscle strength and a moderate effect on physical function in adults who are overweight or obese. However, the effect of resistance training on muscle power is uncertain. In addition, concomitant calorie restriction may compromise the functional adaptations to resistance training.

REGISTRATION

PROSPERO CRD42019146394.

Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults

BACKGROUND

Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described.

METHODS

Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants.

RESULTS

Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets.

CONCLUSION

A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.

Effects of Exercise on the Body Composition and Lipid Profile of Individuals with Obesity: A Systematic Review and Meta-Analysis

Background

Numerous researchers have worked to develop treatments for obesity; however, the prevalence of obesity continues to increase in many countries. Moreover, the effects of physical activity and exercise on obesity remain unclear. Therefore, it is necessary to perform a systematic review and meta-analysis to assess the relationship between exercise and obesity using mediator variables such as the mode of exercise.

Methods

Our review focuses on research tracking the effects of exercise on obesity conducted from 2007 to 2016 and available in any of three databases: Embase, PubMed, and EBSCO Academic Search Premier. The keywords used in the search were “exercise and obesity” and “exercise and obese.”

Results

The average size of the effects that exercise interventions have on body mass index (standardized mean difference [SMD], 0.533), waist circumference (SMD, 0.666), total cholesterol (SMD, 0.721), and triglyceride (TG; SMD, 0.603) were medium or larger. Exercise had greater effects on the outward appearance of obesity (body mass index, waist circumference) than on its practical factors (weight, % body fat). The effect of exercise on TG (SMD, 0.603) was larger than that on low-density lipoprotein (SMD, 0.406) and high-density lipoprotein (SMD, −0.222). Exercise duration (weeks of exercise) and intensity correlate better than exercise time (minutes per week) with a large and consistent improvement in adult obesity.

Conclusion

We suggest that individuals with obesity should exercise consistently to achieve significant improvements in their health.

The Effects of Low Intensity Resistance Exercise on Cardiac Autonomic Function and Muscle Strength in Obese Postmenopausal Women

The present study examined the effects of a 12-week low intensity resistance exercise training (LIRET) regimen on heart rate variability (HRV), strength and body composition in obese postmenopausal women. Participants were randomly assigned to 12 weeks of either LIRET (n= 10) or non-exercising control group (n= 10). HRV, leg muscle strength and body composition were measured before and after 12 weeks. There were significant decreases (P < 0.05) in sympathovagal balance (LnLF/LnHF) and sympathetic tone (nLF) as well as significant increases (P < 0.05) in parasympathetic tone (nHF) and strength following LIRET compared to no changes after control. There were no significant changes in body composition after LIRET or control. LIRET may be an effective therapeutic intervention for improving sympathovagal balance and strength in obese postmenopausal women. Since obese postmenopausal women are at increased risk of developing cardiovascular diseases and physical disability, they could potentially benefit from LIRET.

Effect of combined circuit exercise on arterial stiffness in hypertensive postmenopausal women: a local public health center-based pilot study

OBJECTIVE

Postmenopausal women have increased arterial stiffness compared with premenopausal women. Regular physical activity including aerobic and resistance exercises are recommended to lower cardiovascular disease risk and to enhance musculoskeletal health in these women. This study examined the effect of combined circuit exercise on arterial stiffness in hypertensive postmenopausal women. Furthermore, it ascertained whether performing this exercise program is feasible in local public health centers with better accessibility than research and commercial facilities.

METHODS

Among 24 hypertensive postmenopausal women, 16 finished this study in either the control (n = 8) or exercise (n = 8) group. Except for one participant who withdrew from the study due to the difficulty of the exercise program, seven participants withdrew due to reasons unrelated to the study. Circuit-type exercise (aerobic- and resistance-combined) program was applied to the exercise group, 60 min/d and 3 d/wk for 12 weeks under supervision. Brachial-ankle pulse wave velocity was measured to assess arterial stiffness.

RESULTS

In response to the combined exercise, brachial-ankle pulse wave velocity was significantly reduced in the hypertensive women (-0.7 m/s; P < 0.05). Weight, body mass index, and total cholesterol level were also significantly decreased after the exercise program (-2.1 kg, -0.8 kg/m, and -16 mg/dL, respectively; P < 0.05). In addition, changes in arterial stiffness were related to body adiposity, blood pressure, and blood lipid alterations (r = 0.61-0.70; P < 0.01).

CONCLUSIONS

Circuit combined exercise is an effective intervention to improve arterial stiffness in hypertensive postmenopausal women, and is feasible in local public health centers.

Effects of dietary and exercise intervention on weight loss and body composition in obese postmenopausal women: a systematic review and meta-analysis

OBJECTIVE

This study examined the effects of dietary and exercise interventions on weight loss and body composition in overweight/obese peri- and postmenopausal women.

METHODS

Medline, Central, Embase, and Google Scholar databases were searched for relevant trials conducted until December 31, 2016. Randomized controlled trials (RCTs) and prospective studies of overweight/obese peri- or postmenopausal women that examined the effects of dietary or exercise interventions, alone or combined, on weight loss were included. The primary outcome was percentage reduction in body weight.

RESULTS

From 292 studies initially identified, 11 studies with 12 sets of participants were included. Both dietary and exercise intervention groups had significantly greater weight loss than control groups (diet vs control: difference in means = -6.55, 95% CI, -9.51 to -3.59, P < 0.001; exercise vs control: difference in means = -3.49, 95% CI, -6.96 to -0.02, P = 0.049). Combined dietary and exercise interventions resulted in greater weight loss than dietary interventions alone (diet plus exercise vs diet: difference in means = -1.22, 95% CI, -2.14 to -0.29, P = 0.010). Diet plus exercise resulted in greater fat loss (difference in means = -0.44, 95% CI, -0.67 to -0.20, P < 0.001) and greater lean mass loss (difference in means = -0.84, 95% CI, -1.13 to -0.55, P < 0.001) than diet alone.

CONCLUSIONS

Dietary interventions reduced body weight and body composition profile parameters in peri- and postmenopausal women more than exercise alone. The addition of exercise reinforced the effect of dietary interventions on changing body weight and composition.

Role of Nutrition and Exercise Programs in Reducing Blood Pressure: A Systematic Review

The combined effect of diet and strength training (ST) on blood pressure (BP) seems to be very important for the treatment of prehypertension and hypertension (HT). Therefore, the aim of this study was to determine whether ST alone or combined with nutrition or supplementation has an impact on the arterial pressure reduction in normotensive and hypertensive populations. A systematic computerized literature search was performed according to the PRISMA guidelines using PubMed, Scopus and Google Scholar; only English language studies published from 1999 until 2018 were included. This systematic search identified the results of 303 individuals from nine studies. The ST program alone had a similar effectiveness as the nutrition program (NP) alone; however, their combination did not result in increased effectiveness in terms of a high BP reduction. The consumption of L-citrulline had a similar effect as ST on lowering BP; on the other hand, caffeine led to an increase in BP during the ST session. Our data suggest that a combination of ST 2-3 times a week at moderate intensity and a NP seems to be equally effective in terms of lowering BP (systolic and diastolic) as ST and NP alone.

Sex differences in mechanisms of arterial stiffness

Arterial stiffness progressively increases with aging and is an independent predictor of cardiovascular disease (CVD) risk. Evidence supports that there are sex differences in the time course of aging-related arterial stiffness and the associated CVD risk, which increases disproportionately in postmenopausal women. The association between arterial stiffness and mortality is almost twofold higher in women versus men. The differential clinical characteristics of the development of arterial stiffness between men and women indicate the involvement of sex-specific mechanisms. This review summarizes the current literature on sex differences in vascular stiffness induced by aging, obesity, hypertension, and sex-specific risk factors as well as the impact of hormonal status, diet, and exercise on vascular stiffness in males and females. An understanding of the mechanisms driving sex differences in vascular stiffness has the potential to identify novel sex-specific therapies to lessen CVD risk, the leading cause of death in males and females. LINKED ARTICLES: This article is part of a themed section on The Importance of Sex Differences in Pharmacology Research. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.21/issuetoc.

Postprandial augmentation index is reduced in adults with prediabetes following continuous and interval exercise training

NEW FINDINGS

What is the central question of this study? We compared high-intensity interval versus continuous training on fasting and postprandial arterial stiffness in people with prediabetes. What is the main finding and its importance? We show, for the first time, that exercise improves the augmentation index during the postprandial state, but not the fasted state, in adults with prediabetes. However, the fasted augmentation index improved in relationship to exercise dose, as assessed by kilocalories per session. Collectively, these findings suggest that short-term exercise can improve arterial compliance in adults with prediabetes. Therefore, lifestyle interventions designed to reduce arterial stiffness could have considerable clinical impact.

ABSTRACT

People with prediabetes have elevated risk for cardiovascular disease, in part, owing to arterial stiffness mediated by low insulin sensitivity. However, the effect the intensity and/or amount (i.e. kilocalories per session) of short-term exercise training on fasting and postprandial arterial stiffness is unknown. We tested the hypothesis that increased intensity and dose (i.e. amount) of exercise would be correlated with reduced fasting and postprandial arterial stiffness in obese adults with prediabetes. After randomization, 31 adults (age 61.4 ± 8.3 years, body mass index 32.1 ± 5.4 kg m-2 ) with prediabetes performed supervised continuous (CONT; n = 17; 70% of peak heart rate) or interval (INT; n = 14; 3 min at 50% of peak heart rate and 3 min at 90% of peak heart rate) cycling training for 60 min day-1 over 2 weeks. The amount of exercise was calculated using regression equations derived from oxygen uptake (V ̇ O 2 ) and heart rate. Arterial stiffness [augmentation index (AI) and cartoid-femoral pulse wave velocity], insulin and glucose were determined during a 180 min 75 g oral glucose tolerance test (OGTT) and analysed by the total area under the curve (tAUC) pre- versus post-training. The simple index of insulin sensitivity, (SIIS )OGTT, was calculated; aerobic fitness (peakV ̇ O 2 ) and body mass were also assessed. Short-term training had no effect on weight but did improve peakV ̇ O 2 (P = 0.003), glucose tAUC180min (P = 0.01) and insulin sensitivity (P = 0.002), independent of intensity. The CONT and INT exercise significantly reduced AI 2 h postprandial (P = 0.008) and tAUC180min (P = 0.03). Reductions in fasted AI were related to exercise dose (trend: r = -0.37, P = 0.055). Increased peakV ̇ O 2 was linked to reduced fasted (r = -0.47, P = 0.01) and tAUC180min AI (r = -0.39, P = 0.05). Decreased AI tAUC180min was correlated with increased insulin sensitivity (r = -0.50, P = 0.009). Short-term CONT and INT training reduced postprandial arterial stiffness comparably in adults with prediabetes.

The Effect of Chronic Exercise Training on Leptin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Leptin is a hormone associated with satiety, lipid oxidation, energy expenditure, and energy homeostasis. To date, the current body of research examining the effect of chronic exercise training on leptin has yielded inconsistent results.

OBJECTIVE

The purpose of this meta-analysis was to provide a quantitative estimate of the magnitude of change in leptin levels following participation in exercise interventions lasting ≥ 2 weeks.

METHODS

All studies included were peer-reviewed and published in English. To be included, studies randomized human participants to an exercise training group or non-exercise comparison group for an exercise training intervention. Leptin levels were measured at baseline, during, and/or after completion of the exercise training program. Random-effects models were used to aggregate a mean effect size (ES) and 95% confidence intervals (CIs), and identify potential moderators.

RESULTS

Seventy-two randomized controlled trials met the inclusion criteria and resulted in 107 effects (n = 3826). The mean ES of 0.24 (95% CI 0.16-0.32, p < 0.0001) indicated a decrease in leptin following an exercise training program. A decrease in %Fat (β = - 0.07, p < 0.01) was associated with a decrease in leptin after accounting for the type of control group (β = - 0.38, p < 0.0001) used in each study.

CONCLUSION

These results suggest that engaging in chronic exercise training (≥ 2 weeks) is associated with a decrease in leptin levels for individuals regardless of age and sex. However, a greater decrease in leptin occurred with a decreased percentage of body fat.

Arterial Aging, Metalloproteinase Regulation, and the Potential of Resistance Exercise

Background

Aging is a process that affects all living organisms. The transition through life elicits tissue specific alterations in the functional and structural capabilities of all physiological systems. In particular, the vasculature is vulnerable to aging specific adaptations which induces morphological changes and ultimately increases the risk of pathological states. Matrix metalloproteinases are a group of extremely active enzymes that regulate the age-associated structural changes of the vasculature which has been regarded as the hallmark of arterial aging. Although this process in unavoidable, the structural and functional changes to the vasculature that occur as a result of advancing age can be positively or negatively influenced by our lifestyle choices.

Conclusion

Exercise training has profound effects on the age-associated changes of the arteries which have been shown to be beneficial in offsetting the detrimental responses of aging. This review provides a brief synopsis of the matrix metalloproteinase induced alterations of the arteria during aging and highlights the potential of resistance exercise to influence such changes.

Whole-body vibration training in obese subjects: A systematic review

OBJECTIVE

(i) to determine the outcomes of whole-body vibration training (WBVT) on obese individuals, and the intervention settings producing such effects; (ii) identify potential improper or harmful use of WBVT.

DESIGN

Systematic review.

DATA SOURCES

Medline, Scopus, Web of Science, PEDro and Scielo until July 2018.

ELIGIBILITY CRITERIA

Full papers evaluating the effect of WBVT on body composition, cardiovascular status and functional performance in obese adults. Papers with PEDro score<4 were excluded.

STUDY APPRAISAL AND SYNTHESIS

Risk of bias and quality of WBVT reporting were assessed with PEDro scale (randomized controlled trials) or TREND checklist (non-randomized studies) and a 14-items checklist, respectively. Weighted acceleration, daily exposure and Hedges' adjusted g were computed.

RESULTS

We included 18 papers published 2010-2017. Typical interventions consisted in three sessions/week of exercises (squats, calf-raises) performed on platforms vibrating at 25-40 Hz (amplitude: 1-2 mm); according to ISO 2631-1:1997, daily exposure was "unsafe" in 7/18 studies. Interventions lasting ≥6 weeks improved cardiac autonomic function and reduced central/peripheral arterial stiffness in obese women; 10 weeks of WBVT produced significant weight/fat mass reduction, leg strength improvements as resistance training, and enhanced glucose regulation when added to hypocaloric diet. No paper evidenced losses of lean mass. Isolated cases of adverse effects were reported.

SUMMARY

To date, WBVT is a promising adjuvant intervention therapy for obese women; long-term studies involving larger cohorts and male participants are required to demonstrate the associated safety and health benefits. The therapeutic use of WBVT in the management of obese patients is still not standardised and should be supported by an extensive knowledge on the causality between vibration parameters and outcomes.

High-Fat, High-Sugar Diet-Induced Subendothelial Matrix Stiffening is Mitigated by Exercise

Consumption of a high-fat, high-sugar diet and sedentary lifestyle are correlated with bulk arterial stiffening. While measurements of bulk arterial stiffening are used to assess cardiovascular health clinically, they cannot account for changes to the tissue occurring on the cellular scale. The compliance of the subendothelial matrix in the intima mediates vascular permeability, an initiating step in atherosclerosis. High-fat, high-sugar diet consumption and a sedentary lifestyle both cause micro-scale subendothelial matrix stiffening, but the impact of these factors in concert remains unknown. In this study, mice on a high-fat, high-sugar diet were treated with aerobic exercise or returned to a normal diet. We measured bulk arterial stiffness through pulse wave velocity and subendothelial matrix stiffness ex vivo through atomic force microscopy. Our data indicate that while diet reversal mitigates high-fat, high-sugar diet-induced macro- and micro-scale stiffening, exercise only significantly decreases micro-scale stiffness and not macro-scale stiffness, during the time-scale studied. These data underscore the need for both healthy diet and exercise to maintain vascular health. These data also indicate that exercise may serve as a key lifestyle modification to partially reverse the deleterious impacts of high-fat, high-sugar diet consumption, even while macro-scale stiffness indicators do not change.

Effects of Resistance Training and Protein Supplementation in Breast Cancer Survivors

PURPOSE

This study aimed to evaluate 12 wk of resistance training (RT; n = 16) and protein supplementation (RT + protein; n = 17) on muscular strength, body composition, and blood biomarkers of muscle (insulin-like growth factor 1 [IGF-1]), fat (adiponectin), and inflammation (human C-reactive protein [CRP]) in breast cancer survivors (BCS).

METHODS

Thirty-three BCS (59 ± 8 yr) were measured pre- and posttraining for one-repetition maximum (1-RM) muscular strength (chest press and leg extension), body composition (lean mass [LM] and fat mass [FM]) via dual-energy x-ray absorptiometry, and serum concentrations of IGF-1, adiponectin, and CRP. RT consisted of 2 d·wk using 10 exercises for two sets of 10-12 repetitions and a third set to failure at ~65%-85% of 1-RM. RT + protein consumed 20 g of protein twice a day. ANOVA was used for analyses. Significance was set at P ≤ 0.05.

RESULTS

Average RT intensity was 65%-81% of 1-RM and was not different between RT and RT + protein. There were no group-time interactions for strength, LM, FM, and biomarkers. Both groups significantly increased upper (+31 ± 18 kg) and lower (+19 ± 12 kg) body strength, LM (+0.9 ± 1.0 kg) and decreased FM (-0.5 ± 1.2 kg), and percent body fat (-1.0% ± 1.2%). Serum levels of IGF-1 significantly increased from baseline to 12 wk in both RT (102 ± 34 to 115 ± 33 ng·mL) and RT + protein (110 ± 40 to 119 ± 37 ng·mL); adiponectin and CRP did not change.

CONCLUSIONS

Twelve weeks of RT at 65%-81% of 1-RM, 2 d·wk in BCS, was well tolerated and significantly improved strength, body composition, and IGF-1. Supplemental protein (40 g·d) did not induce a change in any variable. However, on the basis of food logs, reductions in total calories and dietary protein intake from whole foods resulted in only a net protein increase of 17 g·d for RT + protein, which may have influenced the results.

Tratamiento médico-quirúrgico de la obesidad en el SAHOS

La obesidad es uno de los factores de riesgo más importantes en los trastornos respiratorios relacionados con el sueño. Más de 70% de los pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) presenta algún grado de obesidad. La pérdida de peso, ya sea médica o quirúrgica, debe ser un objetivo primordial en el manejo del SAHOS al mejorar el índice de apnea-hipopnea (IAH) en un alto porcentaje, el cual se debe estimular en todos los pacientes. Siempre se debe iniciar con cambios en el estilo de vida a través de intervenciones con múltiples componentes que incluyen hábitos alimentarios, actividad física y soporte psicológico. Si después de 3 a 6 meses de tratamiento no se han alcanzado las metas de peso establecidas, se pueden formular medicamentos contra la obesidad o cirugía bariátrica. El riesgo actual de someterse a una cirugía bariátrica es bajo y los beneficios son evidentes.

Effect of diet-induced weight loss on muscle strength in adults with overweight or obesity - a systematic review and meta-analysis of clinical trials

We conducted a systematic review and meta-analysis to identify how diet-induced weight loss in adults with overweight or obesity impacts on muscle strength. Twenty-seven publications, including 33 interventions, most of which were 8-24 weeks in duration, were included. Meta-analysis of seven interventions measuring knee extensor strength by isokinetic dynamometry in 108 participants found a significant decrease following diet-induced weight loss (-9.0 [95% confidence interval: -13.8, -4.1] N/m, P < 0.001), representing a 7.5% decrease from baseline values. Meta-analysis of handgrip strength from 10 interventions in 231 participants showed a non-significant decrease (-1.7 [-3.6, 0.1] kg, P = 0.070), with significant heterogeneity (I(2)  = 83.9%, P < 0.001). This heterogeneity may have been due to diet type, because there was a significant decrease in handgrip strength in seven interventions in 169 participants involving moderate energy restriction (-2.4 [-4.8, -0.0] kg, P = 0.046), representing a 4.6% decrease from baseline values, but not in three interventions in 62 participants involving very-low-energy diet (-0.4 [-2.0, 1.2] kg, P = 0.610). Because of variability in methodology and muscles tested, no other data could be meta-analyzed, and qualitative assessment of the remaining interventions revealed mixed results. Despite varying methodologies, diets and small sample sizes, these findings suggest a potential adverse effect of diet-induced weight loss on muscle strength. While these findings should not act as a deterrent against weight loss, due to the known health benefits of losing excess weight, they call for strategies to combat strength loss - such as weight training and other exercises - during diet-induced weight loss. © 2016 World Obesity.

Whole-body vibration as a potential countermeasure for dynapenia and arterial stiffness

Age-related decreases in muscle mass and strength are associated with decreased mobility, quality of life, and increased cardiovascular risk. Coupled with the prevalence of obesity, the risk of death becomes substantially greater. Resistance training (RT) has a well-documented beneficial impact on muscle mass and strength in young and older adults, although the high-intensity needed to elicit these adaptations may have a detrimental or negligible impact on vascular function, specifically on arterial stiffness. Increased arterial stiffness is associated with systolic hypertension, left ventricular hypertrophy, and myocardial ischemia. Therefore, improvements of muscle strength and arterial function are important in older adults. Recently, whole-body vibration (WBV) exercise, a novel modality of strength training, has shown to exhibit similar results on muscle strength as RT in a wide-variety of populations, with the greatest impact in elderly individuals with limited muscle function. Additionally, WBV training has been shown to have beneficial effects on vascular function by reducing arterial stiffness. This article reviews relevant publications reporting the effects of WBV on muscle strength and/or arterial stiffness. Findings from current studies suggest the use of WBV training as an alternative modality to traditional RT to countermeasure the age-related detriments in muscle strength and arterial stiffness in older adults.

Effects of Resistance Training With and Without Caloric Restriction on Arterial Stiffness in Overweight and Obese Older Adults

BACKGROUND

Arterial stiffness is an important marker of vascular aging that is increased in sedentary, obese older adults. Weight loss induced by caloric restriction (CR) can improve arterial stiffness in this population; however, the effects of resistance training (RT) are not clear. This pilot study determined the effects of RT with and without CR on arterial stiffness in overweight and obese older adults.

METHODS

Participants (mean age = 68±3 years, mean body mass index = 31.1±2.7 kg/m(2), 56% female, 13% Black) were randomly assigned to 3 days/week of supervised moderate-intensity RT (n = 16) or RT+CR (n = 16) for 5 months. Three indices of arterial stiffness were measured: brachial-ankle pulse wave velocity, large artery elasticity, and small artery elasticity.

RESULTS

Body mass was significantly reduced in the RT+CR group compared to the RT group (-6.2±4.8 vs. 0.2±1.2 kg, P = 0.0006). Within-group analyses showed that none of the arterial stiffness measures changed with RT or RT+CR. There were also no significant between-group differences, though median changes in large artery elasticity were slightly greater with RT+CR: 0.7 (-2.5, 5.1) vs. 0.3 (-2.6, 0.9) ml/mm Hg × 10, P = 0.07. Changes in large artery elasticity were negatively correlated with changes in waist circumference (r = -0.36, P < 0.05), systolic blood pressure (r = -0.38, P = 0.03), and diastolic blood pressure (r = -0.41, P = 0.02).

CONCLUSIONS

The combination of RT and CR, leading to a modest amount of weight loss (7%), tended to increase large artery elasticity more than RT alone. Our data suggest that reductions in waist circumference and blood pressure may promote improvements in elasticity.

CLINICAL TRIALS REGISTRATION

Trial Number NCT01049698.

A randomized clinical trial of a weight loss maintenance intervention in a primary care population

OBJECTIVE

In-person weight loss maintenance visits have been shown to reduce weight regain after initial weight loss. This study examined, in a primary care population, whether in-person visits plus portion-controlled meals were more effective in reducing 12-month weight regain than mailed materials plus portion controlled meals.

METHODS

Study participants (n = 106) received 6 months of intensive behavioral treatment. Participants who completed this phase (n = 84) were then randomized to continue monthly in-person visits for weight loss maintenance as well as telephone calls between visits ("intensified maintenance") or to receive materials by mail ("standard maintenance"). All participants had access to subsidized portion-controlled foods during the 6-month run-in and the 12 months of maintenance. The primary outcome was weight change during the 12 months after randomization.

RESULTS

During months 0-12 after randomization, individuals assigned to standard maintenance regained 5.3% ± 0.8% of body weight, while those assigned to intensified maintenance regained 1.6% ± 1.2% of body weight. The difference between groups (3.7% ± 1.4%) was statistically significant (P = 0.01).

CONCLUSIONS

In a primary care population, continued in-person visits during the weight loss maintenance phase led to greater weight loss than contact by mail.

Association of Ideal Cardiovascular Health and Brachial-Ankle Pulse Wave Velocity: A Cross-Sectional Study in Northern China

BACKGROUND

Brachial-ankle pulse wave velocity (baPWV) is an index for evaluating arterial stiffness and is recognized as an independent predictor of an impending cardiovascular event. Limited large-scale population data are available regarding the relationship between baPWV and the change in ideal cardiovascular health (CVH) status, particularly among Asians.

METHODS

A random sample of 5199 participants (≥40 years of age; 40% women) was enrolled in a cross-sectional study in China to examine the association between ideal CVH and baPWV. Arterial stiffness was defined as a baPWV of 1400 cm/second or higher. Information on CVH was collected based on the American Heart Association's CVH definition by measuring all 7 components (nonsmoking status, body mass index, physical activity, healthy diet, normal total cholesterol, blood pressure, and fasting blood glucose), with 1 or 0 for each component, and a score from 0 to 7 for each participant.

RESULTS

A significant and inverse association was found between the ideal CVH score and baPWV (P <.001). The adjusted odds ratios for arterial stiffness prevalence were .17 (95% confidence interval [CI], .11-.26), .26 (95% CI, .19-.35), .42 (95% CI, .32-.52), .54 (95% CI, .42-.69), and .69 (95% CI, .54-.89) for those with CVH scores of 7-6, 5, 4, 3, and 2, respectively, compared with those with a CVH score of 1-0 (P <.001). Similarly graded relationships were observed in different age and gender subgroups (P <.001).

CONCLUSION

The favorable score of ideal CVH was inversely related to baPWV in Chinese adults, supporting the use of ideal CVH metrics as a useful tool for public health efforts.

Weight Loss, Dietary Intake and Pulse Wave Velocity

We have recently conducted a meta-analysis to determine the effect of weight loss achieved by an energy-restricted diet with or without exercise, anti-obesity drugs or bariatric surgery on pulse wave velocity (PWV) measured at all arterial segments. Twenty studies, including 1,259 participants, showed that modest weight loss (8% of the initial body weight) caused a reduction in PWV measured at all arterial segments. However, due to the poor methodological design of the included studies, the results of this meta-analysis can only be regarded as hypothesis generating and highlight the need for further research in this area. In the future, well-designed randomised controlled trials are required to determine the effect of diet-induced weight loss on PWV and the mechanisms involved. In addition, there is observational evidence that dietary components such as fruit, vegetables, dairy foods, sodium, potassium and fatty acids may be associated with PWV, although evidence from well-designed intervention trials is lacking. In the future, the effect of concurrently improving dietary quality and achieving weight loss should be assessed in randomised controlled trials.

Efficacy of commercial weight-loss programs: an updated systematic review

BACKGROUND

Commercial and proprietary weight-loss programs are popular obesity treatment options, but their efficacy is unclear.

PURPOSE

To compare weight loss, adherence, and harms of commercial or proprietary weight-loss programs versus control/education (no intervention, printed materials only, health education curriculum, or <3 sessions with a provider) or behavioral counseling among overweight and obese adults.

DATA SOURCES

MEDLINE and the Cochrane Database of Systematic Reviews from inception to November 2014; references identified by program staff.

STUDY SELECTION

Randomized, controlled trials (RCTs) of at least 12 weeks' duration; prospective case series of at least 12 months' duration (harms only).

DATA EXTRACTION

Two reviewers extracted information on study design, population characteristics, interventions, and mean percentage of weight change and assessed risk of bias.

DATA SYNTHESIS

We included 45 studies, 39 of which were RCTs. At 12 months, Weight Watchers participants achieved at least 2.6% greater weight loss than those assigned to control/education. Jenny Craig resulted in at least 4.9% greater weight loss at 12 months than control/education and counseling. Nutrisystem resulted in at least 3.8% greater weight loss at 3 months than control/education and counseling. Very-low-calorie programs (Health Management Resources, Medifast, and OPTIFAST) resulted in at least 4.0% greater short-term weight loss than counseling, but some attenuation of effect occurred beyond 6 months when reported. Atkins resulted in 0.1% to 2.9% greater weight loss at 12 months than counseling. Results for SlimFast were mixed. We found limited evidence to evaluate adherence or harms for all programs and weight outcomes for other commercial programs.

LIMITATION

Many trials were short (<12 months), had high attrition, and lacked blinding.

CONCLUSION

Clinicians could consider referring overweight or obese patients to Weight Watchers or Jenny Craig. Other popular programs, such as Nutrisystem, show promising weight-loss results; however, additional studies evaluating long-term outcomes are needed.

PRIMARY FUNDING SOURCE

None. (

PROSPERO

CRD4201-4007155).

Using brachial-ankle pulse wave velocity to screen for metabolic syndrome in community populations

The aim of this study is to investigate the viability of using brachial-ankle pulse wave velocity (baPWV) as a primary tool to screen metabolic syndrome (MetS), and to explore the risk factors of MetS in community populations. A total of 1914 subjects completed medical examination in Shanghai. BaPWV was significantly associated with the components of MetS. The area under curve (AUC) and its 95% confidence interval (CI) in total group were 62.50% and 60.00%-65.30% with the appropriate cut-off point being 1435 cm/sec. The AUC (95%CI) of three subgroups (40-50 yrs, 50-60 yrs and over 60 yrs group) were 75.30% (67.48%-83.35%), 63.35% (58.96%-67.60%), 55.37% (51.19%-60.01%), respectively. A clear pattern surfaced in the process of investigation: the younger were the subjects group, the better receiver operating characteristic (ROC) efficacy would emerge; and the higher sensitivity was, the better negative predictive value (NPV) would be. Male gender, high baPWV values, elevated uric acid (UA) and excess hypersensitive C reaction protein (hs-CRP) levels were stayed in the two regression models as the independent risk factors for MetS. We conclude that baPWV may serve as a potential screening tool for MetS at the cut-off point of 1435 cm/sec.