Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases

Effects of Year Long Aerobic Exercise on Left Atrial Size in Patients With Left Ventricular Hypertrophy

Habitual aerobic exercise is associated with left atrial (LA) enlargement which may increase risk of atrial fibrillation. Patients with LVH and increased LV stiffness may be more predisposed to LA remodeling due to higher LA pressures during exercise. We tested the hypothesis 1 year of aerobic exercise training would increase LA size to a greater extent in patients with LVH than controls. Adults with LVH (n = 53) enriched for increased cardiac risk and LV stiffness and control (CON) subjects (n = 58) were randomized to 1 year of high intensity aerobic exercise (ex) or yoga control. LA and LV volumes were measured using 3D echo. Of 111 participants, 83 had complete data available (LVH: 18 exercisers, 10 yoga; CON: 29 exercisers, 26 yoga). Baseline LA volume indices were similar between groups (LVH: 19.8 ± 4.4 mL/m2 vs CON: 18.8 ± 4.1 mL/m2; p = 0.33). After 1 year, the effects of exercise (p = 0.003) and LVH (p = 0.001) were each associated with increased LA volume index. More subjects in the LVH/exercise group (33.3%) increased LA size >5 mL/m2 and LA/LV volume ratios >0.1 compared to the other groups (10% LVH/yoga, 3.4% CON/ex, 3.8% CON/yoga; Chi square p = 0.006). In conclusion, 1 year of aerobic training resulted in higher LA volumes in subjects with LVH and LV stiffness compared to healthy subjects. The increase in LA size was greater than changes in LV size suggesting chronic aerobic training in may preferentially affect LA remodeling in subjects with LVH and LV stiffness.

Mechanisms of the Native American pain inequity: predicting chronic pain onset prospectively at 5 years in the Oklahoma Study of Native American Pain Risk

ABSTRACT

A pain inequity exists for Native Americans (NAs), but the mechanisms are poorly understood. The Oklahoma Study of Native American Pain Risk (OK-SNAP) addressed this issue and recruited healthy, pain-free NAs and non-Hispanic Whites (NHWs) to attend 2 laboratory visits and assessed mechanisms consistent with the biopsychosocial model of pain: demographics, physical variables, psychosocial factors, and nociceptive/pain phenotypes. Then participants were surveyed every 6 months to assess for chronic pain onset. Results at the 2-year follow-up found that NAs were ∼3x more likely than NHWs to develop chronic pain. Moreover, psychosocial factors (discrimination, stress, pain-related anxiety), cardiometabolic load (higher body mass index and blood pressure, lower heart rate variability), and impaired inhibition of spinal nociception partly mediated the pain inequity. The present study examined mechanisms of chronic pain at the 5-year follow-up for OK-SNAP. Results found that the NA pain inequity worsened-NAs were 4x more likely to develop chronic pain (OR = 4.025; CI = 1.966, 8.239), even after controlling for baseline age, sex assigned at birth, income, and education. Moreover, serial mediation models replicated paths from the 2-year follow-up that linked psychosocial variables, cardiometabolic load, and impaired inhibition of spinal nociception to chronic pain onset. Further, 2 new significant paths were observed. One linked discrimination, stress, sleep problems, and facilitated pain perception to increased pain risk. The other linked discrimination with higher spinal nociceptive threshold and pain risk. These results provide further evidence for a NA pain inequity and identify multiple psychosocial, cardiometabolic, and pronociceptive targets for primary interventions.

Metabolic Response After a Single Maximal Exercise Session in Physically Inactive Young Adults (EASY Study): Relevancy of Adiponectin Isoforms

The metabolic response to a maximal exercise test in physically inactive adults remains poorly understood, particularly regarding the role of adiponectin, an adipokine with insulin-sensitizing and anti-inflammatory properties. Adiponectin circulates in three isoforms-low (LMW), medium (MMW), and high-molecular-weight (HMW)-with differing bioactivities. While exercise is known to influence adiponectin levels, evidence is conflicting, and few studies have explored isoform-specific changes. This study aimed to evaluate the effects of a single maximal exercise session on circulating adiponectin isoforms and their associations with metabolic and kidney function markers in physically inactive young adults. In this quasi-experimental study, twenty-one physically inactive participants (mean age 24.6 ± 2.1 years, 85.7% women) completed a progressive cycle ergometer test. Circulating levels of LMW and MMW adiponectin, metabolic outcomes (e.g., cholesterol, triglycerides, fibroblast growth factor 21 (FGF21)), and kidney function markers (e.g., creatinine, proteinuria) were assessed before and after exercise using biochemical assays and Western blotting. Comparisons between pre- and post-exercise values were made with the Wilcoxon test. Exercise increased lipid metabolism markers (total cholesterol, triglycerides, HDL) and kidney stress indicators (albuminuria, proteinuria) (p < 0.05). LMW and MMW adiponectin levels showed no significant overall changes, but LMW adiponectin positively correlated with changes in total cholesterol and FGF21, while MMW adiponectin negatively correlated with creatinine and proteinuria (p < 0.05). HMW adiponectin was undetectable by our methods. A single maximal exercise session revealed isoform-specific associations between adiponectin and metabolic or kidney stress markers, emphasizing the complex role of adiponectin in exercise-induced metabolic responses. Future research should explore mechanisms underlying these differential associations to optimize exercise interventions for metabolic health improvement.

Provider Lifestyle Counseling Among Adults With Cardiometabolic Disease Diagnosis Differs by Sociodemographic Characteristics and Lifestyle Modification: NHANES 2017-2020

Background

Provider lifestyle counseling is important for improving lifestyles and cardiometabolic disease (CMD) prognosis. However, an examination of the relationship between sociodemographic characteristics, lifestyle modification and provider lifestyle counseling receipt among adults with CMD is scarce. The study examined the prevalence and associations of lifestyle modification and sociodemographic characteristics with provider lifestyle counseling among adults with CMD diagnosis.

Methods

We used cross-sectional data from 2017-2020 National Health and Nutrition Examination Survey (N = 4847). Provider lifestyle counseling (i.e., advice to control/lose weight, exercise, reduce salt, and reduce fat/calories), and lifestyle modification (yes or no) were assessed. Adjusted odds ratios were evaluated using logistic regression models.

Results

Among the sample of adults with CMD, 44.6% received advice to lose weight, 56.1% to exercise, 36.1% to reduce salt, and 43.9% to reduce fat/calories. Adults who made lifestyle modifications had higher odds of receiving advice to lose weight (OR: 1.81), exercise (OR: 1.95), reduce salt (OR: 2.23) and reduce calories (OR: 2.66). Age, sex, race/ethnicity, educational attainment, and insurance were associated with provider lifestyle counseling.

Conclusion

Provider lifestyle counseling is generally suboptimal among U.S. adults with lifetime diagnosis of CMD, and the odds of counseling receipt differ by sociodemographic characteristics and lifestyle modification. CMD control should involve training providers to increase lifestyle counseling.

Assessment of Long-Term Engagement in Aerobic Versus Resistance Exercise on 20-Year Cardiovascular Disease Incidence (2002-2024): The ATTICA Epidemiological Cohort Study

Objective: The aim of this study was to assess whether aerobic exercise, as opposed to resistance training or a combination of both, is associated with long-term cardiovascular outcomes. Methods: The ATTICA study is a population-based cohort study with a 20-year follow-up (2002-2022); it was conducted in the Attica region, Greece, and included 3042 adult participants (45 ± 11 years, 1518 females). Physical activity engagement in aerobic, resistance, or combined exercise, and 20-year tracking, together with information regarding atherosclerotic cardiovascular disease (ASCVD) incidence were available for 1988 participants (45 ± 12 years old, 987 males, 1001 females). Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all follow-up examinations (2001-2002, 2006, 2012, and 2022). Cox proportional hazard models were applied; the results are presented as hazard ratio (HR) and 95% confidence intervals (CIs). Results: Participants engaged in the combined (aerobic and resistance) physical activity group had 0.41-times [95%CI (0.20, 0.82)] lower ASCVD risk compared to inactive participants; participants in the healthy engaging aerobic physical activity (HEPA) group had 0.54-times [95%CI (0.36, 0.80)] lower ASCVD risk; no significant associations were observed regarding the minimally active aerobic group [HR, 0.81, 95%CI (0.57, 1.17)], or the resistance training only group [HR, 1.17, 95%CI (0.25, 1.52)]. Conclusions: These findings carry a strong public health message, underscoring the importance of incorporating aerobic or combined aerobic-resistance training into physical activity guidelines to enhance cardiovascular health and reduce the long-term risk of CVD.

Clockwork conditioning: Aligning the skeletal muscle clock with time-of-day exercise for cardiometabolic health

Circadian rhythms have evolved to synchronize gene expression, physiology, and behavior with time-of-day changes in the external environment. In every mammalian cell exists a core clock mechanism that consists of a transcriptional-translational feedback loop that drives rhythmic gene expression. Circadian disruption, as observed in shift workers and genetic mouse models, contributes to the onset and progression of cardiometabolic disorders. The central clock, located in the hypothalamus, is uniquely sensitive to external light cues, while the peripheral clocks are responsive to non-photic stimuli such as feeding and activity in addition to signals from the central clock. Recent research has illustrated the sensitivity of the skeletal muscle circadian clock to exercise timing, offering a promising avenue for therapeutic intervention in cardiometabolic health. Here we provide an in-depth examination of the molecular mechanisms underlying skeletal muscle clock function and its impact on cardiometabolic pathways, including glucose and lipid metabolism, as well as inflammation. To highlight the role of exercise as a time-cue for the skeletal muscle clock, we discuss evidence of exercise-induced shifts in the skeletal muscle clock and the differential response to exercise performed at different times of the day. Furthermore, we present data in support of time-of-day exercise as a potential therapeutic strategy for mitigating cardiometabolic disease burden. By exploring the relationship between the skeletal muscle clock, exercise timing, and cardiometabolic health, we identify new areas for future research and offer valuable insights into novel therapeutic approaches aimed at improving cardiometabolic disease outcomes.

Unraveling the relationship between sleep behaviors and physical activity in the United States: insights from 2015 to 2020 NHANES data

BACKGROUND

Physical activity is an important component of metabolic health. However, little is known about the impact of specific types/intensities of physical activity on sleep health, especially among ethnically diverse populations. We examined the association of various sleep behaviors with moderate to vigorous work/recreational activity.

METHODS

Self-reported data from the National Health and Nutrition Examination Survey 2015-2020 were cross-sectionally analyzed for a sample of 11,039 participants in the United States (U.S.). Weighted univariate logistic regressions determined unadjusted associations, while weighted multivariable regression models adjusting for age, sex, ethnicity, BMI categories, and socio-economic status assessed the multivariable associations with moderate and vigorous work/recreational activity. Stratified analyses were performed to determine across-group differences by ethnicity and BMI categories.

RESULTS

Of 11,039 adults (mean age 41 years), 50.7% were female, 59.8% were Non-Hispanic White, 17.8% Hispanic/Latino, 12% Non-Hispanic Black, 6.3% Non-Hispanic Asian, and 4.1% other/multiple ethnicities. Moderate work activity increased the odds of short sleep duration [aOR = 1.42; 95% CI: 1.22, 1.65], snoring [aOR = 1.45; 95% CI: 1.21, 1.73], breath cessation [aOR = 1.37; 95% CI: 1.18, 1.59], and daytime sleepiness [aOR = 1.63; 95% CI: 1.39, 1.91]. Vigorous recreational activity reduced the odds of short sleep duration [aOR = 0.81; 95% CI: 0.71, 0.94] and trouble sleeping [aOR = 0.83; 95% CI: 0.73, 0.96]. Stratified analyses indicated significant ethnicity-based differences in the odds of sleep behaviors across physical activity groups and increased odds of poor sleep behaviors among participants who were underweight, overweight or had obesity.

CONCLUSION

Work-related activity was significantly associated with suboptimal sleep behaviors while recreational activity was associated with favorable sleep behaviors. These associations were more pronounced among certain ethnic groups. Further longitudinal investigation is needed to examine the mechanism driving the relationship between sleep behaviors and physical activity.

Impact of Taekwondo training on cognitive and physical function in elderly individuals: A comprehensive review of randomized controlled trials

BACKGROUND

Researchers have investigated the physical and psychosocial advantages of Taekwondo for older adults. However, prior studies of Taekwondo's impact on physical function and psychological well-being in this demographic have produced inconsistent findings. Thus, this systematic review aimed to assess how Taekwondo practice affects the physical function and psychological well-being of older adults.

METHODS

We systematically searched PubMed, EMBASE, CINAHL, SPORTDiscus, Scopus, Korea Education and Research Information Service, Korean Studies Information Service System, Korean National Assembly Library, Research Information Sharing Service, National Digital Science Library, and China National Knowledge Infrastructure from their inception to December 2023. Two reviewers independently selected and extracted data from each study. We calculated effect sizes using a random-effects model with a 95 % confidence interval (CI) and evaluated study quality using the Physiotherapy Evidence Database scale.

RESULTS

This review included ten studies with 227 participants aged 66.1-73.6 years. The meta-analysis revealed significant enhancements in cognitive function [Korean Version of Mini-Mental State Examination, standard mean difference (SMD) = 0.700, 95 % CI (0.364-1.037), I2 = 0 %, p < .001], blood indicators [β-amyloid, SMD = 0.613, 95 % CI (0.103-1.123), I2 = 34.920 %, p < .05; brain-derived neurotrophic factor, SMD = 0.566, 95 % CI (0.166-0.966), I2 = 0 %, p < .01; high-density lipoprotein cholesterol, SMD = 0.677, 95 % CI (0.357-0.966), I2 = 0 %, p < .001; low-density lipoprotein cholesterol, SMD = 0.809, 95 % CI (0.376-1.242), I2 = 42.621 %, p < .001; and total cholesterol, SMD = 0.979, 95 % CI (0.603-1.356), I2 = 22.221 %, p < .001], and physical function [lean body mass, SMD = 0.465, 95 % CI (0.109-0.821), I2 = 0 %, p < .05, and handgrip strength, SMD = 0.929, 95 % CI (0.194-1.663), I2 = 48.217 %, p < .05].

CONCLUSIONS

This meta-analysis indicates that Taekwondo training is a beneficial therapy with protective effects on cognitive function, physical function, and body composition in older adults. These findings highlight its potential significance in cognitive rehabilitation and physiological health promotion among this demographic population.

High-intensity interval swimming improves cardiovascular endurance, while aquatic resistance training enhances muscular strength in older adults

The aim of this study was to examine the effects of free swimming (FS), aquatic resistance training (ART), and their combination (FS&ART) on the body composition, blood pressure, and physical fitness of older adults. The study employed a randomized controlled design, comparing three experimental groups with a control group. Eighty volunteers aged between sixty and seventy years (age: 66.2 ± 2.3 years; body mass index: 25.8 ± 4.3 kg/m²) participated in the 16-week intervention, consisting of two weekly sessions. Assessments were conducted at baseline and post-intervention, including anthropometric measurements, blood pressure readings, and the Senior Fitness Test. Significant differences were found between groups in post-intervention considering the chair stand test (p = 0.017; ES = 0.125), arm curl test (p = 0.029; ES = 0.111), 8-foot up and go test (p = 0.042; ES = 0.102), and walk test - 6 min (p = 0.005; ES = 0.156). Specifically, both ART (+ 20.1%; p < 0.05) and FS&ART (+ 19.5%; p < 0.05) showed significantly greater improvements in the chair stand test compared to the control group. Similarly, ART (+ 23.1%; p < 0.05) and FS&ART (+ 18.7%; p < 0.05) performed better than the control group. FS&ART also exhibited a significant improvement over the control group in the 8-foot up-and-go test (+ 14.6%; p < 0.05). In the 6-minute walk test, FS (+ 19.4%; p < 0.05) and FS&ART (+ 15.9%; p < 0.05) both significantly outperformed the control group. This study found that FS improves cardiovascular endurance, while ART enhances muscular strength and endurance in older adults, with combined benefits for agility, suggesting integration of combined modalities into community wellness initiatives for enhanced physical fitness and health outcomes.

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Variations in Postmenopausal Body Composition: A Cross-Sectional Comparison between Physical Activity Practitioners and Sedentary Individuals

Physical activity is broadly recognized for promoting weight reduction and bestowing numerous health benefits. Nonetheless, robust evidence concerning the impact of physical activity on postmenopausal women, undergoing physiological shifts, remains scant. This study aimed to elucidate the relationship between physical activity and body composition among postmenopausal women. Employing a cross-sectional and retrospective design, 702 women were examined. Data on physical activity and body composition were amassed through anthropometric assessments and Dual-Energy X-ray Absorptiometry (DEXA). A significant proportion of women exhibited anthropometric alterations indicative of overweight/obesity, alongside elevated values in Waist Circumference (WC), Waist-to-Hip Ratio, Waist-to-Height, and bone mass, signifying a heightened risk for disease onset. While a majority engaged in some form of physical activity, this did not yield notable reductions in the assessed metrics. Noteworthy changes were only discerned in BMI and bone mass among pre-menopausal women; whereas among postmenopausal women, in addition to disparities in bone mass, those inactive were 1.18 times more prone to a very high disease risk, as gauged by WC.

Prevention of cardiovascular disease in young adults: Focus on gender differences. A collaborative review from the EAS Young Fellows

A steady rise in cardiovascular morbidity and mortality has been observed in young adults within the last decades. This trend corresponds to an increasing prevalence of traditional cardiovascular risk factors such as obesity and diabetes mellitus type 2 among young adults living in developed countries. Moreover, age-specific risk factors, such as substance abuse, contraceptive medication, and pregnancy-related diseases also correlate with an increased incidence of cardiovascular diseases. In this review, we discuss the available data for young adults on the epidemiology and the rationale for the causality of traditional and newly emerging risk factors of atherosclerotic cardiovascular diseases. We focus on gender-related differences in the exposure to these risk factors, investigate the recent data regarding screening and risk stratification in the young adult population, and describe the current state of the art on lifestyle and therapeutic intervention strategies in the primary prevention setting.

Sex Associations Between Air Pollution and Estimated Atherosclerotic Cardiovascular Disease Risk Determination

Objective: The purpose of this study was to investigate the sex correlations of particulate matters (PM2.5, PM10, PM2.5-10), NO2 and NOx with ASCVD risk in the UK Biobank population. Methods: Among 285,045 participants, pollutants were assessed and correlations between ASCVD risk were stratified by sex and estimated using multiple linear and logistic regressions adjusted for length of time at residence, education, income, physical activity, Townsend deprivation, alcohol, smocking pack years, BMI and rural/urban zone. Results: Males presented higher ASCVD risk than females (8.63% vs. 2.65%, p < 0.001). In males PM2.5, PM10, NO2, and NOx each were associated with an increased ASCVD risk >7.5% in the adjusted logistic models, with ORs [95% CI] for a 10 μg/m3 increase were 2.17 [1.87-2.52], 1.15 [1.06-1.24], 1.06 [1.04-1.08] and 1.05 [1.04-1.06], respectively. In females, the ORs for a 10 μg/m3 increase were 1.55 [1.19-2.05], 1.22 [1.06-1.42], 1.07 [1.03-1.10], and 1.04 [1.02-1.05], respectively. No association was observed in both sexes between ASCVD risk and PM2.5-10. Conclusion: Our findings may suggest the possible actions of air pollutants on ASCVD risk.

Association between Social Isolation and Loneliness with Estimated Atherosclerotic Cardiovascular Disease Risk in a UK Biobank Population-Based Study

OBJECTIVE

The association of cardiovascular (CV) risk with social isolation and loneliness remains poorly studied. The purpose of this cross-sectional study was to investigate the associations between social isolation and loneliness with estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

METHODS

Among 302,553 volunteers of the UK Biobank population, social isolation and loneliness were assessed with a questionnaire. Associations between social isolation and loneliness with ASCVD risk were estimated using multiple gender regressions.

RESULTS

Men presented a higher estimated 10-year ASCVD risk (8.63% vs. 2.65%, p < 0.001) and higher proportions of social isolation (9.13% vs. 8.45%, p < 0.001) and loneliness (6.16% vs. 5.57%, p < 0.001) than women. In all covariate-adjusted models, social isolation was associated with an increased ASCVD risk in men (B = 0.21 (0.16; 0.26), p < 0.001) and women (B = 0.12 (0.10; 0.14), p < 0.001). Loneliness was associated with an increased ASCVD risk in men (B = 0.08 (0.03; 0.14), p = 0.001) but not in women (p = 0.217). A significant interaction was observed between social isolation and loneliness with ASCVD risk in men (p = 0.009) and women (p = 0.016). After adjustment for all covariates, both social isolation and loneliness were significantly associated with ASCVD risk in men (B = 0.44 (0.28; 0.61), p < 0.001) and women (B = 0.20 (0.12; 0.29), p < 0.001).

CONCLUSION

Social isolation was associated with a higher estimated 10-year ASCVD risk in both genders but only loneliness among men. Social isolation and loneliness can be considered potential added risk factors for CV risk. Health policies should address these notions in prevention campaigns, in addition to traditional risk factors.