Exercise blood pressure changes between seasons

BACKGROUND: Blood pressure (casual and daytime) is higher in winter than it is in summer, and this factor might be partly responsible for the higher cardiovascular mortality in winter. OBJECTIVE: To determine in a prospective study whether there is also a seasonal variation in exercise blood pressure. METHODS: We evaluated the pretest, exercise (five-step treadmill test) and recovery values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate of 94 healthy men, aged 20-65 years, during the summer and winter. RESULTS: SBP and DBP values were higher in winter than they were in summer during the resting period immediately before exercise (P = 0.003 and P = 0.07, respectively), and during recovery (both P < 0.0001). Exercise SBP and heart rate values were similar in the two seasons, although exercise DBP was higher in winter than it was in summer (P < 0.0001). The increase in DBP from pretest to stage 3 was 6.5 mmHg in summer and 10.4 mmHg in winter (P = 0.002). After we had controlled for possible confounders, the increase in DBP during exercise was found to be independently associated with season of the year and resting DBP. CONCLUSIONS: Exercise DBP varies according to season whereas exercise SBP does not. Our results suggest that, since measures of the response of blood pressure to exercise testing are frequently used in blood pressure and hypertension research as well as in clinical practice, the seasonal influences should be taken into account.     

Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis

The aims of this study were to describe rheumatoid arthritis patients’ compliance with continued exercise after participation in a 2-year supervised high-intensity exercise program and to investigate if the initially achieved effectiveness and safety were sustained. Data were gathered by follow-up of the participants who completed the 2-year high-intensity intervention in a randomized controlled trial (Rheumatoid Arthritis Patient In Training study). Eighteen months thereafter, measurements of compliance, aerobic capacity, muscle strength, functional ability, disease activity, and radiological damage of the large joints were performed. Seventy-one patients were available for follow-up at 18 months, of whom 60 (84%) were still exercising (exercise group: EG), with average similar intensity but at a lower frequency as the initial intervention. Eleven patients (16%) reported low intensity or no exercises (no-exercise group: no-EG). Patients in the EG had better aerobic fitness and functional ability, lower disease activity, and higher attendance rate after the initial 2-year intervention. At follow-up, both groups showed a deterioration of aerobic fitness and only patients in the EG were able to behold their muscle strength gains. Functional ability, gained during the previous participation in high-intensity exercises, remained stable in both groups. Importantly, no detrimental effects on disease activity or radiological damage of the large joints were found in either group. In conclusion, the majority of the patients who participated in the 24-month high-intensity exercise program continued exercising in the ensuing 18 months. In contrast to those who did not continue exercising, they were able to preserve their gains in muscle strength without increased disease activity or progression of radiological damage.     

Physical activity and health: need to define the required stimulus

Exercise is frequently recommended as part of a comprehensive program of prevention, treatment or rehabilitation of chronic degenerative disease. General guidelines on prescribing exercise are based more on the characteristics of exercise required to improve physical performance than on preventing disease. Most exercise regimens are evaluated according to their effect on aerobic power or endurance. Health benefits of exercise may occur in conjunction with an improvement in physical performance capacity, but some benefits appear to be achieved by exercise that normally does not lead to improved physical fitness. Health benefits may occur as a result of repeated acute responses to exercise (but without producing a training effect) and by frequent performance of low intensity exercise (inadequate for increasing fitness). Psychological benefits may also be derived by the process of exercising. The persons who benefit most from an increase in exercise are the very inactive because the detrimental health-related consequences of extreme inactivity are rapidly reversed. There is less evidence that an increase in exercise by the already active person results in significant health benefits.     

Seasonal variation of serum lipids in the vervet monkey

Seasonal variation of serum lipids has been observed in man, primates and other species. We are presenting data on serum lipid variation in Vervet monkeys (Cercopithecus aethiops). The monkeys (54 males, 33 females) were fed control diets (commercial pellets, fruit, vegetables) and data were pooled and grouped by season. Data having been obtained in South Africa, the seasons were: summer (December, January, February); fall (March, April, May); winter (June, July, August); and spring (September, October, November). Data presented are based on multiple samplings. Total serum cholesterol (mg/dl) and beta-lipoprotein cholesterol (mg/dl) varied significantly with season, peak values being observed in the fall months. Triglyceride and alpha-lipoprotein cholesterol levels showed seasonal variation which was not statistically significant. However, when data were analyzed by weight group (less than 3.3 kg; 3.3-4.3 kg; 4.4-5.3 kg; greater than 5.4 kg) only triglyceride and alpha-lipoprotein levels varied significantly with season. Significant interactions between diet, sex, weight, and season have also been observed. These observations can be used in planning future studies.     

不同运动剂量干预对衰弱老年人健康状况的影响

目的探讨不同运动剂量干预对衰弱老年人肌力、体适能及睡眠状况的效果。方法招募符合纳入标准的衰弱老年人88例,随机将其分为对照组、小量中强度组、小量大强度组和大量大强度组,每组22例。对照组无任何针对性身体训练干预,3个干预组按设计方案进行相应的运动量和强度的下肢抗阻运动。分别在干预前、干预12周后评估老年人的下肢肌力、体适能及睡眠状况。结果对照组干预前后下肢肌力、体适能及睡眠状况差异均无统计学意义(P>0.05);小量中强度组、小量大强度组和大量大强度组干预前后各指标均有改善(P<0.05或P<0.01)。小量大强度组和大量大强度组的下肢肌力、6 min步行距离、30 s坐站次数、总睡眠时间均明显优于小量中强度组(P<0.01)。结论抗阻运动可以有效改善衰弱老年人的肌力、体适能和睡眠状况,运动量和运动强度都有利于衰弱老年人肌力、体适能、睡眠指标的改善,但是强度是影响上述健康指标的主要因素。     

Seasonal variation in lipoprotein lipase and plasma lipids in physically active, normal weight humans

Adipose tissue lipoprotein lipase (ATLPL) provides free fatty acids (FFA) for storage in adipocytes, whereas in skeletal muscle LPL (SMLPL) provides FFA for oxidation. In hibernating animals, the level of SMLPL is relatively higher in summer than winter (promoting fat oxidation), whereas the opposite is seen with ATLPL. A patient-controlled study was designed to determine whether such seasonal variation occurs in normal weight humans. Eighteen subjects were studied in the summer and winter. After 2 days of a standardized diet, they underwent muscle and adipose biopsies for LPL activity, assessment of fitness by VO2 max, and determination of body composition by hydrostatic weighing. The percentages of body fat, body mass index, VO2 max, insulin, glucose, FFA, glycerol, and leptin were not affected by the season. Total cholesterol was higher in the winter than in the summer (157 +/- 5.5 vs. 148 +/- 4.2 mg/dL respectively; P = 0.03). The ATLPL activity was also higher in the winter than in the summer (4.4 +/- 0.8 vs. 2.3 +/- 0.6 nmol FFA/10(6) cells-min; P = 0.04). SMLPL activity trended to be higher in the winter than in the summer (1.9 +/- 0.5 vs. 1.0 +/- 0.1 nmol FFA/g x min; P = 0.06). In summary, ATLPL is seasonally regulated. It appears that SMLPL is similarly regulated by season. For physically active lean subjects, this increase in SMLPL may be a compensatory mechanism to help protect from seasonal weight gain.     

80岁及以上高血压患者血压与心脑事件和季节性变化研究

目的 观察80岁及以上老年高血压患者血压和心脑血管事件的季节性变化. 方法监测67例年龄80～92岁的高血压患者2年间的家庭自测血压、诊室测血压和每季度1次的24 h时动态血压,记录期间发生的心脑血管事件. 结果高血压患者夏季的收缩压、舒张压最低(P＜0.01).冬季的收缩压最高(P＜0.01),冬季舒张压高于夏季(P＜0.01).春季和秋季的收缩压、舒张压差异无统计学意义.心脑血管事件的发病率在夏季和冬季明显高于春季和秋季(P＜0.05).发生心血管事件的相关因素为:季节(OR=1.525,P=0.001)、体质指数(OR=1.145,P=0.018)、心功能(OR=2.037,P=0.01),发生缺血性脑血管事件的相关因素为季节(OR=1. 604,P=0.001)、脑血管病史(OR=1.598,P=0.034)、诊室测收缩压(OR=0.960,P=0.013)、动态血压的舒张压(OR=0.936,P=0.008). 结论 80岁及以上老人通过3种方式测得的血压结果显示,夏季的收缩压、舒张压为全年最低;冬季的收缩压全年最高,舒张压高于夏季;春季和秋季的血压水平无明显差异.心脑血管事件的发生率在冬季和夏季明显高于春季和秋季.

Abstract：

Objective To investigate the effect of seasonal variation of blood pressure (BP) on the incidence of cardiovascular and cerebrovascular events in the elderly aged 80 years and over.Methods The 67 patients (aged 80-86 years) with essential hypertension were enrolled, the BP were measured at home, in consulting room, and by 24-h ambulatory BP monitor in every season for 2 years. The incidences of cardiovascular and cerebrovascular events were recorded in the meantime.Results Both systolic BP (SBP) and diastolic BP (DBP) were lower in summer than in any other season (P＜0. 01 ). SBP was higher in winter than in any other season. (P＜0.01), DBP was higher in winter than in summer(P＜0. 01). There were no significant differences in SBP and DBP between spring and autumn. The incidence of cardiovascular and cerebrovascular events were higher in winter and summer than in spring and autumn (P＜0.05). The season (OR= 1. 525, P=0. 001), BMI (OR =1.145, P=0.018) and heart function (OR= 2. 037, P=0.01) were related to the incidence of cardiovascular events. And the season (OR = 1. 604, P= 0. 001 ), history of cerebrovascular disease (OR= 1. 598, P=0. 034), office-measured SBP (OR=0.960, P=0.013) and ambulatory DBP (OR =0. 936, P = 0. 008) were related to the incidence of cerebrovascular events.Conclusions The blood pressure measured by three methods in the elderly aged 80 and over shows that both SBP and DBP are at the lowest in summer; SBP is at the highest in winter, DBP is higher in winter than in summer. There are no significant differences in BP between spring and autumn. The incidences of cardiovascular and cerebrovascular events are significantly higher in winter and summer than in spring and autumn.     

Effects of physical training on coronary risk factors

The effects of exercise training on the known coronary risk factors were studied as an isolated intervention in 39 middle-aged men who were at high risk of coronary artery disease. They were separated into two groups of 20 exercising and 19 control subjects who were carefully matched with respect to age, occupation, coronary risk factors and physical fitness. The exercising subjects participated in a 12 week, supervised training program, but no other attempt to reduce risk factors was made in either group.Exercise training led to a substantial improvement in the physical fitness as determined by increased maximal oxygen uptake, oxygen pulse, ventilation and physical work capacity. Furthermore, there was a significant reduction of systolic blood pressure in the hypertensive subjects who exercised (from 148 to 135 mm Hg, P < 0.01) but not in the hypertensive control subjects (from 150 to 147 mm Hg); the diastolic pressure decreased in both groups. Hypertriglyceridemia also decreased in response to exercise, but there was no significant change in cholesterol levels, obesity, cigarette smoking or psychological profile. A physical training program is therefore valuable as adjunctive therapy in patients at high risk of coronary disease who have hypertension or hypertriglyceridemia.     

Factors affecting seasonal changes in blood pressure in North India: A population based four-seasons study

ObjectiveThere are no community based, longitudinal, intra individual epidemiological studies on effect of weather and season on blood pressure (BP). We evaluated the effect of season and temperature on prevalence and epidemiology of BP in tropical climate.Methods and resultsIt was a longitudinal cross sectional survey of rural and urban subjects in their native surroundings. BP was measured in four different seasons in same subjects. A total of 978 subjects (452 rural and 521 urban) were included in the current analysis. Demographic characteristics such as age, gender, education, occupational based physical activity and body mass index (BMI) were recorded. Mean BP, both systolic and diastolic were significantly higher in winter season as compared to summer season. Mean difference between winter and summer was 9.01 (95% CI: 7.74–10.28, p < 0.001) in systolic BP and 5.61 (95% CI: 4.75–6.47, p < 0.001) in diastolic BP. This increase in BP was more marked in rural areas and elderly subjects. Prevalence of hypertension was significantly higher during winter (23.72%) than in summer (10.12%).ConclusionBP increases significantly during winter season as compared to summer season. Increase is more marked in rural areas and elderly subjects. Seasonal variation in BP should be taken into account while looking at prevalence of hypertension in epidemiological studies.     

Seasonal variation in physical activity in patients with heart failure

Background and objectivesPhysical activity is important for all heart failure (HF) patients to improve quality of life and physical function. Since adherence to physical activity is low and could differ between seasons, it is essential to explore factors related to change that may depend on seasonal changes. The purpose of this study was to describe the seasonal differences in physical activity and assess factors that influence these differences in a country with markedly different winter-to-summer weather conditions (in temperature, hours of daylight and snow fall).MethodsThe study had a cross-sectional survey design. Outpatients with HF completed a questionnaire on physical activity, motivation and self-efficacy to exercise and HF symptom severity in the summer and the winter in a northern hemisphere country. We used analysis of variance to evaluate seasonal differences in physical activity, motivation, self-efficacy and HF symptom severity.ResultsEighty-seven patients with HF (29% women, mean age 70 ± 9 years) were included and 35% performed less physical activity (METs) in the winter, compared to the summer. Increased symptom severity during the winter was associated with lower activity levels.ConclusionOne-third of the patients performed less physical activity during the winter compared to the summer, and this was associated with symptom severity. Decreased physical activity was not related with motivation and self-efficacy. This study emphasises the need for personalised physical activity programmes that also assess symptom severity and change in symptom severity depending between seasons.     

Increased vitamin D supplementation recommended during summer season in the gulf region: a counterintuitive seasonal effect in vitamin D levels in adult, overweight and obese Middle Eastern residents

Purpose Seasonal variations in circulating vitamin D levels provide vital information as to the most appropriate time to either start or increase vitamin D supplementation to maintain optimal vitamin D levels. In this follow‐up study, we determined seasonal differences in serum 25(OH)‐vitamin D (25(OH)D) levels, as well as parallel changes in metabolic parameters, in a cohort of adult, overweight and obese Saudis. Methods A total of 121 adult, overweight, obese, and consenting Saudis aged 18–70 years were randomly recruited from four Primary Health Care Centers in Riyadh, Saudi Arabia. They were divided according to the season when baseline measurements were made [74 summer (April–October); 47 winter (November–March)]. Anthropometrics were obtained, and fasting blood samples were taken at baseline and every 3 months for 1 year. Fasting blood glucose, corrected calcium levels, and lipid profiles were measured routinely. Serum 25(OH)‐vitamin D was quantified using a specific enzyme‐linked immunosorbent assay (ELISA). Results Age‐ and BMI‐matched mean 25(OH)‐vitamin D levels from the winter group were significantly higher than those of the summer group (P < 0·001). In both groups, HDL‐C levels improved significantly as 25(OH)‐vitamin D levels increased with subsequent follow‐ups, even after adjusting for age, gender and BMI (P < 0·001). Conclusion Seasonal differences in serum 25(OH)‐vitamin D levels in Saudi Arabia are counterintuitive, with circulating levels being higher during the winter than the summer season. Increased vitamin D supplementation is thus recommended to maintain optimal serum 25(OH)‐vitamin D levels during the summer season.     

Seasonal changes in steroid hormone profiles, body weight, semen quality, and the reproductive tract in captive African wild dogs (Lycaon pictus) in South Africa

Characterization of reproductive seasonality in the African wild dog (Lycaon pictus) could assist reintroduction programs. Male wild dogs (n=14) were assessed quarterly (January, mid-summer; April, late summer; August, late winter; November, early summer) for serum testosterone, body weight, testicular and prostatic volume, preputial gland measurement, and ejaculate characteristics. Bi-monthly fecal samples were collected from male (n=11) and female (n=4) wild dogs for analysis of fecal androgens and progestagens. Fecal androgens were higher in early summer (246.4±14.5ng/g) than in early winter (218.6±13.4ng/g). Serum testosterone was higher in mid-summer (1.4±0.3ng/ml) than in late winter (0.7±0.1ng/ml). Number of spermatozoa per ejaculate was greatest in late summer (301.4±39.3×10(6)). Other semen parameters peaked in mid-summer (pH: 7.4; progressive motility: 85.0±0.1%; live spermatozoa: 81.0±16%; normal morphology: 71.5±8.2%). Total testicular and prostatic volume were greater during summer (testicular: 36.7±4.2cm(3); prostatic: 12.0±1.9cm(3)) than winter (testicular: 25.2±1.9cm(3); prostatic: 5.8±0.8cm(3)). Preputial pendulance also was greater in summer (7.1±0.5cm; n=9) than winter (5.9±0.2cm). Baseline fecal progestagen metabolites were 6.2±2.5μg/g and peak fecal progestagen metabolites were 14.7±2.8μg/g. Copulations resulting in pregnancies (n=2) occurred in late summer and gestation was 71days. Female wild dogs were seasonally monoestrous with mating in summer and winter. In conclusion, wild dogs are reproductively seasonal with improvement in male reproductive variables during summer and a bi-phasic seasonal pattern to female receptivity.     

Seasonal changes in blood pressure and frequency of related complications in elderly Israeli patients with essential hypertension

BACKGROUND: Earlier studies on hypertension demonstrated seasonal variations in different age groups. However, slightly greater fluctuations were found in the hypertensive elderly. OBJECTIVE: We conducted a prospective 5-year study from January 1997 to December 2001 to evaluate the seasonal variation in blood pressure and the variables of age, gender, body mass index and related complications in elderly Israeli patients with essential hypertension. METHODS: Blood pressure was measured in four seasons in 182 patients (98 men and 84 women; age range 65-91 years) treated for hypertension in our outpatient clinic. RESULTS: Both systolic and diastolic mean blood pressures were higher during winter compared to summer (165 +/- 11.6 and 90 +/- 13.7 and 134 +/- 47.3 and 74 +/- 8.5 mm Hg, respectively; p < 0.001). There were no significant seasonal differences between spring and autumn or any correlation between the seasonal winter-summer difference in blood pressure and other studied parameters. Patients aged 65-75 years were unexpectedly more sensitive to winter-summer changes than older patients. There was a correlation between a large winter-summer difference in systolic blood pressure and a body mass index between 20 and 30, but there was none in lower or higher ranges. Supplementary antihypertension treatment was required during winter in 38% of these selected patients. Complications such as myocardial infarctions and strokes occurred twice as frequently in winter than in any other season (p < 0.0001). CONCLUSIONS: Both systolic and diastolic blood pressures were highest during winter. Hypertension complications were more frequent in winter. Our results refute those of earlier studies that failed to find significant seasonal variations in blood pressure among the elderly.     

Physical activity in patients with axial spondyloarthritis: a cross-sectional study of 203 patients

Physical activity is recommended in axial spondyloarthritis (axSpA) but may be insufficiently performed. The objective of this study was to assess physical activity in axial spondyloarthritis and to explore its explanatory factors. This was a cross-sectional study of patients with definite axSpA. The level of physical activity (International Physical Activity Questionnaire-Long form, IPAQ-L), type of aerobic exercise and the Exercise Benefits and Barriers Score were collected. Multivariate logistic regression analyses were performed to explain levels of exercise at least as recommended by the World Health Organization. In all, 203 patients were included: mean age 46.0 ± 11.6 years, 108 (53.2 %) males, mean Bath Ankylosing Spondylitis Activity Index (0–100) 37.8 ± 19.9; 137 (68.8 %) were treated with TNF-inhibitors. In all, 111 patients (54.7 %) were exercising at least as recommended; 96 (47.2 %) were in the ‘high physical activity’ category. Aerobic exercise >30 min was performed at least once a week by 61 (30.0 %) patients; the most frequent activities were energetic walking (31.0 %) and swimming (21.2 %). Main perceived benefits of exercising were improving physical fitness and functioning of the cardiovascular system, and the main barrier was physical exertion. Patients with paid employment had lower levels of physical activity whereas other demographic variables, disease activity/severity or TNF-inhibitor treatment were not predictive. One half of these patients performed enough physical activity according to the recommendations, similarly to the French population. Levels of physical activity did not appear to be explained by disease-related variables. Physical activity should be encouraged in axSpA.     

Summer-winter differences in 24 h variability of heart rate

OBJECTIVE: To examine possible seasonal changes in heart rate variability (HRV). BACKGROUND: Greater than normal mortality from cardiovascular disease (CVD) in the winter has been reported for many countries and might be partly explained by considering seasonal changes in CVD risk factors. Depression of HRV is an independent predictor of arrhythmic complications and of cardiac death, and it is also among the variables that may be affected by the season of the year. METHODS: We compared pairs of 24 h HRV data of 120 healthy men who were examined once in the summer and once in the winter. Multivariate analyses were performed for each dependent variable (HRV indexes) in separate statistical models with age, resting heart rate, serum level of cholesterol, cigarette smoking, body mass index, sports habits, alcohol consumption, systolic blood pressure, physical activity at work, years of education, consumption of energy, and season as the independent variables. RESULTS: Although there were no seasonal differences in mean R-R interval, all indexes of HRV were found to be lower in the summer than they were during winter. Differences and 95% confidence intervals were standard deviation (SD) of coupling intervals between normal beats 12 ms, 6-17 ms; SD of 5 min mean R-R intervals 14 ms, 8-20 ms; mean of all 5 min SD of R-R intervals 2.0 ms, 0.6-2.5 ms; proportion of adjacent R-R intervals differing by > 50 ms 1.5%, 0.6-2.5% and root mean square of the difference between successive normal intervals 3.1 ms, 1.5-4 ms. Multivariate analyses showed that HRV in the winter was less than that in the summer even after adjustment for age, serum level of cholesterol, systolic blood pressure, and body mass index. CONCLUSIONS: HRV indexes of healthy men vary physiologically by season, with lowest values obtained in the winter. Since low HRV is linked to pathologic conditions, the significance of seasonal changes for those suffering from CVD and their possible contribution to the greater mortality rates in winter have to be considered.     

Seasonal variations in onset of Wegener's granulomatosis: increased in summer?

OBJECTIVE: Investigators have reported significant seasonal variations of onset of Wegener's granulomatosis (WG), but those data were not confirmed by others. We reexamined the hypothesis of a seasonal pattern of onset of WG. METHODS: We conducted telephone interviews with 59 patients with newly diagnosed WG fulfilling the American College of Rheumatology criteria. Patients were identified having been enrolled from 2001 to 2004 by French hospitals in 2 multicenter therapeutic trials. The interviews investigated precisely how and when their disease had appeared to establish an index date, defined as the year and month of the first symptom(s) attributable to WG. Once telephone interviews had been completed, index dates were also retrieved from medical records. RESULTS: Among the 59 patients interviewed, 14 (24%) were unable to specify an exact month of WG onset. Based on the remaining 45 "informative" patients, the month of onset distribution varied significantly (p = 0.03, exact goodness-of-fit chi-square test), notably with a higher onset rate in August (p = 0.001). Seasonal distributions also differed significantly (p = 0.01), with an increased rate of summer onset (June-August) (p = 0.001). Index dates extracted from medical files showed that onset was also more frequent in summer (p = 0.01). CONCLUSION: Our results confirm the seasonality in onset of WG, but unlike previous reports indicating an increase in winter, instead suggest that this vasculitis preferentially appears in summer. These findings might support an allergic mechanism in the pathogenesis of WG.     

Benefits of 2 years of intense exercise on bone density, physical fitness, and blood lipids in early postmenopausal osteopenic women: results of the Erlangen Fitness Osteoporosis Prevention Study (EFOPS)

BACKGROUND: Growing evidence indicates that physical exercise can prevent at least some of the negative effects on health associated with early menopause. Here we determine the effects of intense exercise on physical fitness, bone mineral density (BMD), back pain, and blood lipids in early postmenopausal women. METHODS: The study population comprised 50 fully compliant women, with no medication or illness affecting bone metabolism, who exercised over 26 months (exercise group [EG]), and 33 women who served as a nontraining control group (CG). Two group training sessions per week and 2 home training sessions per week were performed in the EG. Both groups were individually supplemented with calcium and cholecalciferol. Physical fitness was determined by maximum strength and cardiovascular performance. Bone mineral density was measured at the lumbar spine (dual-energy x-ray absorptiometry [DXA] and quantitative computed tomography [QCT]), the proximal femur (DXA), and the forearm (DXA). In serum samples taken from a subset of the study participants, we determined bone formation (serum osteocalcin) and resorption (serum cross-links) markers as well as blood lipid levels. Vasomotor symptoms related to menopause and pain were also assessed. RESULTS: After 26 months, significant exercise effects determined as percentage changes compared with baseline were observed for physical fitness (isometric strength: trunk extensors [EG +36.5% vs CG +1.7%], trunk flexors [EG +39.3% vs CG -0.4%], and maximum oxygen consumption [EG +12.4% vs CG -2.3%]); BMD (lumbar spine [DXA L1-L4, EG +0.7% vs CG -2.3%], QCT L1-L3 trabecular region of interest [EG +0.4% vs CG -6.6%], QCT L1-L3 cortical region of interest [EG +3.1% vs CG -1.7%], and total hip [DXA, EG -0.3% vs CG -1.7%]); serum levels (total cholesterol [EG -5.0% vs CG +4.1%] and triglycerides [EG -14.2% vs CG +23.2%]); and pain indexes at the spine. CONCLUSION: General purpose exercise programs with special emphasis on bone density can significantly improve strength and endurance and reduce bone loss, back pain, and lipid levels in osteopenic women in their critical early postmenopausal years.     

Seasonal Variations of Severe Hypoglycemia in Patients With Type 1 Diabetes Mellitus,Type 2 Diabetes Mellitus,and Non-diabetes Mellitus: Clinical Analysis of 578 Hypoglycemia Cases

Blood glucose control in patients with diabetes mellitus (DM) is reportedly influenced by the seasons, with hemoglobin A1c (HbA1c) levels decreasing in the summer or warm season and increasing in the winter or cold season. In addition, several studies have shown that sepsis is also associated with the seasons. Although both blood glucose control and sepsis can strongly affect the occurrence of severe hypoglycemia, few studies have examined the seasonal variation of severe hypoglycemia. The aim of the present study is to examine the association between severe hypoglycemia and the seasons in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and non-diabetes mellitus (non-DM). We retrospectively reviewed all the patients with severe hypoglycemia at a national center in Japan between April 1, 2006 and March 31, 2012. A total of 57,132 consecutive cases that had visited the emergency room by ambulance were screened, and 578 eligible cases of severe hypoglycemia were enrolled in this study. The primary outcome was to assess the seasonality of severe hypoglycemia. In the T1DM group (n = 88), severe hypoglycemia occurred significantly more often in the summer than in the winter (35.2% in summer vs 18.2% in winter, P = 0.01), and the HbA1c levels were highest in the winter and lowest in the summer (9.1% [7.6%–10.1%] in winter vs 7.7% [7.1%–8.3%] in summer, P = 0.13). In the non-DM group (n = 173), severe hypoglycemia occurred significantly more often in the winter than in the summer (30.6% in winter vs 19.6% in summer, P = 0.01), and sepsis as a complication occurred significantly more often in winter than in summer (24.5% in winter vs 5.9% in summer, P = 0.02). In the T2DM group (n = 317), the occurrence of severe hypoglycemia and the HbA1c levels did not differ significantly among the seasons. The occurrence of severe hypoglycemia might be seasonal and might fluctuate with temperature changes. Patients should be treated more carefully during the season in which severe hypoglycemia is more common.     

Seasonal cold and circadian changes in blood pressure and physical activity in young and elderly people

AIM: To test the hypothesis that there is no association between seasonal cold and the circadian responses of blood pressure, deep-body temperature and physical activity in healthy young and elderly men. METHODS: 25 healthy elderly (aged 70-82 years) and 21 young volunteers (aged 20-30 years) participated in a 3-year prospective cross-seasonal study. RESULTS: Ambulatory day-time blood pressures in the older men were higher in the winter than in the summer and higher in both seasons than in the young people. The seasonally related differences were associated with lower outdoor and indoor temperatures, lower body temperature and higher activity levels in the elderly group in the winter. The older but not the younger group had higher blood pressure and levels of physical activity at certain times of the day in the winter compared with the summer. CONCLUSION: Time-of-day winter increases in blood pressure in older people may be related to increased activity as well as to levels of ambient temperature. Although it is generally advantageous for older people to be physically active in order to prevent circulatory disease, there may be a rationale for advising that that they should avoid intense activity at certain times of the day, especially in the winter.