Aerobic vs anaerobic exercise training effects on the cardiovascular system

Learning to swim with back pain: a qualitative study of swimmers with chronic low back pain

PURPOSE

Swimming is one form of exercise advised to people with chronic low back pain (CLBP), there is limited research, however, supporting this recommendation and describing the experience and use of swimming in this population. The aim of this study was to explore the experience of people who use swimming to manage CLBP.

METHODS

Semi-structure interviews were conducted with 14 swimmers who were using swimming to manage CLBP. Thematic analysis was used to analyse the interview data, and the themes were mapped onto the capability, opportunity, motivation and behaviour (COM-B) model to understand the behavioural factors.

RESULTS

Five common themes were developed during the analysis: (1) My back pain journey; (2) Learning to swim with back pain; (3) How swimming looks for me; (4) What I gain from swimming; and (5) Keep calm and carry-on swimming. The themes mapped onto all three COM-B domains.

CONCLUSIONS

The participants found that swimming was a valuable self-management tool for CLBP. The findings from the thematic and COM-B analysis indicate that learning to swim with CLBP can be a complex journey, influenced by several interrelated behavioural factors. In the absence of multi-professional support, inclusive swimming communities and accessible swimming venues, swimming participation rates may be affected.

Effects of different exercise habits on mitigating physical frailty in older adults: A cross-sectional study

Encouraging regular exercise is essential for promoting health among older adults. This study aimed to examine the effects of exercise on frailty and aging, considering demographic and economic factors. Between August to December 2022, individuals aged 65 and older were recruited from 12 districts in Taipei. A self-administered questionnaire was used to collect data on exercise frequency, duration, and type. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria. A total of 2,545 participants were analyzed using logistic regression. The results indicated that 23.4% of participants were pre-frail and 8.7% were frail. Regular exercise was significantly associated with a reduced risk of frailty. Specifically, exercise duration exhibited a significant inverse relationship with frailty risk. Participants that exercised 31-60 minutes daily had a 59% lower risk of frailty compared to those who exercised less than 15 minutes daily. Those participants who exercised more than 60 minutes daily had a 69% lower risk. Additionally, participants who did not engaging in aerobic exercise had a 34% higher risk of pre-frailty. Thus, these findings underscore the importance of promoting regular exercise, particularly aerobic exercise, as key strategies to reduce frailty and improve overall health in older adults.

The effect of exercise therapy on pain, fatigue, bone function and inflammatory biomarkers individuals with rheumatoid arthritis and knee osteoarthritis: a meta-research review of randomized controlled trials

Background

Accumulating evidence suggested the potential role of exercise in alleviating rheumatoid arthritis (RA). However, whether exercise improves physical function (walk test, grip strength, muscle strength, joint assessments) and inflammatory biomarkers in patients with RA is unclear. This umbrella meta-analysis aimed to examine the effect of exercise in patients with RA.

Method

PubMed, Scopus, Web of Science, Embase, and Cochrane Central Library databases were systematically searched for meta-analyses of randomized control trials (RCTs) to retrieve relevant studies. The effect sizes were pooled using a random-effects model, with standardized or weighted mean differences (SMDs or WMDs) and 95% confidence intervals (CIs) as summary statistics.

Results

Seventeen studies were included. The improving effects of exercise on fatigue levels (SMD = -0.28, 95% CI: -0.44, -0.13), pain intensity (ES = -0.50, 95% CI: -0.87, -0.14), disease activity score in joints (DAS) (WMD = -0.54, 95% CI: -0.99, -0.09; and SMD = -0.47, 95% CI: -0.64, -0.30), and ESR (ES = -0.85, 95% CI: -1.66, -0.03) were significant. No significant impact on the hand grip, muscle strength, walk test, joints and inflammatory biomarkers was observed.

Conclusion

Exercise significantly reduces fatigue, pain, DAS, and ESR in RA but shows no impact on grip strength, muscle strength, walk test, joints, or other inflammatory biomarkers. This highlights its role in symptom management rather than broad physiological changes.

The role of irisin in exercise-induced muscle and metabolic health: a narrative review

Irisin, a myokine released during physical exercise, has emerged as a key mediator of muscle health and metabolic regulation. This review synthesizes current evidence on how aerobic exercise stimulates irisin release and its subsequent effects, including enhanced muscle mass, strength, and recovery. Additionally, irisin promotes the browning of white adipose tissue, improving fat metabolism and glucose regulation. These adaptations position irisin as a promising therapeutic target for preventing metabolic disorders and optimizing exercise protocols. By exploring human studies and mechanistic insights, this review underscores irisin's potential to address global health challenges, such as obesity and type 2 diabetes, while advancing strategies for personalized exercise interventions.

High-Intensity Interval Training Decreases Circulating HMGB1 in Individuals with Insulin Resistance: Plasma Lipidomics Correlate with Associated Cardiometabolic Benefits

BACKGROUND

Bodyweight high-intensity interval training (BW-HIIT) is an effective, time-efficient exercise method that reduces cardiovascular risk factors and improves muscle endurance without requiring external equipment. High mobility group box 1 (HMGB1) is a proinflammatory protein involved in insulin resistance. Previous studies revealed that HMGB1 knockout mice show improved insulin sensitivity and hyperglycemia. This study investigates whether BW-HIIT exercise can reduce proinflammatory markers, such as HMGB1, in individuals with insulin resistance.

METHODS

In total, 14 adults (2 male/12 female) aged 18 to 55 were subject to six weeks of BW-HIIT. Additionally, 10-week-old mice were subject to exercise conditioning (5 mice per group (all male)) for 4 weeks of treadmill exercise or sedentary. Human and mouse pre- and post-exercise serum/plasma samples were analyzed for lipidomics, hormonal, and cytokine multiplex assays. Cardiometabolic parameters were also performed on human subjects.

RESULTS

Post-exercise decreased systolic blood pressure (SBP), cholesterol, triglycerides, high-density lipoprotein (HDL), and cholesterol/HDL ratio in human patients with insulin resistance. Meanwhile, hormones such as amylin, glucagon, and insulin all increased post-BW-HIIT or treadmill exercise in both human and mouse models. Moreover, circulating HMBG1 levels were reduced in insulin-resistant individuals and mice after exercise. Furthermore, treadmill exercise by the animal model increased anti-inflammatory cytokines, including interleukin (IL)-10, IL-12p40, and IL-12p70, and reduced proinflammatory cytokines: eotaxin, IL-2, and macrophage inflammatory protein (MIP)-2 or CXCL2.

CONCLUSIONS

Six weeks of BW-HIIT exercise can improve cardiometabolic health, anti-inflammatory markers, hormones, and insulin sensitivity in human and mouse models undergoing exercise. Changes in circulating HMBG1 levels following BW-HIIT exercise make HMGB1 a suitable marker for cardiometabolic disease, potentiating its role beyond an alarmin. Further studies are needed to confirm these effects and to elucidate the underlying physiological mechanisms.

Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials

OBJECTIVE

To measure the impact of each type of exercise on sleep quality and identify the exercise that enhances sleep quality the most.

STUDY SELECTION

Eligible randomised controlled trials that compare physical exercise to routine activities, usual care, non-physical activity, or health education to measure the Pittsburgh Sleep Quality Index.

DATA SOURCE

Studies retrieved from Medline, Embase, CINAHL, Scopus, ClinicalTrial.gov and ThaiJo from the database's inception to October 2022.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently identified studies, collected data and assessed bias. In the absence of heterogeneity, a fixed effect model was used for pairwise meta-analysis. Alternatively, a random effect model was used. A two-stage network meta-analysis used the surface under the cumulative ranking curve (SUCRA) to compare exercise efficacy.

MAIN OUTCOME

Global Pittsburgh Sleep Quality Index (GPSQI) and subdomain score.

RESULTS

This review comprised 2170 people from 25 trials. Direct meta-analysis revealed significant improvement in GPSQI with combined exercise (unstandardised mean difference (USMD) -2.35, 95% CI-3.13 to -1.57, p<0.001, I2=69.13%). GPSQI decreased considerably with aerobic activity (USMD -4.36, 95% CI -7.86 to -0.86, p=0.01, I2=97.83%). For the network meta-analysis, strengthening, aerobic and combination exercise significantly lowered GPSQI (USMD-5.75, -3.76 and -2.54, respectively). Strength training improved GPSQI scores most effectively (SUCRA 94.6%).

CONCLUSION

Exercise that strengthens muscles, rather than aerobic or combination exercises, is the most effective way to enhance sleep quality.

Environmental Factors and Cardiovascular Susceptibility: Toward Personalized Prevention Mediated by the Role of Artificial Intelligence-A Narrative Review

Background and Purpose

Cardiovascular diseases (CVD) represent a significant global health challenge due to high morbidity and mortality rates, that necessitate approaching the intricate relation between cardiovascular susceptibility and environmental factors, highlighting the importance of creating personalized cardiovascular prevention plans. Furthermore, as it is becoming integrated with the various aspects of healthcare, the role of artificial intelligence in cardiovascular and precision medicine is driving innovations towards personalized care. This review dives into the complex connection between cardiovascular susceptibility and environmental risk highlighting the importance of creating personalized cardiovascular preventive strategies in light of the upcoming artificial intelligence.

Methods

An in-depth review was conducted using PubMed and ScienceDirect, to collect data from all articles that handled environmental factors and cardiovascular susceptibility with special emphasis on the up-to-date emerging role of artificial intelligence in preventive strategies.

Results

The review revealed high heritability estimates and highlighted the significance of modifiable risk factors which are pivotal determinants affecting CVD susceptibility. The integration of artificial intelligence is implementing the power of precision preventive medicine that can be directed toward specific environmental factors, shifting the whole healthcare system to superior outcomes.

Conclusion

Recognizing the preventability of CVD through personalized environmental modifications, this review advocates tailored prevention plans that account for individual characteristics. Despite its proven efficacy in managing modifiable risk factors, achieving optimal cardiovascular health remains challenging, necessitating innovative strategies and the integration of artificial intelligence in personalized healthcare.

Tailoring Exercise Prescription for Effective Diabetes Glucose Management

CONTEXT

Physical activity, exercise, or both are a staple of lifestyle management approaches both for type 1 diabetes mellitus (T1DM) and type 2 diabetes (T2DM). While the current literature supports both physical activity and exercise for improving glycemic control, reducing cardiovascular risk, maintaining proper weight, and enhancing overall well-being, the optimal prescription regimen remains debated.

EVIDENCE ACQUISITION

We searched PubMed and Google Scholar databases for relevant studies on exercise, insulin sensitivity, and glycemic control in people with T1DM and T2DM.

EVIDENCE SYNTHESIS

In patients with T1DM, exercise generally improves cardiovascular fitness, muscle strength, and glucose levels. However, limited work has evaluated the effect of aerobic plus resistance exercise compared to either exercise type alone on glycemic outcomes. Moreover, less research has evaluated breaks in sedentary behavior with physical activity. When considering the factors that may cause hypoglycemic effects during exercise in T1DM, we found that insulin therapy, meal timing, and neuroendocrine regulation of glucose homeostasis are all important. In T2DM, physical activity is a recommended therapy independent of weight loss. Contemporary consideration of timing of exercise relative to meals and time of day, potential medication interactions, and breaks in sedentary behavior have gained recognition as potentially novel approaches that enhance glucose management.

CONCLUSION

Physical activity or exercise is, overall, an effective treatment for glycemia in people with diabetes independent of weight loss. However, additional research surrounding exercise is needed to maximize the health benefit, particularly in "free-living" settings.

Dose-dependent association between physical activity and mental health, and mitigation effects on risk behaviors

Understanding the dose-response effects of physical activity on mental health and risk behavior mitigation is crucial for mental health promotion. This study using restricted cubic spline and piecewise regression analyses based on a representative national sample of 30,054 Chinese adults, revealed reverse J-shaped (p for nonlinear <0.001) but monotonic beneficial associations between physical activity and depression, anxiety, and stress symptoms, with optimal thresholds identified at 2.15 METs-hour/day for depression and anxiety, and 3.25 METs-hour/day for stress. Engaging in 1-3 METs-hour/day of physical activity appeared to mitigate the adverse effects of unhealthy food intake on depression and anxiety, whereas 4-6 METs-hour/day could offset the impact of short sleep duration on depression, anxiety, and stress. The findings suggest that physical activity prescription could be effective in mitigating the adverse effects of certain risk behaviors on common mental symptoms, and excessive physical activity might not be necessary for mental health promotion.

Effect of water-based aerobic training on anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women: a randomized controlled trial

Background

Obesity is a major health concern that raises the risk of chronic illnesses such as heart disease, diabetes, and metabolic disorders. Traditional workouts such as running or walking can be difficult for overweight individuals due to the heavy impact on joints, which causes discomfort and the possibility of injury. Water-based exercises offer a low-impact alternative that overweight people may find more tolerable. There is minimal research on the specific effects of structured water aerobic exercise on health markers in young overweight and obese women, despite the acknowledged benefits of physical activity for weight control and overall health. This study aimed to assess the effects of 10-week water-based aerobic training (thrice a week) on anthropometric, biochemical, cardiovascular parameters, and explosive strength in young overweight and obese women.

Methods

In a randomized controlled trial with a pre-to-post testing design, twenty-seven young overweight and obese women (age: 27 ± 1 years; body mass index (BMI) = 30.0 ± 3.1) were randomly assigned into experimental (EG: performing a water-based aerobic training, n = 16) or control (CG: maintaining their usual activities during the intervention, n = 11) groups. The pre- and post-intervention participants were assessed for their anthropometrics (body height, body weight, body mass index (BMI), body fat and circumferences), biochemical (fasting glycemia, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG)), cardiovascular parameters (resting blood pressure and resting heart rate (RHR)), and explosive strength of upper and lower limbs.

Results

EG showed reductions in body weight, BMI, %BF, fasting glycemia, and TG, along with improvements in HDL-C, LDL-C, RHR, and explosive strength (all p < 0.05; effect size (ES) = 0.180-1.512, trivial to large). In contrast, CG exhibited increases in body weight, BMI, fasting glycemia, LDL-C, and RHR (all p < 0.05; ES = 0.127-0.993, trivial to large), with no significant changes observed in other measured variables. EG showed superior post-test results in fasting glycemia (p < 0.0001; ES = 2.559, large), LDL-C (p < 0.0001; ES = 0.971, large), and explosive strength measures (0.003 ≤ p < 0.0001; ES = 1.145-1.311, large) compared to the CG.

Conclusions

Our findings indicate that water-based aerobic training could be a useful program to enhance anthropometric, biochemical, cardiovascular, and explosive strength parameters in young overweight and obese women compared to inactive persons.

Cardiovascular training for fatigue in people with cancer

RATIONALE

Cancer-related fatigue (CRF) is the most prevalent and severe symptom among people with cancer. It can be attributed to the cancer itself or to anticancer therapies. CRF affects the individual physically and mentally, and cannot be alleviated by rest. Studies show a positive effect of exercise on CRF.

OBJECTIVES

To evaluate the effects of cardiovascular training on cancer-related fatigue (CRF), quality of life (QoL), adverse events, anxiety, and depression in people with cancer, with regard to their stage of anticancer therapy (before, during, or after), up to 12 weeks, up to six months, or longer, postintervention.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and World Health Organization ICTRP to identify studies that are included in the review. The latest search date was October 2023.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) evaluating cardiovascular training for CRF or QoL, or both, in people with cancer. Trials were eligible if training was structured, included at least five sessions, and instruction was face-to-face (via video tools or in person). We excluded studies with fewer than 20 randomised participants per group and where only an abstract was available.

OUTCOMES

Our critical outcomes were: short-, medium-, long-term CRF and QoL. Important outcomes were adverse events, and short-, medium-, long-term anxiety and depression.

RISK OF BIAS

We used the Cochrane RoB 1 tool to assess bias in RCTs.

SYNTHESIS METHODS

We used standard Cochrane methodology. We synthesised results for each outcome using meta-analysis where possible (inverse variance or Mantel-Haenszel; random-effects model). We pooled data for the respective assessment periods above. We used GRADE to assess certainty of evidence for each outcome.

INCLUDED STUDIES

We included 23 RCTs with 2135 participants, of whom 96.6% originated from high-income countries; 1101 participants were randomised to cardiovascular training and 1034 to no training. Studies included mostly females who were diagnosed with breast cancer. We also identified 36 ongoing and 12 completed studies that have not yet published (awaiting assessment). We only present findings on CRF, QoL and adverse events. For details regarding anxiety and depression, see full text.

SYNTHESIS OF RESULTS

Cardiovascular training before anticancer therapy versus no training for people with cancer We identified no studies for inclusion in this comparison. Cardiovascular training during anticancer therapy versus no training for people with cancer We included 10 studies (1026 participants); eight studies contributed data to quantitative analyses (860 participants). Cardiovascular training probably reduces short-term CRF slightly (mean difference (MD) 2.85, 95% confidence interval (CI) 1.16 to 4.55, on the Functional Assessment of Cancer Therapy - Fatigue (FACT-F), scale 0 to 52, higher values mean better outcome; minimally important difference (MID) 3; 6 studies, 593 participants) and probably results in little to no difference in short-term QoL (MD 3.56, 95% CI 0.21 to 6.90, on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ C-30), scale 0 to 100, higher values mean better outcome, MID 10; 6 studies, 612 participants) (both moderate-certainty evidence). We are uncertain about the effects on medium-term CRF (MD 2.67, 95% CI -2.58 to 7.92, on FACT-F; MID 3; 1 study, 62 participants), long-term CRF (MD 0.41, 95% CI -2.24 to 3.05, on FACT-F; MID 3; 2 studies, 230 participants), medium-term QoL (MD 6.79, 95% CI -4.39 to 17.97, on EORTC QLQ C-30; MID 10; 1 study, 62 participants), and long-term QoL (MD 1.51, 95% CI -3.40 to 6.42, on EORTC QLQ C-30; MID 10; 2 studies, 230 participants) (all very low-certainty evidence). For adverse events (any grade and follow-up), we did not perform meta-analysis due to heterogeneous definitions, reporting, and measurement (9 RCTs, 955 participants; very low-certainty evidence). Cardiovascular training after anticancer therapy versus no training for people with cancer We included 13 studies (1109 participants); nine studies contributed data to quantitative analyses (756 participants). We are uncertain about the effects of cardiovascular training on short-term CRF (MD 3.62, 95% CI 0 to 7.13, on FACT-F; MID 3; 6 studies, 497 participants), long-term CRF (MD -0.80, 95% CI -1.72 to 0.13, on the Fatigue Symptom Inventory (FSI), scale 1 to 10, higher values mean worse outcome; MID 1; 2 studies, 262 participants), short-term QoL (MD 3.70, 95% CI -0.14 to 7.41, on the Functional Assessment of Cancer Therapy - General (FACT-G), scale 0 to 108, higher values mean better outcome; MID 4; 8 studies, 642 participants), long-term QoL (MD 3.10, 95% CI -1.12 to 7.32, on FACT-G; MID 4; 1 study, 201 participants), and adverse events (risk ratio (RR) 2.71, 95% CI 0.58 to 12.67; 1 study, 50 participants) (all very low-certainty evidence). There were no data for medium-term CRF and QoL.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence shows that cardiovascular training by people with cancer during their anticancer therapy slightly reduces short-term CRF and results in little to no difference in short-term QoL. We do not know whether cardiovascular training increases or decreases medium-term CRF/QoL, and long-term CRF/QoL. There is very low-certainty evidence (due to heterogeneous definitions, reporting and measurement) evaluating whether the training increases or decreases adverse events. In people with cancer who perform cardiovascular training after anticancer therapy, we are uncertain about the effects on short-term CRF/QoL, long-term CRF/QoL, and adverse events. We identified a lack of evidence concerning cardiovascular training before anticancer therapy and on safety outcomes. The 36 ongoing and 12 completed, but unpublished, studies could help close this gap, and could contribute to improving the effect estimates and certainty.

FUNDING

This Cochrane review was funded by the Federal Ministry of Education and Research of Germany, grant number: FKZ 01KG2017.

REGISTRATION

Protocol available via DOI: 10.1002/14651858.CD015211.

Machine learning modeling for predicting adherence to physical activity guideline

This study aims to create predictive models for PA guidelines by using ML and examine the critical determinants influencing adherence to the PA guidelines. 11,638 entries from the National Health and Nutrition Examination Survey were analyzed. Variables were categorized into demographic, anthropometric, and lifestyle categories. 18 prediction models were created by 6 ML algorithms and evaluated via accuracy, F1 score, and area under the curve (AUC). Additionally, we employed permutation feature importance (PFI) to assess the variable significance in each model. The decision tree using all variables emerged as the most effective method in the prediction for PA guidelines (accuracy = 0.705, F1 score = 0.819, and AUC = 0.542). Based on the PFI, sedentary behavior, age, gender, and educational status were the most important variables. These results highlight the possibilities of using data-driven methods with ML in PA research. Our analysis also identified crucial variables, providing valuable insights for targeted interventions aimed at enhancing individuals' adherence to PA guidelines.

Part 1-Cardiac Rehabilitation After an Acute Myocardial Infarction: Four Phases of the Programme-Where Do We Stand?

Cardiac rehabilitation is a well-established multidisciplinary interventional protocol that plays a pivotal role in the management and prevention of future cardiovascular events in patients with cardiovascular diseases. This patient-tailored approach includes educating patients about their cardiovascular condition and how to control the associated risk factors, an expert-designed lifestyle modification plan that may include exercise, proper nutrition, pharmacological treatment, and psychological support at each step. Exercise training represents a fundamental component of cardiac rehabilitation. It facilitates an enhancement of cardiovascular fitness, a reduction in heart rate, blood pressure and cardiac remodeling, an increase in the left ventricular ejection fraction, the optimization of endothelial function, and a reduction in inflammation and oxidative stress. Moreover, the beneficial physiological changes resulting from cardiac rehabilitation contribute to a reduction in morbidity and mortality in survivors of myocardial infarction (MI). Furthermore, the European Society of Cardiology Guidelines advocate for the initiation of cardiac rehabilitation as early as possible, while the patient who survived MI is still in hospital. This two-part comprehensive review commences with a historical overview of cardiac rehabilitation, followed by a detailed exploration of the four phases of the cardiac rehabilitation programme and its impact on cardiovascular health. In Part 2, the study aims to provide a detailed account of the optimal timing for starting cardiac rehabilitation programs and to examine the factors affecting low engagement in such programs, as well as gender-based differences in adherence.

Differential Regulation of miRNA and Protein Profiles in Human Plasma-Derived Extracellular Vesicles via Continuous Aerobic and High-Intensity Interval Training

Both continuous aerobic training (CAT) and high-intensity interval training (HIIT) are recommended to promote health and prevent diseases. Exercise-induced circulating extracellular vesicles (EX-EVs) have been suggested to play essential roles in mediating organ crosstalk, but corresponding molecular mechanisms remain unclear. To assess and compare the systemic effects of CAT and HIIT, five healthy male volunteers were assigned to HIIT and CAT, with a 7-day interval between sessions. Plasma EVs were collected at rest or immediately after each training section, prior to proteomics and miRNA profile analysis. We found that the differentially expressed (DE) miRNAs in EX-EVs were largely involved in the regulation of transcriptional factors, while most of the DE proteins in EX-EVs were identified as non-secreted proteins. Both CAT and HIIT play common roles in neuronal signal transduction, autophagy, and cell fate regulation. Specifically, CAT showed distinct roles in cognitive function and substrate metabolism, while HIIT was more associated with organ growth, cardiac muscle function, and insulin signaling pathways. Interestingly, the miR-379 cluster within EX-EVs was specifically regulated by HIIT, involving several biological functions, including neuroactive ligand-receptor interaction. Furthermore, EX-EVs likely originate from various tissues, including metabolic tissues, the immune system, and the nervous system. Our study provides molecular insights into the effects of CAT and HIIT, shedding light on the roles of EX-EVs in mediating organ crosstalk and health promotion.

Effects of Dance-Based Aerobic Training on Frailty and Cognitive Function in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

Background/Objectives: The purpose of this study has been to evaluate the effects of a dance-based aerobic training program on frailty, cognitive impairment, executive functions, and verbal fluency in older adults with mild cognitive impairment. Methods: Randomized clinical trial, whose sample was made up of 92 older adults, of which 47 performed rhythmic physical activity for 12 weeks. Data on frailty were collected through FRAIL, cognitive function through the Mini-Mental State Examination (MMSE), cognitive impairment through The Montreal Cognitive Assessment (MoCA), verbal fluency using the Isaac test, and executive functions with the Trail Making Test (TMT). All variables were measured before and after the intervention by an independent researcher blinded to the treatment. Results: Participants in the experimental group showed statistically significant improvements in frailty (Cohen's d = 0.60), cognitive function (Cohen's d = 0.98), cognitive impairment (Cohen's d = 1.22), verbal fluency (Cohen's d = 0.61) and executive functions (Cohen's d = 0.64). Conclusions: This study demonstrated that a 12-week dance-based aerobic training program can significantly reduce frailty and improve cognitive abilities in older adults with mild cognitive impairment. These improvements suggest that the intervention is not only effective in terms of physical health, but also in promoting mental health and general well-being.

A Systematic Review of the Effects of Low-Carbohydrate Diet on Athletic Physical Performance Parameters

A low-carbohydrate diet (LCD) or ketogenic diet is commonly used by individuals who want to achieve ketosis, which can boost fat metabolism, increase insulin sensitivity, and reduce blood sugar spikes. However, many athletes are hesitant to utilize a diet that specifically restricts the intake of carbohydrates, an important source of energy for physical activity. Athletes usually adopt a high-carbohydrate or high-protein diet, depending on their goals. This review aims to examine the evidence for the impact of an LCD on athletes' aerobic, anaerobic, and upper and lower body strength performance. A systematic review of original studies was conducted for articles indexed in PubMed that utilized an LCD in athletes and reported athletic performance values. A total of 19 studies were included in the final synthesis. An LCD may aid in maintaining or increasing upper and lower body strength. However, this type of diet provides no consistent benefit and may even negatively impact some measures of aerobic and anaerobic performance. Taken together, no strong evidence indicates the benefit of an LCD on athletic performance. Athletes wishing to modify their diet for improved performance should consider possible diets with specific training and performance goals in mind.

Vitamin D and its relationship to performance and health during a competitive period in elite women's basketball and volleyball players

Vitamin D [25(OH)D] is a key nutrient, although its level is often low in the general population. To investigate the relationship between vitamin D levels and muscle performance, and to analyze how vitamin D changes during a 16-week competitive season and its relationship to the performance tests performed. Participant characteristics: age 25.1 ± 4.7 years; height 1.8 ± 0.1 m, and body mass 73.9 ± 15.4 kg. Vitamin D levels (ng/mL) were at T1 (September): 33.7 ± 14.7 (n = 23), and at T2 (January): 26.1 ± 7.3 (n = 23). Over 16 weeks of competition, participants' blood was analyzed to determine their vitamin D levels. Their athletic abilities were evaluated through various tests: vertical jumps (standing jump and countermovement jump); 20-m sprint without direction changes; and intermittent endurance test; the vitamin D level decreased from T1 to T2 by -22. 40% [p < 0.05] but performance improved in all tests performed (SJ: 4.57%; CMJ: 6.94%; VO2max: 4.99% [p < 0.05]; 20 m: -1.83%). There is a relationship between vitamin D levels and physical performance in female indoor athletes. The results suggest that increased training load may also negatively affect vitamin D levels in elite female indoor athletes.

Exercise Training and Cardiovascular Risk Factors in Males with Overweight or Obesity: A Systematic Review of Randomized Controlled Trials

Background and Objectives: Obesity is a significant risk factor for cardiovascular disease. Physical exercise has been established as an effective intervention for reducing cardiovascular mortality. This systematic review aimed to investigate the effects of various exercise modalities on cardiovascular risk factors in men with obesity. Materials and Methods: This review included randomized controlled trials (RCTs) published between 2005 and November 2023. Studies were eligible if they assessed the impact of exercise interventions on blood pressure (BP), lipid profiles, and glucose/insulin regulation in males aged 18 years or older with a body mass index (BMI) of 25 kg/m2 or greater. The quality of included studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results: A total of 25 RCTs were included in the analysis, with PEDro scores ranging from 3 to 7. High-intensity interval training (HIIT) was associated with significant reductions in BP, with an average decrease of 12.5 mmHg. However, the magnitude of BP reduction varied across studies, likely due to differences in training protocols and study quality. Resistance training (RT) was associated with modest improvements in glycemic control, with some studies reporting a reduction in fasting blood glucose levels by 5-10%. Combined exercise (CT) programs, which included both aerobic and resistance training, as well as aerobic exercise alone, were shown to improve lipid profiles, with some studies showing reductions in total cholesterol levels ranging from 10-15%. However, the findings were inconsistent, highlighting the need for further research to better understand the potential benefits and optimal exercise regimens. Conclusions: This systematic review supports the potential of exercise training in reducing cardiovascular risk factors in men with obesity, though the effectiveness varies depends on the type of exercise. Combined exercise programs have shown promise for lipid profiles, but further research is needed to confirm these effects. HIIT has been linked to BP reductions in some studies, although the results are inconsistent and depend on protocols and study quality. The limitations in study quality may impact the reliability of these findings.

The Role of Lifestyle Interventions in PCOS Management: A Systematic Review

Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine disorders among reproductive-aged women. It is characterized by hyperandrogenism, anovulation, and polycystic ovaries. Lifestyle changes are suggested as first-line interventions in managing PCOS. This systematic review aims to assess the scientific evidence regarding the role of lifestyle modifications (dietary changes, physical activity, and behavioral changes) in improving reproductive, anthropometric, metabolic, and psychological outcomes in women with PCOS. Dietary interventions such as foods with low glycemic index scores; caloric restrictions; high-fiber, omega three fatty acid-rich diets; ketogenic diets; Mediterranean diets; antioxidant-rich food; and anti-inflammatory diets improve insulin sensitivity and hormonal balance in women with PCOS. Physical activity, like aerobic and resistance exercise, enhances insulin sensitivity, helps weight loss, and improves metabolic and reproductive outcomes in women with PCOS. Further, behavioral and education modules can also be used to improve awareness, adherence, and the effectiveness of conventional treatment and to manage mental health issues related to PCOS. Collectively, lifestyle modifications not only improve the biochemical, hormonal, and anthropometric parameters in PCOS patients but also reduce the long-term risks of metabolic and cardiovascular diseases.

Ageing, clinical complexity, and exercise therapy: a multidimensional approach

Ageing is a multidimensional concept related to the progressive decline in physiological functions. The decrease of physical autonomy due to the ageing process leads to frailty, which in turn is associated with disability and comorbidity. Ageing represents the primary risk factor for chronic degenerative diseases, especially involving cardiovascular, metabolic, respiratory, and osteoarticular systems, determining the decrease in activities and quality of daily life. Regular physical activity can significantly reduce the risk of chronic degenerative diseases, moderate or severe functional limitations, and premature death in older adults. In light of the relationship between ageing, sedentary lifestyle, disability, comorbidity, and physical activity, a clear need emerges within the health system. Better control on the territory of pathologies related to ageing with the management of clinical and care complexity, multidimensional and multi-professional evaluation of the elderly complex and fragile patient, also through the definition of specific outpatient packages for pathology that allow the simplification of the evaluation process. There is a need for integration between local services, hospitals, and social assistance services. Aim of this review is to highlight the importance of the multidimensional approach is essential to be able to classify the complex elderly patient according to a multi-professional vision aimed at evaluating comorbidities and frailties, including sarcopenia, nutritional deficits, functional capacity, and planning a personalized and monitored motor training program, to improve motor, metabolic, cardiovascular and respiratory functions. In addition, developing an integrated hospital-community-care services management program to follow up with patients post-care is crucial.

Rehabilitation interventions for cognitive deficits in stroke survivors: A systematic review of randomized controlled trials

Cognitive deficits are one of the most common impairments after stroke. It negatively affects physical and social functioning. Rehabilitation interventions for cognitive deficits post-stroke have taken less consideration. The present study aimed to provide an overview of the effects of various rehabilitation interventions on cognitive functions in patients with stroke. PUBMED, SCOPUS, PEDro, EMBASE, MEDLINE, and REHABDATA were searched for randomized controlled trials (RCTs) investigating the effects of rehabilitation interventions on cognitive domains poststroke until August 2021. The methodological quality of the selected studies was evaluated using the Cochrane Collaboration tool, and the effect sizes were calculated. Forty-four studies met the inclusion criteria. A total of 3561 individuals with stroke, 57.60% of whom were males. The mean age for all participants was 65.48 years. Eighteen RCTs were high, moderate (n = 17), and low methodological quality (n = 9). The results showed evidence for the beneficial effects of many rehabilitation interventions on cognition in individuals with stroke. Rehabilitation plays a crucial role in improving cognitive functions in stroke patients with mild cognitive deficits. Virtual reality (VR), computer-based cognitive rehabilitation (CBCR), and non-aerobic exercises may promote cognitive functions in patients with stroke.

Aerobic Exercise Improves the Overall Outcome of Type 2 Diabetes Mellitus Among People With Mental Disorders

The escalating global prevalence of type 2 diabetes mellitus (T2DM) and mental disorder (MD) including schizophrenia, bipolar disorder, major depressive disorder, and anxiety highlights the urgency for comprehensive therapeutic strategies. Aerobic exercise (AE) is a viable adjunct therapy, providing significant benefits for individuals dealing with both T2DM and MD. This review consolidates evidence on AE's role in alleviating the physiological and psychological effects of these comorbid conditions. It delves into the pathophysiological connections between T2DM and various MD, including depression, schizophrenia, anxiety, and bipolar disorder-emphasizing their reciprocal exacerbation. Key neurophysiological mechanisms through which AE confers benefits are explored, including neuroinflammation modulation, brain structure and neuroplasticity enhancement, growth factor expression regulation, and hypothalamic-pituitary-adrenal (HPA)/microbiota-gut-brain (MGB) axis normalization. Clinical results indicate that AE significantly improves both metabolic and psychological parameters in patients with T2DM and MD, providing a substantial argument for integrating AE into comprehensive treatment plans. Future research should aim to establish detailed, personalized exercise prescriptions and explore the long-term benefits of AE in this population. This review underscores the potential of AE to complement existing therapeutic modalities and enhance the management of patients with T2DM and MD.

Exercise as a Therapeutic Strategy to Improve Cerebrovascular Function and Cognition in Breast Cancer Survivors: A Scoping Review

Breast cancer is the most diagnosed cancer globally. While the breast cancer prevalence continues to rise, so too do patient survival rates, thus resulting in a large survivor population. Up to 75% of this population report experiencing cancer-related cognitive impairment during their cancer journey, thus reducing their quality of survivorship. This review systematically evaluates the effect of physical activity and exercise training on cerebrovascular function and cognition in breast cancer survivors. Cross-sectional, intervention or observational studies that examined the effect of acute or chronic exercise training or physical activity levels on cerebrovascular function and cognition in female breast cancer survivors were searched for systematically. The 11 included studies were tabulated and described narratively. The included studies primarily focused on aerobic exercise training, while only four studies investigated the effect of resistance exercise training or concurrent training on cerebrovascular function and/or cognition in breast cancer survivors. Collectively, these studies provide preliminary evidence supporting the positive effect of exercise training on cerebrovascular function and cognition in breast cancer survivors, irrespective of their age, stage of breast cancer and treatment regimen. However, more research is required to comprehensively evaluate the effect of exercise training on cerebrovascular function and cognition in breast cancer survivors and the mechanisms leading to these potential improvements.

Healthy Lifestyle Changes Improve Cortisol Levels and Liver Steatosis in MASLD Patients: Results from a Randomized Clinical Trial

Background: Steatotic liver disease associated with metabolic dysfunction (MASLD) affects up to about 30% of the general adult population and is closely related to obesity and the metabolic syndrome. Cortisol, a stress-related hormone contributing to hepatic fat accumulation and insulin resistance, also promotes progression of the disease. The study aims to investigate the impact of lifestyle modifications on cortisol levels and hepatic steatosis in patients with MASLD. Methods: In a 16-week three-arm randomized trial, 42 patients were randomly assigned to three groups who received dietary advice (CG), dietary advice combined with aerobic exercise (AE + DA), or dietary advice with high-intensity interval training (HIIT + DA). Before the start, after 2 months of intervention, and at the end of the project, medical evaluations, routine biochemical assessments, and psychological questionnaires were analyzed. At baseline and at the end of 4 months, hepatic steatosis was evaluated by Fibroscan®. Results: In the study population, severe hepatic steatosis (74%) and obesity (98%) were prevalent at the beginning of the study. A statistically significant (p-value = 0.001) reduction in circulating cortisol levels was observed over time in the two groups doing exercise, especially in HIIT + DA (p-value = 0.006). Hepatic steatosis, assessed by Fibroscan®, disappeared in 10 participants (CAP value < 248, p-value = 0.003). CAP values and waist circumference decreased in all groups, statistically significantly in the AE + DA group (p-value = 0.005; p-value = 0.04, respectively). Conclusions: The study emphasizes the benefits of combining diet and exercise in managing MASLD. HIIT + DA significantly decreased cortisol levels, while AE + DA was the most potent intervention for reducing hepatic steatosis.

Association between social jetlag and leisure-time physical activity and muscle strengthening exercise in young adults: findings from a nationally representative sample in South Korea

OBJECTIVES

Social jetlag (SJL), which is characterised by a misalignment between biological and social time, is associated with cardiometabolic risk factors. This study investigated the relationship between SJL, leisure-time physical activity (LTPA) and muscle strengthening exercise (MSE) in young adults.

STUDY DESIGN

This was a cross-sectional study.

METHODS

This cross-sectional study included a nationally representative sample of young adults aged 19-29 years (n = 2113). SJL was calculated as the difference in the midpoint of sleep onset and offset time between weekdays and weekends. The dependent variables were engagement in ≥150 min/week of moderate-to-vigorous LTPA and engagement in MSE ≥2 days/week based on guidelines provided by the World Health Organisation. Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Non-linear relationships were estimated using restricted cubic spline regression.

RESULTS

The study population comprised 975 men and 1138 women. Among participants, 4.6% had <0 min, 41.9% had 0-59 min, 25.7% had 60-119 min and 27.7% had ≥120 min SJL. Those with ≥120 min SJL had a reduced likelihood of achieving the recommended level of LTPA (OR: 0.71, 95% CI: 0.52-0.95) and MSE (OR: 0.73, 95% CI: 0.55-0.97). In the non-linear model, an inverse U-shaped association was observed, wherein the highest probability of meeting the recommended level of LTPA and MSE was observed in those with 45 min SJL, decreasing after this threshold.

CONCLUSIONS

Individuals with ≥120 min SJL were less likely to engage in the recommended level of both aerobic and anaerobic exercise. Although future studies using a longitudinal design are required to elucidate the causal relationship between SJL and physical activity, the current findings suggest that physical inactivity during leisure time may play an important role in the increased risk of cardiometabolic abnormalities in young adults with SJL.

Endurance in Long-Distance Swimming and the Use of Nutritional Aids

BACKGROUND

Long-distance swimmers exert energetic, physiological, and neuromuscular demands that must be matched with adequate body composition to improve their performance in long-distance swimming.

OBJECTIVES

This review aims to compile all available information on energetic and physiological demands, optimal body composition, nutrition, and ergogenic supplements in long-distance swimming. This will provide an understanding of the specific challenges and needs of this sport and will help swimmers and coaches design more effective training and nutrition plans to optimise performance and achieve their goals.

METHODS

Databases such as Web of Science, SciELO Citation Index, MEDLINE (PubMed), Current Contents Connect, KCI-Korean Journal Database, and Scopus were searched for publications in English using keywords such as swimming, endurance, energy demands, physiological demands, nutrition, body composition, and ergogenic aids, individually or in combination.

RESULTS

There is convincing evidence that several physical indicators, such as propulsive surface area, technical, such as stroke rate, and functional, such as hydration strategies, are related to swimming performance and body composition. Each athlete may have a specific optimal body fat level that is associated with improved sporting performance. The nutritional needs of open water swimmers during competition are quite different from those of pool swimmers.

CONCLUSIONS

Swimmers with an adequate physique have a high body muscle mass and moderately related anaerobic strength both on land and in the water. These general and specific strength capacities, which are given by certain anthropometric and physiological characteristics, are seen throughout the work, as well as ergogenic and nutritional strategies, which have an important impact on long-distance swimming performance.

The impact of aerobic and anaerobic exercise interventions on the management and outcomes of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a metabolic disorder that includes non-alcoholic hepatic steatosis without or with moderate inflammation and non-alcoholic steatohepatitis (NASH), characterized by necroinflammation and a more rapid progression of fibrosis. It is the primary pathological basis for hepatocellular carcinoma. With its prevalence escalating annually, NAFLD has emerged as a global health epidemic, presenting a significant hazard to public health worldwide. Existing studies have shown that physical activity and exercise training have a positive effect on NAFLD. However, the extent to which exercise improves NAFLD depends on the type, intensity, and duration. Therefore, the type of exercise that has the best effect on improving NAFLD remains to be explored. To date, the most valuable discussions involve aerobic and anaerobic exercise. Exercise intervenes in the pathological process of NAFLD by regulating physiological changes in cells through multiple signaling pathways. The review aims to summarize the signaling pathways affected by two different exercise types associated with the onset and progression of NAFLD. It provides a new basis for improving and managing NAFLD in clinical practice.

Regenerative rehabilitation: a novel multidisciplinary field to maximize patient outcomes

Regenerative rehabilitation is a novel and rapidly developing multidisciplinary field that converges regenerative medicine and rehabilitation science, aiming to maximize the functions of disabled patients and their independence. While regenerative medicine provides state-of-the-art technologies that shed light on difficult-to-treated diseases, regenerative rehabilitation offers rehabilitation interventions to improve the positive effects of regenerative medicine. However, regenerative scientists and rehabilitation professionals focus on their aspects without enough exposure to advances in each other's field. This disconnect has impeded the development of this field. Therefore, this review first introduces cutting-edge technologies such as stem cell technology, tissue engineering, biomaterial science, gene editing, and computer sciences that promote the progress pace of regenerative medicine, followed by a summary of preclinical studies and examples of clinical investigations that integrate rehabilitative methodologies into regenerative medicine. Then, challenges in this field are discussed, and possible solutions are provided for future directions. We aim to provide a platform for regenerative and rehabilitative professionals and clinicians in other areas to better understand the progress of regenerative rehabilitation, thus contributing to the clinical translation and management of innovative and reliable therapies.

A Respiratory Sensor-Based Study of the Relationship between Voluntary Breathing Patterns and Aerobic and Anerobic Exercise Capacity-An Exploratory Applied Study

(1) Background: Exploring the relationship between spontaneous breathing patterns and aerobic and anerobic running exercise performance can greatly improve our understanding of optimizing physical fitness. Spontaneous breathing patterns refer to how the rhythm and depth of breathing affect performance and physical adaptation during exercise. (2) Methods: This study aimed to investigate this relationship by enrolling 240 college students (120 males and 120 females, aged 18-22). We evaluated their resting respiratory rate (RR), the combined total of abdominal and thoracic movements (AM+TM), the proportion of abdominal movement to the overall respiratory movement (AM/(AM+TM)), and the inhalation to exhalation ratio (I/E ratio). Additionally, their performance in a 50 m sprint (measuring anerobic capability), an 800- or 1000 m run (assessing mixed aerobic and anerobic capacity), and a 12 min distance run (evaluating aerobic capacity) was recorded. (3) Results: Our findings, through both correlational and comparative analyses, indicate that a larger AM+TM is predictive of a greater distance covered in the 12 min run, suggesting enhanced aerobic capacity. Interestingly, among female participants, a lower body mass index (BMI) coupled with a higher proportion of abdominal movement (AM/(AM+TM)) was linked to better performance in the 800 m run, indicative of superior mixed aerobic and anerobic capacities. These results imply that women with a larger tidal volume and those with a lower BMI but higher abdominal contribution to breathing at rest may exhibit better aerobic and mixed exercise capacities, respectively. (4) Conclusions: Based on these findings, we recommend that healthcare professionals and physical education instructors incorporate respiratory pattern assessments into their practices to potentially improve the physical health of their clients and students, with a particular emphasis on female populations. This study underscores the importance of understanding the intricate relationship between spontaneous respiratory patterns and exercise capabilities in enhancing overall physical fitness and health.

Obesity and Environmental Risk Factors Significantly Modify the Association between Ischemic Stroke and the Hero Chaperone C19orf53

The unique chaperone-like properties of C19orf53, discovered in 2020 as a "hero" protein, make it an intriguing subject for research in relation to ischemic stroke (IS). Our pilot study aimed to investigate whether C19orf53 SNPs are associated with IS. DNA samples from 2138 Russian subjects (947 IS and 1308 controls) were genotyped for 7 C19orf53 SNPs using probe-based PCR. Dominant (D), recessive (R), and log-additive (A) regression models in relation to the effect alleles (EA) were used to interpret associations. An increased risk of IS was associated with rs10104 (EA G; Pbonf(R) = 0.0009; Pbonf(A) = 0.0004), rs11666524 (EA A; Pbonf(R) = 0.003; Pbonf(A) = 0.02), rs346158 (EA C; Pbonf(R) = 0.006; Pbonf(A) = 0.045), and rs2277947 (EA A; Pbonf(R) = 0.002; Pbonf(A) = 0.01) in patients with obesity; with rs11666524 (EA A; Pbonf(R) = 0.02), rs346157 (EA G; Pbonf(R) = 0.036), rs346158 (EA C; Pbonf(R) = 0.005), and rs2277947 (EA A; Pbonf(R) = 0.02) in patients with low fruit and vegetable intake; and with rs10104 (EA G; Pbonf(R) = 0.03) and rs11666524 (EA A; Pbonf(R) = 0.048) in patients with low physical activity. In conclusion, our pilot study provides comprehensive genetic and bioinformatic evidence of the involvement of C19orf53 in IS risk.

Pickleball Participation and the Health and Well-Being of Adults-A Scoping Review

BACKGROUND

Pickleball has grown tremendously in recent years, yet little evidence exists regarding pickleball-related injuries. This scoping review extends current work on pickleball participation by identifying positive and negative health effects associated with the sport. We summarize how pickleball impacts the health and well-being of adult participants.

METHODS

Searches were conducted on MEDLINE, CINAHL, ProQuest Nursing, ERIC, SPORTDiscus, PsycINFO, Scopus, CBCA Complete, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ProQuest Dissertations and Theses. Selected studies considered aspects of health and/or well-being of adult pickleball participants. Using the population/concept/context framework, participants were healthy, able-bodied adults 18 years of age or over, who had played pickleball at least once. The positive and negative outcomes of pickleball on participants' health and well-being (concept) within the context of pickleball participation were examined. Full-text articles written in English since 2013 were included. Extracted data were tabulated, and a descriptive summary with thematic analysis was completed.

RESULTS

This scoping review comprised 27 articles that met the inclusion criteria. Pickleball is promising as an exercise intervention for all adults, and there is evidence of positive social and psychological effects, and health and fitness benefits to participating in pickleball by older adults.

CONCLUSIONS

Although we are still in the early stages of studying pickleball, there have been some documented health benefits of using the sport as a physical exercise intervention for adults. More research is needed on the types, prevalence, and severity of pickleball injuries and the sport's impact on younger players.

High-Intensity Interval Training Decreases Circulating HMGB1 in Individuals with Insulin Resistance; Plasma Lipidomics Identifies Associated Cardiometabolic Benefits

Background: Exercise is a fundamental primary standard of care for cardiometabolic health. Body Weight (BW) High-Intensity Interval Training (HIIT) is an effective strategy for reducing cardiometabolic markers in individuals with insulin resistance and Type-2 diabetes (T2D). High-mobility group box 1 (HMGB1), a ubiquitous nuclear factor, plays an ample role beyond an alarmin in T2D development and progression. Our group has described this novel role previously, showing the beneficial effect of whole body HMGB1 silencing in decreasing hyperglycemia in diabetic mice. In the present study we tested the hypothesis that BW-HIIT as an effective exercise training modality will decrease cardiometabolic risk with a concomitant decrease in circulating HMGB1 more prominently in insulin resistant individuals compared to non-insulin resistant individuals contrasting to what we can evidence in a preclinical murine model of insulin resistance; Methods: Human and mouse pre- and post-exercise serum/plasma samples were analyzed for Lipidomics as well as Metabolic and Cytokine Multiplex assays. Standard of care, as well as cardiometabolic parameters, was also performed in human subjects; Results: insulin resistant individuals had the most positive effect, primarily with a decrease in the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). as an index of insulin resistance as well as decreased HMGB1 post-exercise. Lipidomic analysis illustrated the highly beneficial effect of exercise training using a modified HIIT program, showing an enhanced panel of circulating lipids post-exercise exclusively in insulin resistant individuals. Plasma multiplex revealed significant translational heterogeneity in our studies with distinct metabolic hormone responses to exercise conditioning with a decrease in inflammatory markers in insulin resistant individuals; Conclusions: The current study demonstrated that 6-week BW-HIIT training improves cardiometabolic, anti-inflammatory markers, metabolic hormones, and insulin sensitivity in humans, strongly associated with decreased circulating HMGB1. Overall, these experiments reinforce the potential of HMGB1 as a marker of changes in insulin resistance and the positive effect of exercise training on insulin resistance possibly preventing the development of T2D and associated complications.

Aerobic and Anaerobic Exercise's Impact on Cognitive Functions in Eighth Grade Students

The present study examined the impact of aerobic and anaerobic exercise on cognitive abilities in eighth grade students at one middle school in southeastern US. It is known that youth do not meet recommended physical activity levels, yet there is research demonstrating a clear connection between aerobic exercise and academic performance. There is a gap in evidence regarding anaerobic exercise and cognitive capabilities. If professionals know which type of exercise is most beneficial for enhancing cognition in youth, it will behoove them to incorporate these practices in physical education and other areas throughout the school day for students. Thus, this research aimed to answer the following question: what is the effect of both aerobic and anaerobic exercise on the cognitive functions of eighth grade students, specifically measuring working memory, attention, and impulsivity? Fifty research participants (N = 31 males, 18 females, 1 other), aged 13-14, consented/assented to the complete study protocols. Participants engaged in an experiment containing three different cognitive tasks after partaking in three separate exercise conditions. The cognitive measures were the Stroop color-word task, the Flanker test, and the Go/No Go task, which all measured reaction time and the number of correct responses. The exercise conditions were baseline (after no exercise), aerobic (after a continuous running activity in PE), and anaerobic (after completing an interval dumbbell workout in PE). Each condition took place on a separate day to decrease the effect of confounding variables. The data were analyzed using the Scheffe modification of the MANOVA to determine whether multiple levels of the independent variable influenced the dependent variables (the reaction time and number of correct responses) or if a combination of variables influenced the outcomes. Each cognitive test was analyzed separately. The results showed that the exercise condition did significantly impact the reaction time and the number of correct responses for the Stroop color-word task [F(4, 254) = 8.59, p < 0.001; Pillai's Trace = 0.24]. Specifically, aerobic exercise improved both reaction time (p < 0.001) and the number of correct responses (p = 0.001) compared to baseline, while anaerobic exercise improved just reaction time compared to baseline. To find out more detailed information about the specific dependent variable affected by the exercise program, individual ANOVA tests were conducted, resulting in statistical significance for both the number of correct responses and reaction time regarding the program. The partial Eta2 of 0.07 for the number of correct responses and 0.24 for reaction time indicated that 7% of the variance in correct responses and 24% of the variance in reaction time could be explained by the exercise program. While both are significant, reaction time is more impacted by exercise program than correct responses are. Given these findings, it is recommended that aerobic physical activity be offered in school prior to assigning cognitively challenging tasks, while quick anaerobic activity breaks should be used to refocus students' attention. More research should be conducted to examine other cognitive abilities, as well as in other populations.

Revitalizing the Gut Microbiome in Chronic Kidney Disease: A Comprehensive Exploration of the Therapeutic Potential of Physical Activity

Both physical inactivity and disruptions in the gut microbiome appear to be prevalent in patients with chronic kidney disease (CKD). Engaging in physical activity could present a novel nonpharmacological strategy for enhancing the gut microbiome and mitigating the adverse effects associated with microbial dysbiosis in individuals with CKD. This narrative review explores the underlying mechanisms through which physical activity may favorably modulate microbial health, either through direct impact on the gut or through interorgan crosstalk. Also, the development of microbial dysbiosis and its interplay with physical inactivity in patients with CKD are discussed. Mechanisms and interventions through which physical activity may restore gut homeostasis in individuals with CKD are explored.

Mechanisms and benefits of cardiac rehabilitation in individuals with stroke: emerging role of its impact on improving cardiovascular and neurovascular health

Human and animal studies have demonstrated the mechanisms and benefits of aerobic exercise for both cardiovascular and neurovascular health. Aerobic exercise induces neuroplasticity and neurophysiologic reorganization of brain networks, improves cerebral blood flow, and increases whole-body VO2peak (peak oxygen consumption). The effectiveness of a structured cardiac rehabilitation (CR) program is well established and a vital part of the continuum of care for people with cardiovascular disease. Individuals post stroke exhibit decreased cardiovascular capacity which impacts their neurologic recovery and extends disability. Stroke survivors share the same risk factors as patients with cardiac disease and can therefore benefit significantly from a comprehensive CR program in addition to neurorehabilitation to address their cardiovascular health. The inclusion of individuals with stroke into a CR program, with appropriate adaptations, can significantly improve their cardiovascular health, promote functional recovery, and reduce future cardiovascular and cerebrovascular events thereby reducing the economic burden of stroke.

Combined Aerobic Exercise with Intermittent Fasting Is Effective for Reducing mTOR and Bcl-2 Levels in Obese Females

The integration of combined aerobic exercise and intermittent fasting (IF) has emerged as a strategy for the prevention and management of obesity, including its associated health issues such as age-related metabolic diseases. This study aimed to examine the potential of combined aerobic exercise and IF as a preventative strategy against cellular senescence by targeting mTOR and Bcl-2 levels in obese females. A total of 30 obese women, aged 23.56 ± 1.83 years, body fat percentage (FAT) 45.21 ± 3.73% (very high category), BMI 30.09 ± 3.74 kg/m2 were recruited and participated in three different types of interventions: intermittent fasting (IF), exercise (EXG), and a combination of intermittent fasting and exercise (IFEXG). The intervention program was carried out 5x/week for 2 weeks. We examined mTOR and Bcl-2 levels using ELISA kits. Statistical analysis used the one-way ANOVA test and continued with Tukey's HSD post hoc test, with a significance level of 5%. The study results showed that a combination of aerobic exercise and IF significantly decreased mTOR levels (-1.26 ± 0.79 ng/mL) compared to the control group (-0.08 ± 1.33 ng/mL; p ≤ 0.05). However, combined aerobic exercise and IF did not affect Bcl-2 levels significantly (-0.07 ± 0.09 ng/mL) compared to the control group (0.01 ± 0.17 ng/mL, p ≥ 0.05). The IF-only group, exercise-only group, and combined group all showed a significant decrease in body weight and fat mass compared to the control group (p ≤ 0.05). However, the combined aerobic exercise and IF program had a significant effect in reducing the total percentage of body fat and fat mass compared to the IF-only group (p ≤ 0.05). Therefore, it was concluded that the combined intermittent fasting and exercise group (IFEXG) undertook the most effective intervention of the three in terms of preventing cellular senescence, as demonstrated by decreases in the mTOR level, body weight, and fat mass. However, the IFEXG did not present reduced Bcl-2 levels.

Functional Exercise Capacity and Perceived Exertion in Patients with Empty Nose Syndrome

Empty nose syndrome (ENS) is a complex condition characterized by symptoms such as dyspnea, nasal discomfort, and emotional challenges. This study aimed to evaluate functional exercise capacity and perceived exertion in patients with ENS. Patients with ENS who presented with a range of severe symptoms were prospectively enrolled. Pulmonary function was evaluated using spirometry, and functional exercise capacity was measured via the 6 min walk test (6-MWT). Perceived exertion was quantified using the Borg scale, and cardiopulmonary function was evaluated by monitoring peripheral oxygen saturation (SpO2). These parameters were assessed before and after nasal reconstruction surgery. A total of 44 patients with ENS were enrolled and classified into mild-to-moderate (n = 20) and severe (n = 24) symptom groups. Spirometry results showed no significant differences before and after surgery in the entire cohort. Perceived exertion showed significant postoperative improvement (p = 0.006). The severe ENS symptom group experienced significant improvement in SpO2 (p = 0.013) and perceived exertion (p = 0.002) at the end of the 6-MWT after surgery. Surgical intervention significantly enhanced functional exercise capacity (p = 0.038) in patients with mild-to-moderate ENS symptoms. Surgical reconstruction positively affected perceived exertion and SpO2 at the end of the 6-MWT in patients with ENS. The severity of ENS symptoms, as assessed by SNOT-25 scores, influenced these outcomes. These findings underscore the potential benefits of surgical intervention for enhancing exercise tolerance and respiratory efficiency.

Effectiveness of aerobic exercise on cognition in individuals with traumatic brain injury: A systematic review

Cognitive deficits are among the most common impairments in individuals with traumatic brain injury (TBI). Aerobic exercise is a repetitive and structured physical activity that influences structural and functional brain alterations differently. This review aims to examine the effects of aerobic exercise on cognition in individuals with TBI. PubMed, CINAHL, EMBASE, SCOPUS, MEDLINE, and Web of Science were searched from inception to December 20, 2023. Studies designed as randomized controlled trials (RCT), clinical controlled trials (CCT), and pilot studies included individuals with a confirmed diagnosis of TBI, comparing aerobic exercise with passive, active, or no control group and included at least one outcome measure assessing any cognitive domain were selected. The quality of the selected studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Six studies met the eligibility criteria (n = 118), with 53% of participants being female. Four studies were of good quality, fair quality (n = 1), and poor quality (n = 1) on the PEDro. Two of the selected studies showed significant improvements in cognition after moderate and vigorous aerobic exercises, while four studies indicated that moderate and vigorous aerobic exercise did not improve cognition post-TBI. The evidence on the effects of moderate and vigorous aerobic exercise on cognitive function post-TBI remains limited. Additional studies are strongly warranted to understand aerobic exercise's effects on cognition post-TBI.

The Impact of Physical Exercise on microRNAs in Hemodialysis Patients: A Review and a Protocol for an Ancillary Study

Physical inactivity is considered a significant risk factor for mortality and morbidity among chronic hemodialysis (HD) patients. Therefore, physical exercise is recommended in the treatment of HD patients. Although the beneficial effects of physical exercise in HD patients are well-described in the literature, the underlying physiological mechanisms still need to be fully understood. Recently, microRNAs (miRNAs) have emerged as potential mediators of the therapeutic effects of physical exercise in healthy individuals. miRNAs are short, single-stranded, noncoding RNAs involved in gene expression regulation. Specifically, upon forming the RNA-induced silencing complex, miRNAs selectively bind to specific miRNAs within cells, reducing gene expression. miRNAs can be secreted by cells in an accessible form or enclosed within exosomes or extracellular vesicles. They can be detected in various body fluids, including serum (circulating miRNAs), facilitating the study of their diverse expression. Currently, there is no available data regarding the impact of physical exercise on the expression of miRNAs involved in osteogenic differentiation, a fundamental mechanism in the development of vascular calcification, for HD patients. Therefore, we have designed an observational and longitudinal case-control study to evaluate the expression of miR-9 and miR-30b in HD patients participating in a 3-month interdialytic physical exercise program. This paper aims to present the study protocol and review the expression of circulating miRNAs in HD patients and their modulation through physical exercise.

Energy expenditure, oxygen consumption, and heart rate while exercising on seven different indoor cardio machines at maximum and self-selected submaximal intensity

Objective

One of the main objectives of practicing indoor cardiovascular exercise is to maximize caloric expenditure. This study aimed to compare energy expenditure (EE), oxygen consumption (VO2), and heart rate (HR) recorded in middle-aged adults while exercising on seven different indoor cardiovascular machines at self-selected maximal and submaximal intensity.

Method

Thirty recreational-active adult males (Age: 41.69 ± 4.64) performed 12-min bouts at RPE (Rate of perceived exertion) 17 and maximum intensity (MAX INT) on the following indoor cardio machines: Recumbent bike (r_BIKE), upright bike (u-BIKE), spin bike (s-BIKE), rowing machine (ROW), elliptical trainer (ELLIP), stair climber (STAIR), and treadmill (TMILL). Heart rate (HR) and oxygen consumption (VO2) were measured during exercise, whereas EE (energy expenditure) was calculated indirectly.

Results

Overall, TMILL induced the highest levels of EE, VO2, and HR, followed by STAIR, ELLIP, s_BIKE, u_BIKE, ROW, and r_BIKE. RPE was reliable across exercise modalities (r_BIKE, u-BIKE, s-BIKE, ROW, ELLIP, STAIR, and TMILL) and intensities (RPE 17 and MAX INT) for EE, HR, and VO2 measurements.

Conclusion

To maximize EE while performing indoor cardiovascular exercise for recreational active middle-aged male participants, the TMILL is the best option, followed by the STAIR and the ELLIP. The least recommended options are, respectively, s_BIKE, u_BIKE, ROW, and r_BIKE. Beyond caloric expenditure considerations, promoting exercises that participants genuinely enjoy can enhance adherence, fostering sustained health benefits. Furthermore, RPE is a reliable tool for assessing EE, VO2, and HR across different exercise modalities and intensities.

Understanding the mechanisms of disease modifying effects of aerobic exercise in people with Alzheimer's disease

Alzheimer's disease (AD) is a very disabling disease. Pathologically, it is characterized by the presence of amyloid plaques and neurofibrillary tangles in the brain that results in neurodegeneration. Its clinical manifestations include progressive memory impairment, language decline and difficulty in carrying out activities of daily living (ADL). The disease is managed using interventions such as pharmacological interventions and aerobic exercise. Use of aerobic exercise has shown some promises in reducing the risk of developing AD, and improving cognitive function and the ability to carry out both basic and instrumental ADL. Although, the mechanisms through which aerobic exercise improves AD are poorly understood, improvement in vascular function, brain glucose metabolism and cardiorespiratory fitness, increase in antioxidant capacity and haemoglobin level, amelioration of immune-related and inflammatory responses, modulation of concentration of circulating Neurotrophins and peptides and decrease in concentration of tau protein and cortisol level among others seem to be the possible mechanisms. Therefore, understanding these mechanisms is important to help characterize the dose and the nature of the aerobic exercise to be given. In addition, they may also help in finding ways to optimize other interventions such as the pharmacological interventions. However, more quality studies are needed to verify the mechanisms.

EFFECT OF RESISTANCE TRAINING THROUGH IN-PERSON AND TELECONFERENCING SESSIONS IN REHABILITATION OF ACUTE STROKE PATIENTS

Objective

To determine whether application of a strength training regimen yields measurable results on stroke survivors and compare different methods for the proposed intervention.

Design Patients and Methods

Ninety stroke patients were recruited from the neurological clinic of a local third-level clinic. Sixty patients participated in a strength training regimen with trainings taking place 3 times a week for 12 weeks with the use of resistance bands. Thirty of these patients were given face-to-face sessions and 30 patients were given trainings through an on-line platform. The last 30 patients who comprised the control group only followed usual care after the stroke.

Results

The applied strength regimen had a statistically significant effect on Visual Analog Scale scores of stroke patients who received it (p = 0.009), as well as in the teleconferencing group (p = 0.004). The measured arteriovenous oxygen difference was elevated for stroke patients who received the intervention as a whole (p = 0.007). Patients who were trained in person and the ones who were trained via teleconferencing yielded similar results as evaluated through the VAS index.

Discussion and Conclusion

Administration of strength training 3 times weekly for 12 weeks to stroke patients yielded measurable results in terms of general function and quality of life.

Physical Exercise-Induced DNA Methylation in Disease-Related Genes in Healthy Adults-A Systematic Review With Bioinformatic Analysis

ABSTRACT

Vasileva, F, Hristovski, R, Font-Lladó, R, Georgiev, G, Sacot, A, López-Ros, V, Calleja-González, J, Barretina-Ginesta, J, López-Bermejo, A, and Prats-Puig, A. Physical exercise-induced DNA methylation in disease-related genes in healthy adults-A systematic review with bioinformatic analysis. J Strength Cond Res 38(2): 384-393, 2024-This study aimed to systematically review the existing literature regarding physical exercise (PE) and DNA methylation (DNAm) in healthy adults. Specific goals were to (a) identify differently methylated genes (DMGs) after PE intervention, their imprinting status, chromosome and genomic location, function, and related diseases; and (b) to screen for core genes and identify methylation changes of the core genes that can be modified by PE intervention. Our search identified 2,869 articles from which 8 were finally included. We identified 1851 DMGs ( p < 0.05) after PE intervention, although 45 of them were imprinted. Aerobic exercise (AE) seems to induce more DNA hypermethylation rather than hypomethylation, whereas anaerobic exercise (AN) seems to induce more DNA hypomethylation rather than hypermethylation. Aerobic exercise induced highest % of methylation changes on chromosome 6, whereas AN and mixed type (MT) on chromosome 1. Mixed type induced higher % of methylation changes close to transcription start site in comparison to AE and AN. After PE intervention, DMGs were mainly involved in fat metabolism, cell growth, and neuronal differentiation, whereas diseases regulated by those genes were mainly chronic diseases (metabolic, cardiovascular, neurodegenerative). Finally, 19 core genes were identified among DMGs, all related to protein metabolism. In conclusion, our findings may shed some light on the mechanisms explaining PE-induced health benefits such as the potential role that PE-induced DNAm may have in disease prevention and disease treatment.

Harnessing the Systemic Biology of Functional Decline and Cachexia to Inform more Holistic Therapies for Incurable Cancers

Options for treatment of incurable cancer remain scarce and are largely focused on limited therapeutic mechanisms. A new approach specific to advanced cancers is needed to identify new and effective treatments. Morbidity in advanced cancer is driven by functional decline and a number of systemic conditions, including cachexia and fatigue. This review will focus on these clinical concepts, describe our current understanding of their underlying biology, and then propose how future therapeutic strategies, including pharmaceuticals, exercise, and rehabilitation, could target these mechanisms as an alternative route to addressing incurable cancer.

The effects of aerobic exercise on cardiometabolic health in postmenopausal females: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

After menopause, reductions in ovarian hormones increase the risk of cardiovascular disease. Aerobic exercise training has been shown to reduce cardiovascular risk in older adults, but its effectiveness in postmenopausal females is less definitive.

OBJECTIVES

The objectives of this study were to examine the: (1) effects of aerobic training, and (2) association between aerobic training intensity and cardiometabolic health outcomes in postmenopausal females.

DESIGN

Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES AND METHODS

Six electronic databases were searched from inception to July 21, 2023 for aerobic training interventions reporting cardiometabolic outcomes in postmenopausal females. Data were synthesized qualitatively and random-effects meta-analyses and subgroup analyses (light, moderate, and vigorous intensity) were performed. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence.

RESULTS

Fifty-nine studies (n = 4,225; 45-78 years old) were identified, 53 (n = 3,821) were included in the quantitative analyses. Aerobic training interventions varied in frequency (3-21×/week), intensity, type, time (8-60 min/session), and duration (3-52 weeks). Aerobic training improved systolic blood pressure (mean difference (MD) = -4.41 mmHg, 95% confidence interval (95%CI) [-7.29, -1.52], p = 0.01), resting heart rate (MD = -3.08 bpm, 95%CI [-5.11, -1.05], p < 0.01), body mass index (BMI, MD = -0.65 kg/m2, 95%CI [-0.99, -0.31], p < 0.01), waist circumference (MD = -2.03 cm, 95%CI [-2.65, -1.41], p < 0.01), body fat (MD = -2.57 kg, 95%CI [-3.65, -1.49], p < 0.01), low-density lipoprotein cholesterol (MD = -10.46 mg/dL, 95%CI [-16.31, -4.61], p < 0.01), high-density lipoprotein cholesterol (MD = 3.28 mg/dL, 95%CI [0.20, 6.36], p = 0.04) and cardiorespiratory fitness (standardized MD = 1.38, 95%CI [1.13, 1.64], p < 0.01). There was a very low certainty of evidence for all outcomes. In subgroup analyses, light- and vigorous intensities were beneficial for BMI with no effect for moderate-intensity exercise (p < 0.01). Light intensity showed a beneficial effect (p = 0.02) for glucose levels (p < 0.01) and triglycerides; there was no effect with moderate or vigorous intensities.

CONCLUSION

Aerobic training may improve cardiometabolic health outcomes in postmenopausal females. There may be differential effects of exercise intensity on BMI, blood triglycerides, and blood glucose; however, this warrants further investigation.

REGISTRATION

PROSPERO-CRD42022313350.

Exercise and cardiac rehabilitation in hypertensive patients with heart failure with preserved ejection fraction: A position statement on behalf of the Working Group of Arterial Hypertension of the Hellenic Society of Cardiology

Arterial hypertension is a major cause of cardiovascular morbidity and mortality and the most common cause of comorbidity in heart failure (HF) with preserved ejection fraction (HFpEF). As an adjunct to medication, healthy lifestyle modifications with emphasis on regular exercise are strongly recommended by both the hypertension and the HF guidelines of the European Society of Cardiology. Several long-term studies have shown that exercise is associated with a reduction in all-cause mortality, a favorable cardiac and metabolic risk profile, mental health, and other non-cardiovascular benefits, as well as an improvement in overall quality of life. However, the instructions for the prescriptive or recommended exercise in hypertensive patients and, more specifically, in those with HFpEF are not well defined. Moreover, the evidence is based on observational or small randomized studies, while well-designed clinical trials are lacking. Despite the proven benefit and the guidelines' recommendations, exercise programs and cardiac rehabilitation in patients with hypertensive heart disease and HFpEF are grossly underutilized. This position statement provides a general framework for exercise and exercise-based rehabilitation in patients with hypertension and HFpEF, guides clinicians' rehabilitation strategies, and facilitates clinical practice. It has been endorsed by the Working Group of Arterial Hypertension of the Hellenic Society of Cardiology and is focused on the Health Care System in Greece.

Feasibility of Different Exercise Modalities for Community-Dwelling Residents With Physical Inactivity: A Randomized Controlled Trial

BACKGROUND

Exercise interventions can promote health, but they can be difficult to implement. Moreover, no consensus has been reached regarding which exercise modality promotes the most significant improvement in metabolic health.

PURPOSE

This feasibility study was conducted to (a) determine the implementation efficacy of supervised and home-based exercise interventions by investigating their respective rates of intervention adherence, adherence to targeted intensity, attrition, and adverse events and (b) explore the preliminary efficacy of 12-week exercise programs among aerobic exercise, aerobic exercise combined with resistance exercise, and high-intensity interval training on body composition, anthropometric parameters, and lipid profiles for community-dwelling residents with physical inactivity.

METHODS

This randomized controlled trial was conducted from April to October 2020. Seventy-two sedentary participants aged 40-70 years were enrolled and randomized into one of four groups: 12-week aerobic exercise, aerobic exercise combined with resistance exercise, high-intensity interval training, and control. The three exercise groups performed at least moderate-intensity supervised exercise twice a week and home-based exercise once a week, whereas the control group maintained their usual daily activities. The target variables, including body composition, anthropometric parameters, and lipid profiles, were measured before and after the 12-week intervention.

RESULTS

The intervention adherence rates were 74.01%-87.54% for the supervised exercise group, 64.98%-83.90% for the home-based exercise group, and 82.65%-92.65% for the target exercise intensity group. The attrition rate ranged from 12.50% to 17.65%, and no adverse events were reported in any of the exercise groups. Preliminary efficacy data show the reductions in body weight (95% CI [0.01, 1.20], p = .048) and low-density lipoprotein (95% CI [2.76, 30.32], p = .02) were greater in the exercise groups than the control group, although the intergroup differences were not significant.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Body weight and low-density lipoprotein may be efficiently reduced in a 12-week period using any of the three exercise modalities with at least 82.65% adherence to moderate-intensity exercise and 70.84% adherence to exercising 3 times a week.

Major Depressive Disorder and Gut Microbiota: Role of Physical Exercise

Major depressive disorder (MDD) has a high prevalence and is a major contributor to the global burden of disease. This psychiatric disorder results from a complex interaction between environmental and genetic factors. In recent years, the role of the gut microbiota in brain health has received particular attention, and compelling evidence has shown that patients suffering from depression have gut dysbiosis. Several studies have reported that gut dysbiosis-induced inflammation may cause and/or contribute to the development of depression through dysregulation of the gut-brain axis. Indeed, as a consequence of gut dysbiosis, neuroinflammatory alterations caused by microglial activation together with impairments in neuroplasticity may contribute to the development of depressive symptoms. The modulation of the gut microbiota has been recognized as a potential therapeutic strategy for the management of MMD. In this regard, physical exercise has been shown to positively change microbiota composition and diversity, and this can underlie, at least in part, its antidepressant effects. Given this, the present review will explore the relationship between physical exercise, gut microbiota and depression, with an emphasis on the potential of physical exercise as a non-invasive strategy for modulating the gut microbiota and, through this, regulating the gut-brain axis and alleviating MDD-related symptoms.

Association of exercise, brain-derived neurotrophic factor, and cognition among older women: A systematic review and meta-analysis

This systematic review and meta-analysis explored the effects of structured exercise regimens on brain-derived neurotrophic factor (BDNF) levels, a proxy for cognitive function, in older women. In this study, we collated evidence from the available clinical trials that reported BDNF levels and other outcomes following structured exercise regimens. Adhering to PRISMA Statement 2020 guidelines. PubMed/MEDLINE, Scopus, CINAHL Plus, and Cochrane were systematically searched using a combination of the following keywords: brain-derived neurotrophic factor, women, exercise, older, cognition, and/or cognitive. A random-effects model was applied; the statistical analysis was conducted in RevMan 5.4 (Cochrane). The risk of bias in the included trials was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Across 12 trials, 994 older women were included that were enrolled in different exercise regimens globally. Exercise regimens were categorized as aerobic, resistance/power training, aquatic, taekwondo, and multimodal and ranging from 30 to 60 min, 1-5 times per week across 5-24 weeks. Moderate improvement (Cohen's d: 0.44, 95% CI: 0.04-0.84, p = 0.03) was found in BDNF levels across all trials. There was a small yet insignificant improvement in mini-mental state examination (MMSE) scores (Cohen's d: 0.17, 95% CI: -0.79-1.13, p = 0.73). Aerobic exercise, aquatic exercise, and multimodal regimens showed significant association with improved BDNF levels but the sample size for individual exercise regimens was small A main limitation was the inclusion of 114 (10.3%) males in the data, introducing gender bias. This study provides novel insight into the association between various exercise regimens and BDNF levels among older women.