Effects of Exercise Training on Vascular Markers of Disease Progression in Patients with Small Abdominal Aortic Aneurysms

BackgroundCurrently, no medical therapy is effective in limiting progression of small abdominal aortic aneurysms (AAA; ≤5.5 cm). Previously, we have demonstrated safety and efficacy of exercise training in patients with AAA. However, the impact of exercise training on vascular markers of AAA progression, such as lipid accumulation product and matrix metalloproteinase 9 (MMP-9, linked to destruction of aortic matrix), is unknown. The aim of this study was to assess the impact of exercise training on AAA diameter, lipid accumulation product, MMP-9, and other risk markers of vascular disease.MethodsIn this randomized trial, complete data of 96 patients (male: n = 87, female: n = 9; exercise training (exercise) n = 42, usual care n = 54) were studied. Changes in AAA diameter, exercise capacity, lipid accumulation product (men = [waist circumference 65] × fasting triglycerides; women = [waist circumference ?58] × triglycerides) and MMP-9 were performed.ResultsThe exercise group demonstrated a significant increase in maximal exercise time and estimated metabolic equivalent of tasks. Lipid accumulation product decreased in exercise and increased in usual care (P < .001 between groups); MMP-9 remained statistically unchanged in exercise, but increased significantly in usual care (P = .005; between groups P = .094). In both groups, there was a significant increase in transverse diameter, but no difference between groups; neither group assignment nor level of fitness correlated with AAA enlargement. No adverse clinical events occurred.ConclusionsThis is the first study to demonstrate that in AAA, exercise beneficially modifies lipid accumulation product and MMP-9, both markers of vascular disease, without inducing aneurysmal growth beyond what is otherwise observed during usual care.     

Patterns of Suicidality and Alcohol Use in Alcoholics with Major Depression

The aims of this study were (1) to comprehensively characterize a population of alcoholics with major depression in a psychiatric hospital, (2) to determine the prevalence of suicidal behavior in this sample, and (3) to determine whether quantity of alcohol ingested was associated with level of suicidality. Ratings of drinking, depression, and suicidality were obtained using both self-rated and observer-rated instruments. The prevalence of suicide attempts in the week before hospitalization was remarkably high, approaching 40%, whereas 70% had made a suicide attempt at some point in their lifetime. These suicide attempts were typically impulsive in nature, involving little if any premeditation. Most subjects reported drinking more heavily than usual on the day of their suicide attempt. Recent suicidal behavior was significantly associated with recent very heavy drinking (<70 drinks per week) and with number of drinks per drinking day. Quantity of drinking per drinking day was also significantly higher in those making a recent suicide attempt. However, no association was found between quantity of alcohol consumption and suicidal ideation. These findings suggest that recent heavy alcohol use primarily affects suicidality by increasing the likelihood of acting on suicidal ideation rather than by inducing suicidal ideation.     

The Beneficial Effect of Regular Endurance Exercise Training on Blood Pressure and Quality of Life in Patients with Hypertension

Regular aerobic exercise can reduce blood pressure and is recommended as part of the lifestyle modification to reduce high blood pressure and cardiovascular risk. Hypertension itself, or/and pharmacological treatment for hypertension is associated with adverse effects on some aspects of quality of life. This study was performed to evaluate the effects of regular endurance exercise training on quality of life and blood pressure. Patients with mild to moderate hypertension (systolic blood pressure 140–180 or diastolic blood pressure 90–110 mm Hg) were randomized to a moderate‐intensity aerobic exercise group training for 3 sessions/week over 10 weeks or to a non‐exercising control group. Health‐related quality of life was assessed with the Short Form 36‐item Health Survey (SF‐36) at baseline and after 6 and 10 weeks. In the 102 subjects (47 male, mean age 47 years) who completed the study, reductions in blood pressure in the exercise group at 10 weeks (? 13.1/? 6.3 mm Hg) were significant (P < 0.001) compared to baseline and to the control group (? 1.5/+ 6.0 mm Hg). Unlike the control group, the exercise group showed an increase in exercise capacity from 8.2 ± 1.6 to 10.8 ± 2.2 METS (P < 0.01) and showed higher scores on 7 out of 8 subscales (P < 0.05) of the SF‐36. Improvement in bodily pain and general health sub‐scores correlated with reduction in systolic blood pressure. Regular endurance training improves both blood pressure and quality of life in hypertensive patients and should be encouraged more widely.     

Effects of the HEART Camp Trial on Adherence to Exercise in Patients With Heart Failure

Background

Few exercise training studies in patients with heart failure (HF) report adherence to guideline-recommended 150 minutes of moderate-intensity exercise per week, and no studies have focused on a primary outcome of adherence.

Effects of a Renal Rehabilitation Exercise Program in Patients with CKD: A Randomized,Controlled Trial

Background and objectives

Patients with CKD have a high prevalence of cardiovascular disease associated with or exacerbated by inactivity. This randomized, controlled study investigated whether a renal rehabilitation exercise program for patients with stages 3 or 4 CKD would improve their physical function and quality of life.

Design, setting, participants, & measurements

In total, 119 adults with CKD stages 3 and 4 were randomized, and 107 of these patients proceeded to usual care or the renal rehabilitation exercise intervention consisting of usual care plus guided exercise two times per week for 12 weeks (24 sessions). Physical function was determined by three well established performance-based tests: 6-minute walk test, sit-to-stand test, and gait-speed test. Health-related quality of life was assessed by the RAND 36-Item Short Form Health Survey.

Results

At baseline, no differences in self-reported level of activity, 6-minute walk test, and sit-to-stand test scores were observed between the usual care (n=48) and renal rehabilitation exercise (n=59) groups, although baseline gait-speed test score was higher in the renal rehabilitation exercise group (P<0.001). At follow-up, the renal rehabilitation exercise group but not the usual care group showed significant improvements in the 6-minute walk test (+210.4±266.0 ft [19% improvement] versus −10±219.9 ft; P<0.001), the sit-to-stand test (+26.9±27% of age prediction [29% improvement] versus +0.7±12.1% of age prediction; P<0.001), and the RAND-36 physical measures of role functioning (P<0.01), physical functioning (P<0.01), energy/fatigue levels (P=0.01), and general health (P=0.03) and mental measure of pain scale (P=0.04). The renal rehabilitation exercise regimen was generally well tolerated.

Conclusions

A 12-week/24-session renal rehabilitation exercise program improved physical capacity and quality of life in patients with CKD stages 3 and 4. Longer follow-up is needed to determine if these findings will translate into decreased mortality rates.     

Effects of Intradialytic Resistance Exercise on Protein Energy Wasting,Physical Performance and Physical Activity in Ambulatory Patients on Dialysis: A Single‐Center Preliminary Study in a Japanese Dialysis Facility

Patients under hemodialysis present protein‐energy wasting (PEW), which is related with higher mortality rates. The study aimed to determine whether intradialytic resistance exercise training could improve physical performance, physical activity, and PEW in hemodialysis patients. In single center study, 75 hemodialysis patients were enrolled in an intradialytic resistance exercise training consisting of 20 min of adapted leg press, with a gymnastic ball, 3 days/week, during 9 months on the same day of hemodialysis therapy. Physical performance by short physical performance battery (SPPB), physical activity by life space assessment (LSA), and PEW score based on the nomenclature proposed by the International Society of Renal Nutrition and Metabolism in 2008 were assessed at baseline and after 9 months. Intradialytic resistance exercise training significantly improved SPPB score, LSA score, and PEW score (all, P < 0.05). In addition, intradialytic resistance exercise training improved SPPB score in patients with moderate and severe PEW subgroups (P < 0.05), associated with reduced prevalence of the patients with moderate to severe PEW (53% vs. 36%, P < 0.05). Intradialytic resistance exercise training was safe and effective to improve physical performance, physical activity, and PEW in hemodialysis patients.     

Effects of combined physical exercise training on DNA damage and repair capacity: role of oxidative stress changes

Regular physical exercise has been shown to be one of the most important lifestyle influences on improving functional performance, decreasing morbidity and all causes of mortality among older people. However, it is known that acute physical exercise may induce an increase in oxidative stress and oxidative damage in several structures, including DNA. Considering this, the purpose of this study was to identify the effects of 16 weeks of combined physical exercise in DNA damage and repair capacity in lymphocytes. In addition, we aimed to investigate the role of oxidative stress involved in those changes. Fifty-seven healthy men (40 to 74 years) were enrolled in this study. The sample was divided into two groups: the experimental group (EG), composed of 31 individuals, submitted to 16 weeks of combined physical exercise training; and the control group (CG), composed of 26 individuals, who did not undergo any specifically orientated physical activity. We observed an improvement of overall physical performance in the EG, after the physical exercise training. A significant decrease in DNA strand breaks and FPG-sensitive sites was found after the physical exercise training, with no significant changes in 8-oxoguanine DNA glycosylase enzyme activity. An increase was observed in antioxidant activity, and a decrease was found in lipid peroxidation levels after physical exercise training. These results suggest that physical exercise training induces protective effects against DNA damage in lymphocytes possibly related to the increase in antioxidant capacity.     

Effects of endurance,circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients

Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake (V˙o2peak), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (−18 %), V˙o2peak (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (−11 %), V˙o2peak (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in V˙o2peak, mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.     

Effect of lifetime endurance training on left atrial mechanical function and on the risk of atrial fibrillation

Background

Left atrium (LA) dilation and P-wave duration are linked to the amount of endurance training and are risk factors for atrial fibrillation (AF). The aim of this study was to evaluate the impact of LA anatomical and electrical remodeling on its conduit and pump function measured by two-dimensional speckle tracking echocardiography (STE).

Method

Amateur male runners > 30 years were recruited. Study participants (n = 95) were stratified in 3 groups according to lifetime training hours: low (< 1500 h, n = 33), intermediate (1500 to 4500 h, n = 32) and high training group (> 4500 h, n = 30).

Results

No differences were found, between the groups, in terms of age, blood pressure, and diastolic function. LA maximal volume (30 ± 5, 33 ± 5 vs. 37 ± 6 ml/m², p < 0.001), and conduit volume index (9 ± 3, 11 ± 3 vs. 12 ± 3 ml/m², p < 0.001) increased significantly from the low to the high training group, unlike the STE parameters: pump strain − 15.0 ± 2.8, − 14.7 ± 2.7 vs. − 14.9 ± 2.6%, p = 0.927; conduit strain 23.3 ± 3.9, 22.1 ± 5.3 vs. 23.7 ± 5.7%, p = 0.455. Independent predictors of LA strain conduit function were age, maximal early diastolic velocity of the mitral annulus, heart rate and peak early diastolic filling velocity. The signal-averaged P-wave (135 ± 11, 139 ± 10 vs. 148 ± 14 ms, p < 0.001) increased from the low to the high training group. Four episodes of non-sustained AF were recorded in one runner of the high training group.

Conclusion

The LA anatomical and electrical remodeling does not have a negative impact on atrial mechanical function. Hence, a possible link between these risk factors for AF and its actual, rare occurrence in this athlete population, could not be uncovered in the present study.     

抑郁对冠心病患者生存质量和运动耐力的影响

目的：探讨抑郁对冠心病（CHD ）患者生存质量、运动耐力的影响程度。方法131例CHD患者由本人独立填写完成贝克抑郁自评量表（BDI）和简明健康测量量表（SF-36）。根据BDI评分将患者分为抑郁组（n＝34）、非抑郁组（n＝97）并分别行心肺运动试验（CPET ）。结果（1）131例CHD患者SF-36各维度均低于中国常模,除社会功能外各维度有显著差异（ P＜0.01）,抑郁组CHD患者SF-36各维度得分均低于非抑郁组患者,除生理功能、生理职能外各维度有显著差异（ P＜0.05,或 P＜0.01）。（2）抑郁组CHD患者CPET结果中峰值氧耗量（VO2 peak ）、无氧代谢阈值氧耗量（VO2AT）、无氧代谢阈值负荷（LoadAT）均低于非抑郁组,分别为VO2peak：（17.3±1.7）ml·kg^-1·min^-1比（18.6±2.9）ml· kg^-1·min^-1,P＜0.05;VO2AT：（12.0±1.7）ml·kg^-1·min^-1比（13.2±2.2）ml·kg^-1·min^-1,P＜0.01;LoadAT ：（30.7±11.4）J ·s^-1比（36.0±13.9）J·s^-1,P＜0.05。（3）CHD患者SF-36与运动耐力有相关性（ P＜0.05）;SF-36各维度得分与BDI评分有显著负相关性（ P＜0.05）;BDI评分与CPET结果中VO2 peak、VO2 AT、LoadAT有显著负相关性（ P＜0.05）。结论合并抑郁的冠心病患者生存质量和运动耐力下降,抑郁与冠心病患者生存质量和运动耐力密切相关。     

Effects of Whole Body Vibration in Patients With COPD

Background: Whole body vibration training (WBVT) improves muscle force in healthy subjects. Resistance training (RT) is an important component of a pulmonary program. Aim: To investigate the effects of either 12 weeks WBVT or RT, both provided after 15 min of aerobic training as warming up. Methods: COPD patients, referred for pulmonary rehabilitation, were randomized to either a WBVT or a conventional RT group. Primary outcome was the change in 6 Minute Walking Distance (6MWD) after 12 weeks. Maximum exercise capacity (Wmax), quadriceps force (QF), quality of life (QoL) and number of responders, defined as the percentage of patients reaching the minimally clinically important difference (MCID) for the aforementioned outcome measurements were the secondary outcomes. Data are expressed as medians (interquartile range). Results: 62 patients with COPD were included. After WBVT, 6MWD improved by 35 (-14-76) m (p = 0.003), Wmax by 7 (2-23) Watt (p = 0.001), QoL by 13 (4-25) points (p = 0.002) and QF by 9 (-16-29) Nm (NS). In the RT-group, 6MWD, Wmax, QoL and QF increased significantly, with 60 (-13-96) m (p < 0.001), 12 (8-18) Watt (p < 0.001), 11 (3-16) points (p = 0.002) and 12 (-3-44) Nm (p = 0.009), respectively. The MCID for 6MWD (54 m) was reached by 8/26 patients in the WBVT-group and by 16/25 patients in RT-group (p = 0.05). No significant differences between groups were observed for the primary and secondary outcomes. Conclusions: WBVT after 15 min aerobic training enhances 6MWD, Wmax and QoL in COPD patients; however only 30% of patients reached the MCID for 6MWD.     

Effects of acute bouts of endurance exercise on retinal vessel diameters are age and intensity dependent

Alterations of retinal vessel diameters are associated with increased cardiovascular risk. We aimed to investigate changes in retinal vessel diameters in response to acute dynamic exercise of different intensities and whether these changes are age dependent. Seventeen healthy seniors (median (IQR) age 68 (65, 69) years) and 15 healthy young adults (median (IQR) age 26 (25, 28) years) first performed a maximal treadmill test (MTT) followed by a submaximal treadmill test (SMTT) and a resting control condition in randomised order. Central retinal arteriolar (CRAE) and central retinal venular (CRVE) diameter equivalents were measured before as well as 5 (t₅) and 40 (t₄₀) minutes after exercise cessation using a static retinal vessel analyser. Both exercise intensities induced a significant dilatation in CRAE and CRVE at t₅ compared to the control condition (P < 0.001). At t₄₀, the mean increase in CRAE and CRVE was greater for MTT compared to that for SMTT (CRAE 1.7 μm (95 % confidence interval (CI) −0.1, 3.6; P = 0.061); CRVE 2.2 μm (95 % CI 0.4, 4.1; P = 0.019)). However, the estimated difference at t₅ between seniors and young adults in their response to MTT compared to SMTT was 5.3 μm (95 % CI 2.0, 8.5; P = 0.002) for CRAE and 4.1 μm (95 % CI −0.4, 8.6; P = 0.076) for CRVE. Wider arteries and veins after maximal versus submaximal exercise for seniors compared to young adults suggest that myogenic vasoconstriction in response to exhaustive exercise may be reduced in seniors. Age-related loss of vascular reactivity has clinical implications since the arteriolar vasoconstriction protects the retinal capillary bed from intraluminal pressure peaks.

Electronic supplementary material

The online version of this article (doi:10.1007/s11357-014-9650-3) contains supplementary material, which is available to authorized users.     

Effects of physical exercise training in syndrome x

Syndrome X categorizes myocardial disease characterized by impaired myocardial flow without macrovessel injury.^1,2 The pathogenesis of this condition remains obscure.^3,4 Similarly, therapy is not well defined.⁵ We report the effects of physical exercise training in a patient with Syndrome X.     

Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials

AimAim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes.Data synthesisThis metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing ‘no exercise’ as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (?0.3 [-0.1;-0.4]%, ?1.44 [-2.22, ?0.66]%, and ?5.6 [-9.5, ?1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, ?0.4 [-0.6;-0.3], ?0.2 [-0.4;-0.1], and ?0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise.ConclusionsPhysical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.     

III度房室阻滞患者VVI起搏时运动耐力和心力储备的研究

采用心肺运动试验的方法，对１６例ＶＶＩ起搏的ＩＩ度房室阻滞患者行最大症状限制性运动试验，以测定病人的心力储备和耐力储备。结果表明病人运动时心脏指数较运动前增加１倍。最大作功８８．６±１６．３６Ｗ／ｍｉｎ，最大氧耗量１７．３８±４．４８ｍｌ／ｍｉｎ。１６例中有９例未测出无氧阈。极量运动时每个病人都出现运动性心律失常。认为ＶＶＩ起搏的患者极量运动时病理生理特点是低无氧阈、低最大氧耗量、低心输出量、低全身耐力。     

Effects of home-based exercise training on neurovascular control in patients with heart failure

BACKGROUND: The effect of home-based exercise training on neurovascular control in heart failure patients is unknown. AIMS: To test the hypothesis that home-based training would maintain the reduction in muscle sympathetic nerve activity (MSNA) and forearm vascular resistance (FVR) acquired after supervised training. METHODS AND RESULTS: Twenty-nine patients (54+/-1.9 years, EF<40%) were randomised into two groups: untrained control (n=12) and exercise trained (n=17). Both groups underwent assessment of Quality of Life (QoL), MSNA, and forearm blood flow. The exercise group underwent a 4-month supervised training program followed by 4 months of home-based training. After the initial 4 months of training, patients in the exercise group showed a significant increase in peak VO(2) and reduction in MSNA, compared to the untrained group, but this was not maintained during 4 months of home-based training. In contrast, the decrease in FVR (56+/-3 vs. 46+/-4 vs. 40+/-2 U, p=0.008) and the improvement in QOL that were achieved during supervised training were maintained during home-based training. CONCLUSIONS: Home-based training following supervised training is a safe strategy to maintain improvements in QoL and reduction in FVR in chronic heart failure patients, but is an inadequate strategy to maintain fitness as estimated by peak VO(2) or reduction in neurohumoral activation.     

高血压病康复医疗90例报告

目的：研究康复运动对高血压病人的疗效。方法：随机将180例病人对等分为常规治疗组（Ⅰ组，90例），康复治疗组（Ⅱ组，常现治疗十康复运动，90例）。结果：2周内血压控制（降至正常）率：Ⅰ组56％，Ⅱ组83％（P＜0．005）；平均住院日：Ⅰ组是18日，Ⅱ组11日；1年内血压控制率：Ⅰ组67％，Ⅱ组89％（P＜0．005）；长期适应工作率：Ⅰ组72％，Ⅱ组91％（P＜0．005）。结论：康复运动可显著提高对高血压病的疗效。