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Lehmann S, Retschlag U, Oberbach A, Morgenroth R, Linder N, Schaudinn A, Garnov N, Busse H, Solty K, Prettin C, Köppe-Bauernfeind N, Flehmig G, Selig L, Trips E, Stumvoll M, Petroff D, Blüher M. Visceral fat mass dynamics in a 2-year randomized STrength versus ENdurance training trial in people with obesity. Diabetes Obes Metab 2024; 26:4087-4099. [PMID: 39014526 DOI: 10.1111/dom.15767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 07/18/2024]
Abstract
AIM To compare the effectiveness of strength versus endurance training on reducing visceral fat in individuals with obesity. MATERIALS AND METHODS For the STrength versus ENdurance (STEN) 24-month randomized clinical trial, we assigned 239 participants with abdominal obesity to either strength or endurance training (two to three times a week, 60 min/training session) in addition to standard nutritional counselling to promote a healthy diet. Changes in abdominal visceral adipose tissue (VAT) area quantified by magnetic resonance imaging after 12 months were defined as a primary endpoint. RESULTS Participants (aged 44 years, 74% women, body mass index: 37 kg/m2, mean VAT volume: 4050 cm3) had an approximately 50% retention rate and a 30% good training programme adherence at 12 months. There was no difference between strength and endurance training in VAT volume dynamics after 12 and 24 months (p = .13). Only in the good adherence group did we find a trend for reduced VAT volume in both training regimens. Independently of the exercise programme, there was a continuous trend for moderate loss of abdominal subcutaneous AT volume, body fat mass, body mass index and improved parameters of insulin sensitivity. Although parameters of physical fitness improved upon both exercise interventions, the dynamics of resting energy expenditure, glucose and lipid metabolism parameters were not different between the intervention groups and did not significantly improve during the 2-year trial (p > .05). CONCLUSIONS Despite heterogeneous individual training responses, strength and endurance training neither affected VAT volume nor key secondary endpoints differently.
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Affiliation(s)
- Stefanie Lehmann
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
- Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
| | - Ulf Retschlag
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
| | - Andreas Oberbach
- Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
- Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Roland Morgenroth
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Nicolas Linder
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Alexander Schaudinn
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Nikita Garnov
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | - Kilian Solty
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
| | | | | | - Gesine Flehmig
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Lars Selig
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
| | - Evelyn Trips
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Michael Stumvoll
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Matthias Blüher
- Integrated Research and Treatment Centre (IFB) AdiposityDiseases, Leipzig University Medical Centre, Leipzig, Germany
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
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Yu HK, Chen CY, Chen YC, Cheng CH, Chen CY, Hu GC. Effect of Cardiac Rehabilitation on Cardiorespiratory Fitness in Patients With Acute Myocardial Infarction: Role of Diabetes Mellitus and Glycated Hemoglobin Level. J Cardiopulm Rehabil Prev 2024; 44:311-316. [PMID: 39230352 DOI: 10.1097/hcr.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
PURPOSE Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels. METHODS Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period. RESULTS In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9 ± 1.5 vs. 3.7 ± 3.2 mL/kg/min, P < .001). Among patients with DM, those with HbA1c levels < 7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c ≥ 7% (2.7 ± 1.5 vs. 1.1 ± 1.8 mL/kg/min, P < .001) during the follow-up period. CONCLUSIONS Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.
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Affiliation(s)
- Hui-Kung Yu
- Author Affiliations: Department of Nursing (Ms Yu), Institute of Clinical Nursing (Dr Y-C Chen), College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Cardiovascular Division, Department of Internal Medicine (Dr Chun-Yen Chen), Mackay Medical College, Department of Medicine (Drs Chun-Yen Chen and Hu), Department of Rehabilitation Medicine (Drs Cheng, Chi-Yen Chen, and Hu), Mackay Memorial Hospital, Taipei, Taiwan
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López-Hernández A, Gimeno-Santos E, Navarro-Ripoll R, Arguis MJ, Romano-Andrioni B, López-Baamonde M, Teres S, Sanz-de la Garza M, Martinez-Palli G. Differential response to preoperative exercise training in patients candidates to cardiac valve replacement. BMC Anesthesiol 2024; 24:280. [PMID: 39123146 PMCID: PMC11311913 DOI: 10.1186/s12871-024-02671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND There is lack of evidence regarding safety, effectiveness and applicability of prehabilitation on cardiac surgery population, particularly in patients candidates to cardiac valve replacement. The aim of the study is to assess and compare the effect of a multimodal prehabilitation program on functional capacity in patients with severe aortic stenosis (AoS) and severe mitral regurgitation (MR) proposed for valve replacement surgery. METHODS Secondary analysis from a randomised controlled trial whose main objective was to analyze the efficacy of a 4-6 weeks multimodal prehabilitation program in cardiac surgery on reducing postoperative complications. For this secondary analysis, only candidates for valve replacement surgery were selected. The primary outcome was the change in endurance time (ET) from baseline to preoperative assessment measured by a cycling constant work-rate cardiopulmonary exercise test. RESULTS 68 patients were included in this secondary analysis, 34 (20 AoS and 14 MR) were allocated to the prehabilitation group and 34 (20 AoS and 14 MR) to control group. At baseline, patients with AoS had better left systolic ventricular function and lower prevalence of atrial fibrillation compared to MR (p = 0.022 and p = 0.035 respectively). After prehabilitation program, patients with MR showed greater improvement in ET than AoS patients (101% vs. 66% increase from baseline). No adverse events related to the prehabilitation program were observed. CONCLUSIONS A 4-6 week exercise training program is safe and overall improves functional capacity in patients with severe AoS and MR. However, exercise response is different according to the cardiac valve type disfunction, and further studies are needed to know the factors that predispose some patients to have better training response. TRIAL REGISTRATION The study has been registered on the Registry of National Institutes of Health ClinicalTrials.gov (NCT03466606) (05/03/2018).
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Affiliation(s)
- Antonio López-Hernández
- Anesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elena Gimeno-Santos
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Barcelona of Global Health Institute (ISGlobal) - Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Carlos III Health Institute, Madrid, Spain
| | - Ricard Navarro-Ripoll
- Anesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - María José Arguis
- Anesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Bárbara Romano-Andrioni
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Nutrition and Clinical Dietetics, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel López-Baamonde
- Anesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Silvia Teres
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Sanz-de la Garza
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Graciela Martinez-Palli
- Anesthesiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
- Prehabilitation Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
- CIBER de Enfermedades Respiratorias (CIBERES), Carlos III Health Institute, Madrid, Spain.
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Zaki S, Alam MF, Sharma S, El-Ashker S, Ahsan M, Nuhmani S. Impact of Concurrent Exercise Training on Cardiac Autonomic Modulation, Metabolic Profile, Body Composition, Cardiorespiratory Fitness, and Quality of Life in Type 2 Diabetes with Cardiac Autonomic Neuropathy: A Randomized Controlled Trial. J Clin Med 2024; 13:3910. [PMID: 38999476 PMCID: PMC11242881 DOI: 10.3390/jcm13133910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) often leads to cardiac autonomic neuropathy (CAN), a severe complication affecting cardiovascular health. Exercise training is a proven intervention for improving metabolic control and cardiovascular health in T2DM, but the effects of concurrent exercise training (CET), combining aerobic and resistance exercises, on CAN are not fully understood. Objective: This randomized controlled trial investigates the impact of a structured CET program on cardiac autonomic modulation, metabolic profile, body composition, cardiorespiratory fitness (CRF), and quality of life (QoL) in individuals with T2DM and CAN. Methods: A total of 96 participants, aged 35-70 years, with T2DM and CAN, were randomized into CET (n = 48) and control (n = 48) groups. The CET group engaged in combined aerobic and resistance training three times per week for 13 weeks, while the control group received standard care. Primary outcomes included heart rate variability (HRV) and heart rate recovery (HRR). Secondary outcomes were metabolic profile, body composition, CRF, and QoL, which were assessed using standardized protocols and validated questionnaires. The trial was registered with the Clinical Trials Registry-India (CTRI/2021/09/036711). Results: Significant improvements were noted in the CET group compared to controls. HRV metrics (SDNN, RMSSD, pNN50, TP, LF power, HF power, and LF/HF ratio) and HRR metrics (HRR30s, HRR1, HRR2, and HRR3) all showed significant enhancements (p < 0.01). The CET group also exhibited substantial reductions in fasting blood glucose, postprandial blood glucose, HbA1c, waist circumference, hip circumference, and percentage body fat (p < 0.01). Improvements were observed in lipid profile markers and CRF (VO2max) (p < 0.01). QoL scores improved significantly in the CET group as per the ADDQoL-19 (p < 0.01). Conclusions: CET significantly enhances cardiac autonomic modulation, metabolic profile, body composition, CRF, and QoL in individuals with T2DM and CAN. These findings support the integration of CET into standard T2DM management to improve clinical outcomes and QoL. Further research is needed to explore the long-term benefits and broader applicability of CET in diverse diabetic populations.
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Affiliation(s)
- Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Muhammad Ali Jauhar Marg, New Delhi 110025, India; (S.Z.); (M.F.A.)
| | - Md Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Muhammad Ali Jauhar Marg, New Delhi 110025, India; (S.Z.); (M.F.A.)
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Maulana Muhammad Ali Jauhar Marg, New Delhi 110025, India; (S.Z.); (M.F.A.)
| | - Said El-Ashker
- Self-Development Department, Deanship of Preparatory Year, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia;
| | - Mohammad Ahsan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (S.N.)
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (M.A.); (S.N.)
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Viken JK, Olsen T, Drevon CA, Hjorth M, Birkeland KI, Norheim F, Lee-Ødegård S. Intra-Individual Variations in How Insulin Sensitivity Responds to Long-Term Exercise: Predictions by Machine Learning Based on Large-Scale Serum Proteomics. Metabolites 2024; 14:335. [PMID: 38921470 PMCID: PMC11206077 DOI: 10.3390/metabo14060335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 06/27/2024] Open
Abstract
Physical activity is effective for preventing and treating type 2 diabetes, but some individuals do not achieve metabolic benefits from exercise ("non-responders"). We investigated non-responders in terms of insulin sensitivity changes following a 12-week supervised strength and endurance exercise program. We used a hyperinsulinaemic euglycaemic clamp to measure insulin sensitivity among 26 men aged 40-65, categorizing them into non-responders or responders based on their insulin sensitivity change scores. The exercise regimen included VO2max, muscle strength, whole-body MRI scans, muscle and fat biopsies, and serum samples. mRNA sequencing was performed on biopsies and Olink proteomics on serum samples. Non-responders showed more visceral and intramuscular fat and signs of dyslipidaemia and low-grade inflammation at baseline and did not improve in insulin sensitivity following exercise, although they showed gains in VO2max and muscle strength. Impaired IL6-JAK-STAT3 signalling in non-responders was suggested by serum proteomics analysis, and a baseline serum proteomic machine learning (ML) algorithm predicted insulin sensitivity responses with high accuracy, validated across two independent exercise cohorts. The ML model identified 30 serum proteins that could forecast exercise-induced insulin sensitivity changes.
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Affiliation(s)
- Jonas Krag Viken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (J.K.V.); (K.I.B.)
| | - Thomas Olsen
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, 0313 Oslo, Norway; (T.O.); (C.A.D.); (M.H.); (F.N.)
| | - Christian André Drevon
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, 0313 Oslo, Norway; (T.O.); (C.A.D.); (M.H.); (F.N.)
- Vitas Ltd., Oslo Science Park, 0349 Oslo, Norway
| | - Marit Hjorth
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, 0313 Oslo, Norway; (T.O.); (C.A.D.); (M.H.); (F.N.)
| | - Kåre Inge Birkeland
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (J.K.V.); (K.I.B.)
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0586 Oslo, Norway
| | - Frode Norheim
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, 0313 Oslo, Norway; (T.O.); (C.A.D.); (M.H.); (F.N.)
| | - Sindre Lee-Ødegård
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0313 Oslo, Norway; (J.K.V.); (K.I.B.)
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0586 Oslo, Norway
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Noone J, Mucinski JM, DeLany JP, Sparks LM, Goodpaster BH. Understanding the variation in exercise responses to guide personalized physical activity prescriptions. Cell Metab 2024; 36:702-724. [PMID: 38262420 DOI: 10.1016/j.cmet.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Understanding the factors that contribute to exercise response variation is the first step in achieving the goal of developing personalized exercise prescriptions. This review discusses the key molecular and other mechanistic factors, both extrinsic and intrinsic, that influence exercise responses and health outcomes. Extrinsic characteristics include the timing and dose of exercise, circadian rhythms, sleep habits, dietary interactions, and medication use, whereas intrinsic factors such as sex, age, hormonal status, race/ethnicity, and genetics are also integral. The molecular transducers of exercise (i.e., genomic/epigenomic, proteomic/post-translational, transcriptomic, metabolic/metabolomic, and lipidomic elements) are considered with respect to variability in physiological and health outcomes. Finally, this review highlights the current challenges that impede our ability to develop effective personalized exercise prescriptions. The Molecular Transducers of Physical Activity Consortium (MoTrPAC) aims to fill significant gaps in the understanding of exercise response variability, yet further investigations are needed to address additional health outcomes across all populations.
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Affiliation(s)
- John Noone
- Translational Research Institute, AdventHealth, Orlando, FL 32804, USA
| | | | - James P DeLany
- Translational Research Institute, AdventHealth, Orlando, FL 32804, USA
| | - Lauren M Sparks
- Translational Research Institute, AdventHealth, Orlando, FL 32804, USA
| | - Bret H Goodpaster
- Translational Research Institute, AdventHealth, Orlando, FL 32804, USA.
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Kirsch M, Vitiello D, Trachsel LD, Boidin M, Lalongé J, Juneau M, Bherer L, Nigam A, Gayda M. Cardiac hemodynamics phenotypes and individual responses to training in coronary heart disease patients. Scand J Med Sci Sports 2024; 34:e14633. [PMID: 38650385 DOI: 10.1111/sms.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/18/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND In patients with coronary heart disease (CHD), individualized exercise training (ET) programs are strongly recommended to optimize peak oxygen uptake (V ̇ $$ \dot{\mathrm{V}} $$ O2peak) improvement and prognosis. However, the cardiac hemodynamic factors responsible for a positive response to training remain unclear. The aim of this study was to compare cardiac hemodynamic changes after an ET program in responder (R) versus non-responder (NR) CHD patients. METHODS A total of 72 CHD patients completed a 3-month ET program and were assessed by cycle ergometer cardiopulmonary exercise test (CPET:V ̇ $$ \dot{\mathrm{V}} $$ O2peak assessment) with impedance cardiography (ICG) for hemodynamic measurements before and after training. Cardiac hemodynamics (e.g., CO, CI, SV, ESV, EDV, and SVR) were measured by ICG during CPET. The R and NR groups were classified using the median change inV ̇ $$ \dot{\mathrm{V}} $$ O2peak (>the median for R and ≤the median for NR). RESULTS In the R group,V ̇ $$ \dot{\mathrm{V}} $$ O2peak (+17%, p < 0.001), CO, CI, SV, and HR increased by 17%, 17%, 13%, and 5%, respectively (p < 0.05) after the training program. In the NR group,V ̇ $$ \dot{\mathrm{V}} $$ O2peak, CO, CI, and SV increased by 0.5%, 5%, 8%, and 6%, respectively (p < 0.01). The SVR decreased in both groups (-19% in R and -11% in NR, p < 0.001). CONCLUSION Among CHD patients, the R group showed a better improvement in peak cardiac output via an increase in peak stroke volume and heart rate and a reduced systemic vascular resistance than the NR group. Different cardiac phenotype adaptations and clinical individual responses were identified in CHD patients according to the aerobic fitness responder's status.
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Affiliation(s)
- Marine Kirsch
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France
| | - Damien Vitiello
- Université Paris Cité, Institut des Sciences du Sport Santé de Paris (I3SP), URP 3625, Paris, France
| | - Lukas-Daniel Trachsel
- University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maxime Boidin
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Julie Lalongé
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
| | - Martin Juneau
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Louis Bherer
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Anil Nigam
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Mathieu Gayda
- Preventive Medicine and Physical Activity Center (ÉPIC) & Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
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Brinkmann C. Road map for personalized exercise medicine in T2DM. Trends Endocrinol Metab 2023; 34:789-798. [PMID: 37730486 DOI: 10.1016/j.tem.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
The number of patients with type 2 diabetes mellitus (T2DM) is rising at an alarming rate. Regular physical activity and exercise are cornerstones in the therapy of T2DM. While a one-size-fits-all approach fails to account for many between-subject differences, the use of personalized exercise medicine has the potential of optimizing health outcomes. Here, a road map for personalized exercise therapy targeted at patients with T2DM is presented. It considers secondary complications, glucose management, response heterogeneity, and other relevant factors that might influence the effectiveness of exercise as medicine, taking exercise-medication-diet interactions, as well as feasibility and acceptance into account. Furthermore, the potential of artificial intelligence and machine learning-based applications in assisting sports therapists to find appropriate exercise programs is outlined.
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Affiliation(s)
- Christian Brinkmann
- Institute of Cardiovascular Research and Sport Medicine, Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, Cologne, Germany; Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany.
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Domaradzki J. Minimal Detectable Change in Resting Blood Pressure and Cardiorespiratory Fitness: A Secondary Analysis of a Study on School-Based High-Intensity Interval Training Intervention. J Clin Med 2023; 12:6146. [PMID: 37834790 PMCID: PMC10573284 DOI: 10.3390/jcm12196146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
High-intensity interval training (HIIT) effects on resting blood pressure (BP) and cardiorespiratory fitness (CRF) have already been studied. Furthermore, the responses of responders and non-responders to HIIT in terms of these physiological outcomes have also been examined. However, the minimal detectable change (MDC) in BP and CRF has not been addressed yet. Therefore, the current study aimed to compare the MDC90 of BP (systolic and diastolic) and CRF (fitness index (FI) results) in the context of a school-based HIIT program for adolescents. Participants were adolescents, with an average age of 16.16 years (n = 141; 36.6% males). A preplanned secondary analysis was conducted using pre-post data from the control group to estimate MDC90. The MDC90 of SBP, DBP, and FI were 7.82 mm HG, 12.45 mm HG, and 5.39 points, respectively. However, taking into account the relative values of these changes, MDC90 required a greater change in DBP (17.27%) than FI (12.15%) and SBP (6.68%). Any training-induced physiological changes in the average values of the outcomes did not exceed MDC90. However, a comparison of the participants who exceeded and did not exceed MDC90 showed statistically significant differences. These findings reveal the huge variability in and insensitivity to the intervention effect for all measurements. This is likely because of the large subgroup of participants with low sensitivity to the physiological stimulus. As such, there is a considerable need to create individually tailored intervention programs.
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Affiliation(s)
- Jarosław Domaradzki
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
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Reuter M, Rosenberger F, Barz A, Venhorst A, Blanz L, Hecksteden A, Meyer T. Does Higher Intensity Increase the Rate of Responders to Endurance Training When Total Energy Expenditure Remains Constant? A Randomized Controlled Trial. SPORTS MEDICINE - OPEN 2023; 9:35. [PMID: 37209213 PMCID: PMC10199994 DOI: 10.1186/s40798-023-00579-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Standardized training prescriptions often result in large variation in training response with a substantial number of individuals that show little or no response at all. The present study examined whether the response in markers of cardiorespiratory fitness (CRF) to moderate intensity endurance training can be elevated by an increase in training intensity. METHODS Thirty-one healthy, untrained participants (46 ± 8 years, BMI 25.4 ± 3.3 kg m-2 and [Formula: see text]O2max 34 ± 4 mL min-1 kg-1) trained for 10 weeks with moderate intensity (3 day week-1 for 50 min per session at 55% HRreserve). Hereafter, the allocation into two groups was performed by stratified randomization for age, gender and VO2max response. CON (continuous moderate intensity) trained for another 16 weeks at moderate intensity, INC (increased intensity) trained energy-equivalent for 8 weeks at 70% HRreserve and then performed high-intensity interval training (4 × 4) for another 8 weeks. Responders were identified as participants with VO2max increase above the technical measurement error. RESULTS There was a significant difference in [Formula: see text]O2max response between INC (3.4 ± 2.7 mL kg-1 min-1) and CON (0.4 ± 2.9 mL kg-1 min-1) after 26 weeks of training (P = 0.020). After 10 weeks of moderate training, in total 16 of 31 participants were classified as VO2max responders (52%). After another 16 weeks continuous moderate intensity training, no further increase of responders was observed in CON. In contrast, the energy equivalent training with increasing training intensity in INC significantly (P = 0.031) increased the number of responders to 13 of 15 (87%). The energy equivalent higher training intensities increased the rate of responders more effectively than continued moderate training intensities (P = 0.012). CONCLUSION High-intensity interval training increases the rate of response in VO2max to endurance training even when the total energy expenditure is held constant. Maintaining moderate endurance training intensities might not be the best choice to optimize training gains. Trial Registration German Clinical Trials Register, DRKS00031445, Registered 08 March 2023-Retrospectively registered, https://www.drks.de/DRKS00031445.
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Affiliation(s)
- Marcel Reuter
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany.
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany.
| | - Friederike Rosenberger
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Andreas Barz
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
| | - Andreas Venhorst
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
| | - Laura Blanz
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
| | - Anne Hecksteden
- Institute of Psychology and Sport Science, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria
| | - Tim Meyer
- Insitute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany
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Diaz-Canestro C, Chen J, Liu Y, Han H, Wang Y, Honoré E, Lee CH, Lam KSL, Tse MA, Xu A. A machine-learning algorithm integrating baseline serum proteomic signatures predicts exercise responsiveness in overweight males with prediabetes. Cell Rep Med 2023; 4:100944. [PMID: 36787735 PMCID: PMC9975321 DOI: 10.1016/j.xcrm.2023.100944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/11/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023]
Abstract
The molecular transducers conferring the benefits of chronic exercise in diabetes prevention remain to be comprehensively investigated. Herein, serum proteomic profiling of 688 inflammatory and metabolic biomarkers in 36 medication-naive overweight and obese men with prediabetes reveals hundreds of exercise-responsive proteins modulated by 12-week high-intensity interval exercise training, including regulators of metabolism, cardiovascular system, inflammation, and apoptosis. Strong associations are found between proteins involved in gastro-intestinal mucosal immunity and metabolic outcomes. Exercise-induced changes in trefoil factor 2 (TFF2) are associated with changes in insulin resistance and fasting insulin, whereas baseline levels of the pancreatic secretory granule membrane major glycoprotein GP2 are related to changes in fasting glucose and glucose tolerance. A hybrid set of 23 proteins including TFF2 are differentially altered in exercise responders and non-responders. Furthermore, a machine-learning algorithm integrating baseline proteomic signatures accurately predicts individualized metabolic responsiveness to exercise training.
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Affiliation(s)
- Candela Diaz-Canestro
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jiarui Chen
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yan Liu
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hao Han
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yao Wang
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eric Honoré
- Université Côte d'Azur, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Institut de Pharmacologie Moléculaire et Cellulaire, Labex ICST, Valbonne, France
| | - Chi-Ho Lee
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Karen S L Lam
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Michael Andrew Tse
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Centre for Sports and Exercise, The University of Hong Kong, Hong Kong, China.
| | - Aimin Xu
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China; Department of Medicine, The University of Hong Kong, Hong Kong, China; Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China.
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12
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Patel KV, Saha A, Ayers CR, Rohatgi A, Berry JD, Almandoz JP, Johannsen NM, deFilippi C, Church TS, de Lemos JA, Pandey A. Exercise Training, Cardiac Biomarkers, and Cardiorespiratory Fitness in Type 2 Diabetes: The HART-D Study. JACC. ADVANCES 2023; 2:100174. [PMID: 38939024 PMCID: PMC11198483 DOI: 10.1016/j.jacadv.2022.100174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 06/29/2024]
Abstract
Background High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are cardiac biomarkers commonly detected in adults with type 2 diabetes (T2D) and are associated with heart failure risk. Objectives The purpose of this study was to evaluate the effects of exercise training (ET) on hs-cTnT and NT-proBNP and evaluate the associations of these biomarkers with cardiorespiratory fitness among adults with T2D. Methods Participants of the HART-D (Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes) trial who were randomly assigned to one of 3 ET groups or a non-exercise control group were included. Cardiac biomarkers and cardiorespiratory fitness (evaluated by peak oxygen uptake [VO2peak]) were assessed at baseline and after 9 months. The effects of ET (3 ET groups pooled) vs non-exercise control on hs-cTnT and NT-proBNP were assessed using separate analysis of covariance models. Multivariable-adjusted linear regression was performed to identify factors associated with follow-up biomarkers and ΔVO2peak. Results The present study included 166 participants randomized to the ET (n = 135) and non-exercise control (n = 31) groups. Compared with the non-exercise control, ET did not significantly change hs-cTnT or NT-proBNP. In adjusted analysis, each ET group and ΔVO2peak were not significantly associated with hs-cTnT or NT-proBNP levels on follow-up. Among individuals in the ET group, baseline hs-cTnT was inversely associated with ΔVO2peak [per 1 SD higher log (hs-cTnT): β = -0.08 (95% CI = -0.15 to -0.01)]. Conclusions Among individuals with T2D, ET did not modify cardiac biomarkers. Higher baseline hs-cTnT was associated with blunted cardiorespiratory fitness improvement in response to exercise.
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Affiliation(s)
- Kershaw V. Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Amit Saha
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colby R. Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P. Almandoz
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neil M. Johannsen
- School of Kinesiology, College of Human Sciences & Education, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Timothy S. Church
- Preventive Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - James A. de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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13
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Xie L, Gou B, Bai S, Yang D, Zhang Z, Di X, Su C, Wang X, Wang K, Zhang J. Unsupervised cluster analysis reveals distinct subgroups in healthy population with different exercise responses of cardiorespiratory fitness. J Exerc Sci Fit 2023; 21:147-156. [PMID: 36688000 PMCID: PMC9827383 DOI: 10.1016/j.jesf.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Background Considerable attention has been paid to interindividual differences in the cardiorespiratory fitness (CRF) response to exercise. However, the complex multifactorial nature of CRF response variability poses a significant challenge to our understanding of this issue. We aimed to explore whether unsupervised clustering can take advantage of large amounts of clinical data and identify latent subgroups with different CRF exercise responses within a healthy population. Methods 252 healthy participants (99 men, 153 women; 36.8 ± 13.4 yr) completed moderate endurance training on 3 days/week for 4 months, with exercise intensity prescribed based on anaerobic threshold (AT). Detailed clinical measures, including resting vital signs, ECG, cardiorespiratory parameters, echocardiography, heart rate variability, spirometry and laboratory data, were obtained before and after the exercise intervention. Baseline phenotypic variables that were significantly correlated with CRF exercise response were identified and subjected to selection steps, leaving 10 minimally redundant variables, including age, BMI, maximal oxygen uptake (VO2max), maximal heart rate, VO2 at AT as a percentage of VO2max, minute ventilation at AT, interventricular septal thickness of end-systole, E velocity, root mean square of heart rate variability, and hematocrit. Agglomerative hierarchical clustering was performed on these variables to detect latent subgroups that may be associated with different CRF exercise responses. Results Unsupervised clustering revealed two mutually exclusive groups with distinct baseline phenotypes and CRF exercise responses. The two groups differed markedly in baseline characteristics, initial fitness, echocardiographic measurements, laboratory values, and heart rate variability parameters. A significant improvement in CRF following the 16-week endurance training, expressed by the absolute change in VO2max, was observed only in one of the two groups (3.42 ± 0.4 vs 0.58 ± 0.65 ml⋅kg-1∙min-1, P = 0.002). Assuming a minimal clinically important difference of 3.5 ml⋅kg-1∙min-1 in VO2max, the proportion of population response was 56.1% and 13.9% for group 1 and group 2, respectively (P<0.001). Although group 1 exhibited no significant improvement in CRF at group level, a significant decrease in diastolic blood pressure (70.4 ± 7.8 vs 68.7 ± 7.2 mm Hg, P = 0.027) was observed. Conclusions Unsupervised learning based on dense phenotypic characteristics identified meaningful subgroups within a healthy population with different CRF responses following standardized aerobic training. Our model could serve as a useful tool for clinicians to develop personalized exercise prescriptions and optimize training effects.
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Affiliation(s)
- Lin Xie
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Bo Gou
- Department of Physical Activity and Public Health, Xi'an Physical Education University, Xi'an, 710068, China
| | - Shuwen Bai
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Dong Yang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Zhe Zhang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaohui Di
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Chunwang Su
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiaoni Wang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China
| | - Kun Wang
- Department of Physical Activity and Public Health, Xi'an Physical Education University, Xi'an, 710068, China,Corresponding author.
| | - Jianbao Zhang
- Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China,Corresponding author. Key Laboratory of Biomedical Information Engineering of Education Ministry, Department of Life Science and Technology, Xi'an Jiaotong University, No.28, Xianning West Road, Xi'an, China.
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14
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Sugimoto T, Uchitomi R, Onishi T, Kamei Y. A combination of exercise and calorie restriction improves the development of obesity-related type 2 diabetes mellitus in KKAy mice. Biosci Biotechnol Biochem 2022; 87:108-113. [PMID: 36307382 DOI: 10.1093/bbb/zbac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
We observed that exercise and calorie restriction reduced the body weight and blood glucose levels, concurrently improving insulin resistance and glucose tolerance in obese/diabetic model KKAy mice. Analysis of gene expression in the skeletal muscle showed enhanced mRNA levels of GLUT4 (glucose uptake), ATGL (lipolytic enzyme), and slow-twitch myosin heavy chain, which may contribute to the antiobesity and antidiabetic effects.
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Affiliation(s)
- Takumi Sugimoto
- Laboratory of Molecular Nutrition, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Ran Uchitomi
- Laboratory of Molecular Nutrition, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Takumi Onishi
- Laboratory of Molecular Nutrition, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Yasutomi Kamei
- Laboratory of Molecular Nutrition, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
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15
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High-Intensity Interval Training is Safe, Feasible and Efficacious in Nonalcoholic Steatohepatitis: A Randomized Controlled Trial. Dig Dis Sci 2022; 68:2123-2139. [PMID: 36538276 PMCID: PMC9763796 DOI: 10.1007/s10620-022-07779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND High-Intensity Interval Training (HIIT) involves bursts of high-intensity exercise interspersed with lower-intensity exercise recovery. HIIT may benefit cardiometabolic health in people with nonalcoholic steatohepatitis (NASH). AIMS We aimed to examine the safety, feasibility, and efficacy of 12-weeks of supervised HIIT compared with a sham-exercise control (CON) for improving aerobic fitness and peripheral insulin sensitivity in biopsy-proven NASH. METHODS Participants based in the community [(n = 14, 56 ± 10 years, BMI 39.2 ± 6.7 kg/m2, 64% male), NAFLD Activity Score 5 (range 3-7)] were randomized to 12-weeks of supervised HIIT (n = 8, 4 × 4 min at 85-95% maximal heart rate, interspersed with 3 min active recovery; 3 days/week) or CON (n = 6, stretching; 3 days/week). Safety (adverse events) and feasibility determined as ≥ 70% program completion and ≥ 70% global adherence (including session attendance, interval intensity adherence, and duration adherence) were assessed. Changes in cardiorespiratory fitness (V̇O2peak), exercise capacity (time-on-test) and peripheral insulin sensitivity (euglycemic hyperinsulinemic clamp) were assessed. Data were analysed using ANCOVA with baseline value as the covariate. RESULTS There were no HIIT-related adverse events and HIIT was globally feasible [program completion 75%, global adherence 100% (including adherence to session 95.4 ± 7.3%, interval intensity 95.3 ± 6.0% and duration 96.8 ± 2.4%)]. A large between-group effect was observed for exercise capacity [mean difference 134.2 s (95% CI 19.8, 248.6 s), ƞ2 0.44, p = 0.03], improving in HIIT (106.2 ± 97.5 s) but not CON (- 33.4 ± 43.3 s), and for peripheral insulin sensitivity [mean difference 3.4 mg/KgLegFFM/min (95% CI 0.9,6.8 mg/KgLegFFM/min), ƞ2 0.32, p = 0.046], improving in HIIT (1.0 ± 0.8 mg/KgLegFFM/min) but not CON (- 3.1 ± 1.2 mg/KgLegFFM/min). CONCLUSIONS HIIT is safe, feasible and efficacious for improving exercise capacity and peripheral insulin sensitivity in people with NASH. CLINICAL TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (anzctr.org.au) identifier ACTRN12616000305426 (09/03/2016).
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16
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Hall M, Lima YL, Huschtscha Z, Dobson F, Costa RJS. What is real change in submaximal cardiorespiratory fitness in older adults? Retrospective analysis of a clinical trial. SPORTS MEDICINE - OPEN 2022; 8:59. [PMID: 35482259 PMCID: PMC9051008 DOI: 10.1186/s40798-022-00447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
Objective To assess the test–retest reliability of submaximal cardiorespiratory fitness in healthy active older adults.
Methods This was a retrospective analysis of 41 adults enrolled in a clinical trial [mean (sd) aged 59 yrs (7); 29% females; and body mass index 24.5 kg/m2 (3.3)]. Cardiorespiratory fitness was assessed using a cycle ergometer 6 weeks apart. The initial workload was 1 W per kilogram of free fat mass (W/kg FFM) and increased by 0.5 W/kg FFM every 3 min until participants could not maintain the speed at ≥ 60 rpm, they reached a rating of perceived exertion of 15–17, and/or obtained a respiratory exchange ratio (RER) of 1.000. Reliability of \documentclass[12pt]{minimal}
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\begin{document}$${V}{\text{O}}_{2}$$\end{document}VO2, heart rate and RER was assessed for each workload, and for \documentclass[12pt]{minimal}
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\begin{document}$${V}{\text{O}}_{2}$$\end{document}VO2, when RER reached 1.00. Reliability was examined as the intraclass correlation coefficient (ICC(2,1)), Bland–Altman plots, standard error of measurement (SEM and SEM%), and the minimal detectable change (MDC).
Results Test–retest agreement ranged between (ICC(2,1) 0.44–0.84) with no discernible systematic differences between assessments. The SEM% for absolute and relative \documentclass[12pt]{minimal}
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\begin{document}$${V}{\text{O}}_{2}$$\end{document}VO2 ranged between 13.0 to 20.2%, and 13.8 to 26.3%, respectively. The MDC90% for absolute and relative \documentclass[12pt]{minimal}
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\begin{document}$${V}{\text{O}}_{2}$$\end{document}VO2 ranged between 30.4% to 47.1%, and 32.2% to 61.4%, respectively. The lowest SEMs% and MDCs% for both absolute and relative \documentclass[12pt]{minimal}
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\begin{document}$${V}{\text{O}}_{2}$$\end{document}VO2 were observed for workloads at 2.5 W kg/FFM (~ 13% and ~ 31%, respectively). Conclusions Although at least modest relative reliability was consistently demonstrated, the smaller measurement error associated with absolute and relative \documentclass[12pt]{minimal}
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\begin{document}$${V}{\text{O}}_{2}$$\end{document}VO2 at 2.5 W kg/FFM may indirectly suggest that submaximal cardiorespiratory fitness can be monitored more confidently at higher workloads. Findings provide critical information to determine how much change is considered ‘real change’ in repeated measures of cardiorespiratory fitness using a submaximal graded exercise testing protocol in healthy active older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00447-6.
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Brellenthin AG, Bennie JA, Lee DC. Aerobic or Muscle-Strengthening Physical Activity: Which Is Better for Health? Curr Sports Med Rep 2022; 21:272-279. [PMID: 35946846 PMCID: PMC9373235 DOI: 10.1249/jsr.0000000000000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT The Physical Activity Guidelines recommend performing 150 min of moderate- to vigorous-intensity aerobic physical activity (MVPA) per week. These guidelines also recommend muscle-strengthening physical activity (MSPA) on ≥2 d·wk-1 for additional benefits including muscular fitness and bone health. The majority of the scientific evidence supporting the PA recommendations for health comes from studies of MVPA while the possible contributions of MSPA in these findings have been overlooked historically. Emerging evidence suggests that MSPA can independently protect against major cardiometabolic risk factors, chronic diseases, and mortality. Additional data from clinical trials indicate that many of the well-known health benefits of exercise, like improvements in cardiovascular disease risk factors, are more robust with combined MVPA and MSPA. This review will clarify the relative benefits of MSPA versus MVPA on health-related outcomes to determine the best type of PA for health.
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Affiliation(s)
| | - Jason A. Bennie
- Murrumbidgee Primary Health Network, Wagga Wagga,
New South Wales, Australia
| | - Duck-chul Lee
- Department of Kinesiology, Iowa State University, Ames,
IA
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18
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Pandey A, Segar MW, Singh S, Reeves G, O'Connor C, Pina I, Whellan D, Kraus W, Mentz R, Kitzman D. Frailty Status Modifies the Efficacy of Exercise Training Among Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the HF-ACTION Trial. Circulation 2022; 146:80-90. [PMID: 35616018 DOI: 10.1161/circulationaha.122.059983] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Supervised aerobic exercise training (ET) is recommended for stable outpatients with heart failure (HF) with reduced ejection fraction (HFrEF). Frailty, a syndrome characterized by increased vulnerability and decreased physiologic reserve, is common in patients with HFrEF and associated with a higher risk of adverse outcomes. The effect modification of baseline frailty on the efficacy of aerobic ET in HFrEF is not known. METHODS Stable outpatients with HFrEF randomized to aerobic ET versus usual care in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were included. Baseline frailty was estimated using the Rockwood frailty index (FI), a deficit accumulation-based model of frailty assessment; participants with FI scores >0.21 were identified as frail. Multivariable Cox proportional hazard models with multiplicative interaction terms (frailty treatment arm) were constructed to evaluate whether frailty modified the treatment effect of aerobic ET on the primary composite end point (all-cause hospitalization and mortality), secondary end points (composite of cardiovascular death or cardiovascular hospitalization, and cardiovascular death or HF hospitalization), and Kansas City Cardiomyopathy Questionnaire score. Separate models were constructed for continuous (FI) and categorical (frail versus not frail) measures of frailty. RESULTS Among 2130 study participants (age, 59±13 years; 28% women), 1266 (59%) were characterized as frail (FI>0.21). Baseline frailty burden significantly modified the treatment effect of aerobic ET (P interaction: FI × treatment arm=0.02; frail status [frail versus nonfrail] × treatment arm=0.04) with a lower risk of primary end point in frail (hazard ratio [HR], 0.83 [95% CI, 0.72-0.95]) but not nonfrail (HR, 1.04 [95% CI, 0.87-1.25]) participants. The favorable effect of aerobic ET among frail participants was driven by a significant reduction in the risk of all-cause hospitalization (HR, 0.84 [95% CI, 0.72-0.99]). The treatment effect of aerobic ET on all-cause mortality and other secondary endpoints was not different between frail and nonfrail patients (P interaction>0.1 for each). Aerobic ET was associated with a nominally greater improvement in Kansas City Cardiomyopathy Questionnaire scores at 3 months among frail versus nonfrail participants without a significant treatment interaction by frailty status (P interaction>0.2). CONCLUSION Among patients with chronic stable HFrEF, baseline frailty modified the treatment effect of aerobic ET with a greater reduction in the risk of all-cause hospitalization but not mortality.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.S.)
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston (M.W.S.)
| | - Sumitabh Singh
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.S.)
| | - Gordon Reeves
- Cardiovascular Disease, Heart Failure and Transplant, Novant Health, Charlotte, NC (G.R.)
| | - Christopher O'Connor
- Inova Heart and Vascular Institute, Falls Church, VA (C.O.).,Duke University Medical Center, Durham, NC. (C.O.).,Duke Clinical Research Institute, Durham, NC. (C.O., R.M.)
| | | | - David Whellan
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (D.W.)
| | - William Kraus
- Division of Cardiology, Duke University School of Medicine, Durham, NC. (W.K., R.M.)
| | - Robert Mentz
- Duke Clinical Research Institute, Durham, NC. (C.O., R.M.).,Division of Cardiology, Duke University School of Medicine, Durham, NC. (W.K., R.M.)
| | - Dalane Kitzman
- Cardiovascular Medicine and Geriatrics Sections, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
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19
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Chow LS, Gerszten RE, Taylor JM, Pedersen BK, van Praag H, Trappe S, Febbraio MA, Galis ZS, Gao Y, Haus JM, Lanza IR, Lavie CJ, Lee CH, Lucia A, Moro C, Pandey A, Robbins JM, Stanford KI, Thackray AE, Villeda S, Watt MJ, Xia A, Zierath JR, Goodpaster BH, Snyder MP. Exerkines in health, resilience and disease. Nat Rev Endocrinol 2022; 18:273-289. [PMID: 35304603 PMCID: PMC9554896 DOI: 10.1038/s41574-022-00641-2] [Citation(s) in RCA: 296] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 12/16/2022]
Abstract
The health benefits of exercise are well-recognized and are observed across multiple organ systems. These beneficial effects enhance overall resilience, healthspan and longevity. The molecular mechanisms that underlie the beneficial effects of exercise, however, remain poorly understood. Since the discovery in 2000 that muscle contraction releases IL-6, the number of exercise-associated signalling molecules that have been identified has multiplied. Exerkines are defined as signalling moieties released in response to acute and/or chronic exercise, which exert their effects through endocrine, paracrine and/or autocrine pathways. A multitude of organs, cells and tissues release these factors, including skeletal muscle (myokines), the heart (cardiokines), liver (hepatokines), white adipose tissue (adipokines), brown adipose tissue (baptokines) and neurons (neurokines). Exerkines have potential roles in improving cardiovascular, metabolic, immune and neurological health. As such, exerkines have potential for the treatment of cardiovascular disease, type 2 diabetes mellitus and obesity, and possibly in the facilitation of healthy ageing. This Review summarizes the importance and current state of exerkine research, prevailing challenges and future directions.
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Affiliation(s)
- Lisa S Chow
- Division of Diabetes Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN, USA.
| | - Robert E Gerszten
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joan M Taylor
- Department of Pathology, McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Bente K Pedersen
- Centre of Inflammation and Metabolism/Centre for PA Research (CIM/CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henriette van Praag
- Stiles-Nicholson Brain institute and Charles E. Schmidt College of Medicine, Florida Atlantic University, Jupiter, FL, USA
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, IN, USA
| | - Mark A Febbraio
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Zorina S Galis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yunling Gao
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jacob M Haus
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Ian R Lanza
- Division of Endocrinology, Nutrition, and Metabolism, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Carl J Lavie
- Division of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | - Chih-Hao Lee
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Research Institute Hospital 12 de Octubre ('imas12'), Madrid, Spain
- CIBER en Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Cedric Moro
- Institute of Metabolic and Cardiovascular Diseases, Team MetaDiab, Inserm UMR1297, Toulouse, France
- Toulouse III University-Paul Sabatier (UPS), Toulouse, France
| | - Ambarish Pandey
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy M Robbins
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kristin I Stanford
- Department of Physiology and Cell Biology, Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alice E Thackray
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Saul Villeda
- Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - Matthew J Watt
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Victoria, Australia
| | - Ashley Xia
- Division of Diabetes, Endocrinology, & Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Juleen R Zierath
- Department of Molecular Medicine and Surgery, Section for Integrative Physiology, Karolinska Institutet, Stockholm, Sweden
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Michael P Snyder
- Department of Genetics, Stanford School of Medicine, Stanford, CA, USA.
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20
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Pinches JL, Pinches YL, Johnson JO, Haddad NC, Boueri MG, Oke LM, Haddad GE. Could “Cellular Exercise” be the Missing Ingredient in a Healthy Life? Diets, Caloric Restriction and Exercise-Induced Hormesis. Nutrition 2022; 99-100:111629. [DOI: 10.1016/j.nut.2022.111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/28/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
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21
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Melo X, Pinto R, Angarten V, Coimbra M, Correia D, Roque M, Reis J, Santos V, Fernhall B, Santa-Clara H. Training responsiveness of cardiorespiratory fitness and arterial stiffness following moderate-intensity continuous training and high-intensity interval training in adults with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:1058-1072. [PMID: 34713518 DOI: 10.1111/jir.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) prompts antiatherogenic adaptations in vascular function and structure. However, there is an extraordinary interindividual variability in response to a standard dose of exercise, wherein a substantial number of adults with intellectual and developmental disabilities (IDD) do not improve CRF. We (1) evaluated the effects of 12-month of moderate-intensity continuous training (MICT) on CRF and arterial stiffness and (2) tested whether an additional 3-month of high-intensity interval training (HIIT) would add to improvements in CRF responsiveness and arterial stiffness. METHODS Fifteen adults with mild-to-moderate IDD (male adults = 9, 30.1 ± 7.5 years old) met 3 days per week for 30 min MICT for 12 months, after which the incidence of CRF responsiveness was calculated (≥5.0% change in absolute peak VO2 ). Thereafter, responders and non-responders started HIIT for 3 months with identical daily training load/frequency. Peak VO2 , local and regional indices of arterial stiffness were assessed prior to and after each period. RESULTS Sixty per cent of the participants were non-responders following MICT, but the incidence dropped to 20% following HIIT (P = 0.03). Absolute peak VO2 values reached significant difference from pre-intervention (+0.38 ± 0.08 L min-1 , P = 0.001) only when HIIT was added. Lower limb pulse wave velocity (PWV) decreased following MICT (-0.8 ± 1.1 m s-1 , P = 0.049), whereas central PWV only decreased following HIIT (-0.8 ± 0.9 m s-1 , P = 0.013). CONCLUSIONS Cardiorespiratory fitness responsiveness and reductions in PWV to a 12-month MICT period in adults with IDD improved following a period of HIIT programme inducing higher metabolic stress.
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Affiliation(s)
- X Melo
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
- Ginásio Clube Português, Research & Development Department, GCP Lab, Lisbon, Portugal
| | - R Pinto
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
- Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - V Angarten
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - M Coimbra
- CERCIOEIRAS - Cooperativa de Educação e Reabilitação dos Cidadãos com Incapacidade, CRL, Barcarena, Portugal
| | - D Correia
- CERCIOEIRAS - Cooperativa de Educação e Reabilitação dos Cidadãos com Incapacidade, CRL, Barcarena, Portugal
| | - M Roque
- CERCIOEIRAS - Cooperativa de Educação e Reabilitação dos Cidadãos com Incapacidade, CRL, Barcarena, Portugal
| | - J Reis
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - V Santos
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
| | - B Fernhall
- College of Applied Health Sciences, The University of Illinois at Chicago, Integrative Physiology Laboratory, Chicago, IL, USA
| | - H Santa-Clara
- Faculdade de Motricidade Humana, Universidade de Lisboa, Centro Interdisciplinar de Estudo da Performance Humana (CIPER), Lisbon, Portugal
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22
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Bonafiglia JT, Preobrazenski N, Gurd BJ. A Systematic Review Examining the Approaches Used to Estimate Interindividual Differences in Trainability and Classify Individual Responses to Exercise Training. Front Physiol 2021; 12:665044. [PMID: 34819869 PMCID: PMC8606564 DOI: 10.3389/fphys.2021.665044] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Many reports describe statistical approaches for estimating interindividual differences in trainability and classifying individuals as "responders" or "non-responders." The extent to which studies in the exercise training literature have adopted these statistical approaches remains unclear. Objectives: This systematic review primarily sought to determine the extent to which studies in the exercise training literature have adopted sound statistical approaches for examining individual responses to exercise training. We also (1) investigated the existence of interindividual differences in trainability, and (2) tested the hypothesis that less conservative thresholds inflate response rates compared with thresholds that consider error and a smallest worthwhile change (SWC)/minimum clinically important difference (MCID). Methods: We searched six databases: AMED, CINAHL, EMBASE, Medline, PubMed, and SportDiscus. Our search spanned the aerobic, resistance, and clinical or rehabilitation training literature. Studies were included if they used human participants, employed standardized and supervised exercise training, and either: (1) stated that their exercise training intervention resulted in heterogenous responses, (2) statistically estimated interindividual differences in trainability, and/or (3) classified individual responses. We calculated effect sizes (ESIR) to examine the presence of interindividual differences in trainability. We also compared response rates (n = 614) across classification approaches that considered neither, one of, or both errors and an SWC or MCID. We then sorted response rates from studies that also reported mean changes and response thresholds (n = 435 response rates) into four quartiles to confirm our ancillary hypothesis that larger mean changes produce larger response rates. Results: Our search revealed 3,404 studies, and 149 were included in our systematic review. Few studies (n = 9) statistically estimated interindividual differences in trainability. The results from these few studies present a mixture of evidence for the presence of interindividual differences in trainability because several ESIR values lay above, below, or crossed zero. Zero-based thresholds and larger mean changes significantly (both p < 0.01) inflated response rates. Conclusion: Our findings provide evidence demonstrating why future studies should statistically estimate interindividual differences in trainability and consider error and an SWC or MCID when classifying individual responses to exercise training. Systematic Review Registration: [website], identifier [registration number].
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Affiliation(s)
- Jacob T Bonafiglia
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | | | - Brendon J Gurd
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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23
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Ardavani A, Aziz H, Phillips BE, Doleman B, Ramzan I, Mozaffar B, Atherton PJ, Idris I. Indicators of response to exercise training: a systematic review and meta-analysis. BMJ Open 2021; 11:e044676. [PMID: 34301648 PMCID: PMC8728353 DOI: 10.1136/bmjopen-2020-044676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Means-based analysis of maximal rate of oxygen consumption (VO2max) has traditionally been used as the exercise response indicator to assess the efficacy of endurance (END), high intensity interval (HIIT) and resistance exercise training (RET) for improving cardiorespiratory fitness and whole-body health. However, considerable heterogeneity exists in the interindividual variability response to the same or different training modalities. OBJECTIVES We performed a systematic review and meta-analysis to investigate exercise response rates in the context of VO2max: (1) in each training modality (END, HIIT and RET) versus controls, (2) in END versus either HIIT or RET and (3) exercise response rates as measured by VO2max versus other indicators of positive exercise response in each exercise modality. METHODS Three databases (EMBASE, MEDLINE, CENTRAL) and additional sources were searched. Both individual response rate and population average data were incorporated through continuous data, respectively. Of 3268 identified manuscripts, a total of 29 studies were suitable for qualitative synthesis and a further 22 for quantitative. Stratification based on intervention duration (less than 12 weeks; more than or equal to 12 weeks) was undertaken. RESULTS A total of 62 data points were procured. Both END and HIIT training exhibited differential improvements in VO2max based on intervention duration. VO2max did not adequately differentiate between END and HIIT, irrespective of intervention length. Although none of the other exercise response indicators achieved statistical significance, LT and HRrest demonstrated common trajectories in pooled and separate analyses between modalities. RET data were highly limited. Heterogeneity was ubiquitous across all analyses. CONCLUSIONS The potential for LT and HRrest as indicators of exercise response requires further elucidation, in addition to the exploration of interventional and intrinsic sources of heterogeneity.
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Affiliation(s)
- Arash Ardavani
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Hariz Aziz
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Bethan E Phillips
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Brett Doleman
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Imran Ramzan
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Boshra Mozaffar
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Philip J Atherton
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
| | - Iskandar Idris
- Division of Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK
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24
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Abstract
Since ancient times, the health benefits of regular physical activity/exercise have been recognized and the classic studies of Morris and Paffenbarger provided the epidemiological evidence in support of such an association. Cardiorespiratory fitness, often measured by maximal oxygen uptake, and habitual physical activity levels are inversely related to mortality. Thus, studies exploring the biological bases of the health benefits of exercise have largely focused on the cardiovascular system and skeletal muscle (mass and metabolism), although there is increasing evidence that multiple tissues and organ systems are influenced by regular exercise. Communication between contracting skeletal muscle and multiple organs has been implicated in exercise benefits, as indeed has other interorgan "cross-talk." The application of molecular biology techniques and "omics" approaches to questions in exercise biology has opened new lines of investigation to better understand the beneficial effects of exercise and, in so doing, inform the optimization of exercise regimens and the identification of novel therapeutic strategies to enhance health and well-being.
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Affiliation(s)
- Mark Hargreaves
- Department of Anatomy & Physiology, The University of Melbourne, Melbourne, Victoria, Australia
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25
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Meyler S, Bottoms L, Muniz-Pumares D. Biological and methodological factors affecting V ̇ O 2 max response variability to endurance training and the influence of exercise intensity prescription. Exp Physiol 2021; 106:1410-1424. [PMID: 34036650 DOI: 10.1113/ep089565] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022]
Abstract
NEW FINDINGS What is the topic of this review? Biological and methodological factors associated with the variable changes in cardiorespiratory fitness in response to endurance training. What advances does it highlight? Several biological and methodological factors exist that each contribute, to a given extent, to response variability. Notably, prescribing exercise intensity relative to physiological thresholds reportedly increases cardiorespiratory fitness response rates compared to when prescribed relative to maximum physiological values. As threshold-based approaches elicit more homogeneous acute physiological responses among individuals, when repeated over time, these uniform responses may manifest as more homogeneous chronic adaptations thereby reducing response variability. ABSTRACT Changes in cardiorespiratory fitness (CRF) in response to endurance training (ET) exhibit large variations, possibly due to a multitude of biological and methodological factors. It is acknowledged that ∼20% of individuals may not achieve meaningful increases in CRF in response to ET. Genetics, the most potent biological contributor, has been shown to explain ∼50% of response variability, whilst age, sex and baseline CRF appear to explain a smaller proportion. Methodological factors represent the characteristics of the ET itself, including the type, volume and intensity of exercise, as well as the method used to prescribe and control exercise intensity. Notably, methodological factors are modifiable and, upon manipulation, alter response rates to ET, eliciting increases in CRF regardless of an individual's biological predisposition. Particularly, prescribing exercise intensity relative to a physiological threshold (e.g., ventilatory threshold) is shown to increase CRF response rates compared to when intensity is anchored relative to a maximum physiological value (e.g., maximum heart rate). It is, however, uncertain whether the increased response rates are primarily attributable to reduced response variability, greater mean changes in CRF or both. Future research is warranted to elucidate whether more homogeneous chronic adaptations manifest over time among individuals, as a result of exposure to more homogeneous exercise stimuli elicited by threshold-based practices.
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Affiliation(s)
- Samuel Meyler
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lindsay Bottoms
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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26
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Remchak MME, Piersol KL, Bhatti S, Spaeth AM, Buckman JF, Malin SK. Considerations for Maximizing the Exercise "Drug" to Combat Insulin Resistance: Role of Nutrition, Sleep, and Alcohol. Nutrients 2021; 13:1708. [PMID: 34069950 PMCID: PMC8157556 DOI: 10.3390/nu13051708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/24/2021] [Accepted: 05/13/2021] [Indexed: 01/12/2023] Open
Abstract
Insulin resistance is a key etiological factor in promoting not only type 2 diabetes mellitus but also cardiovascular disease (CVD). Exercise is a first-line therapy for combating chronic disease by improving insulin action through, in part, reducing hepatic glucose production and lipolysis as well as increasing skeletal muscle glucose uptake and vasodilation. Just like a pharmaceutical agent, exercise can be viewed as a "drug" such that identifying an optimal prescription requires a determination of mode, intensity, and timing as well as consideration of how much exercise is done relative to sitting for prolonged periods (e.g., desk job at work). Furthermore, proximal nutrition (nutrient timing, carbohydrate intake, etc.), sleep (or lack thereof), as well as alcohol consumption are likely important considerations for enhancing adaptations to exercise. Thus, identifying the maximal exercise "drug" for reducing insulin resistance will require a multi-health behavior approach to optimize type 2 diabetes and CVD care.
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Affiliation(s)
- Mary-Margaret E. Remchak
- Department of Kinesiology & Health, Rutgers University, New Brunswick, NJ 08901, USA; (M.-M.E.R.); (K.L.P.); (A.M.S.); (J.F.B.)
| | - Kelsey L. Piersol
- Department of Kinesiology & Health, Rutgers University, New Brunswick, NJ 08901, USA; (M.-M.E.R.); (K.L.P.); (A.M.S.); (J.F.B.)
| | - Sabha Bhatti
- Division of Cardiovascular Medicine, Rutgers University, New Brunswick, NJ 08901, USA;
| | - Andrea M. Spaeth
- Department of Kinesiology & Health, Rutgers University, New Brunswick, NJ 08901, USA; (M.-M.E.R.); (K.L.P.); (A.M.S.); (J.F.B.)
| | - Jennifer F. Buckman
- Department of Kinesiology & Health, Rutgers University, New Brunswick, NJ 08901, USA; (M.-M.E.R.); (K.L.P.); (A.M.S.); (J.F.B.)
- Center of Alcohol Studies, Rutgers University, Piscataway, NJ 08854, USA
| | - Steven K. Malin
- Department of Kinesiology & Health, Rutgers University, New Brunswick, NJ 08901, USA; (M.-M.E.R.); (K.L.P.); (A.M.S.); (J.F.B.)
- Division of Endocrinology, Metabolism & Nutrition, Rutgers University, New Brunswick, NJ 08901, USA
- New Jersey Institute for Food, Nutrition and Health, Rutgers University, New Brunswick, NJ 08901, USA
- Institute of Translational Medicine and Science, Rutgers University, New Brunswick, NJ 08901, USA
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27
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Whipple MO, Schorr EN, Talley KMC, Wolfson J, Lindquist R, Bronas UG, Treat-Jacobson D. Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease. West J Nurs Res 2020; 43:770-784. [PMID: 33334275 DOI: 10.1177/0193945920977479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease (N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual's potential benefit from exercise therapy.
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Affiliation(s)
- Mary O Whipple
- Divisions of Geriatric Medicine and General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,School of Nursing, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Erica N Schorr
- School of Nursing, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Kristine M C Talley
- School of Nursing, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Ruth Lindquist
- School of Nursing, University of Minnesota - Twin Cities, Minneapolis, MN, USA
| | - Ulf G Bronas
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois - Chicago, Chicago, IL, USA
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28
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Peña A, McNeish D, Ayers SL, Olson ML, Vander Wyst KB, Williams AN, Shaibi GQ. Response heterogeneity to lifestyle intervention among Latino adolescents. Pediatr Diabetes 2020; 21:1430-1436. [PMID: 32939893 PMCID: PMC8274397 DOI: 10.1111/pedi.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize the heterogeneity in response to lifestyle intervention among Latino adolescents with obesity. METHODS We conducted secondary data analysis of 90 Latino adolescents (age 15.4 ± 0.9 y, female 56.7%) with obesity (BMI% 98.1 ± 1.5%) that were enrolled in a 3 month lifestyle intervention and were followed for a year. Covariance pattern mixture models identified response phenotypes defined by changes in insulin sensitivity as measured using a 2 hour oral glucose tolerance test. Baseline characteristics were compared across response phenotypes using one-way ANOVA and chi-square test. RESULTS Three distinct response phenotypes (PH1, PH2, PH3) were identified. PH1 exhibited the most robust response defined by the greatest increase in insulin sensitivity over time (β ± SE, linear 0.52 ± 0.17, P < .001; quadratic -0.03 ± 0.01, P = .001). PH2 showed non-significant changes, while PH3 demonstrated modest short-term increases in insulin sensitivity which were not sustained over time (linear 0.08 ± 0.03, P = .002; quadratic -0.01 ± 0.002, P = .003). At baseline, PH3 (1.1 ± 0.4) was the most insulin resistant phenotype and exhibited the highest BMI% (98.5 ± 1.1%), 2 hours glucose concentrations (144.0 ± 27.5 mg/dL), and lowest beta-cell function as estimated by the oral disposition index (4.5 ± 2.8). CONCLUSION Response to lifestyle intervention varies among Latino youth with obesity and suggests that precision approaches are warranted to meet the prevention needs of high risk youth.
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Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Daniel McNeish
- Department of Psychology, Arizona State University, Tempe, AZ
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Kiley B. Vander Wyst
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Allison N. Williams
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ,Department of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
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29
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Moreno-Cabañas A, Ortega JF, Morales-Palomo F, Ramirez-Jimenez M, Alvarez-Jimenez L, Pallares JG, Mora-Rodriguez R. The use of a graded exercise test may be insufficient to quantify true changes in V̇o 2max following exercise training in unfit individuals with metabolic syndrome. J Appl Physiol (1985) 2020; 129:760-767. [PMID: 32881617 DOI: 10.1152/japplphysiol.00455.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We studied the accuracy of graded exercise testing (GXT) to assess improvements in maximal oxygen uptake (V̇o2max) with exercise training in unfit individuals with metabolic syndrome (MetS). Forty-four adults with MetS (58 ± 7 yr, 36% women, BMI 31.8 ± 4.8 kg/m-2) underwent 4 mo of supervised high-intensity interval exercise training. V̇o2max was assessed using GXT, followed by a constant-load verification test (VerT) at 110% of the maximal work rate achieved during GXT. V̇o2 data from GXT and VerT were compared using repeated-measures ANOVA. The mean improvement in V̇o2max following exercise training was similar when using GXT only or VerT. However, before training, 18 subjects achieved a higher V̇o2max during the verification test that was (+159 mLO2/min) higher than the GXT (P < 0.001). After training, the underestimation of V̇o2max by GXT was reduced but still present (+64 mLO2/min). As a result, improvements in V̇o2max following exercise training as assessed using GXT only almost doubled the "real" increase in V̇o2max as measured by VerT in these 18 individuals. In the remaining 26 subjects, GXT scored below VerT only after training (+54 mLO2/min, P = 0.046). As a consequence, GXT underestimated the actual V̇o2max increases (-49 mLO2/min, P = 0.013) in these individuals. Assessment of changes in V̇o2max following exercise training using only GXT over- or underestimates V̇o2max gains in unfit individuals with MetS. Thus, a verification test may be required to 1) identify the highest V̇o2max during a maximal exercise test on a cycle ergometer and 2) accurately quantify the true changes in cardiorespiratory fitness following exercise training in unfit individuals with MetS.NEW & NOTEWORTHY It is unclear whether the traditional GXT is suitable to assess V̇o2max changes in unfit individuals with metabolic syndrome. Mean changes in V̇o2max following exercise training were similar using GXT or VerT. However, we showed that the GXT overestimated V̇o2max improvements in 41% and underestimated V̇o2max improvements in 59% of subjects. Our data suggest the need for a verification test to appropriately determine training-induced improvements in V̇o2max in unfit individuals with metabolic syndrome.
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Affiliation(s)
- Alfonso Moreno-Cabañas
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - Juan Fernando Ortega
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - Felix Morales-Palomo
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - Miguel Ramirez-Jimenez
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - Laura Alvarez-Jimenez
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
| | - Jesus G Pallares
- Human Performance and Sports Science Laboratory, University of Murcia, Murcia, Spain
| | - Ricardo Mora-Rodriguez
- Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain
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Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
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Hébert JJ, Sénéchal M, Fairchild T, Møller NC, Klakk H, Wedderkopp N. Developmental Trajectories of Body Mass Index, Waist Circumference, and Aerobic Fitness in Youth: Implications for Physical Activity Guideline Recommendations (CHAMPS Study-DK). Sports Med 2020; 50:2253-2261. [PMID: 32880817 DOI: 10.1007/s40279-020-01335-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Describe the trajectories of body mass index (BMI), waist circumference, and aerobic fitness in children and identify different outcomes of guideline-recommended physical activity (PA) in a subset of active children. METHODS We recruited students from 10 public primary schools and obtained repeated measures of BMI, waist circumference, and aerobic fitness over 30 months. Aerobic fitness was measured with the Andersen test. We objectively measured physical activity behaviour with accelerometers and classified children as 'physically active' when they achieved ≥ 60 min of moderate-to-vigorous PA per day (guideline concordance). Univariate trajectories of BMI, waist circumference, and aerobic fitness were calculated for all children, and we constructed a multi-trajectory model comprising all outcomes in the subgroup of physically active children. The construct validity of all models was investigated by examining for between-group differences in cardiovascular disease risk factors obtained from fasting blood samples. RESULTS Data from 1208 children (53% female) with a mean (SD) age of 8.4 (1.4) years were included. The univariate trajectory models identified three distinct trajectories for BMI, waist circumference, and aerobic fitness. The multi-trajectory model classified 9.1% of physically active children as following an 'overweight/obese/low fitness' trajectory. There were moderate-to-large differences in cardiovascular risk factors between all trajectory groups (p < 0.001; d = 0.4-1.20). CONCLUSION We identified distinct developmental trajectories of BMI, waist circumference, and aerobic fitness in children. Nearly one in 10 children who met PA guideline recommendations followed an unfavourable health trajectory. Health-related PA recommendations may be insufficient for some children.
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Affiliation(s)
- Jeffrey J Hébert
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada.
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia.
| | - Martin Sénéchal
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
- Cardiometabolic Exercise and Lifestyle Laboratory, Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Timothy Fairchild
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia
| | - Niels Christian Møller
- Department of Sports Science and Clinical Biomechanics, Exercise Epidemiology, Center for Research in Childhood Health, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk
- Department of Sports Science and Clinical Biomechanics, Exercise Epidemiology, Center for Research in Childhood Health, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Center for Applied Health Science, University College Lillebælt, Odense, Denmark
| | - Niels Wedderkopp
- Department of Sports Science and Clinical Biomechanics, Exercise Epidemiology, Center for Research in Childhood Health, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- The Orthopedic Department, Hospital of Southwestern Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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MacDonald TL, Pattamaprapanont P, Pathak P, Fernandez N, Freitas EC, Hafida S, Mitri J, Britton SL, Koch LG, Lessard SJ. Hyperglycaemia is associated with impaired muscle signalling and aerobic adaptation to exercise. Nat Metab 2020; 2:902-917. [PMID: 32694831 PMCID: PMC8278496 DOI: 10.1038/s42255-020-0240-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
Increased aerobic exercise capacity, as a result of exercise training, has important health benefits. However, some individuals are resistant to improvements in exercise capacity, probably due to undetermined genetic and environmental factors. Here, we show that exercise-induced improvements in aerobic capacity are blunted and aerobic remodelling of skeletal muscle is impaired in several animal models associated with chronic hyperglycaemia. Our data point to chronic hyperglycaemia as a potential negative regulator of aerobic adaptation, in part, via glucose-mediated modifications of the extracellular matrix, impaired vascularization and aberrant mechanical signalling in muscle. We also observe low exercise capacity and enhanced c-Jun N-terminal kinase activation in response to exercise in humans with impaired glucose tolerance. Our work indicates that current shifts in dietary and metabolic health, associated with increasing incidence of hyperglycaemia, might impair muscular and organismal adaptations to exercise training, including aerobic capacity as one of its key health outcomes.
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Affiliation(s)
- Tara L MacDonald
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Pattarawan Pattamaprapanont
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Prerana Pathak
- Research Division, Joslin Diabetes Center, Boston, MA, USA
| | | | - Ellen C Freitas
- School of Physical Education and Sport, University of São Paulo, Ribeirão Preto, Brazil
| | - Samar Hafida
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joanna Mitri
- Research Division, Joslin Diabetes Center, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven L Britton
- Department of Molecular and Integrative Physiology, and Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Lauren G Koch
- Department of Physiology and Pharmacology, The University of Toledo, Toledo, OH, USA
| | - Sarah J Lessard
- Research Division, Joslin Diabetes Center, Boston, MA, USA.
- Harvard Medical School, Harvard University, Boston, MA, USA.
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Kasiakogias A, Sharma S. Exercise: The ultimate treatment to all ailments? Clin Cardiol 2020; 43:817-826. [PMID: 32506511 PMCID: PMC7403692 DOI: 10.1002/clc.23369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/29/2022] Open
Abstract
Extensive clinical research has provided robust evidence that exercise is a cost‐effective measure to substantially alleviate the burden of a large number of diseases, many of which belong to the cardiovascular (CV) spectrum. In terms of cardiac benefit, the positive effects of exercise are attributed to improvements in standard risk factors for atherosclerosis, as well as to its positive impact on several pathophysiological mechanisms for CV diseases. For secondary prevention, exercise, optimally in the context of a cardiac rehabilitation program, has been shown to improve functional capacity and survival. Clinicians should encourage physical activity and provide exercise recommendations for all patients, taking into consideration any underlying pathology. In the present review, the benefits of exercise for the prevention and treatment of major CV risk factors and heart conditions are analyzed.
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Affiliation(s)
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, London, UK
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34
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Peterman JE, Harber MP, Imboden MT, Whaley MH, Fleenor BS, Myers J, Arena R, Finch WH, Kaminsky LA. Accuracy of Nonexercise Prediction Equations for Assessing Longitudinal Changes to Cardiorespiratory Fitness in Apparently Healthy Adults: BALL ST Cohort. J Am Heart Assoc 2020; 9:e015117. [PMID: 32458761 PMCID: PMC7428991 DOI: 10.1161/jaha.119.015117] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Repeated assessment of cardiorespiratory fitness (CRF) improves mortality risk predictions in apparently healthy adults. Accordingly, the American Heart Association suggests routine clinical assessment of CRF using, at a minimum, nonexercise prediction equations. However, the accuracy of nonexercise prediction equations over time is unknown. Therefore, we compared the ability of nonexercise prediction equations to detect changes in directly measured CRF. Methods and Results The sample included 987 apparently healthy adults from the BALL ST (Ball State Adult Fitness Longitudinal Lifestyle Study) cohort (33% women; average age, 43.1±10.4 years) who completed 2 cardiopulmonary exercise tests ≥3 months apart (3.2±5.4 years of follow‐up). The change in estimated CRF (eCRF) from 27 distinct nonexercise prediction equations was compared with the change in directly measured CRF. Analysis included Pearson product moment correlations, SEE values, intraclass correlation coefficient values, Cohen's κ coefficients, γ coefficients, and the Benjamini‐Hochberg procedure to compare eCRF with directly measured CRF. The change in eCRF from 26 of 27 equations was significantly associated to the change in directly measured CRF (P<0.001), with intraclass correlation coefficient values ranging from 0.06 to 0.63. For 16 of the 27 equations, the change in eCRF was significantly different from the change in directly measured CRF. The median percentage of participants correctly classified as having increased, decreased, or no change in CRF was 56% (range, 39%–61%). Conclusions Variability was observed in the accuracy between nonexercise prediction equations and the ability of equations to detect changes in CRF. Considering the appreciable error that prediction equations had with detecting even directional changes in CRF, these results suggest eCRF may have limited clinical utility.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being Ball State University Muncie IN
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Mary T Imboden
- Health and Human Performance Department George Fox University Newberg OR
| | | | - Bradley S Fleenor
- Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Jonathan Myers
- Division of Cardiology Veterans Affairs Palo Alto Healthcare System and Stanford University Palo Alto CA
| | - Ross Arena
- Department of Physical Therapy College of Applied Science University of Illinois Chicago IL
| | - W Holmes Finch
- Department of Educational Psychology Ball State University Muncie IN
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being Ball State University Muncie IN
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35
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Hetherington-Rauth M, Magalhães JP, Júdice PB, Melo X, Sardinha LB. Vascular improvements in individuals with type 2 diabetes following a 1 year randomised controlled exercise intervention, irrespective of changes in cardiorespiratory fitness. Diabetologia 2020; 63:722-732. [PMID: 31960071 DOI: 10.1007/s00125-020-05089-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS Vascular changes in individuals with type 2 diabetes mellitus majorly contribute to the development of cardiovascular disease. Increased cardiorespiratory fitness (CRF) has been associated with improvements in vascular health. Although CRF tends to improve with exercise training, there remains a portion of participants with little or no improvement. Given the importance of vascular function in individuals with type 2 diabetes, we assessed whether individuals who failed to improve CRF following a 1 year exercise intervention also failed to improve arterial stiffness and structural indices. METHODS Individuals with type 2 diabetes with no major micro- and macrovascular complications and aged between 30 and 75 years old (n = 63) participated in a three-arm, 1 year, randomised controlled exercise intervention in Lisbon, Portugal. The study involved a non-exercise control group, a moderate continuous training combined with resistance training (RT) group and a high-intensity interval training with RT group. Allocation of participants into the intervention and control groups was done using a computer-generated list of random numbers. An improvement in CRF was defined as a change in [Formula: see text] ≥5%. Vascular stiffness and structural indices were measured using ultrasound imaging and applanation tonometry. Generalised estimating equations were used to compare changes in vascular measures across individuals in the control group (n = 22) and those in the exercise groups who either had improved CRF (CRF responders; n = 14) or whose CRF did not improve (CRF non-responders; n = 27) following 1 year of exercise training. RESULTS Compared with the control group, exercisers, with and without improvements in CRF, had decreased carotid intima-media thickness (IMT) (CRF responders: β = -2.84 [95% CI -5.63, -0.04]; CRF non-responders: β = -5.89 [95% CI -9.38, -2.40]) and lower-limb pulse wave velocity (PWV) (CRF responders: β = -0.14 [95% CI -0.25, -0.03]; CRF non-responders: β = -0.14 [95% CI -0.25, -0.03]), the latter being an indicator of peripheral arterial stiffness. Only CRF responders had decreased PWV of the upper limb compared with control participants (β = -0.12 [95% CI -0.23, -0.01]). As for central stiffness, CRF non-responders had increased aortic PWV compared with CRF responders (β = 0.19 [95% CI 0.07, 0.31]), whereas only the CRF non-responders had altered carotid distensibility coefficient compared with the control group (β = 0.00 [95% CI 3.01 × 10-5, 0.00]). No interaction effects between the CRF responders and non-responders vs control group were found for the remaining stiffness or haemodynamic indices (p>0.05). CONCLUSIONS/INTERPRETATION Regardless of improvements in CRF, individuals with type 2 diabetes had significant improvements in carotid IMT and lower-limb arterial stiffness following a 1 year exercise intervention. Thus, a lack of improvement in CRF following exercise in people with type 2 diabetes does not necessarily entail a lack of improvement in vascular health. TRIAL REGISTRATION ClinicalTrials.gov NCT03144505 FUNDING: This work was supported by fellowships from the Portuguese Foundation for Science and Technology. This work is also financed by a national grant through the Fundação para a Ciência e Tecnologia (FCT), within the unit I&D 472.
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Affiliation(s)
- Megan Hetherington-Rauth
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - João P Magalhães
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Pedro B Júdice
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Xavier Melo
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
- Ginásio Clube Português, GCP Lab, Lisbon, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal.
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Deng X, Wang P, Yuan H. Epidemiology, risk factors across the spectrum of age-related metabolic diseases. J Trace Elem Med Biol 2020; 61:126497. [PMID: 32247247 DOI: 10.1016/j.jtemb.2020.126497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Population aging is dynamic process of increasing proportion of older adults in the total population, which is an inescapable result of decline in fertility rate and extension in life expectancy. Inevitably, age-related metabolic diseases, for example obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, and nonalcoholic fatty liver disease, are becoming epidemic globally along with the demographic transition. CONTENT The review examines the literatures related to: 1) the epidemiology of age related metabolic diseases including obesity, type 2 diabetes, metabolic syndrome, dyslipidemia, and nonalcoholic fatty liver disease; and 2) the risk factors of age related metabolic diseases including genetic factors, diet, smoking, Physical activity, intestinal microbiota and environmental factors. CONCLUSION Population aging is becoming epidemic worldwide, resulting in increasing incidence and prevalence of a serious of age-related metabolic diseases. Both genetic and environmental factors contribute to the diseases, thus interventions targeting on these factors may have beneficial effect on the development of age-related metabolic diseases.
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Affiliation(s)
- Xinru Deng
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Pengxu Wang
- Department of Endocrinology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, 450003, China
| | - Huijuan Yuan
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China.
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Monteiro KS, Azevedo MDP, Jales LM, da Silva FEP, Arrais RF, de Mendonça KMPP. Effects of aerobic interval training on glucose tolerance in children and adolescents with cystic fibrosis: a randomized trial protocol. Trials 2019; 20:768. [PMID: 31878961 PMCID: PMC6933706 DOI: 10.1186/s13063-019-3803-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Individuals with cystic fibrosis (CF) may develop CF-related diabetes (CFDR). This comorbidity is related to a poorer quality of life, microvascular complications, a decline in lung function, and an increase in exacerbations, as well as delayed growth and puberty. Evidence exists that physical exercise contributes to glycemic control in individuals with non-CF-related diabetes. This exercise is usually continuous with moderate intensity and long duration, which can cause muscle dyspnea and fatigue in CF individuals. Aerobic interval training (AIT) emerges as a safe and effective alternative for treating these individuals. The objective of this study is to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. METHODS This study will be a two-arm, prospectively registered, randomized controlled trial with blind assessors and twenty 6- to 18-year-old individuals with cystic fibrosis (CF) from two different Brazilian states. People with CF will be randomly allocated to either the experimental or control group using block randomization, stratified by puberty stage,. Participants from both groups will receive an educational intervention and will be asked to continue their usual daily treatment for the full duration of the study. Those in the experimental group will perform AIT on a cycle ergometer at home three times a week, for 8 consecutive weeks. The sample characterization will include an assessment of puberty stage, socioeconomic status, dyspnea, and anthropometry. The primary outcome will be the change in glucose tolerance, while the secondary outcomes will include lung function, exercise tolerance, respiratory muscle strength, quality of life, and CF exacerbations. All outcomes will be assessed at baseline, week 9, and week 17. DISCUSSION This is the first study to evaluate the effects of AIT on glucose tolerance in children and adolescents with CF. This study will serve as a basis for guiding clinical practice and decision-making in treating glucose intolerance and CF-related diabetes (CFRD) in children and adolescents with CF. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: NCT03653949. Registered on August 31, 2018.
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Affiliation(s)
- Karolinne Souza Monteiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
- Faculty of Health Science of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brasil
| | - Matheus de Paiva Azevedo
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
| | - Lucas Menescal Jales
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
| | | | - Ricardo Fernando Arrais
- Department of Pediatrics, Pediatric and Adolescent Unit of University Hospital Prof. Onofre Lopes of Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
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Exercise Training as a Treatment for Cardiometabolic Risk in Sedentary Adults: Are Physical Activity Guidelines the Best Way to Improve Cardiometabolic Health? The FIT-AGEING Randomized Controlled Trial. J Clin Med 2019; 8:jcm8122097. [PMID: 31805736 PMCID: PMC6947226 DOI: 10.3390/jcm8122097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022] Open
Abstract
This 12-week randomized controlled trial investigates the effects of different training modalities on cardiometabolic risk in sedentary, middle-aged adults, and examines whether alterations in cardiometabolic risk are associated with changes in those health-related variables that are modifiable by exercise training. The study subjects were 71 middle-aged adults (~54 years old; ~50% women) who were randomly assigned to one of the following treatment groups: (1) no exercise (control group), (2) concurrent training based on international physical activity recommendations (PAR group), (3) high intensity interval training (HIIT) group, or (4) HIIT plus whole-body electromyostimulation (HIIT+EMS group). A cardiometabolic risk score was calculated based on the International Diabetes Federation's clinical criteria. A significant reduction in cardiometabolic risk was observed for all exercise training groups compared to the control group (all p < 0.05), which persisted after adjusting potential confounders (all p < 0.05). However, the HIIT+EMS group experienced the most significant reduction (p < 0.001). A significant inverse relationship was detected between the change in lean mass and the change in cardiometabolic risk (p = 0.045). A 12-week exercise training programs-especially the HIIT+EMS program-significantly reduced cardiometabolic risk in sedentary, middle-aged adults independent of sex, age, and cardiorespiratory fitness.
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Rodriguez S, Stewart AN, Lei X, Cao X, Little HC, Fong V, Sarver DC, Wong GW. PRADC1: a novel metabolic-responsive secretory protein that modulates physical activity and adiposity. FASEB J 2019; 33:14748-14759. [PMID: 31689374 DOI: 10.1096/fj.201901279r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Interorgan communication mediated by secreted proteins plays a pivotal role in metabolic homeostasis, yet the function of many circulating secretory proteins remains unknown. Here, we describe the function of protease-associated domain-containing 1 (PRADC1), an enigmatic secretory protein widely expressed in humans and mice. In metabolically active tissues (liver, muscle, fat, heart, and kidney), we showed that Pradc1 expression is significantly suppressed by refeeding and reduced in kidney and brown fat in the context of obesity. PRADC1 is dispensable for whole-body metabolism when mice are fed a low-fat diet. However, in obesity induced by high-fat feeding, PRADC1-deficient female mice have reduced weight gain and adiposity despite similar caloric intake. Decreased fat mass is attributed, in part, to increased metabolic rate, physical activity, and energy expenditure in these animals. Reduced adiposity in PRADC1-deficient mice, however, does not improve systemic glucose and lipid metabolism, insulin sensitivity, liver steatosis, or adipose inflammation. Thus, in PRADC1-deficient animals, decreased fat mass and enhanced physical activity are insufficient to confer a healthy metabolic phenotype in the context of an obesogenic diet. Our results shed light on the physiologic function of PRADC1 and the complex regulation of metabolic health.-Rodriguez, S., Stewart, A. N., Lei, X., Cao, X., Little, H. C., Fong, V., Sarver, D. C., Wong, G. W. PRADC1: a novel metabolic-responsive secretory protein that modulates physical activity and adiposity.
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Affiliation(s)
- Susana Rodriguez
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ashley N Stewart
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xia Lei
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Xi Cao
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China; and
| | - Hannah C Little
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vincent Fong
- Department of Medicine, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dylan C Sarver
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G William Wong
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Metabolism and Obesity Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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40
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Pandey A, Johnson JL, Slentz CA, Ross LM, Agusala V, Berry JD, Kraus WE. Short-Term Changes in Cardiorespiratory Fitness in Response to Exercise Training and the Association with Long-Term Cardiorespiratory Fitness Decline: The STRRIDE Reunion Study. J Am Heart Assoc 2019; 8:e012876. [PMID: 31597504 PMCID: PMC6818024 DOI: 10.1161/jaha.119.012876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Substantial heterogeneity exists in the cardiorespiratory fitness (CRF) change in response to exercise training, and its long‐term prognostic implication is not well understood. We evaluated the association between the short‐term supervised training‐related changes in CRF and CRF levels 10 years later. Methods and Results STRRIDE (Studies of a Targeted Risk Reduction Intervention Through Defined Exercise) trial participants who were originally randomized to exercise training for 8 months and participated in the 10‐year follow‐up visit were included. CRF levels were measured at baseline, after training (8 months), and at 10‐year follow‐up as peak oxygen uptake (vo2, mL/kg per min) using the maximal treadmill test. Participants were stratified into low, moderate, and high CRF response groups according to the training regimen–specific tertiles of CRF change. The study included 80 participants (age: 52 years; 35% female). At 10‐year follow‐up, the high‐response CRF group had the least decline in CRF compared with the moderate‐ and low‐response CRF groups (−0.35 versus −2.20 and −4.25 mL/kg per minute, respectively; P=0.02). This result was largely related to the differential age‐related changes in peak oxygen pulse across the 3 groups (0.58, −0.23, and −0.86 mL/beat, respectively; P=0.03) with no difference in the peak heart rate change. In adjusted linear regression analysis, high response was significantly associated with greater CRF at follow‐up independent of other baseline characteristics (high versus low [reference] CRF response: standard β=0.25; P=0.004). Conclusions Greater CRF improvement in response to short‐term training is associated with higher CRF levels 10 years later. Lack of CRF improvements in response to short‐term training may identify individuals at risk for exaggerated CRF decline with aging.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Johanna L Johnson
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC
| | - Cris A Slentz
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC
| | - Leanna M Ross
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC
| | - Vijay Agusala
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Jarett D Berry
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - William E Kraus
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC.,Division of Cardiology Medicine Duke University School of Medicine Durham NC
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41
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Pino MF, Stephens NA, Eroshkin AM, Yi F, Hodges A, Cornnell HH, Pratley RE, Smith SR, Wang M, Han X, Coen PM, Goodpaster BH, Sparks LM. Endurance training remodels skeletal muscle phospholipid composition and increases intrinsic mitochondrial respiration in men with Type 2 diabetes. Physiol Genomics 2019; 51:586-595. [PMID: 31588872 DOI: 10.1152/physiolgenomics.00014.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The effects of exercise training on the skeletal muscle (SKM) lipidome and mitochondrial function have not been thoroughly explored in individuals with Type 2 diabetes (T2D). We hypothesize that 10 wk of supervised endurance training improves SKM mitochondrial function and insulin sensitivity that are related to alterations in lipid signatures within SKM of T2D (males n = 8). We employed integrated multi-omics data analyses including ex vivo lipidomics (MS/MS-shotgun) and transcriptomics (RNA-Seq). From biopsies of SKM, tissue and primary myotubes mitochondrial respiration were quantified by high-resolution respirometry. We also performed hyperinsulinemic-euglycemic clamps and blood draws before and after the training. The lipidomics analysis revealed that endurance training (>95% compliance) increased monolysocardiolipin by 68.2% (P ≤ 0.03), a putative marker of mitochondrial remodeling, and reduced total sphingomyelin by 44.8% (P ≤ 0.05) and phosphatidylserine by 39.7% (P ≤ 0.04) and tended to reduce ceramide lipid content by 19.8%. Endurance training also improved intrinsic mitochondrial respiration in SKM of T2D without alterations in mitochondrial DNA copy number or cardiolipin content. RNA-Seq revealed 71 transcripts in SKM of T2D that were differentially regulated. Insulin sensitivity was unaffected, and HbA1c levels moderately increased by 7.3% despite an improvement in cardiorespiratory fitness (V̇o2peak) following the training intervention. In summary, endurance training improves intrinsic and cell-autonomous SKM mitochondrial function and modifies lipid composition in men with T2D independently of alterations in insulin sensitivity and glycemic control.
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Affiliation(s)
- Maria F Pino
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Natalie A Stephens
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Alexey M Eroshkin
- Sanford Burnham Prebys Medical Discovery Institute, Torrey Pines, California
| | - Fanchao Yi
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Andrew Hodges
- Sanford Burnham Prebys Medical Discovery Institute, Torrey Pines, California
| | - Heather H Cornnell
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Richard E Pratley
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Miao Wang
- University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Xianlin Han
- University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Paul M Coen
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
| | - Lauren M Sparks
- Translational Research Institute for Metabolism and Diabetes, Adventhealth, Orlando, Florida
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42
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Magalhães JP, Melo X, Correia IR, Ribeiro RT, Raposo J, Dores H, Bicho M, Sardinha LB. Effects of combined training with different intensities on vascular health in patients with type 2 diabetes: a 1-year randomized controlled trial. Cardiovasc Diabetol 2019; 18:34. [PMID: 30885194 PMCID: PMC6423850 DOI: 10.1186/s12933-019-0840-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background Exercise, when performed on a regular basis, is a well-accepted strategy to improve vascular function in patients with type 2 diabetes. However, the exercise intensity that yields maximal adaptations on structural and functional indices in patients with type 2 diabetes remains uncertain. Our objective was to analyze the impact of a 1-year randomized controlled trial of combined high-intensity interval training (HIIT) with resistance training (RT) vs. a combined moderate continuous training (MCT) with RT on structural and functional arterial indices in patients with type 2 diabetes. Methods Patients with type 2 diabetes (n = 80) were randomized into an exercise intervention with three groups: control, combined HIIT with RT and combined MCT with RT. The 1-year intervention had 3 weekly exercise sessions. High-resolution ultrasonography of the common carotid artery and central and peripheral applanation tonometry were used to assess the changes in structural and functional arterial indices. Generalized estimating equations were used to model the corresponding outcomes. Results After adjusting the models for sex, baseline moderate-to-vigorous physical activity, and mean arterial pressure changes, while using the intention-to-treat analysis, a significant interaction was observed on the carotid intima-media thickness (cIMT) for both the MCT (β = − 4.25, p < 0.01) and HIIT group (β = − 3.61, p < 0.01). However, only the HIIT observed favorable changes from baseline to 1-year on peripheral arterial stiffness indices such as carotid radial arterial pulse wave velocity (β = − 0.10, p = 0.044), carotid to distal posterior tibial artery pulse wave velocity (β = − 0.14, p < 0.01), and on the distensibility coefficient (β = − 0.00, p < 0.01). No effect was found for hemodynamic variables after the intervention. Conclusions Following a 1-year intervention in patients with type 2 diabetes, both the MCT and HIIT group reduced their cIMT, whereas only the HIIT group improved their peripheral arterial stiffness indices and distensibility coefficient. Taken together, HIIT may be a meaningful tool to improve long-term vascular complications in type 2 diabetes. Trial registration clinicaltrials.gov ID: NCT03144505
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Affiliation(s)
- João P Magalhães
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Xavier Melo
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal.,GCP Lab, Ginásio Clube Português, Lisbon, Portugal
| | - Inês R Correia
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Rogério T Ribeiro
- Education and Research Centre, APDP-Diabetes Portugal (APDP-ERC), Lisbon, Portugal
| | - João Raposo
- Education and Research Centre, APDP-Diabetes Portugal (APDP-ERC), Lisbon, Portugal
| | - Hélder Dores
- Military Forces Hospital, Lisbon, Portugal.,Light Hospital, Lisbon, Portugal.,NOVA Medical School, Lisbon, Portugal
| | - Manuel Bicho
- Genetics Laboratory Environmental Health Institute (ISAMB), Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Institute of Scientific Research Bento da Rocha Cabral, Lisbon, Portugal
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal.
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Ross R, Goodpaster BH, Koch LG, Sarzynski MA, Kohrt WM, Johannsen NM, Skinner JS, Castro A, Irving BA, Noland RC, Sparks LM, Spielmann G, Day AG, Pitsch W, Hopkins WG, Bouchard C. Precision exercise medicine: understanding exercise response variability. Br J Sports Med 2019; 53:1141-1153. [PMID: 30862704 PMCID: PMC6818669 DOI: 10.1136/bjsports-2018-100328] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
There is evidence from human twin and family studies as well as mouse and rat selection experiments that there are considerable interindividual differences in the response of cardiorespiratory fitness (CRF) and other cardiometabolic traits to a given exercise programme dose. We developed this consensus statement on exercise response variability following a symposium dedicated to this topic. There is strong evidence from both animal and human studies that exercise training doses lead to variable responses. A genetic component contributes to exercise training response variability. In this consensus statement, we (1) briefly review the literature on exercise response variability and the various sources of variations in CRF response to an exercise programme, (2) introduce the key research designs and corresponding statistical models with an emphasis on randomised controlled designs with or without multiple pretests and post-tests, crossover designs and repeated measures designs, (3) discuss advantages and disadvantages of multiple methods of categorising exercise response levels—a topic that is of particular interest for personalised exercise medicine and (4) outline approaches that may identify determinants and modifiers of CRF exercise response. We also summarise gaps in knowledge and recommend future research to better understand exercise response variability.
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Affiliation(s)
- Robert Ross
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA
| | - Lauren G Koch
- Department of Physiology and Pharmacology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Mark A Sarzynski
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA
| | - Wendy M Kohrt
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Neil M Johannsen
- Interventional Resources, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.,School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - James S Skinner
- Department of Kinesiology, Indiana University, Bloomington, Indiana, USA
| | - Alex Castro
- Department of Physical Education, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Brian A Irving
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA.,Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert C Noland
- John S Mcilhenny Skeletal Muscle Physiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Lauren M Sparks
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida, USA
| | - Guillaume Spielmann
- School of Kinesiology, Louisiana State University, Baton Rouge, Louisiana, USA.,Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Andrew G Day
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Werner Pitsch
- Economics and Sociology of Sport, Saarland University, Saarbrücken, Saarland, Germany
| | - William G Hopkins
- College of Sport and Exercise Science, Victoria University, Melbourne, Victoria, Australia
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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44
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Affiliation(s)
- Martijn Scherrenberg
- 1 Heart Centre Hasselt, Jessa Hospital, Belgium.,2 Faculty of Medicine & Life Sciences, Hasselt University, Belgium
| | - Paul Dendale
- 1 Heart Centre Hasselt, Jessa Hospital, Belgium.,2 Faculty of Medicine & Life Sciences, Hasselt University, Belgium
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45
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Gu Y, Dennis SM, Kiernan MC, Harmer AR. Aerobic exercise training may improve nerve function in type 2 diabetes and pre-diabetes: A systematic review. Diabetes Metab Res Rev 2019; 35:e3099. [PMID: 30462877 DOI: 10.1002/dmrr.3099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/03/2018] [Accepted: 11/04/2018] [Indexed: 12/14/2022]
Abstract
Diabetic neuropathy is a major complication of type 2 diabetes. Emerging evidence also suggests that people with pre-diabetes may develop similar symptoms related to nerve dysfunction. While regular exercise provides many benefits to patients with diabetes, whether exercise influences nerve function has not been established. As such, the aim of this systematic review was to evaluate current evidence regarding the effect of exercise training on the progression and development of diabetic neuropathy. A systematic search of MEDLINE (Ovid), CINAHL, AMED, PEDro, the Cochrane Library, Embase, and Scopus databases identified a total of 12 studies that were eligible for inclusion in this systematic review. Quality rating and data extraction were performed by two independent reviewers. The 12 included studies examined people with pre-diabetes (n = 1) and with type 2 diabetes (n = 11). There was heterogeneity of study quality and exercise type and dosage among these studies. Eleven studies reported that exercise training had a positive influence on nerve function or neuropathy-related symptoms; and only one study reported mild adverse events. Evidence from this systematic review suggests aerobic exercise training may positively influence nerve function among people with type 2 diabetes, with minimal risk of adverse events. Further research will be required to determine the optimal dosage of exercise training and the effect on nerve function in pre-diabetes and in women with previous gestational diabetes. This review is registered on PROSPERO (CRD42018088182).
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Affiliation(s)
- Yu Gu
- Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
- Physiotherapy Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah M Dennis
- Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Liverpool, NSW, Australia
- Physical Activity, Lifestyle, Ageing & Wellness Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Matthew C Kiernan
- Discovery and Translation, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Alison R Harmer
- Musculoskeletal Health Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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46
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De Schutter A, Kachur S, Lavie CJ, Menezes A, Shum KK, Bangalore S, Arena R, Milani RV. Cardiac rehabilitation fitness changes and subsequent survival. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:173-179. [PMID: 29701805 DOI: 10.1093/ehjqcco/qcy018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Aims Assessments of cardiac rehabilitation (CR) in coronary heart disease (CHD) cohorts usually examine mortality in aggregate. This study examines the prognosis and characteristics of patients who enrolled and completed CR, stratified by their level of improvement in cardiorespiratory fitness (CRF) by examining the characteristics, outcomes and predictors of non-response in CRF (NonRes) compared with low-responders (LowRes) and high-responders (HighRes) after CR. Methods and results A total of 1171 CHD patients were referred for a phase II CR programme after therapy for an acute coronary syndrome, coronary artery bypass graft procedure or a percutaneous coronary intervention between 1 January 2000 and 30 June 2013 underwent cardiopulmonary exercise testing before and after CR. This cohort was divided according to absolute improvements in CRF (i.e. change in peak oxygen consumption expressed in mL⋅kg-1⋅min-1). Mortality was analysed after 0.5-13.4 years of follow-up (mean 6.4 years). A total of 266 (23%) subjects were NonRes. After adjustment for body mass index, age, gender, left ventricular ejection fraction and baseline CRF, NonRes, and LowRes had a statistically significant three-fold and two-fold higher mortality, respectively, when compared with HighRes (HighRes 8% vs. LowRes 17% vs. NonRes 22%; P < 0.001). Age, female gender, baseline CRF, hostility, and presence of diabetes were significant predictors of NonRes and LowRes. In addition, higher waist circumference was a predictor of NonRes. Conclusion Significant proportions of subjects referred to CR have no/low improvement in CRF and higher associated mortality risks. Greater attention is required to increase improvements in CRF following CR and avoid NonRes.
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Affiliation(s)
- Alban De Schutter
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sergey Kachur
- Department of Graduate Medical Education, Ocala Regional Medical Center, 1431 SW 1st Ave, Ocala, FL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Arthur Menezes
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Kelly K Shum
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
| | - Sripal Bangalore
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL, USA
| | - Richard V Milani
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, USA
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Kemps H, Kränkel N, Dörr M, Moholdt T, Wilhelm M, Paneni F, Serratosa L, Ekker Solberg E, Hansen D, Halle M, Guazzi M. Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019; 26:709-727. [PMID: 30642190 DOI: 10.1177/2047487318820420] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.
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Affiliation(s)
- Hareld Kemps
- 1 Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Nicolle Kränkel
- 2 Charité - Universitätsmedizin Berlin, Klinik für Kardiologie, Campus Benjamin Steglitz, Germany.,3 DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany
| | - Marcus Dörr
- 4 University Medicine Greifswald, Department of Internal Medicine B, Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany
| | - Trine Moholdt
- 6 Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway.,7 St Olav's Hospital, Trondheim, Norway
| | - Matthias Wilhelm
- 8 Department of Cardiology, Bern University Hospital and University of Bern, Switzerland
| | - Francesco Paneni
- 9 Centre for Molecular Cardiology and Cardiology, Zurich University Hospital, University of Zurich, Switzerland
| | - Luis Serratosa
- 10 Hospital Universitario Quironsalud, Madrid, Spain.,11 Ripoll & De Prado Sport Clinic, FIFA Medical Centre of Excellence, Murcia, Spain
| | | | - Dominique Hansen
- 13 Hasselt University, Faculty of Rehabilitation Sciences, Diepenbeek, Belgium.,14 Heart Centre Hasselt, Jessa Hospital, Belgium
| | - Martin Halle
- 15 Technical University Munich, Department of Prevention, Rehabilitation and Sports Medicine, Germany.,16 DZHK (German Centre for Cardiovascular Research), partner site Munich, Germany
| | - Marco Guazzi
- 17 University Cardiology Department and Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, I.R.C.C.S., Milan, Italy.,18 Policlinico San Donato University Hospital, Milan, Italy
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48
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Stephens NA, Brouwers B, Eroshkin AM, Yi F, Cornnell HH, Meyer C, Goodpaster BH, Pratley RE, Smith SR, Sparks LM. Exercise Response Variations in Skeletal Muscle PCr Recovery Rate and Insulin Sensitivity Relate to Muscle Epigenomic Profiles in Individuals With Type 2 Diabetes. Diabetes Care 2018; 41:2245-2254. [PMID: 30072402 DOI: 10.2337/dc18-0296] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/15/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Some individuals with type 2 diabetes do not reap metabolic benefits from exercise training, yet the underlying mechanisms of training response variation are largely unexplored. We classified individuals with type 2 diabetes (n = 17) as nonresponders (n = 6) or responders (n = 11) based on changes in phosphocreatine (PCr) recovery rate after 10 weeks of aerobic training. We aimed to determine whether the training response variation in PCr recovery rate was marked by distinct epigenomic profiles in muscle prior to training. RESEARCH DESIGN AND METHODS PCr recovery rate as an indicator of in vivo muscle mitochondrial function in vastus lateralis (31P-magnetic resonance spectroscopy), insulin sensitivity (M-value; hyperinsulinemic-euglycemic clamp), aerobic capacity (Vo2peak), and blood profiles were determined pretraining and post-training. Muscle biopsies were performed pretraining in vastus lateralis for the isolation of primary skeletal muscle cells (HSkMCs) and assessments of global DNA methylation and RNA sequencing in muscle tissue and HSkMCs. RESULTS By design, nonresponders decreased and responders increased PCr recovery rate with training. In nonresponders, insulin sensitivity did not improve and glycemic control (HbA1c) worsened. In responders, insulin sensitivity improved. Vo2peak improved by ∼12% in both groups. Nonresponders and responders were distinguished by distinct pretraining molecular (DNA methylation, RNA expression) patterns in muscle tissue, as well as in HSkMCs. Enrichment analyses identified elevations in glutathione regulation, insulin signaling, and mitochondrial metabolism in nonresponders pretraining, which was reflected in vivo by higher pretraining PCr recovery rate and insulin sensitivity in these same individuals. CONCLUSIONS A training response variation for clinical risk factors in individuals with type 2 diabetes is reflected by distinct basal myocellular epigenomic profiles in muscle tissue, some of which are maintained in HSkMCs, suggesting a cell-autonomous underpinning. Our data provide new evidence to potentially shift the diabetes treatment paradigm for individuals who do not benefit from training, such that supplemental treatment can be designed.
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Affiliation(s)
- Natalie A Stephens
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL
| | - Bram Brouwers
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL
| | | | - Fanchao Yi
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL
| | - Heather H Cornnell
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL
| | - Christian Meyer
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL
| | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL.,Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL
| | - Richard E Pratley
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL.,Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL.,Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL
| | - Lauren M Sparks
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, FL .,Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL
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Whipple MO, Schorr EN, Talley KMC, Lindquist R, Bronas UG, Treat-Jacobson D. Variability in Individual Response to Aerobic Exercise Interventions Among Older Adults. J Aging Phys Act 2018; 26:655-670. [PMID: 28952853 PMCID: PMC5871585 DOI: 10.1123/japa.2017-0054] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Although a plethora of evidence supports the benefits of exercise among older adults, a majority of studies have emphasized group differences, while giving little, if any, attention to individual differences. Given the lack of data on variability in response, the present review examined how nonresponse to aerobic exercise has been defined in older adult populations and characteristics associated with nonresponse among older adults. The results of this review suggest that interindividual variability in response of maximal oxygen consumption to aerobic exercise interventions is prevalent among older adults (1.4-63.4%); age, sex, race, and body mass index may not be critical determinants of nonresponse; whereas health status, baseline fitness, and exercise dose appear important. Future intervention studies should evaluate and report the variability in individual response of older adults to exercise; investigators should develop programs that allow for modification of components to assist older adults in achieving optimal benefit from exercise programs.
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Hunter GR, Fisher G, Bryan DR, Borges JH, Carter SJ. Divergent Blood Pressure Response After High-Intensity Interval Exercise: A Signal of Delayed Recovery? J Strength Cond Res 2018; 32:3004-3010. [PMID: 30239453 DOI: 10.1519/jsc.0000000000002806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hunter, GR, Fisher, G, Bryan, DR, Borges, JH, and Carter, SJ. Divergent blood pressure response after high-intensity interval exercise: a signal of delayed recovery? J Strength Cond Res 32(11): 3004-3010, 2018-The objective of this commentary is to highlight potential factors influential to the adaptation of high-intensity exercise. Herein, we present a rationale supporting the contention that elevated systolic blood pressure, after a bout of high-intensity exercise, may be indicative of delayed/incomplete recovery. Relative to type I skeletal muscle fibers, the unique cellular/vascular characteristics of type II muscle fibers may necessitate longer recovery periods, especially when exposed to repeated high-intensity efforts (i.e., intervals). In addition to the noted race disparities in cardiometabolic disease risk, including higher mean blood pressures, African Americans may have a larger percentage of type II muscle fibers, thus possibly contributing to noted differences in recovery after high-intensity exercise. Given that optimal recovery is needed to maximize physiological adaptation, high-intensity training programs should be individually-tailored and consistent with recovery profile(s). In most instances, even among those susceptible, the risk to nonfunctional overreaching can be largely mitigated if sufficient recovery is integrated into training paradigms.
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Affiliation(s)
| | - Gordon Fisher
- Human Studies, University of Alabama at Birmingham, Birmingham, AL
| | | | - Juliano H Borges
- Departments of Nutrition Sciences, and.,Growth and Development Laboratory, Center for Investigation in Pediatrics, School of Medicine, University of Campinas, Campinas, São Paulo, Brazil
| | - Stephen J Carter
- Departments of Nutrition Sciences, and.,Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN
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