Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome

CONTEXT: Polycystic ovary syndrome (PCOS) is an endocrine disease closely related to several risk factors for cardiovascular disease. An impaired cardiopulmonary functional capacity was previously demonstrated in PCOS women. No data regarding the effects of a structured exercise training (ET) program on cardiopulmonary functional capacity in PCOS women are available. OBJECTIVE: Our objective was to evaluate the effects of a 3-month ET program on cardiopulmonary functional capacity in young PCOS women. DESIGN AND SETTING: A prospective baseline-randomized clinical study was conducted at the University "Federico II" of Naples, School of Medicine (Italy). PATIENTS: Ninety young overweight PCOS women were enrolled. MEAN OUTCOME MEASURES: Ninety young PCOS women were randomly subdivided into two groups, each composed of 45 subjects. The PCOS-T (trained) group underwent a 3-month structured ET program, whereas the PCOS-UnT (untrained) group did not. Hormonal and metabolic profiles and cardiopulmonary and exercise parameters were evaluated. RESULTS: After 3-month ET, PCOS-T showed a significant improvement in peak oxygen consumption (+35.4%; P<0.001) and in maximal workload (+37.2%; P<0.001). In PCOS-T we also observed a significant reduction in body mass index (-4.5%; P<0.001) and in C-reactive protein (-10%; P<0.001), and a significant (P<0.001) improvement in insulin sensitivity indexes. After 3 months, no changes were observed in PCOS-UnT. CONCLUSIONS: A 3-month structured ET program improves cardiopulmonary functional capacity in young PCOS women.     

Left ventricular function after exercise training in young men

The effects of endurance training have been extensively studied in athletes, but longitudinal studies of exercise-induced cardiac changes in normal patients are limited. To assess the effects of 6 months of moderate-intensity aerobic training (1 hour/day, 3 times/week) on normal hearts, 23 sedentary men aged 31.1 +/- 3.5 years were studied by standard and tissue Doppler echocardiography. Left ventricular (LV) systolic function was assessed by the ejection fraction and Doppler-measured stroke volume, and diastolic function was assessed by transmitral and pulmonary venous flow. Tissue Doppler systolic (Sm), early (Em), and late (Am) myocardial velocities were obtained at the septal and lateral mitral annulus. After training, there was a 14.5% increase in peak oxygen consumption (p = 0.000002) and a decrease in heart rate (60 +/- 7 to 56 +/- 8 beats/min, p = 0.01). Septal and posterior wall thickness increased (8.7 +/- 1.0 to 9.4 +/- 1.3 mm, p = 0.002, and 8.2 +/- 0.7 to 8.8 +/- 1.1 mm, p = 0.0009, respectively), with a 15% increase in LV mass index (p = 0.0002). LV diameters, stroke volumes, and ejection fractions were unchanged. Mitral inflow showed a decrease in late-wave velocity (p = 0.00004), thus increasing the early (E)/A ratio. Septal and lateral Sm (p = 0.02) and Em velocities (p <0.05) increased after training. In conclusion, the physiologic increase in LV mass in response to regular exercise in healthy young men occurs in parallel with a decrease in atrial contribution to flow. LV function estimated by tissue Doppler is improved despite the lack of changes in standard echocardiographic indexes.     

Abnormal heart rate recovery after maximal cardiopulmonary exercise stress testing in young overweight women with polycystic ovary syndrome

Objective Heart rate recovery (HRR) is a measure derived from exercise test, defined as the fall in heart rate during the first minute after maximal exercise. Abnormal HRR is a measure of autonomic dysfunction associated with an increased mortality. This study was performed to evaluate the HRR in polycystic ovary syndrome (PCOS). Design Prospective controlled clinical study. Patients Seventy‐five PCOS women compared to 75 healthy women matched for age (21·7 ± 2·1 years vs. 21·9 ± 1·8 years, respectively) and body mass index (BMI) (29·0 ± 2·6 kg/m² vs. 29·1 ± 2·9 kg/m², respectively). Measurements Subjects were studied for their hormonal and metabolic profile, and underwent cardiopulmonary exercise test (CPX). Results PCOS women showed a significantly reduced HRR (12·9 ± 1·8 vs. 20·4 ± 3·1 beats/min, P < 0·001) compared to healthy controls, an impairment in maximal oxygen consumption (18·0 ± 2·3 ml/kg/min vs. 29·3 ± 3·9 ml/kg/min) and in oxygen consumption at anaerobic threshold (13·6 ± 2·6 ml/kg/min vs. 24·2 ± 3·0 ml/kg/min). In PCOS women, abnormal HRR was inversely correlated to BMI (r = ?0·582, P < 0·001) and to the area under the curve for insulin (r = ?0·596, P < 0·001). Conclusions Our data demonstrate an abnormal HRR after maximal CPX in young overweight PCOS patients, and that HRR should be investigated as a further potential marker of increased cardiovascular risk in PCOS.     

Moderate-intensity exercise with blood flow restriction on cardiopulmonary kinetics and efficiency during a subsequent high-intensity exercise in young women: A cross-sectional study

Blood flow restriction (BFR) training applied prior to a subsequent exercise has been used as a method to induce changes in oxygen uptake pulmonary kinetics (V˙O_2P) and exercise performance. However, the effects of a moderate-intensity training associated with BFR on a subsequent high-intensity exercise on V˙O_2P and cardiac output (Q_T) kinetics, exercise tolerance, and efficiency remain unknown.This prospective physiologic study was performed at the Exercise Physiology Lab, University of Brasilia. Ten healthy females (mean ± SD values: age = 21.3 ± 2.2 years; height = 1.6 ± 0.07 m, and weight = 55.6 ± 8.8 kg) underwent moderate-intensity training associated with or without BFR for 6 minutes prior to a maximal high-intensity exercise bout. V˙O_2P, heart rate, and Q_T kinetics and gross efficiency were obtained during the high-intensity constant workload exercise test.No differences were observed in V˙O_2P, heart rate, and Q_T kinetics in the subsequent high-intensity exercise following BFR training. However, exercise tolerance and gross efficiency were significantly greater after BFR (220 ± 45 vs 136 ± 30 seconds; P < .05, and 32.8 ± 6.3 vs 27.1 ± 5.4%; P < .05, respectively), which also resulted in lower oxygen cost (1382 ± 227 vs 1695 ± 305 mL min^–1).We concluded that moderate-intensity BFR training implemented prior to a high-intensity protocol did not accelerate subsequent V˙O_2P and Q_T kinetics, but it has the potential to improve both exercise tolerance and work efficiency at high workloads.     

Differential effects of exercise training in men and women with chronic heart failure

Background

Abnormalities of myosin heavy chain (MHC) isoforms, enzyme activity, and capillarity contribute to the exercise intolerance that is characteristic of patients with heart failure. To what extent these changes can be reversed with exercise training and whether differences exist in the responses of men and women remains uncertain. We described and compared the effects of exercise training on exercise capacity and skeletal muscle histochemistry in men and women with chronic heart failure.

Methods

Fifteen patients (10 male) undergoing standard medical therapy completed a 14- to 24-week exercise training program. Peak oxygen consumption, MHC isoforms, capillary density, and selected metabolic enzymes were assessed before and after training.

Results

Peak oxygen consumption was improved 14% (P <.05); however, this increase was mostly because of the improvement observed in men versus women (+20% versus +2%, respectively, P < .01). At baseline, MHC I content was lower in men than in women (33% ± 3% vs 49.6% ± 5.5%, P < .05). MHC I improved with training in men, to 45.6% ± 4.5% (+38%, P < .05), versus women (−3%, P = .82), and the increase in men tended (P = .12) to be significant when compared with that in women. There were no significant changes in capillary density or muscle enzyme activity with training in the group as a whole or in men and women separately.

Conclusion

Among patients with chronic heart failure, improvements in peak exercise capacity may be more pronounced in men than in women. This difference in response of functional capacity to training paralleled differences observed between men and women for changes in MHC I isoforms.     

Time-course effects of aerobic interval training and detraining in patients with metabolic syndrome

Background and aimsExercise training can improve health of patients with metabolic syndrome (MetS). However, which MetS factors are most responsive to exercise training remains unclear. We studied the time-course of changes in MetS factors in response to training and detraining.Methods and resultsForty eight MetS patients (52 ± 8.8 yrs old; 33 ± 4 BMI) underwent 4 months (3 days/week) of supervised aerobic interval training (AIT) program. After 1 month of training, there were progressive increases in high density lipoprotein cholesterol (HDL-c) and reductions in waist circumference and blood pressure (12 ± 3, −3.9 ± 0.4, and −12 ± 1%, respectively after 4 months; all P < 0.05). However, fasting plasma concentration of triglycerides and glucose were not reduced by training. Insulin sensitivity (HOMA), cardiorespiratory fitness (VO₂peak) and exercise maximal fat oxidation (FO_MAx) also progressively improved with training (−17 ± 5; 21 ± 2 and 31 ± 8%, respectively, after 4 months; all P < 0.05). Vastus lateralis samples from seven subjects revealed that mitochondrial O₂ flux was markedly increased with training (71 ± 11%) due to increased mitochondrial content. After 1 month of detraining, the training-induced improvements in waist circumference and blood pressure were maintained. HDL-c and VO₂peak returned to the values found after 1–2 months of training while HOMA and FO_MAx returned to pre-training values.ConclusionsThe health related variables most responsive to aerobic interval training in MetS patients are waist circumference, blood pressure and the muscle and systemic adaptations to consume oxygen and fat. However, the latter reverse with detraining while blood pressure and waist circumference are persistent to one month of detraining.     

Cardiovascular and behavioral effects of aerobic exercise training in healthy older men and women

The cardiovascular and behavioral adaptations associated with a 4-month program of aerobic exercise training were examined in 101 older men and women (mean age = 67 years). Subjects were randomly assigned to an Aerobic Exercise group, a Yoga and Flexibility control group, or a Waiting List control group. Prior to and following the 4-month program, subjects underwent comprehensive physiological and psychological evaluations. Physiological measures included measurement of blood pressure, lipids, bone density, and cardiorespiratory fitness including direct measurements of peak oxygen consumption (VO2) and anaerobic threshold. Psychological measures included measures of mood, psychiatric symptoms, and neuropsychological functioning. This study demonstrated that 4 months of aerobic exercise training produced an overall 11.6% improvement in peak VO2 and a 13% increase in anaerobic threshold. In contrast, the Yoga and Waiting List control groups experienced no change in cardiorespiratory fitness. Other favorable physiological changes observed among aerobic exercise participants included lower cholesterol levels, diastolic blood pressure levels, and for subjects at risk for bone fracture, a trend toward an increase in bone mineral content. Although few significant psychological changes could be attributed to aerobic exercise training, participants in the two active treatment groups perceived themselves as improving on a number of psychological and behavioral dimensions.     

The effects of a three-month exercise programme on neuropsychological function in elderly institutionalized women: a randomized controlled trial

This randomized controlled trial examined the effect of a 3-month exercise programme on neuropsychological function in a population of very elderly institutionalized women. Baseline neuropsychological testing was performed, and following 3 months of exercise or control intervention, subjects were retested 3-7 days after the completion of the study period. Apart from the Word Fluency Test, there was no significant improvement in any of the neuropsychological test scores. This study may not have shown any significant improvement in neuropsychological function because our exercise programme was too light to improve aerobic fitness, or because neuropsychological tests were repeated 3-7 days after exercise was completed and any acute effects of exercise may have disappeared by that time.     

Acute exercise increases systemic arterial compliance after 6-month exercise training in older women.

High physical activity or aerobic exercise training increases central arterial distensibility in older humans. However, the effect of a single bout of exercise on central arterial distensibility in older humans is unknown. Furthermore, the effect of exercise training on central arterial distensibility during exercise is unclear. We investigated whether systemic arterial compliance (SAC) changes after acute exercise in older humans, and, if so, whether this change in SAC is enhanced by aerobic exercise training. Seven untrained older women (61-69 years old) participated in a 6-month exercise intervention study. We measured SAC after acute exercise (cycling exercise at 80% of their individual ventilatory threshold for 30 min) before and after 6 months of aerobic exercise training. After exercise training, the individual ventilatory threshold was significantly increased. In addition, both the SAC at rest and that 30 min after acute exercise were significantly increased after the exercise training program. Before exercise training, there was no significant increase in SAC after acute exercise, whereas, after exercise training, the SAC was significantly increased 30 min after acute exercise. The present study suggests that, after aerobic exercise training, SAC increases after acute exercise in older humans, and that the SAC at rest and after acute exercise is enhanced by aerobic exercise training, thereby causing an effective adaptation in increase in cardiac output during exercise.     

The effects of exercise, training on body composition and metabolism in men and women

In order to examine whether there are sex-differences in the response of energy balance to physical training slightly obese men and women participated in the same 3 months physical training program with the same individual relative intensity. The men became somewhat lighter (-2 kg) and leaner (-2.9 kg body fat) and showed decreases in sum of insulin and sum of C-peptide values during an oral glucose tolerance test as well as cholesterol values. The women showed decrease of 2.6 kg body fat, and also increased lean body mass (1.9 kg) and similar metabolic changes. The women had, however, a larger body fat mass at the outset. When women with similar body fat mass as that of men were analysed separately, no change in body weight or body fat had occurred, and the metabolic adaptations were less pronounced. No compensatory increase of energy intake could be discovered in any of the groups, the most obese women actually showed a decrease. Taken together with previous information these results suggest that men, like male rats, become leaner during physical training due to a lack of energy intake compensation. Women with similar body fat mass, however, like female rats, may react with such a compensation, causing a protection of their body fat. Women usually have more body fat than men, however. Obese women in this study showed a decrease of body fat.     

Metabolic syndrome and cardiometabolic risk in PCOS

The cardiovascular risk associated with the polycystic ovary syndrome (PCOS) has recently attracted much interest. Women with PCOS are more likely to fulfill the diagnosis of the metabolic syndrome, a cluster of related cardiometabolic factors known to predict long-term risk of cardiovascular disease and type 2 diabetes. We review the literature pertaining to the link between the metabolic syndrome, cardiovascular disease, and PCOS. We focus on the influence of obesity and hyperandrogenemia, and on strategies for identifying cardiovascular risk in PCOS.     

Insulin-sensitizing effects of exercise on adiponectin and retinol-binding protein-4 concentrations in young and middle-aged women

CONTEXT: Exercise training enhances insulin sensitivity. Changes in retinol-binding protein-4 (RBP4) and adiponectin levels are linked to insulin resistance. OBJECTIVE: We tested whether the insulin-sensitizing effect of exercise is associated with age-related changes in circulating RBP4 and adiponectin levels in women. DESIGN, SUBJECTS, AND INTERVENTION: We studied 36 healthy young (22.4 +/- 2.8 yr) and 38 middle-aged (59.8 +/- 5.9 yr) women. All subjects performed 60 min of aerobic exercise three times per week for 10 wk at about 70% maximal exercise capacity. RESULTS: After a 10-wk training program, maximal exercise capacity was significantly increased in both young and middle-aged women, suggesting increased oxidative capacity. Insulin sensitivity was also improved, as indicated by decreases in plasma insulin levels and homeostasis model assessment for insulin resistance index. Serum adiponectin and RBP4 concentrations were increased and decreased more in older than younger women, respectively (P < 0.01). Concurrently, circulating transthyretin levels were also decreased in older subjects in response to exercise training. The older women showed higher correlations between changes in adiponectin or RBP4 levels and obesity indices or metabolic parameters than the younger group. When subjects showing increasing adiponectin or decreasing RBP4 levels were classified as responders, there were higher correlations between these changes in responders than in nonresponders. CONCLUSIONS: We conclude that the mechanism for the insulin-sensitizing effects of exercise could involve increased adiponectin and reduced RBP4 levels in exercise-trained women. These data suggest that alterations in circulating RBP4 and adiponectin levels could play an important role in regulating insulin sensitivity.