Physical Activity Over the Lifecourse and Cardiovascular Disease

Exploring the Path Between Life-Course Trajectories of Physical Activity Levels and Cardiometabolic Disease Incidence: Insights From the ATTICA Cohort Study (2002-2022)

OBJECTIVE

To evaluate the paths between lifelong physical activity levels and the development of cardiometabolic disease.

METHODS

The ATTICA is a population-based cohort study with a 20-year follow-up conducted in the Attica region, Greece and included, 3042 adult males and females (45 [11] y). Participants physical activity levels' tracking together with data regarding cardiovascular disease, obesity, hypertension, hypercholesterolemia, and diabetes incidence, were available in 1988 participants (45 [12] y old, 987 males and 1001 females), at 20-year follow-up. Physical activity levels were evaluated using the validated International Physical Activity Questionnaire, in all examinations (2001-2002, 2006, 2012, and 2022). Four physical activity trajectories were defined, that is, consistently active/inactive and changed from active/inactive. Path analysis was applied using structure equation models.

RESULTS

54% of participants were classified as always inactive, 5% classified as became inactive from physically active, 38% as became active and, only 3% sustained physical activity levels. Participants who reported being consistently physically active throughout the 20-year period were 6% (OR, 0.94, 95% CI, 0.89-0.99) less likely to develop cardiovascular disease as compared with those who remained consistently physically inactive, had 21% lower risk of developing hypercholesterolemia (OR, 0.79, 95% CI, 0.59-1.04), 33% lower risk of obesity (OR, 0.67, 95% CI, 0.44-1.02), and 30% lower risk of diabetes (OR, 0.70, 95% CI, 0.48-1.03).

CONCLUSIONS

Lifelong physical activity was strongly associated with reduced fatal or nonfatal cardiovascular disease events, as well as reduced risk of developing other cardiometabolic disorders, hypercholesterolemia, obesity, and diabetes.

Latest developments of microphysiological systems (MPS) in aging-related and geriatric diseases research: A review

Aging is a gradual and irreversible process accompanied by the decline in tissue function and a significantly increased risk of various aging-related and geriatric diseases. Especially in the paradoxical context of accelerated global aging and the widespread emergence of pandemics, aging-related and geriatric diseases have become leading causes of individual mortality and disability, drawing increasing attention from researchers and investors alike. Despite the utility of current in vitro systems and in vivo animal models for studying aging, these approaches are limited by insurmountable inherent constraints. In response, microphysiological systems (MPS), leveraging advances in tissue engineering and microfluidics, have emerged as highly promising platforms. MPS are capable of replicating key features of the tissue microenvironment within microfabricated devices, offering biomimetic tissue culture conditions that enhance the in vitro simulation of intact or precise human body structure and function. This capability improves the predictability of clinical trial outcomes while reducing time and cost. In this review, we focus on recent advancements in MPS used to study age-related and geriatric diseases, with particular emphasis on the application of organoids and organ-on-a-chip technologies in understanding cardiovascular diseases, cerebrovascular diseases, neurodegenerative diseases, fibrotic diseases, locomotor and sensory degenerative disorders, and rare diseases. And we aim to provide readers with critical guidelines and an overview of examples for modeling age-related and geriatric diseases using MPS, exploring mechanisms, treatments, drug screening, and other subsequent applications, from a physiopathological perspective, emphasizing the characteristic of age-related and geriatric diseases and their established correlations with the aging process. We also discuss the limitations of current models and propose future directions for MPS in aging research, highlighting the potential of interdisciplinary approaches to address unresolved challenges in the field.

[How do people with long COVID cope with their symptoms and everyday limitations? A qualitative study with four focus groups]

BACKGROUND

The heterogenous and fluctuating intensity of long COVID symptoms poses a challenge to both patients and healthcare providers due to a lack of causal treatment options. The aim of supportive therapies is to help individuals cope with symptoms in daily life and maintain functionality. This study aims to identify coping strategies employed by those affected by long COVID and their perceived benefits.

METHODS

A qualitative study was conducted with four focus groups comprising 23 adult patients suffering from long COVID. The recorded and transcribed group discussions were analyzed using content-structuring content analysis according to Kuckartz. The results were then systematically analyzed, interpreted, and put in a theoretical context.

RESULTS

Participants utilized healthcare resources but developed their own strategies for dealing with long COVID because of their dissatisfaction with medical care. These strategies included energy and resource management, physical activity, enhancing health literacy, changing mindset and lifestyle, infection prevention, using medical aids, and dietary changes.

CONCLUSIONS

This study demonstrates that people with long COVID employ a variety of strategies to cope with impairments in everyday life. According to the interviewees, integrating these approaches into the treatment of long COVID can help to reduce the burden of symptoms on those affected, restore their everyday functionality, and improve their self-efficacy and quality of life. Established concepts like "pacing" or "shared-decision making" can serve as a starting point for developing individualized coping strategies and treatment concepts together with patients.

Inverse associations of the lifestyle critical 9 with cardiorenal syndrome: the mediating role of the dietary inflammatory index

Background

Cardiorenal syndrome (CRS) represents a burgeoning global health concern characterized by its increasing prevalence. Life's Crucial 9 (LC9), an innovative tool for cardiovascular health assessment, and the Dietary Inflammatory Index (DII), which quantifies diet's impact on body inflammation, have not been previously studied in conjunction regarding their association with CRS.

Objective

This study aims to explore the relationship between LC9 and CRS, using data from the National Health and Nutrition Examination Survey (NHANES), and to examine whether DII serves as a mediator in this association.

Methods

This research included data from 25,792 NHANES participants spanning from 2005 to 2018. The study leverages the dataset's comprehensive representativeness and robust statistical power to ensure generalizable and reliable findings. We employed weighted logistic regression to evaluate the association between LC9 scores and CRS presence, conducted subgroup analyses, and performed mediation analysis to investigate the role of DII.

Results

Our analysis demonstrated a significant inverse relationship between LC9 and CRS. Upon controlling for confounders, each 10-point rise in LC9 correlates with a 26% reduction in CRS prevalence (p < 0.001). Additionally, stratifying LC9 into tertiles with T1 as the reference group revealed that T2 (OR = 0.59, 95% CI = 0.48-0.72, p < 0.001) and T3 (OR = 0.57, 95% CI = 0.38-0.88, p < 0.001) exhibited a strong negative correlation trend. The dose-response curve illustrates a linear relationship between LC9 and CRS; as LC9 increases, the occurrence of CRS decreases. DII shows a significant positive connection with CRS (p < 0.001), but DII indicates a decreasing trend when LC9 rises (β = -0.65, p < 0.001). Mediation analysis reveals that DII mediates the association between LC9 and CRS, with a mediation proportion of 12.5% (p < 0.001).

Conclusion

The findings indicate a robust inverse correlation between LC9 scores and CRS incidence, with DII is associated with this relationship. This suggests potential preventive strategies against CRS through lifestyle modifications guided by LC9.

Neuroimmune Interactions and Their Role in Immune Cell Trafficking in Cardiovascular Diseases and Cancer

Sympathetic nerves innervate bone marrow and various immune organs, where norepinephrine-the primary sympathetic neurotransmitter-directly interacts with immune cells that express adrenergic receptors. This article reviewed the key molecular pathways triggered by sympathetic activation and explored how sympathetic activity influences immune cell migration. Norepinephrine serves as a chemoattractant for monocytes, macrophages, and stem cells, promoting the migration of myeloid cells while inhibiting the migration of lymphocytes at physiological concentrations. We also examined the role of immune cell infiltration in cardiovascular diseases and cancer. Evidence suggests that sympathetic activation increases myeloid cell infiltration into target tissues across various cardiovascular diseases, including atherosclerosis, hypertension, cardiac fibrosis, cardiac hypertrophy, arrhythmia, myocardial infarction, heart failure, and stroke. Conversely, inhibiting sympathetic activity may serve as a potential therapeutic strategy to treat these conditions by reducing macrophage infiltration. Furthermore, sympathetic activation promotes macrophage accumulation in cancer tissues, mirroring its effects in cardiovascular diseases, while suppressing T lymphocyte infiltration into cancerous sites. These changes contribute to increased cancer growth and metastasis. Thus, inhibiting sympathetic activation could help to protect against cancer by enhancing T cell infiltration and reducing macrophage presence in tumors.

Age-Dependent Relationship of Physical Inactivity With Incident Cardiovascular Disease: Analysis of a Large Japanese Cohort

BACKGROUND

There have been limited studies examining age-dependent associations between physical inactivity and cardiovascular disease (CVD). We aimed to clarify the age-dependent relationship of physical inactivity with incident CVD.

METHODS

We analyzed 1,097,424 participants, aged 18 to 105 years, without histories of CVD, enrolled in the DeSC database (median age, 63 years; 46.4% men). We categorized participants into the following 4 groups based on age: ≤ 44 years (n = 203,835); 45 to 64 years (n = 403,619); 65 to 79 years (n = 437,236); and ≥ 80 years (n = 52,734). We used 3 physical inactivity components gained from the self-reported questionnaire during a health checkup. The outcomes were composite CVD events including myocardial infarction, stroke, heart failure, and each CVD event.

RESULTS

During a mean follow-up of 3.2 ± 1.9 years, 81,649 CVD events were observed. The hazard ratios of 3 physical inactivity components for CVD events increased with age category (P for interaction < 0.001). For example, the hazard ratio (95% confidence interval) of physical inactivity defined as not doing light sweaty exercise for 30 minutes at least twice a week for incident CVD in the groups aged ≤ 44 years, 45 to 64 years, 65 to 79 years, and ≥ 80 years were 0.97 (0.88-1.05), 1.08 (1.05-1.12), 1.12 (1.10-1.15), and 1.17 (1.12-1.21), respectively (P for interaction < 0.001). This association was consistent across subtypes of CVD including heart failure, myocardial infarction, and stroke.

CONCLUSIONS

The association of physical inactivity with a higher risk of developing CVD increased with age. Preventive efforts for physical activity optimization may be more valuable in older people.

The Acquisition of Cardiovascular Adaptation to Aerobic Exercise: When Does It Begin and How Does It Evolve Depending on Intrinsic and Extrinsic Factors?

The acquisition and evolution of cardiovascular (CV) adaptation to physical activity or exercise training are critical in enhancing cardiorespiratory fitness and reducing CV disease (CVD) risk. CV adaptations to exercise occur through structural, functional, and molecular changes that enhance cardiac efficiency. These adaptations, such as increased stroke volume, improved blood pressure regulation, and enhanced endothelial function, collectively reduce CVD morbidity and mortality. In this review we explore how CV adaptations vary across different demographic characteristics, and highlight the importance of exercise timing, intensity, and recovery periods. We delve into the immediate physiological responses to physical activity, such as increased heart rate and cardiac output, and the longer-term adaptations, including cardiac hypertrophy and improved vascular function. The influence of age, sex, and preexisting health conditions on CV responses to exercise is also discussed, emphasizing the need for tailored exercise interventions. Finally, the review highlights the significance of recovery periods in optimizing CV adaptations and how insufficient recovery might lead to adverse outcomes. Overall, understanding the timing and evolution of CV adaptations can inform exercise prescriptions to improve CV health across populations for the primary and secondary prevention of CVD.

Different Intensities of Physical Activity and Risk of Male Genital Cancers: Exploring Potential Causal Relationships

Physical activity is associated with cancer of the male genitalia. However, the genetic causality of this association remains unclear. In this study, Mendelian randomization (MR) was used to explore the potential causal relationship between different intensities of physical activity and cancer of the male genitalia. This study utilized single nucleotide polymorphisms (SNPs) associated with vigorous exercise obtained from published genome-wide association studies (GWAS) and summary genetic data associated with male genital cancer from published GWAS. The main analysis method used was the inverse variance weighted (IVW) method for two-sample MR analysis. The heterogeneity of the results was assessed using Cochran's Q statistic, while horizontal pleiotropy was assessed using MR-Egger. Sensitivity analysis included a "leave-one-out" test. The results showed that light DIY activity was a risk factor for male genital cancer (OR = 1.045, 95% confidence interval [1.004, 1.089], p = .033). The result passed the sensitivity test. This study found the effect of light DIY activities on male genital cancer. Future studies should further explore the impact of different types of physical activity on specific types of male genital cancer to improve relevant prevention strategies.

Physical Inactivity and Cardiovascular Health in Aging Populations: Epidemiological Evidence and Policy Implications from Riyadh, Saudi Arabia

BACKGROUND

Cardiovascular Diseases (CVDs) are the leading cause of morbidity and mortality globally, particularly among older adults. Physical inactivity, a modifiable risk factor, is strongly associated with the development and progression of CVD through its correlation with hypertension, diabetes, obesity, and hyperlipidemia. This study examines the association between physical inactivity and cardiovascular health among older adults in the Riyadh region, Saudi Arabia.

METHODS

A cross-sectional study was conducted on 168 participants aged 60 years and older attending a tertiary hospital in Riyadh. Data were collected using a structured questionnaire, the Physical Activity Scale for the Elderly (PASE), anthropometric measurements, and medical record reviews. Cardiovascular health indicators and risk factors were analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression.

RESULTS

Participants with low physical activity levels had a higher prevalence of hypertension (78.2%), diabetes (64.4%), and obesity (51.3%) compared to those with high activity levels (41.8%, 28.7%, and 22.3%, respectively). Multivariate analysis showed that physical inactivity was significantly associated with an increased likelihood of CVD (adjusted OR: 1.98, p < 0.001), with hypertension and diabetes also being strong predictors.

CONCLUSIONS

Physical inactivity is strongly correlated with adverse cardiovascular outcomes in older adults. Interventions targeting increased physical activity are essential to reducing the CVD burden. Community-based programs and policy-driven initiatives tailored to the Riyadh region's specific environmental and cultural factors are crucial in promoting active lifestyles among aging populations.

The Emerging Role of m6A and Programmed Cell Death in Cardiovascular Diseases

N6-methyladenosine (m6A) is the most prevalent internal chemical modification in eukaryotic messenger RNA (mRNA), significantly impacting its lifecycle through dynamic and reversible processes involving methyltransferase, demethylase, and binding proteins. These processes regulate mRNA stability, splicing, nuclear export, translation, and degradation. Programmed cell death (PCD), a tightly controlled process encompassing apoptosis, pyroptosis, ferroptosis, autophagy, and necroptosis, plays a crucial role in maintaining cellular homeostasis, tissue development, and function. Recently, m6A modification has emerged as a significant research area due to its role in regulating PCD and its implications in cardiovascular diseases (CVDs). In this review, we delve into the intricate relationship between various PCD types and m6A modification, emphasizing their pivotal roles in the initiation and progression of CVDs such as myocardial ischemia-reperfusion (I/R), atherosclerosis (AS), pulmonary hypertension (PH), cardiomyopathy, doxorubicin (Dox)-induced cardiotoxicity (DIC), heart failure (HF), and myocardial infarction (MI). Our findings underscore the potential of elucidating the roles of m6A and PCD in CVD to pave new pathways for prevention and treatment strategies.

Leukoglycemic Index and Its Prognostic Implications in Diabetic and Nondiabetic Patients with Acute Pulmonary Embolism

BACKGROUND The leuko-glycemic index (LGI) combines the white blood cell count and blood glucose levels and is calculated by multiplying the 2 values and dividing them by 1000. This study aimed to compare the prognostic value of the LGI in 199 patients with acute pulmonary embolism (APE) with and without diabetes mellitus. MATERIAL AND METHODS This study was conducted retrospectively on 199 patients who were admitted to the Emergency Department of Sakarya Training and Research Hospital between January 1, 2019, and December 31, 2022, and received a diagnosis of APE by pulmonary angiography. The patients were divided into 2 groups, diabetic and nondiabetic, based on their medical history. The groups were compared in terms of mortality according to the optimal cut-off value of LGI. RESULTS Of the 199 patients with APE included in the study, 61% were women and 39% were men. Mortality was higher in the diabetic group, and a simplified Pulmonary Embolism Severity Index score ≥1 was an independent predictor of all-cause mortality during the 30-day follow-up in the nondiabetic group (P=0.024). Multivariate logistic regression analysis showed that LGI was not an independent predictor of all-cause mortality during the first 30 days of follow-up in either group (P>0.05). CONCLUSIONS Mortality was higher in patients with diabetes and APE. However, the LGI was not an independent predictor of mortality in patients with or without diabetes. Since there are not enough studies on this subject, this result needs to be supported by additional research.

PEGylated Ultrasmall Iron Oxide Nanoparticles as MRI Contrast Agents for Vascular Imaging and Real-Time Monitoring

Accurate imaging evaluations of pre- and post-treatment of cardiovascular diseases are pivotal for effective clinical interventions and improved patient outcomes. However, current imaging methods lack real-time monitoring capabilities with a high contrast and resolution during treatments. This study introduces PEGylated ultrasmall iron oxide nanoparticles (PUSIONPs), which have undergone comprehensive safety evaluations, boasting an r1 value of 6.31 mM-1 s-1, for contrast-enhanced magnetic resonance angiography (MRA). Systematic comparisons against common clinical methods in rabbits reveal that PUSIONPs-enhanced MRA exhibited improved vascular contrast, clearer vascular boundaries, and superior vessel resolution. Moreover, owing to their nanosize, PUSIONPs demonstrate significantly prolonged blood circulation compared to small molecular contrast agents such as Magnevist and Ultravist. This extended circulation enables captivating real-time monitoring of thrombolysis treatment for up to 4 h in rabbit models postsingle contrast agent injection. Additionally, in larger animal models such as beagles and Bama minipigs, PUSIONPs-enhanced MRA also showcases superior contrast effects, boundary delineation, and microvessel visualization, underscoring their potential to transform cardiovascular imaging, particularly in real-time monitoring and high-resolution visualization during treatment processes.

Gender-specific dual effects of physical activity on depression and mortality: a nine-year cohort study in Chinese adults aged 45 and above

Background

Regular participation in physical activity (PA) reduces all-cause mortality (ACM) in the general population. However, the effects of PA on depressed patients and potential gender-specific responses have not been fully elucidated. In this study, we aimed to investigate the role of PA on new-onset depression and ACM in Chinese adults aged 45 year and older, with particular emphasis on gender differences.

Methods

This was a longitudinal cohort study that took place over a nine-year period and featured 2,264 participants drawn from the China Health and Retirement Longitudinal Study (CHARLS). PA levels were categorized into quartiles using metabolic equivalents (MET; minutes/week), and depression was evaluated according to the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) scale. Specific relationships between PA, depression, and mortality were then investigated by applying multivariate logistic regression and Cox proportional hazards models.

Results

Highest quantile levels of PA were correlated with a 37% increase in the risk of new-onset depression in middle-aged (45-59 years) and older adults (>60 years). This association was predominantly influenced by a significant increase in the risk of mild depression (a score of 10-14 on the CESD-10) (odds ratio [OR]: 1.76; 95% confidence interval [CI]: 1.29-2.42, p < 0.001), with a more pronounced effect observed in women (OR: 1.83; 95% CI: 1.26-2.66, p = 0.002). A critical threshold for PA was identified at 4536 MET-minutes/week, beyond which the risk of depression increased significantly (p < 0.05). Conversely, higher levels of PA were linked to a 90% reduction in ACM (HR: 0.10; 95% CI: 0.02-0.44, p = 0.002), with the effect being more pronounced in men.

Conclusion

While PA reduces mortality, excessive activity may increase the risk of mild depression, particularly in women. These findings highlight the need for gender-specific PA guidelines that balance physical and mental health outcomes.

Long Non-Coding RNAs in Diabetic Cardiomyopathy: Potential Function as Biomarkers and Therapeutic Targets of Exercise Training

Recent studies emphasize the beneficial effects of exercise on diabetic cardiomyopathy (DCM), adding to the growing body of evidence that underscores the role of exercise in improving health outcomes. Despite this, a notable gap persists in the number of healthcare providers who actively prescribe exercise as a therapeutic intervention for DCM management. In addition, exercise modulates the expression of lncRNAs, which play a pivotal role in DCM progression. Further investigation into this relationship may facilitate the identification of novel biomarkers and therapeutic targets for DCM. This review consolidates recent advances in identifying lncRNAs biomarkers in DCM, summarizing the current knowledge on dysregulated lncRNAs and their molecular mechanisms. Additionally, it offers new insights into the mechanistic roles of lncRNAs, highlighting their potential as biomarkers and therapeutic targets for DCM. Overall, this review aims to inform future research and reinforce the significance of addressing diabetes-related cardiovascular diseases to potentially improve clinical outcomes.

People with spinal cord injury or stroke are able to reach moderate-to-vigorous intensity while exercising on an end-effector robot assisted gait trainer: A pilot study

Background: Spinal cord injury and stroke are neurological disorders that lead to aerobic deconditioning and increased likelihood of cardiovascular disease. Sessions of at least 20 minutes of moderate-to-vigorous intensity exercise is recommended but decreased mobility limits engagement in such exercise. The aim of the study was to assess whether individuals can achieve exercise recommendations with the assistance of an end-effector robot assisted gait trainer (E-RAGT). Methods: We conducted an observational study during which participants were required to complete one exercise session on an E-RAGT. Heart rate, dyspnea, lower limb fatigue and enjoyment were monitored. Based on current guidelines, participants were considered to have reached exercise recommendations if they reached prespecified intensity thresholds for at least 20 minutes. Results: Five people with spinal cord injury and ten people with stroke agreed to participate. Every participant was able to reach moderate-to-vigorous exercise intensity and 3 out of 5 participants with spinal cord injury and 4 out of 10 participants with stroke were able to maintain this intensity for at least 20 minutes. Overall, participants rated their session as very enjoyable with a median score of 4 out of 5 on a Likert Scale (IQR 3 to 4). Discussion: Individuals with spinal cord injury or stroke who use an E-RAGT can reach moderate-to-vigorous exercise intensity, but not all are able to maintain this intensity of exercise according to disease-specific recommendations. Future research should explore the effectiveness of a training program using an E-RAGT.

S, Babu NS, K. S. Cardiologists' knowledge and implementation of lifestyle counselling for cardiovascular disease prevention: A national survey

Cardiovascular disease remains a leading global cause of morbidity and mortality, with lifestyle modification playing a critical role in prevention. This nationwide cross-sectional survey of 100 cardiologists assessed attitudes, practices and knowledge regarding lifestyle counseling for CVD prevention. While most cardiologists recognized the importance of lifestyle counseling, gaps were evident in its consistent implementation, particularly in areas like dietary guidance and physical activity promotion. Key barriers included time and resource constraints and concerns about patient compliance. These findings highlight the need for targeted interventions and training to enhance the integration of lifestyle counseling into clinical practice, fostering a more comprehensive approach to CVD prevention.

Level of elderly-supportive infrastructure, fine particulate matter and cardiovascular disease hospitalisations: a time-stratified case-crossover study in Wuhan

BACKGROUND

Amid rapid urbanisation, the health effects of the built-environment have been widely studied, while research on elderly-supportive infrastructure and its interaction with PM2.5 (PM, Particulate Matter) exposure remains limited.

OBJECTIVES

To examine the effect of PM2.5 on cardiovascular hospitalisation risk among the elderly and the moderating role of elderly-supportive infrastructure in Wuhan, a city undergoing rapid urbanisation.

METHODS

A time-stratified case-crossover design was adopted in which the K-means cluster analysis was applied to categorize elderly-supportive infrastructure. The correlation of PM2.5 with cardiovascular hospitalisations and the moderating role of elderly-supportive infrastructure were elucidated through the conditional logistic regression and z-test. Nonlinear relationships among variables were determined using restricted cubic splines.

RESULTS

173,486 case days and 589,188 control days were included. The cumulative lag effect of PM2.5 increased over time, peaking at 5 days. For every 10 µg/m3 increase in PM2.5, the risk of hospitalisation rose by 1.5% (OR = 1.0150, 95% CI: 1.0113-1.0190). The aforementioned effect of PM2.5 exposure on health did not differ among varying levels of elderly-supportive infrastructure within a 300 m buffer zone. When the buffer zone was extended to 500 and 1000 m, a higher level of elderly-supportive infrastructure mitigated the adverse effects of short-term PM2.5 exposure on cardiovascular hospitalisations (p = 0.013), particularly for stroke (p = 0.017) and ischaemic heart disease (p = 0.026).

CONCLUSIONS

Our findings suggest that high-level elderly-supportive infrastructure may protect against the adverse effects of PM2.5 on cardiovascular hospitalisation, highlighting the need to optimize elderly-supportive infrastructure for its health benefits in the elderly.

Association between physical activity levels and stroke risk among Chinese adults aged 45 and over based on CHARLS

Stroke is one of the leading causes of death in developing countries, and China bears the largest global burden of stroke. This study aims to investigate the relationship between different dimensions of physical activity levels and stroke risk using a nationally representative database. We performed a cross-sectional analysis using data from the China Health and Retirement Longitudinal Study (CHARLS) 2020. Binary logistic regression models were used to analyze the associations between different dimensions of physical activity levels (intensity, frequency, duration, and total physical activity (TPA)) and stroke risk in Chinese middle-aged and older adults. Subgroups were analyzed according to participants' age, sex, residency, hypertension, dyslipidemia, and diabetes stratification. The results showed that after adjusting for all covariates, almost all frequencies and durations of moderate physical activity (MPA), and high-frequency and long-duration vigorous physical activity (VPA) were associated with lower stroke risk. No significant relationship was observed between light physical activity (LPA) and stroke risk. TPA was categorized into quartiles (Q1, Q2, Q3, Q4). Compared with the first quartile, the third and fourth quartiles were significantly associated with lower stroke risk, with risk reductions of 35% (OR 0.65, 95% CI 0.50-0.84) and 42% (OR 0.58, 95% CI 0.44-0.76), respectively. Subgroup analysis revealed differences in the association between TPA and stroke risk in different populations, and the interaction test indicated no significant interactions between these variables and TPA. Our findings suggested that appropriate participation in physical activity is effective in preventing stroke in middle-aged and older adults. Both MPA and high-frequency or long-duration VPA were significantly associated with lower stroke risk, and keeping TPA at a high level was significantly associated with lower stroke risk.

Effect of Ginseng Supplementation on Exercise Endurance as a Support for Cardiovascular Disease Management: A Systematic Review and Meta-Analysis

Ginseng has multi-directional pharmacological properties. Some data suggest that ginseng can enhance physical endurance, which, in turn, leads to protection of the cardiovascular system. However, not all experiments are conclusive. For this reason, the main aim of this research was to perform a meta-analysis and review of studies published between the years 2013 and 2023 concerning the ginseng effect on physical performance in animal and human models. Medline, Pubmed, and ClinicalKey electronic databases were used to analyze data. The search strategy included the following criteria: ginseng and exercise; ginseng supplementation; and ginseng supplements. The results suggest that ginseng supplementation may have a positive effect on CK levels in animal studies. Similar observations were stated in relation to serum lactate and BUN. Furthermore, a human study showed a significant increase in exercise time to exhaustion and VO2 max after supplementation. The review of the literature and conducted meta-analysis identified that ginseng supplementation may have a positive effect on exercise endurance. Due to the fact that most of the current studies were based on animal models, further research on human models is needed to identify the most effective dosage or form of applied ginseng to be a supportive element in CVD management.

Core reference ontology for individualized exercise prescription

"Exercise is medicine" emphasizes personalized prescriptions for better efficacy. Current guidelines need more support for personalized prescriptions, posing scientific challenges. Facing those challenges, we gathered data from established guidelines, databases, and articles to develop the Exercise Medicine Ontology (EXMO), intending to offer comprehensive support for personalized exercise prescriptions. EXMO was constructed using the Ontology Development 101 methodology, incorporating Open Biological and Biomedical Ontology Foundry principles. EXMO v1.0 comprises 434 classes and 9,732 axioms, encompassing physical activity terms, health status terms, exercise prescription terms, and other related concepts. It has successfully undergone expert evaluation and consistency validation using the ELK and JFact reasoners. EXMO has the potential to provide a much-needed standard for individualized exercise prescription. Beyond prescription standardization, EXMO can also be an excellent tool for supporting databases and recommendation systems. In the future, it could serve as a valuable reference for developing sub-ontologies and facilitating the formation of an ontology network.

Association between physical activity and sedentary behavior and depression in US adults with cardiovascular disease: NHANES 2007-2016

BACKGROUND

Previous studies reported the effect of physical activity (PA) or sedentary behavior (SB) on increasing occurrence of depression in patients with cardiovascular disease, leading to a higher risk of adverse clinical outcomes. However, the association between the combination of PA and SB and depression in patients with cardiovascular disease remained unstudied.

METHODS

Patients with cardiovascular disease (aged ≥18 years) who participated in the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. Multivariable logistic regression was used to investigate the association between PA, SB, and depression.

RESULTS

Among the 2585 patients (mean age 64.43 years; 54.65 % male) in this study, the prevalence of depression was 16.40 %. After adjustment for age, gender, race, education level, marital status, poverty income ratio, employment status, smoking, alcohol use, BMI, hypertension, and number of cardiovascular diseases, depression was negatively associated with higher PA (adjusted OR = 0.567, 95 % CI 0.403, 0.799) and positively associated with higher SB (adjusted OR = 1.472, 95 % CI 1.089, 1.990), respectively. The risk of depression associated with higher PA and lower SB was significantly lower (adjusted OR = 0.464, 95 % CI 0.307, 0.702) compared to those with lower PA but higher SB.

LIMITATIONS

This was a cross-sectional study with limited ability to make causal inferences.

CONCLUSIONS

Our findings indicate that patients with higher PA and lower SB have a lower risk of depression than those with low PA levels and high SB levels. Moving more and sitting less is a potential preventive measure against depression in patients with cardiovascular disease.

Association Between Amount of Physical Activity and Clinical Outcomes After Treatment for Cardiovascular Disease in Cancer Survivors

Background

The present study aimed to investigate the association between physical activity before the incidence of cardiovascular disease (CVD) and clinical outcomes in cancer survivors.

Methods and Results

We analyzed 904 cancer survivors (median age [interquartile range] 75 [68-80] years; 297 [32.9%] patients were female) who required hospitalization for treatment of CVD. The amount of physical activity 1 month before the admission was assessed using the 3-question (3Q) assessment tool, and categorized as minimal, low, adequate, and high according to physical activity level. The primary outcome was the composite events of all-cause death and/or rehospitalization for CVD up to 1 year after discharge. The total amount of physical activity was identified in 544 (60.2%) patients in the minimal group, 95 (10.5%) in the low group, 253 (28.0%) in the adequate group, and 12 (1.3%) in the high group. A total of 686 (75.9%) patients completed follow up, with 252 (27.9%) composite events occurring. Even after adjustment for various confounders, higher physical activity was significantly associated with a lower composite event rate (adjusted hazard ratio [95% confidence interval] 0.859 [0.833-0.900]).

Conclusions

High physical activity in cancer survivors was associated with a lower composite event rate after treatment for CVD. Assessment of prehospital physical activity using the 3Q score may be useful in their risk stratification.

Moderate-intensity aerobic exercise inhibits cell pyroptosis to improve myocardial ischemia-reperfusion injury

BACKGROUND

Myocardial ischemia-reperfusion injury (MI/RI) significantly impacts the patients with acute myocardial infarction (AMI), with the NLRP3-mediated necrosis exacerbates the pathological progression of myocardial infarction. Exercise, recognized as a crucial approach for both disease prevention and treatment, is widely utilized in clinical practice worldwide and has demonstrated broad effectiveness in cardiovascular disease (CVD) prevention.

PURPOSE

To explore the cardio protective effect of exercise preconditioning and the mechanism by which exercise modulation of NLRP3 improves myocardial ischemia and reperfusion injury.

METHODS AND RESULTS

In this study, C57BL/6 N mice were employed to establish an exercise preconditioning model and a MI/RI model. The exercise intervention involved moderate-intensity aerobic exercise on a treadmill (50-70% VO2max) for small animals. Our research findings indicate that moderate-intensity aerobic exercise intervention improved cardiac function, reduced myocardial injury and inflammatory response, decreased myocardial infarction area and degree of cell apoptosis in mice compared to those raised under conventional conditions. Additionally, the expression of NLRP3 in the myocardial tissue of mice with MI/RI was reduced after exercise intervention. Moreover, exercise inhibited the activation of apoptosis related proteins such as Caspase-1 and GSDMD, while reducing the levels of inflammatory factors such as IL-1β and IL-18.

CONCLUSIONS

This study found that moderate-intensity aerobic exercise can reduce the inflammatory response, reduce the degree of cell pyroptosis, reduce myocardial ischemia and reperfusion injury, and achieve endogenous protective effects on the myocardium.

Understanding the Relationships Between Physical Activity and Climate Change: An Umbrella Review

BACKGROUND

Physical activity is crucial for maintaining health and preventing chronic diseases. However, climate conditions can impact physical activity patterns, and conversely, physical activity can impact climate change. This umbrella review aims to summarize the existing evidence regarding the relationships between physical activity and climate change, as revealed in previous reviews.

METHODS

Systematic reviews and meta-analyses were analyzed. Searches were conducted across GreenFILE, PubMed, and Web of Science databases for peer-reviewed articles published in English. A 2-stage independent screening process was conducted, and methodological quality was assessed using the JBI framework. Standardized data extraction methods were then applied.

RESULTS

Out of 1292 articles retrieved, 7 met all eligibility criteria and were included in the review. Three articles examined physical activity as a primary exposure, 3 focused on the impacts of climate change, and one considered both physical activity and climate change as primary exposures.

CONCLUSIONS

Findings reveal an interplay between climate change and physical activity. While rising temperatures may prompt outdoor activities up to a certain temperature threshold, air pollution and extreme heat can have harmful effects. Active transportation and improved logistics around large-scale sporting events can mitigate climate change by reducing greenhouse gas emissions, but transportation systems linked to sports venues may increase emissions. Research on the reciprocal relationship between climate change and physical activity domains, and integrating the community into climate discussions, is crucial for equity, especially for marginalized communities. Incorporating climate adaptation and mitigation strategies in physical activity infrastructure to minimize environmental impacts is critical.

Dietary Factors and Cardiovascular Diseases: Comprehensive Insights from the National Health and Nutrition Examination Survey 2017-2020 and Mendelian Randomization Analysis

BACKGROUND

Cardiovascular diseases (CVDs) are a major public health concern. The impact of dietary components on CVD risk has been recognized, but their interactions require further investigation. This study aimed to examine the associations between major nutrient intake and CVD risk and to assess potential causal relationships via Mendelian randomization.

METHODS

We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, with a sample size of 5464 adult participants. Nutrient intake was derived from two 24 h dietary recalls. Associations between four principal nutrients and CVD risk were evaluated via Mendelian randomization analysis. Additionally, weighted multivariable logistic regression analyses were performed to adjust for potential confounders, including age, sex, BMI, and other lifestyle factors.

RESULTS

An observational analysis revealed that increased log-transformed dietary fat intake was associated with reduced heart failure risk (OR = 0.722, 95% CI: 0.549-0.954). Log-transformed protein intake was protective against heart failure (OR = 0.645, 95% CI: 0.471-0.889), coronary artery disease (OR = 0.684, 95% CI: 0.504-0.931), and stroke (OR = 0.747, 95% CI: 0.568-0.988). IVW-MR analyses confirmed causal relationships between relative fat intake and heart failure risk (OR = 0.766, 95% CI: 0.598-0.982, p = 0.035) and between protein intake and stroke risk (OR = 0.993, 95% CI: 0.988-0.998, p = 0.010). MR analysis also revealed causal relationships between relative fat intake and coronary artery disease risk and between relative protein intake and hypertension risk.

CONCLUSIONS

Both the observational and Mendelian randomization studies indicated that dietary fat is inversely associated with heart failure risk and that protein intake is correlated with reduced stroke risk. Future studies should investigate the optimal balance of macronutrients for CVD prevention, explore potential mechanisms underlying these associations, and consider long-term dietary interventions to validate these findings.

Total physical activity, plant-based diet and neurodegenerative diseases: A prospective cohort study of the UK biobank

INTRODUCTION

Neurodegenerative diseases (NDDs) result from a complex interplay of genetic, environmental and aging factors. A balanced diet and adequate physical activity (PA) are recognized as pivotal components among modifiable environmental factors. The independent impact on NDD incidence has been previously debated. This investigation seeks to delineate the association between PA and NDDs across various levels of adherence to a plant-based diet.

METHODS

In this study, a cohort of 368,934 participants from the UK Biobank was analyzed. Total physical activity (TPA) levels and healthful plant-based diet index (hPDI) were calculated and categorized. A multiple adjusted Cox model was utilized to evaluate the influence of TPA and hPDI on common NDDs, respectively.

RESULTS

Finally, 4602 identified cases diagnosed as Alzheimer's disease (AD), Parkinson's disease (PD) or amyotrophic lateral sclerosis (ALS). We found that higher TPA was significantly associated with a reduced risk of developing AD (Q3: HR 0.87; Q4: HR 0.78) and PD (Q3: HR 0.86; Q4: HR 0.81). The protective effect was further accentuated with adherence to a plant-based diet. However, these connections were not observed in the analysis of ALS regardless of dietary patterns.

CONCLUSION

Our findings underscore a significant association between higher TPA and reduced risks of AD and PD, with an enhanced effect observed in conjunction with a plant-based diet. This study contributes to addressing the knowledge gap regarding the combined impact of TPA and a plant-based diet on NDDs occurrence, providing insights into potential underlying mechanisms.

Motivation for Physical Activity in Low-Income Adults: An Integrative Literature Review

AIM

To explore, review and assess the literature on motivation for physical activity in low-income adults to inform future research and clinical interventions.

DESIGN

An integrative review of the literature on motivation for physical activity in low-income adults.

METHODS

Whittemore and Knaul's five-stage methodological approach for integrative reviews was utilised. Studies written in English that focused primarily on low-income adults discussed physical activity and included a component of motivation or drive were included. The Johns Hopkins Evidence Level and Quality Guide was used to assess the quality of the studies.

DATA SOURCES

PubMed, CINAHL, PsycINFO, SPORTDiscuss and Google Scholar from 1 January 2018 - 23 August 2024.

RESULTS

A total of 20 studies met the inclusion criteria. Three main categories of factors impacting physical activity in low-income adults were identified: (1) motivators for physical activity, (2) barriers for physical activity (3) and items that were both a motivator and a barrier. Despite the key role nurses play in promoting health and wellness, studies conducted by nurses or employing nursing interventions were notably absent.

CONCLUSION

This integrative literature review highlights the need for more information about what motivates low-income adults to be more physically active.

IMPLICATIONS FOR THE PROFESSION

Understanding the experience of low-income adults with physical activity is integral to meeting their needs and facilitating increased physical activity. Future research should utilise nursing theories and interventions to improve physical activity levels among low-income adults.

IMPACT

This study addressed physical inactivity in low-income adults. More information is needed about motivation for physical activity. This information will impact researchers and clinicians.

REPORTING METHOD

The search strategy and reporting method were consistent with PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Plant-based diet and risk of all-cause mortality: a systematic review and meta-analysis

Objective

A systematic analysis was conducted to determine the relationship between a plant-based diet and all-cause mortality.

Methods

The PubMed, Embase and Web of Science databases were searched. Two authors selected English documents from the database. Then the other two authors extracted the data and evaluated the Newcastle-Ottawa Scale (NOS). This study adhered to the guidelines of the Preferred Reporting Project (PRISMA) and the PROSPERO Registry protocols. A mixed-effects model combined maximum adjusted estimates, with heterogeneity measured using the I2 statistic. The sensitivity analysis validated the analysis's robustness, while publication bias was assessed.

Results

The results of the meta-analysis of 14 articles revealed that a plant-based diet (PDI) can reduce cancer mortality (RR = 0.88, [95% CI 0.79-0.98], τ2: 0.02, I2: 84.71%), cardiovascular disease (CVD) mortality (RR = 0.81, [95% CI 0.76-0.86], τ2: 0.00, I2: 49.25%) and mortality (RR = 0.84, [95% CI 0.79-0.89], τ2: 0.01, I2: 81.99%) risk. Adherence to a healthy plant-based diet (hPDI) was negatively correlated with cancer mortality (RR = 0.91, [95% CI 0.83-0.99], τ2:0.01, I2:85.61%), CVD mortality (RR = 0.85, [95% CI 0.77-0.94], τ2: 0.02, I2: 85.13%) and mortality (RR = 0.85, [95% CI 0.80-0.90], τ2: 0.01, I2: 89.83%). An unhealthy plant-based diet (uPDI) was positively correlated with CVD mortality (RR = 1.19, [95% CI 1.07-1.32], τ2: 0.02, I2: 80.03%) and mortality (RR = 1.18, [95% CI 1.09-1.27], τ2: 0.01, I2: 89.97%) and had a certain correlation with cancer mortality (RR = 1.10, [95% CI 0.97-1.26], τ2: 0.03, I2: 93.11%). Sensitivity analysis showed no contradictory results.

Conclusion

The hPDI was negatively associated with all-cause mortality, and the uPDI was positively associated with all-cause mortality.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#loginpage.

Evaluating physical activities in clinical diabetes: lifestyle scores hypothesis

BACKGROUND

The concept of lifestyle-based risk scores is known but not evaluated in most rural communities of low- to mid-income countries. This study investigated the correlation of lifestyle scores with health indices.

METHODS

This was a descriptive cross-sectional investigation. A total of 203 participants (141 females and 62 males), 18-90 years, had anthropometric assessments and lifestyle scores determined from a 12-item framework. Data analysis included average age in different health conditions, lifestyle scores in age groups, and correlations with age.

RESULTS

Average age of healthy subpopulation was 39 years while diabetes, hypertension, and obesity subpopulations were 58, 64, and 56 years, respectively. The percentage of participants whose activities of daily living (ADL) were unaffected by ill-health decreased with age (P < 0.0001), and lifestyle scores also decreased with age (P < 0.01) and negatively correlated with physical activities.

CONCLUSION

This report contributes to diabetes cardiovascular complications management. Sedentary ADL factors need integration in healthy lifestyle education especially among the elderly.

The impact of physical activity on the prevalence of edentulism: an analysis of the relationships between active lifestyle and dental health

BACKGROUND

Edentulism is considered the ultimate sign of oral health disease burden. It is a common and frequent clinical disease, mostly seen in the elderly, which has been reported to be closely associated with many diseases. While physical activity is known to benefit many chronic diseases, the relationship between the volume of physical activity and edentulism remains unclear.

MATERIALS AND METHODS

The CHARLS provided the data for this study. A total of 6,480 participants were enrolled in this study, of whom 46.02% were male and 53.98% were female. The edentulism was defined according to self-report and physical activity volume can be represented by metabolic equivalents. Multiple logistic regression, smooth curve fitting, threshold effects analysis, and Cox regression models were used to explore the relationship between physical activity volume and edentulism.

RESULTS

In the fully adjusted model, physically active participants had a 24% lower risk of edentulism compared to those who were physically inactive. Then, we subdivided participants with adequate physical activity into four levels: 600 ≤ PAV < 1200; 1200 ≤ PAV < 1800; 1800 ≤ PAV < 3000; and PAV ≥ 3000. We found that the risk of developing edentulism was lowest and statistically significant at the level of 1,800-3,000 MET-minutes/week physical activity volume (OR = 0.41; 95% CI, 0.24-0.69, p < 0.001). A U-shaped relationship between physical activity volume and edentulism with an inflection point of 2514 (MET-minutes/week) was observed. The results of the longitudinal study also confirm the benefits of physical activity volume with edentulism, participants with adequate physical activity volume had a 21% lower risk of developing edentulism than participants with inadequate physical activity volume (HR = 0.79; 95% CI, 0.67-0.94, p = 0.008).

CONCLUSIONS

This study reveals a U-shaped relationship between physical activity volume and edentulism. Physical activity reduces the risk of developing edentulism in middle-aged and older populations, but it is important to control the appropriate volume of physical activity.

Causal associations of physical activity and leisure sedentary behaviors with age at onset of Huntington's disease: A mendelian randomization study

BACKGROUND

Huntington's disease (HD) is a neurodegenerative disorder for which effective therapies are currently lacking. Studies suggest that increasing physical activity (PA) and reducing leisure sedentary behavior (LSB) mitigate the progression of HD, but their causal relationship with the age at onset (AAO) of HD remains uncertain. To investigate this, we conducted the Two-sample Mendelian Randomization (MR).

METHODS

Exposure were retrieved from the UK BioBank's (UKB) Genome-Wide Association Study (GWAS). PA included accelerometer-based average PA, vigorous PA, self-reported moderate-to-vigorous PA (MVPA), and light do-it-yourself activity. LSB included television (TV) time, computer time, and driving time. Outcome came from the GWAS of the GEM-HD Consortium. We applied several MR methods such as inverse variance weighted (IVW), MR-Egger regression, weighted median (WM) for sensitivity analysis.

RESULTS

Increases in light PA (β = 8.53 years, 95 % CI = 10.64 to 44.09, P = 0.001) and accelerometer-based vigorous PA (β = 5.18, 95 % CI = 0.92 to 9.43, P = 0.017) delayed AAO of HD, while longer TV time was associated with earlier AAO of HD (β = -2.88 years, 95 % CI = -4.99 to -0.77, P = 0.007). However, other PA and LSB phenotypes did not significantly affect AAO of HD.

CONCLUSION

The study revealed a unidirectional causality between PA, LSB and the AAO of HD. Increasing PA and reducing TV time delay HD onset. Therefore, we recommend increasing physical activity and reducing sedentary behavior to delay the occurrence of motor symptoms for premanifest HD individuals.

Overview of pyroptosis mechanism and in-depth analysis of cardiomyocyte pyroptosis mediated by NF-κB pathway in heart failure

The pyroptosis of cardiomyocytes has become an essential topic in heart failure research. The abnormal accumulation of these biological factors, including angiotensin II, advanced glycation end products, and various growth factors (such as connective tissue growth factor, vascular endothelial growth factor, transforming growth factor beta, among others), activates the nuclear factor-κB (NF-κB) signaling pathway in cardiovascular diseases, ultimately leading to pyroptosis of cardiomyocytes. Therefore, exploring the underlying molecular biological mechanisms is essential for developing novel drugs and therapeutic strategies. However, our current understanding of the precise regulatory mechanism of this complex signaling pathway in cardiomyocyte pyroptosis is still limited. Given this, this study reviews the milestone discoveries in the field of pyroptosis research since 1986, analyzes in detail the similarities, differences, and interactions between pyroptosis and other cell death modes (such as apoptosis, necroptosis, autophagy, and ferroptosis), and explores the deep connection between pyroptosis and heart failure. At the same time, it depicts in detail the complete pathway of the activation, transmission, and eventual cardiomyocyte pyroptosis of the NF-κB signaling pathway in the process of heart failure. In addition, the study also systematically summarizes various therapeutic approaches that can inhibit NF-κB to reduce cardiomyocyte pyroptosis, including drugs, natural compounds, small molecule inhibitors, gene editing, and other cutting-edge technologies, aiming to provide solid scientific support and new research perspectives for the prevention and treatment of heart failure.

Replacement of sedentary behavior with various physical activities and the risk of all-cause and cause-specific mortality

BACKGROUND

Sedentary behavior (SB) has emerged as a significant health concern that deserves attention. This study aimed to examine the associations between prolonged sedentary behavior and the risk of all-cause and cause-specific mortality as well as to explore desirable alternatives to sitting in terms of physical activity (PA).

METHODS

Two prospective cohort investigations were conducted using the UK Biobank and NHANES datasets, with a total of 490,659 and 33,534 participants, respectively. Cox proportional hazards regression models were used to estimate the associations between SB and the risk of all-cause and cause-specific mortality due to cancer, cardiovascular disease (CVD), respiratory diseases, and digestive diseases. In addition, we employed isotemporal substitution models to examine the protective effect of replacing sitting with various forms of PA.

RESULTS

During the average follow-up times of 13.5 and 6.7 years, 36,109 and 3057 deaths were documented in the UK Biobank and NHANES, respectively. Both cohorts demonstrated that, compared with individuals sitting less than 5 h per day, individuals with longer periods of sitting had higher risks of all-cause and cause-specific mortality due to cancer, CVD, and respiratory diseases but not digestive diseases. Moreover, replacing SB per day with PA, even substituting 30 min of walking for pleasure, reduced the risk of all-cause mortality by 3.5% (hazard ratio [HR] 0.965, 95% confidence interval [CI] 0.954-0.977), whereas cause-specific mortality from cancer, CVD, and respiratory diseases was reduced by 1.6% (HR 0.984, 95% CI 0.968-1.000), 4.4% (HR 0.956, 95% CI 0.930-0.982), and 15.5% (HR 0.845, 95% CI 0.795-0.899), respectively. Furthermore, the protective effects of substitution became more pronounced as the intensity of exercise increased or the alternative duration was extended to 1 h.

CONCLUSIONS

SB was significantly correlated with substantially increased risks of all-cause mortality and cause-specific mortality from cancer, CVD, and respiratory diseases. However, substituting sitting with various forms of PA, even for short periods involving relatively light and relaxing physical activity, effectively reduced the risk of both overall and cause-specific mortality.

Identifying the subgroups of depression trajectories among the middle-aged and older Chinese individuals with chronic diseases: an 8-year follow-up study based on CHARLS

Background

Prior studies have demonstrated a prevalent occurrence of depression among the middle-aged and older Chinese individuals with chronic diseases. Nevertheless, there is limited research on the specific subgroups of depression trajectories within this population and the factors influencing these subgroups.

Objective

To explore the changing trajectory and influencing factors of depression in the middle-aged and older individuals with chronic disease in China, and provide the data reference for the health management of the older adult population in China.

Methods

A longitudinal cohort study was conducted using the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, 2018, and 2020. A total of 2,178 participants with complete data were included. The level of depression was evaluated using the Center for Epidemiologic Studies Depression Scale (CESD-10). The Latent Class Mixed Models (LCMM) were employed to estimate trajectories of depressive symptoms. The Kruskal-Wallis H test and the Pearson χ 2 test were used to determine the significant factors affecting trajectory grouping. Subsequently, the multinomial logistic regression model was utilized to perform a multifactorial analysis of the variables impacting the trajectory subgroup of change in depressive symptoms.

Results

The LCMM-analysis revealed three distinct subgroups of depression trajectories: the "Low stable group" comprising 36.7% of the sample, the "Medium growth group" comprising 34.4% of the sample, and the "High growth group" comprising 28.9% of the sample. Among the baseline characteristics of different depression trajectory subgroups, there were significant differences in gender, residence, education, marital status, social activity participation, number of chronic diseases, smoking status, BMI, midday napping (minutes) and nighttime sleep duration (hours). Through multiple logistic regression analysis, our findings demonstrate that among the middle-aged and older Chinese individuals with chronic diseases, the following individuals should be the key groups for the prevention and treatment of depressive symptoms: Those who are young, female, residing in rural areas, having primary school education and below, being single, not participating in social activities, suffering from multiple chronic diseases, and having shorter naps and sleeping at night.

Conclusion

There is heterogeneity in the subgroups of depression trajectories among the Chinese middle-aged and older individuals with chronic diseases. The focus should be on the distinct characteristics of various trajectories of depression within the realm of health management.

Physical activity, long-term fine particulate matter exposure and type 2 diabetes incidence: A prospective cohort study

Background

Despite the adverse effects of ambient fine particulate matter (PM2.5) on type 2 diabetes and the beneficial role of physical activity (PA), the influence of PM2.5 on the relationship between PA and type 2 diabetes remains unclear.

Methods

In this prospective study with 71,689 participants, PA was assessed by a questionnaire and was categorized into quartiles for volume and three groups for intensity. Long-term PM2.5 exposure was calculated using 1-km resolution satellite-based PM2.5 estimates. PM2.5 exposure and PA's effect on type 2 diabetes were assessed by cohort-stratified Cox proportional hazards models, individually and in combination.

Results

In 488,166 person-years of follow-up, 5487 incident type 2 diabetes cases were observed. The association between PA and type 2 diabetes was modified by PM2.5. Compared with the lowest quartile of PA volume, the highest quartile was associated with reduced type 2 diabetes risk in low PM2.5 stratification (≤65.02 µg/m3) other than in high PM2.5 stratification (>65.02 µg/m3), with the hazard ratio (HR) of 0.75 (95% confidence interval [CI]: 0.66-0.85) and 1.10 (95% CI: 0.99-1.22), respectively. Similar results were observed for PA intensity. High PM2.5 exposure combined with the highest PA levels increased the risk of type 2 diabetes the most (HR = 1.79, 95% CI: 1.59-2.01 for PA volume; HR = 1.82, 95% CI: 1.64-2.02 for PA intensity).

Conclusion

PA could reduce type 2 diabetes risk in low-pollution areas, but high PM2.5 exposure may weaken or even reverse the protective effects of PA. Safety and health benefits of PA should be thoroughly assessed for long-term polluted residents.

Brown Adipose Stem Cell-Loaded Resilin Elastic Hydrogel Rebuilds Cardiac Function after Myocardial Infarction via Collagen I/III Reorganisation

Irreversible fibrosis following myocardial infarction (MI) stiffens the infarcted myocardium, which remains challenging to restore. This study aimed to investigate whether the injectable RLP12 hydrogel, derived from recombinant resilin protein, could serve as a vehicle for stem cells to enhance the function of the infarcted myocardium. The RLP12 hydrogel was prepared and injected into the myocardium of rats with MI, and brown adipose-derived mesenchymal stem cells (BADSCs) were loaded. The survival and differentiation of BADSCs in vivo were investigated using immunofluorescence one week and four weeks after treatment, respectively. The heart function, MI area, collagen deposition, and microvessel density were further assessed four weeks after treatment through echocardiography, histology, immunohistochemistry, and immunofluorescence. The RLP12 hydrogel was prepared with a shear modulus of 10-15 kPa. Four weeks after transplantation, the RLP12 hydrogel significantly improved cardiac function by increasing microvessel density and reducing infarct area size and collagen deposition in MI rats. Furthermore, the distribution ratio of collagen III to I increased in both the centre and edge areas of the MI, indicating the improved compliance of the infarct heart. Moreover, the RLP12 hydrogel also promoted the survival and differentiation of BADSCs into cardiac troponin T- and α-smooth muscle-positive cells. The RLP12 hydrogel can be utilised as an injectable vehicle of BADSCs for treating MI and regulating collagen I and III expression profiles to improve the mechanical microenvironment of the infarct site, thereby restoring heart function. The study provides novel insights into the mechanical interactions between the hydrogel and the infarct microenvironment.

The association between physical activity and neck circumference with cardiovascular disease risk in older wheelchair users

OBJECTIVE

To examine the association between physical activity, neck circumference, and cardiovascular disease risk in older wheelchair users.

DESIGN

A cross-sectional study.

SUBJECTS/PATIENTS

Sixty-one Korean wheelchair users aged 50 years and older.

METHODS

Physical activity was assessed using a self-administered questionnaire. Neck circumference was measured with a tape ruler. Cardiovascular disease risk was evaluated by calculating the Framingham risk score (FRS) for estimating 10-year cardiovascular disease risk, which was classified as low-moderate (19% or less) or high risk (20% or more).

RESULTS

The FRS for 10-year cardiovascular disease risk was inversely related to physical activity (beta [SE] = -0.213 (0.103), p = 0.043) and positively related to neck circumference (beta [SE] = 1.331 ± 0.419, p = 0.003). Binary logistic regression showed that those with low physical activity (odds ratio [95% confidence interval] = 4.256 (1.188~15.243), p = 0.026) or a large neck circumference (odds ratio [95% confidence interval] = 3.645 (1.172~11.338), p = 0.025) had a higher risk for high cardiovascular disease risk compared with those with high physical activity or normal neck circumference.

CONCLUSION

The current study findings suggest that an intervention targeting physical inactivity and upper-body obesity should be implemented to reduce cardiovascular disease risk in older wheelchair users.

Modulating the Expression of Exercise-induced lncRNAs: Implications for Cardiovascular Disease Progression

Recent research shows exercise is good for heart health, emphasizing the importance of physical activity. Sedentary behavior increases the risk of cardiovascular disease, while exercise can help prevent and treat it. Additionally, physical exercise can modulate the expression of lncRNAs, influencing cardiovascular disease progression. Therefore, understanding this relationship could help identify prospective biomarkers and therapeutic targets pertaining to cardiovascular ailments. This review has underscored recent advancements concerning the potential biomarkers of lncRNAs in cardiovascular diseases, while also summarizing existing knowledge regarding dysregulated lncRNAs and their plausible molecular mechanisms. Additionally, we have contributed novel perspectives on the underlying mechanisms of lncRNAs, which hold promise as potential biomarkers and therapeutic targets for cardiovascular conditions. The knowledge imparted in this review may prove valuable in guiding the design of future investigations and furthering the understanding of lncRNAs as diagnostic, prognostic, and therapeutic biomarkers for cardiovascular diseases.

The association between triglyceride-glucose index and related parameters and risk of cardiovascular disease in American adults under different glucose metabolic states

BACKGROUND

Cardiovascular disease (CVD) encompasses an array of cardiac and vascular disorders, posing a significant threat to global health. It remains unclear whether there exists an association between triglyceride-glucose index (TyG) and its derived indices and the incidence of cardiovascular disease, and in particular, the strength of the association in populations with different glucose metabolisms is not known.

METHODS

Data extracted from the National Health and Nutrition Examination Survey (NHANES) covering the period from 1999 to 2020, involving a cohort of 14,545 participants, were leveraged for the analysis. Statistical assessments were executed utilizing R software, employing multivariable logistic regression models to scrutinize the correlation between TyG and its associated parameters with the incidence of cardiovascular disease across diverse glucose metabolism categories. Interaction analyses and restricted cubic splines were applied to evaluate potential heterogeneity in associations and investigate the link between TyG and its derivatives with the occurrence of cardiovascular disease. Furthermore, receiver operating characteristic curves were constructed to evaluate the extent of variability in the predictive performance of TyG and its derived parameters for cardiovascular disease across distinct glucose metabolic statuses.

RESULTS

This study found that TyG and its related parameters were differentially associated with the occurrence of cardiovascular disease in different glucose metabolic states. Curvilinear correlations were found between TyG in the IFG population and TyG-WC, TyG-BMI, and TyG-WHtR in the impaired glucose tolerance (IGT) population with the occurrence of cardiovascular disease. In addition, the introduction of TyG and its derived parameters into the classical Framingham cardiovascular risk model improved the predictive performance in different glucose metabolism populations. Among them, the introduction of TyG-WHtR in the normal glucose tolerance (NGT), impaired fasting glucose (IFG), IFG & IGT and diabetes groups and TyG in the IGT group maximized the predictive power.

CONCLUSIONS

The findings provide new insights into the relationship between the TyG index and its derived parameters in different glucose metabolic states and the risk of cardiovascular disease, offering important reference value for future clinical practice and research. The study highlights the potential for improved risk stratification and prevention strategies based on TyG and its derived parameters.

Domain-Specific Physical Activity and Stroke in Sweden

Importance

Associations of domain-specific physical activity with stroke incidence and poststroke outcomes have not been extensively studied using long-term, population-based data.

Objective

To investigate associations of leisure time, work time, transport, and household physical activity with stroke incidence and death or dependency in activities of daily living (ADL) 3 months after stroke.

Design, Setting, and Participants

The prospective, population-based Interplay Between Genetic Susceptibility and External Factors (INTERGENE) cohort study was conducted among a random sample of individuals from an urban-rural area covering western Sweden; 3614 individuals aged 24 to 77 years were examined in 2001 to 2004, and 1394 individuals were reexamined in 2014 to 2016. The median (range) follow-up was 20.0 years (56 days to 21.9 years). Data were analyzed from September through October 2023.

Exposure

Physical activity levels were self-reported for leisure time, work time, transportation, and household domains. The mean number of steps taken over a 6-day period was collected in a subgroup of participants using a sealed pedometer.

Main Outcomes and Measures

Follow-up for stroke incidence and mortality rates continued until December 31, 2022. The composite outcome of death or ADL dependency was assessed at 3 months after stroke.

Results

Among 3614 individuals (mean [SD] age, 51.4 [13.1] years; 1910 female [52.9%]); 269 individuals (7.4%) developed stroke, of whom 120 individuals (44.6%) were dead or ADL dependent at 3 months. Intermediate (adjusted hazard ratio [aHR], 0.54; 95% CI, 0.38-0.77) and high (aHR, 0.47; 95% CI, 0.31-0.73) levels of leisure time physical activity were associated with a reduced incidence of stroke compared with low levels, as was an intermediate level of physical activity in transportation (aHR, 0.69; 95% CI, 0.52-0.93). High levels of leisure time physical activity were also associated with a reduced risk of poststroke death or ADL dependency (adjusted odds ratio, 0.34; 95% CI, 0.16-0.71) compared with low levels. Work time and household physical activity were not associated with stroke incidence or stroke outcomes. In exploratory subgroup analyses, there were interactions between physical activity and smoking (current smoking or smoking in the past year associated with stroke risk only in participants with low or intermediate physical activity: aHR, 2.33; 95% CI, 1.72-3.15) and family history of stroke (first-degree relative with a history of stroke associated with stroke risk only in participants with low or intermediate physical activity: aHR, 1.73; 95% CI, 1.27-2.38).

Conclusions and Relevance

In this study, leisure time and transport-related physical activities were associated with a reduced risk of stroke. A high level of leisure time physical activity was also associated with a lower risk of death or ADL dependency 3 months after stroke.

Mediation Role of Recreational Physical Activity in the Relationship between the Dietary Intake of Live Microbes and the Systemic Immune-Inflammation Index: A Real-World Cross-Sectional Study

The main topic of this research is the relationship between dietary intake of live microbe-containing (LMC) foods, recreational physical activity (RPA), and the systemic immune-inflammation index (SII). This study presented a cohort of 26,254 individuals in the National Health and Nutrition Examination Survey (NHANES), representing an estimated weighted population of 193,637,615 in the United States. Weighted multivariable linear regression models were used in consideration of the multi-stage sampling design. Results: The study found that medium-LMC foods were negatively associated with the SII [β (95% CI): -4.807 (-7.752, -1.862), p = 0.002], indicating that their intake was correlated with lower levels of the SII. However, no significant associations were found with low- or high-LMC foods. The study also explored the relationship between RPA and the SII, finding that more time spent in RPA was negatively associated with the SII [β (95% CI): -0.022 (-0.034, -0.011), p < 0.001]. A mediation analysis was conducted to investigate the role of RPA in the relationship between medium-LMC food intake and the SII. The analysis revealed that RPA had a notable indirect effect, contributing to 6.7% of the overall change in the SII. Overall, this study suggests that medium-LMC food intake and RPA may have beneficial effects on systemic immune inflammation.

Spatiotemporal trends of cardiovascular disease burden attributable to low physical activity during 1990-2019: an analysis of the Global Burden of Disease Study 2019

OBJECTIVES

The epidemiological trends of cardiovascular disease (CVD) burden attributed to low physical activity (LPA) across various regions and countries are poorly understood. Hence, we assessed the global, regional, and national spatiotemporal trends of LPA-related CVD from 1990 to 2019.

STUDY DESIGN

We conducted a secondary analysis of the Global Burden of Disease Study 2019. The data on LPA-related CVD were examined with regard to sex, age, year, and Socio-Demographic Index (SDI).

METHODS

We assessed the temporal changes in age-standardized mortality rate (ASMR) and age-standardized death rate (ASDR) using the estimated annual percentage change (EAPC) over a 30-year period.

RESULTS

There were a staggering 0.64 million deaths and 9.99 million disability-adjusted life-years globally attributed to LPA-related CVD in 2019. The majority of the LPA-related CVD burden was observed in the population aged ≥80 years. It also indicated a high disease burden of LPA-related CVD in Central Asia, Arabian Peninsula, and North Africa. Although there has been a decline in ASMR and ASDR associated with LPA-related CVD on a global scale, the countries experiencing the most substantial increase in LPA-related CVD burden are Uzbekistan, Tajikistan, and Azerbaijan. The ASMR and ASDR remained stable in regions with low, low-middle, and middle SDI levels. The EAPCs of ASMR and ASDR were negatively linked with SDI in 2019.

CONCLUSIONS

From 1990 to 2019, LPA led to a significant and escalating burden of CVD in certain regions, namely, Uzbekistan, Tajikistan, and Azerbaijan. It is imperative for governments and policymakers to implement regulatory measures and strategic interventions aimed at mitigating this burden.

Swimming behavior indicates stress and adaptations to exercise

Introduction: Behaviors of swimming rodents are not uniform, exhibiting large variations, which may underlie the individual differences in swimming exercise-induced benefits. The study aimed to monitor individualized swimming behavior and evaluate its biological significance. Methods: A swimming tank which can monitor individualized rodent swimming behavior during exercise was established. A total of 45 mice were subjected to swimming training for 1 month (1 h per day) and the swimming behaviors of each mouse were recorded. Results: The swimming behaviors of mice displayed considerable variations in aspects of distance, velocity, and area preference. For example, nearly one-third of mice preferred to swim in central area and most of the mice exhibited an even area distribution. Long-term exercise training improved cardiac systolic function and decreased blood pressure in mice, but hardly changed swimming behaviors. Analyses of the relationship between swimming behavior and cardiovascular adaptations to exercise training revealed that swimming behavior indicated the biological effects of swimming training. Specifically, mice which preferred swimming at the central zone or were trainable in behavior during 1-month training exhibited better outcomes in cardiac function and blood pressure post long-term exercise. Mechanistically, a centralized swimming behavior indicated a smaller stress during exercise, as evidenced by a milder activation of hypothalamic-pituitary-adrenal axis. Discussion: These results suggest that swimming behavior during training indicates individualized adaptations to long-term exercise, and highlight a biological significance of swimming behavior monitoring in animal studies.

Comparing the Use and Effectiveness of In-Person and Remote Physical Education Delivery During the COVID-19 Pandemic

BACKGROUND

Physical Education is a key component to improve youth health, but there is limited information on Physical Education delivery in different formats.

PURPOSE

We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio.

METHODS

We distributed questionnaires (2020-2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n=216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables.

RESULTS

Among 165 schools, 10% (n=17) offered in-person instruction, 31% (n=51) offered remote instruction, and 59% offered both (n=97). Results revealed higher in-person PE minutes (77.2±7.3) compared to remote minutes (67.1±14.6), but results were not significantly different (p=0.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p<0.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p<0.001).

DISCUSSION

Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE.

TRANSLATION to HEALTH EDUCATION PRACTICE

Efforts are needed to improve remote PE to reinforce high-quality PE in the future.

mHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study

Objective

To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme.

Methods

The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers.

Results

Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported.

Conclusion

Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation.

Multimorbidity is associated with lower total 24-hour movement activity among US adults

Objective

Having chronic conditions may result in reduced physical and cognitive function but less is known about multimorbidity with daily movement. We examined the association of multimorbidity and device-measured total daily movement in a nationally representative sample of US adults aged ≥ 30 years from the 2011-2014 National Health and Nutrition Examination Surveys.

Methods

Any multimorbidity (≥2 conditions) and complex multimorbidity (≥3 conditions across ≥ 3 body systems) were quantified using 16 chronic conditions via self-report and/or clinical thresholds. Total movement over 24-hours (Monitor-Independent Movement Summary units [MIMS-units]) was measured using a wrist-worn device (ActiGraph GT3X). Multivariable linear regression examined the association of 1) each chronic condition, 2) number of conditions, 3) any multimorbidity, and 4) complex multimorbidity with total movement. Covariates included age, gender, race/ethnicity, educational attainment, and smoking status.

Results

Among US adults (N = 7304, mean age: 53.2 ± 0.34 years, 53.2% female, 69.4% Non-Hispanic White), 62.2% had any multimorbidity with 34.2% having complex multimorbidity. After adjustment, a higher number of chronic conditions was associated with incrementally lower total movement (β MIMS-units [95% CI] compared to those with no chronic conditions; one: -419 [-772, -66], two: -605 [-933, -278], three: -1201 [-1506, -895], four: -1908 [-2351, -1465], 5+: -2972 [-3384, -2560]). Complex multimorbidity presence was associated with -1709 (95% CI: -2062, -1357) and -1269 (-1620, -918) lower total movement compared to those without multimorbidity and multimorbidity but not complex, respectively.

Conclusions

Multimorbidity was associated with lower 24-h movement among US adults and may be helpful for identifying adults at risk for low movement.