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Survival of the fittest: VO2max, a key predictor of longevity?

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Abstract

Cardiorespiratory fitness, as measured by maximal oxygen uptake (VO2max), is related to functional capacity and human performance and has been shown to be a strong and independent predictor of all-cause and disease-specific mortality. The purpose of this review is to emphasize age-related physiological adaptations occurring with regular exercise training, with specific reference to the main organs (lung, heart, skeletal muscles) involved in oxygen delivery and utilization as well as the importance of exercise training for promoting life expectancy in clinically referred populations. As yet, it is not possible to extend the genetically fixed lifespan with regular exercise training, but to give the years more life. This is where physical fitness plays an important role

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... A higher physical fitness index in adults significantly reduces the metabolic risk for a particular body fat level [17]. Preventive measures against cardiovascular diseases which are intended to optimise CRF are also implemented in low-risk groups (10% risk of ischaemic heart disease occcurrence within the next 10 years) [18][19][20]. The authors of many studies emphasise the significance of lifelong physical activity to improve or maintain the appropriate level of CRF [19,21,22]. ...
... Preventive measures against cardiovascular diseases which are intended to optimise CRF are also implemented in low-risk groups (10% risk of ischaemic heart disease occcurrence within the next 10 years) [18][19][20]. The authors of many studies emphasise the significance of lifelong physical activity to improve or maintain the appropriate level of CRF [19,21,22]. In early adulthood, a high CRF level provides the most benefit related to survival. ...
... The models were calculated on the basis of 23 independent variables (x 0 -x 22 ) and one dependent variable (y). Independent variables include: gender (x 1 ), parameters of the 20 m shuttle run (x 1 -x 4 ), age (x 5 ), anthropometric features (x 6 -x 10 ), somatic indexes (x 11 -x 19 ), and body components (x 20 -x 22 ). The VO 2 max result (y) obtained during the 20 m shuttle run test with a telemetry gas exchange system (Cosmed K4b 2 ) was a dependent variable. ...
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This study presents mathematical models for predicting VO2max based on a 20 m shuttle run and anthropometric parameters. The research was conducted with data provided by 308 young healthy people (aged 20.6 ± 1.6). The research group includes 154 females (aged 20.3 ± 1.2) and 154 males (aged 20.8 ± 1.8). Twenty-four variables were used to build the models, including one dependent variable and 23 independent variables. The predictive methods of analysis include: the classical model of ordinary least squares (OLS) regression, regularized methods such as ridge regression and Lasso regression, artificial neural networks such as the multilayer perceptron (MLP) and radial basis function (RBF) network. All models were calculated in R software (version 3.5.0, R Foundation for Statistical Computing, Vienna, Austria). The study also involved variable selection methods (Lasso and stepwise regressions) to identify optimum predictors for the analysed study group. In order to compare and choose the best model, leave-one-out cross-validation (LOOCV) was used. The paper presents three types of models: for females, males and the whole group. An analysis has revealed that the models for females ( RMSE C V = 4.07 mL·kg−1·min−1) are characterised by a smaller degree of error as compared to male models ( RMSE C V = 5.30 mL·kg−1·min−1). The model accounting for sex generated an error level of RMSE C V = 4.78 mL·kg−1·min−1.
... Cardiorespiratory fitness (measured by the maximum oxygen uptake [VO 2 max]) has been the most used parameter to describe functional capacity and human physical performance. 34 Notably, higher levels of VO 2 max are associated to the enhancement of several functions of the human organism, 35 such as cardiovascular, neuromuscular, and cognitive functions. [36][37][38] It is also related to decreased stress and anxiety levels, as well as improved mental health. ...
... 37 It acts as a strong and independent predictor of all-cause and disease-specific mortality. 34 Endurance exercise is the most effective method to improve cardiorespiratory fitness and has been suggested to be included as part of SUD rehabilitation programs; 41,42 however, it is unclear how these benefits may affect ANS control in patients with SUD, especially under stressful situations. ...
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ABSTRACT: While drug use has been shown to impair cardiac autonomic regulation, exercise might overcome some of the damage. Herein, we describe how individuals with substance use disorder (SUD) have their heart rate variability (HRV) and drug-related behaviors negatively affected in response to a stressor. However, we show how cardiorespiratory fitness may attenuate those impairments in autonomic control. Fifteen individuals with SUD were matched with 15 non-SUD individuals by age, weight, height, and fitness level, and had their HRV responses under stress induced by the Cold Pressor Test (CPT). The SUD group had lower mean of R-R intervals before and after the CPT when compared with the non-SUD group. In addition, in individuals with SUD, higher cardiorespiratory fitness level predicted greater vagal activity before, during, and after CPT. Moreover, for individuals with SUD, days of abstinence predicted greater mean of R-R intervals during recovery from the CPT. Finally, years of drug use negatively predicted mean of R-R intervals during recovery. Thus, our results suggest that chronic drug use impairs cardiac autonomic regulation at rest and after a physical stress. However, cardiorespiratory fitness might attenuate these impairments by increasing vagal autonomic activity.
... The VO 2max is widely regarded as the gold standard measure of cardiorespiratory fitness and is typically determined using a cardiopulmonary exercise test (CPET) in clinical, applied physiology, and sport and exercise science settings [1,[3][4][5][6]. The VO 2max is often used to diagnose cardiovascular disease [7], predict all-cause mortality [8][9][10], develop exercise prescriptions [3,11,12], and evaluate the efficacy of exercise programmes [13][14][15]. Consequently, the validity of VO 2max values obtained during CPETs has widespread importance in clinical, sporting, and research-related contexts. ...
... The total number of participants recruited across all included studies was 1,680 (1,077 men, 473 women, and the sex of 130 participants was not specified). Included studies had a median (interquartile range [IQR]) sample size of 13 [10] participants. Participants were aged between 19 and 68 yr, all apparently healthy, and with a physical activity status ranging from sedentary to highly-trained endurance athletes. ...
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Background The ‘verification phase’ has emerged as a supplementary procedure to traditional maximal oxygen uptake (VO 2max ) criteria to confirm that the highest possible VO 2 has been attained during a cardiopulmonary exercise test (CPET). Objective To compare the highest VO 2 responses observed in different verification phase procedures with their preceding CPET for confirmation that VO 2max was likely attained. Methods MEDLINE (accessed through PubMed), Web of Science, SPORTDiscus, and Cochrane (accessed through Wiley) were searched for relevant studies that involved apparently healthy adults, VO 2max determination by indirect calorimetry, and a CPET on a cycle ergometer or treadmill that incorporated an appended verification phase. RevMan 5.3 software was used to analyze the pooled effect of the CPET and verification phase on the highest mean VO 2 . Meta-analysis effect size calculations incorporated random-effects assumptions due to the diversity of experimental protocols employed. I ² was calculated to determine the heterogeneity of VO 2 responses, and a funnel plot was used to check the risk of bias, within the mean VO 2 responses from the primary studies. Subgroup analyses were used to test the moderator effects of sex, cardiorespiratory fitness, exercise modality, CPET protocol, and verification phase protocol. Results Eighty studies were included in the systematic review (total sample of 1,680 participants; 473 women; age 19–68 yr.; VO 2max 3.3 ± 1.4 L/min or 46.9 ± 12.1 mL·kg ⁻¹ ·min ⁻¹ ). The highest mean VO 2 values attained in the CPET and verification phase were similar in the 54 studies that were meta-analyzed (mean difference = 0.03 [95% CI = -0.01 to 0.06] L/min, P = 0.15). Furthermore, the difference between the CPET and verification phase was not affected by any of the potential moderators such as verification phase intensity ( P = 0.11), type of recovery utilized ( P = 0.36), VO 2max verification criterion adoption ( P = 0.29), same or alternate day verification procedure ( P = 0.21), verification-phase duration ( P = 0.35), or even according to sex, cardiorespiratory fitness level, exercise modality, and CPET protocol ( P = 0.18 to P = 0.71). The funnel plot indicated that there was no significant publication bias. Conclusions The verification phase seems a robust procedure to confirm that the highest possible VO 2 has been attained during a ramp or continuous step-incremented CPET. However, given the high concordance between the highest mean VO 2 achieved in the CPET and verification phase, findings from the current study would question its necessity in all testing circumstances. PROSPERO Registration ID CRD42019123540.
... Low cardiorespiratory fitness (CRF) quantified as low maximal oxygen uptake (VO2max) is one of the most important risk factors for CVD and premature death, and suggested to be a stronger predictor of morbidity and mortality than established CVD risk factors like obesity, diabetes, smoking, and hypercholesterolemia (2). VO2max is also shown to a be strong and independent predictor of allcause and diseases-specific mortality (3). Low VO2max is shown to increase risk of dementia, cancer, and other lifestyle-related diseases (4,5). ...
Article
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Central Norway Regional Health Authority Norwegian Health Association Introduction Cardiovascular disease (CVD) is the leading cause of death worldwide. Several studies have shown that low cardiorespiratory fitness (CRF) is a major risk factor for CVD and is suggested to be a stronger predictor of CVD morbidity and mortality than established cardiovascular risk factors. CRF quantified as maximal oxygen uptake (VO2max) has a strong genetic component, estimated to be ~50%. Unfortunately, current studies on genetic markers for CRF are limited by small sample sizes. In addition, there are few studies on directly measured VO2max, as most of the previous studies are based on estimated CRF. To overcome these limitations, we performed a large-scale systematic screening for genetic variants associated with VO2max aiming to provide awaited insight to this complex trait and discover possible links between VO2max and CVD. Purpose To identify and validate genetic factors associated with VO2max. Methods The genotypes of 70,000 participants from the Trøndelag Health study (HUNT) were imputed providing information on 25 million single-nucleotide polymorphisms (SNPs). We conducted a genome-wide association study (GWAS) including 4,525 participants with directly measured VO2max from the HUNT3 Fitness study. The GWAS was performed using BOLT-LMM, adjusted for age, gender, physical activity, principal components, and genotyping batch. In addition, we ran a GWAS with the same covariates except physical activity. Further, gender specific analyses were conducted. For validation, similar analyses were performed in the United Kingdom Biobank (UKBB). In the UKBB, CRF was assessed through a submaximal bicycle test. The analyses of UKBB included ~60,000 participants and over 90 million SNPs. Functional analyses of the GWAS results were examined by functional mapping and annotation (FUMA). Results Two GWAS-significant (p < 5×10-8) SNPs associated with VO2max were identified in the total population, two in the male population, and 24 in the female population in HUNT. Two of the 24 SNPs found in the female population were nominally significant in the UKBB. One of the validated SNPs in the female population is located inside PIK3R5, that is shown to be of importance in cardiac function and CVD. In addition, the functional analyses in the total- and male population revealed candidate SNPs in a gene previously found to be associated with endurance, PPP3CA. Conclusions We have identified 28 novel SNPs associated with VO2max in the HUNT cohort. Two of these SNPs were nominally validated in females in UKBB. One of the validated SNPs resides within a gene previously reported to be related to heart function and CVD. In addition, the functional analyses in the total- and male population revealed candidate SNPs in a gene previously found to be associated with endurance. Further functional analyses using bioinformatic approaches may provide more information on the physiological importance of these findings and their relation to CVD.
... Low cardiorespiratory fitness (CRF) quantified as low maximal oxygen uptake (VO2max) is one of the most important risk factors for CVD and premature death, and suggested to be a stronger predictor of morbidity and mortality than established CVD risk factors like obesity, diabetes, smoking, and hypercholesterolemia (2). VO2max is also shown to a be strong and independent predictor of allcause and diseases-specific mortality (3). Low VO2max is shown to increase risk of dementia, cancer, and other lifestyle-related diseases (4,5). ...
Article
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Central Norway Regional Health AuthorityNorwegian Health Association Introduction Cardiovascular disease (CVD) is the leading cause of death worldwide. Several studies have shown that low cardiorespiratory fitness (CRF) is a major risk factor for CVD. Low CRF is suggested to be a stronger predictor of CVD morbidity and mortality than established cardiovascular risk factors like obesity, diabetes, and cholesterol. Several studies suggest that CRF quantified as maximal oxygen uptake (VO2max) has a strong genetic component, estimated to be ~50%. Unfortunately, current studies on genetic markers for CRF are limited by small sample sizes. In addition, there are few studies on directly measured VO2max, as most of the previous studies are based on estimated CRF. Directly measured VO2max is considered as the gold standard for measuring CRF. Thus, a large-scale systematic screening for genetic variants associated with VO2max may provide awaited insight to this complex trait and discover possible links between VO2max and CVD. Purpose To identify and validate genetic factors associated with VO2max. Methods The genotypes of 70.000 participants from the Trøndelag Health study (HUNT) were imputed providing information on 25 million SNPs. We conducted a genome-wide association study (GWAS) including 4525 participants with directly measured VO2max from the HUNT3 Fitness study. The GWAS was performed using BOLT-LMM, adjusted for age, gender, physical activity, principal components, and genotyping batch. In addition, we ran a GWAS with the same covariates except physical activity. Further, gender specific analyses were conducted. For validation, similar analyses were performed in the United Kingdom Biobank (UKBB). In the UKBB, CRF was assessed through a submaximal bicycle test. The analyses of UKBB included ~60.000 participants and over 90 million SNPs. Results Two GWAS-significant (p < 5x10-8) SNPs associated with VO2max were identified in the total population in HUNT. Further, 24 GWAS-significant SNPs associated with VO2max in females, and two GWAS-significant SNPs associated with VO2max in males were discovered. Two of the 24 SNPs found in the female population were nominally significant in the UKBB. The validated SNPs are rs376927175, an intergenic SNP downstream of APBA1, and rs551942830 (proxy for rs190675254 with LD = 1.0), a 3 Prime UTR variant inside PIK3R5. PIK3R5 encodes the regulatory subunit of one class of PI3Ks, that is shown to be of importance in cardiac function and CVD. None of the SNPs found in the total population nor the male population were validated in UKBB. Conclusions We have identified 28 novel SNPs associated with VO2max in the HUNT cohort. Two of these SNPs were nominally validated in females in UKBB. One of the validated SNPs resides within a gene previously reported to be related to heart function and CVD. Further functional analyses using bioinformatic approaches may provide more information on the physiological importance of these findings and their relation to CVD.
... However, direct assessments of cardiorespiratory fitness provide a more objective method of investigating the relationship between fitness and mental health. In the exercise physiology literature, two objective measures include maximal aerobic capacity (VO 2max ) and aerobic economy (Barnes & Kilding, 2015;Bassett & Howley, 2000;Strasser & Burtscher, 2018).VO 2max represents the maximal amount of oxygen that can be consumed during exhaustive exercise, where a higherVO 2max is indicative of greater cardiorespiratory fitness. Aerobic economy represents the steady-state energy requirement of exercise conducted at a constant exercise intensity (e.g., running at a constant velocity). ...
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Objectives Researchers have begun delivering mindfulness and aerobic exercise training concurrently on the premise that a combination intervention will yield salutary outcomes over and above each intervention alone. An estimate of the effect of combination training on chronic psychosocial stress in a nonclinical population has not been established. The objective of this study was to establish protocol feasibility in preparation of a definitive RCT targeting healthy individuals, and to explore the preliminary effect of combination training on reducing chronic psychosocial stress in this population.Methods Twenty-four participants were allocated to a single-arm pre-post study and subjected to 16 weeks of concurrent mindfulness psychoeducation and aerobic exercise training. Feasibility criteria were collected and evaluated. Within-group changes in chronic psychosocial stress, mindfulness, emotion regulation, and cardiorespiratory fitness were also assessed. Primary analyses were based on 17 participants.ResultsRetention rate, response rate, recruitment rate, and sample size analyses indicate a definitive trial is feasible for detecting most effects with precision. There was also a decline in our primary dependent measure of chronic psychosocial stress (dpretest = −0.56, 95% CI [ −1.14,−0.06]). With regard to secondary measures, there was an increase in the use of cognitive reappraisal, and a reduction in use of maladaptive emotion regulation strategies. We are insufficiently confident to comment on changes in mindfulness and aerobic capacity (𝑉˙𝑂2𝑚𝑎𝑥). However, there were subgroup improvements in aerobic economy at submaximal exercise intensities.Conclusions We recommend a definitive trial is feasible and should proceed.
... Our results linked with studies in humans (30) support the idea to not limited the prescription at one modality of training (low or moderate continuous intensity) because HIIE does not cause deleterious effects. However, it is important to note among other things that HIIE had more of an effect on the increasing of MRS since performance seems to be a good indicator of mortality risk (35,65). ...
Article
Exercise training offers possible nonpharmacological therapy for cardiovascular diseases including hypertension. High-intensity intermittent exercise (HIIE) training has been shown to have as much or even more beneficial cardiovascular effect in patients with cardiovascular diseases than moderate-intensity continuous exercise (CMIE) training. The aim of this study was to investigate the effects of the two types of training on cardiac remodeling of spontaneously hypertensive rats (SHR) induced by hypertension. Eight-week-old male SHR and normotensive Wistar-Kyoto rats (WKY) were divided into four groups: normotensive and hypertensive control (WKY and SHR-C) and hypertensive trained with CMIE (SHR-T CMIE) or HIIE (SHR-T HIIE). After 8 wk of training or inactivity, maximal running speed (MRS), arterial pressure, and heart weight were all assessed. CMIE or HIIE protocols not only increased final MRS and left ventricular weight/body weight ratio but also reduced mean arterial pressure compared with sedentary group. Then, left ventricular tissue was enzymatically dissociated, and isolated cardiomyocytes were used to highlight the changes induced by physical activity at morphological, mechanical, and molecular levels. Both types of training induced restoration of transverse tubule regularity, decrease in spark site density, and reduction in half-relaxation time of calcium transients. HIIE training, in particular, decreased spark amplitude and width, and increased cardiomyocyte contractility and the expression of sarco(endo)plasmic reticulum Ca2+-ATPase and phospholamban phosphorylated on serine 16. NEW & NOTEWORTHY High-intensity intermittent exercise training induces beneficial remodeling of the left ventricular cardiomyocytes of spontaneously hypertensive rats at the morphological, mechanical, and molecular levels. Results also confirm, at the cellular level, that this type of training, as it appears not to be deleterious, could be applied in rehabilitation of hypertensive patients.
... Some authors have found a strong relationship between low exercise tolerance and survival. Therefore, we aimed to stablish an association between peak oxygen uptake (peak VO2) and the occurrence of malignant ventricular arrhythmia (MVA) [5][6][7][8][9]. ...
Article
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Keywords: Exercise test heart failure cardiovascular disease implantable defibrillator sudden death ventricular arrhythmia VO2 A B S T R A C T Malignant ventricular arrhythmia (MVA) is one of the most frequent causes of mortality among patients with cardiovascular disease. Exercise tolerance is a powerful variable to evaluate the cardiopulmonary system condition. The proposal of this research is to establish an association between peak oxygen uptake (VO2) and the incidence of long-term malignant ventricular arrhythmia. Methods: A historical cohort of patients with heart disease of a third level hospital of cardiology were studied. Every patient performed a symptoms-limited cardiopulmonary exercise testing and were followed-up to10 years. We defined malignant ventricular arrhythmia (MVA) as a combined outcome composed by tachycardia or ventricular fibrillation, implantation of a cardioverter (ICD) or sudden death. Patients were split in 2 groups according to MVA. Using a ROC curve, peak VO2 was divided in two groups, according to a 25 mlO2/kg/min cut-point. Bivariate analysis identified those variables associated with MVA, that were included in a multivariable regression Cox model. All p values less than 0.05 were considered stochastically significant. Results: A total of 1767 individuals were studied, and 116 combined outcomes occurred. After Cox regression analysis, four variables were identified as statistically significant risk-factors for MVA: reduced VO2 (HR 1.75, CI 95% 1.04 to 2.92), heart failure (HR 6.15, CI 95% 2.85 to 13.21), history of ICD (HR 2.12, CI 95% 1.26 to 3.55) and diuretic use (HR 2.6, CI 95% 1.6 to 4.2). Conclusion: Maximal exercise tolerance is strongly associated with a long-term occurrence of malignant ventricular arrhythmia, together with other variables such as heart failure, history of previous ICD or diuretic use.
... Regular participation in moderate-to-vigorous activity moderates an individual's exercise capacity and is the mechanism that stimulates the transient inflammatory response that prevents low-grade chronic inflammation ( Dring et al., 2019). When focusing on the relationship between physical fitness and risk factors for cardio-metabolic disease the measurement of fitness should therefore be sensitive to changes in an individual's ability to perform prolonged exercise (Strasser and Burtscher, 2018). The blood lactate response to submaximal exercise is more sensitive to changes in training status than maximal oxygen uptake in both adults ( Edwards et al., 2003) and young people (Grant, 2001). ...
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The role of physical activity in determining the metabolic health of adolescents is poorly understood, particularly concerning the effect on low-grade chronic inflammation (chronic elevation of pro-inflammatory cytokines IL-1β, IL-6, TNF-α and acute phase protein CRP, which is implicated in the etiology of atherosclerosis) and anti-inflammatory mediators such as IL-10. Furthermore, there is limited information on the mediating effects of performance on the multi-stage fitness test (MSFT), V ˙ O2 peak and adiposity on risk factors for cardio-metabolic disease in adolescents. Purpose: To examine the effect of performance on the MSFT, V ˙ O2 peak and adiposity on risk factors for cardio-metabolic diseases in adolescents. Methods: Following ethical approval, 121 adolescents (11.3 ± 0.8 year) completed the study. Risk factors for cardio-metabolic disease (circulating inflammatory cytokines, blood glucose and plasma insulin concentrations) was assessed using a fasted capillary blood sample. Participants were separated into quartiles based upon distance ran during the MSFT, the blood lactate response to submaximal exercise, V ˙ O2 peak (determined during an uphill graded treadmill test), and adiposity (determined as the sum of four skinfolds). The blood lactate response to submaximal exercise and V02 peak were measured in a sub-group of participants. Data were analyzed using two-way between-subjects ANCOVA and multiple linear regression. Results: Participants with the lowest performance on the MSFT had higher blood concentrations of IL-6 (3.25 ± 0.25 pg mL-1) and IL-1β (4.78 ± 0.54 pg mL-1) and lower concentrations of IL-10 (1.80 ± 0.27 pg mL-1) when compared with all other quartiles (all p < 0.05). Yet, when categorized into V ˙ O2 peak quartiles, no differences existed in any of the inflammatory mediators (all p > 0.05). Performance on the MSFT was the only predictor of IL-6 (β = -0.291, p = 0.031), IL-1β (β = -0.405, p = 0.005), IL-10 (β = 0.325, p = 0.021) and fasted blood glucose (β = -0.545, p < 0.001) concentrations. Adiposity was the only predictor of plasma insulin concentration (β = 0.515, p < 0.001) and blood pressure (diastolic: β = 0.259, p = 0.042; mean arterial pressure: β = 0.322, p = 0.011). Conclusion: Enhanced performance on the MSFT, but not V ˙ O2 peak, was associated with a favorable inflammatory profile in adolescents; whilst adiposity adversely affected plasma insulin, diastolic and mean arterial blood pressure. These findings demonstrate that enhancing performance on the MSFT and maintaining a healthy body composition are a potential therapeutic intervention for the attenuation of risk factors for cardio-metabolic diseases in adolescents.
... Cardiorespiratory fitness is one of the strongest predictors of mortality. Given that individuals with higher cardiorespiratory fitness live longer than those with average or below average cardiorespiratory fitness, aerobic exercise training is one of the few established healthspan extending interventions practiced in humans to date [8,[90][91][92]. In skeletal muscle, aerobic exercise training enhances mitochondrial function [93,94], stimulates skeletal muscle hypertrophy [88], and maintains strength and function throughout life [95,96]. ...
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Oxidative damage is one mechanism linking aging with chronic diseases including the progressive loss of skeletal muscle mass and function called sarcopenia. Thus, mitigating oxidative damage is a potential avenue to prevent or delay the onset of chronic disease and/or extend healthspan. Mitochondrial hormesis (mitohormesis) occurs when acute exposure to stress stimulates adaptive mitochondrial responses that improve mitochondrial function and resistance to stress. For example, an acute oxidative stress via mitochondrial superoxide production stimulates the activation of endogenous antioxidant gene transcription regulated by the redox sensitive transcription factor Nrf2, resulting in an adaptive hormetic response. In addition, acute stresses such as aerobic exercise stimulate the expansion of skeletal muscle mitochondria (i.e., mitochondrial biogenesis), constituting a mitohormetic response that protects from sarcopenia through a variety of mechanisms. This review summarized the effects of age-related declines in mitochondrial and redox homeostasis on skeletal muscle protein homeostasis and highlights the mitohormetic mechanisms by which aerobic exercise mitigates these age-related declines and maintains function. We discussed the potential efficacy of targeting the Nrf2 signaling pathway, which partially mediates adaptation to aerobic exercise, to restore mitochondrial and skeletal muscle function. Finally, we highlight knowledge gaps related to improving redox signaling and make recommendations for future research.
... determinants of fitness and health. During aging, the amount of vigorous and moderate intensity physical activity decreases and sufficient intensity of physical activity is required to improve VO 2 max 33 and in this study, VO 2 max was one of the important predictors of MS. So, it can be concluded that daily physical activity with low intensity cannot be correlated with improving MS. 34 According to present findings, sitting time (energy expenditure) was the most important predictor of MS. ...
Article
Objective: The aim of this study was to investigate the relationship between daily physical activity (daily activities, exercise, and sitting time), cardiorespiratory fitness (CRF), and body composition (body mass index [BMI], waist to hip ratio [WHR)] with menopausal symptoms and to determine the strongest predictor(s) of menopausal symptoms. Methods: The Menopause Rating Scale questionnaire was used to examine somatic, psychological, urogenital, and total symptoms of menopause. The energy expenditure of daily physical activity, exercise, and sitting time was measured by the International Physical Activity Questionnaire, and CRF was measured by estimating the maximal oxygen intake (VO2max) through the Rockport test. Statistical methods of the Pearson correlation coefficient and hierarchical multiple linear regression were used for data analysis. Results: Fifty-six women, aged 50 to 65 years, voluntarily participated in the study. Exercise energy expenditure was inversely correlated with total (r = -0.403, P = 0.002), somatic (r = -0.293, P = 0.023), and urogenital (r = -0.343, P = 0.009) symptoms of menopause. VO2max was inversely correlated with urogenital symptoms of menopause (r = -0.414, P = 0.002). WHR was positively correlated with somatic symptoms of menopause (r = 0.286, P = 0.032); sitting was correlated with total (r = 0.40, P = 0.002), somatic (r = 0.325, P = 0.015), and psychological (r = 0.274, P = 0.015) symptoms of menopause. Among the study variables, sitting (β=0.365, P = 0.004) and VO2max (β=-0.286, P = 0.030) were the most important predictors of total symptoms of menopause; sitting was the predictor of somatic symptoms (β=0.265, P = 0.045), and VO2max was the predictor of urogenital symptoms of menopause (β=-0.332, P = 0.014). The inclusion of age, BMI, WHR, and duration of menopause as confounding variables in regression analysis did not change the findings related to the predictions of menopausal symptoms. Conclusion: Reducing sitting time, improving VO2max, decreasing WHR, and exercise can be recommended by priority to alleviate menopausal symptoms. Considering the small number of participants in this investigation, future studies are, however, recommended.
... Studies on currently-injured individuals show that realtime feedback can be effective to prevent injury-or pain-related discontinuation (Agresta & Brown, 2015;Dos Santos et al., 2019;Noehren, Scholz, & Davis, 2011). Similarly, gait retraining for individuals that were above a threshold shown to increase injury risk was effective at modifying injury risk factors (Bowser, Fellin, Milner, • Estimated physical fitness level (e.g., estimated VO 2 max as predictor of longevity and risk factor for developing adverse health conditions (Strasser & Burtscher, 2018)) Social motive Social affiliation and/or recognition • Interacting via a smartphone and headphones with another runner that runs in a remote location and/or on a different speed (Mueller, O'Brien, & Thorogood, 2007;Mueller et al., 2012;Mueller et al., 2010; • Flying drone that serves as a jogging companion (Mueller & Muirhead, 2014, Mueller & Muirhead, 2015, which also can provide social support (Romanowski et al., 2017) • Allowing others to show digital support on the wearable during running (Curmi, Ferrario, & Whittle, 2014; • Displaying heart rate data or running pace to group members on the back of a t-shirt to facilitate group running (Mauriello, Gubbels, & Froehlich, 2014) Achievement motive Information on personal achievements and/ or competition with others ...
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Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.
... Exercise capacity is at best evaluated with a full Cardiopulmonary Exercise Test (CPET). Peak oxygen uptake upon maximal exercise (VO 2 peak) has been shown to be a significant predictor of life expectancy not only in CF patients but also in healthy population [22]. Even though CPET can provide valuable information regarding a patient's status, few CF centers worldwide implement exercise testing as a part of their routine CF evaluation [23,24]. ...
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Introduction: Cardio-Pulmonary Exercise Testing (CPET) has been recognized as a valuable method in assessing disease burden and exercise capacity among CF patients. Aim: To evaluate whether Pseudomonas aeruginosa colonization status affects Exercise Capacity, LCI and High-Resolution Computed Tomography (HRCT) indices among patients with CF; to check if Pseudomonas colonization can predict exercise intolerance. Subjects: Seventy-eight (78) children and adults with CF (31 males) mean (range) age 17.08 (6.75; 24.25) performed spirometry, Multiple Breath Washout (MBW) and CPET along with HRCT on the same day during their admission or follow up visit. Results: 78 CF patients (mean FEV1: 83.3% mean LCI: 10.9 and mean VO2 peak: 79.1%) were evaluated: 33 were chronically colonized with Pseudomonas aeruginosa, 24 were intermittently colonized whereas 21 were Pseudomonas free. Statistically significant differences were observed among the three groups in: peak oxygen uptake % predicted (VO2 peak% (p < 0.001), LCI (p < 0.001), as well as FEV1% (p < 0.001) and FVC% (p < 0.001). Pseudomonas colonization could predict VO2 peak% (p < 0.001, r2: -0.395). Conclusion: Exercise capacity as reflected by peak oxygen uptake is reduced in Pseudomonas colonized patients and reflects lung structural damages as shown on HRCT. Pseudomonas colonization could predict exercise limitation among CF patients.
... Accordingly, endurance training for higher cardiorespiratory fitness levels (measured during cardiopulmonary exercise testing and expressed as maximum rate of oxygen consumption (VO 2max )) is associated with numerous health benefits (e.g., longer lifespan, better quality of life, lower declination of functional and aerobic capacity, and reduced risks of allcause and cardiovascular mortality). 7,8 Partly for these reasons, endurance and ultraendurance races, as PA practices, have become very popular, and the number of participants has increased in recent times. 9 However, extreme and competitive endurance events involve a considerably higher level of exercise than is recommended by the official guidelines, without being associated with the benefits that moderate PA could lead to in health status. 10 Short, medium, and long-distance running races differ in terms of volume and intensity, can involve vigorous physical effort, and can generate changes in blood biomarkers caused by physiopathologic events. ...
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Background To finish an endurance race, athletes perform a vigorous effort that induces the release of cardiac damage markers. There are several factors that can affect the total number of these markers, so the aim of this review was to analyze the effect of endurance running races on cardiac damage markers and to identify the factors that modify the levels of segregation of these cardiac damage markers. Methods A systematic search of PubMed, Web of Science, and the Cochrane Library databases was performed. This analysis included studies where the acute effects of running races on cardiac damage markers (troponin I and troponin T) were analyzed, assessing the levels of these markers before and after the races. Results The effects of running races on troponin I (mean difference = 0.038 ng/mL) and troponin T (mean difference = 0.026 ng/mL) levels were significant. The ages (R² = 14.4%; p = 0.033) and body mass indexes (R² = 14.5%; p = 0.045) of the athletes had a significant interaction with troponin I. In addition, gender, mean speed, time to finish the race, and type of race can affect the level of cardiac damage markers. Conclusion Endurance running races induce the release of cardiac-damage markers that remain elevated for at least 24 h after the race. In addition, young male athletes with high body mass indexes who perform races combining long duration and moderate intensity (i.e., marathons) release the highest levels of cardiac damage markers. Physicians should take into consideration these results in the diagnosis and treatment of patients admitted to the hospital days after finishing endurance running races.
... A greater physical fitness relates to a better prognosis and (disability-free) life expectancy in many different cohorts of patients and in healthy individuals [30]). The physical fitness actually is prognostically more important than adiposity in obese individuals [31]. ...
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Although there is growing evidence on the importance of physical activity and exercise intervention after bariatric surgery, it remains to be clarified as to why and how post-operative exercise intervention should be implemented. In this narrative and practically oriented review, it is explained why exercise interventions and physical activity are important after bariatric surgery, how to prescribe exercise and monitor physical activity and how and when physical fitness, muscle strength, fat (-free) mass and bone mineral density could be assessed during follow-up. It is suggested that the inclusion of physical activity and exercise training in the clinical follow-up trajectory could be of great benefit to bariatric surgery patients, since it leads to greater improvements in body composition, bone mineral density, muscle strength and physical fitness.
... For every 10% decrease in VO 2max , there is a 15% increase in overall mortality [24]. CRF also predicts mortality in persons with chronic disease, including NAFLD [5,25,26]. The HUNT study demonstrated a 52% increased risk of all-cause mortality over a mean follow-up of 9.4 years in 15,781 NAFLD subjects with low CRF [5•]. ...
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Purpose of Review Nonalcoholic fatty liver disease (NAFLD) is a leading cause of global liver disease. Because current pharmacologic treatments are ineffective, lifestyle change centered on exercise remains the most effective NAFLD treatment. The aim of this systematic review is to summarize and evaluate the current evidence supporting the use of exercise training as a medical treatment for adult patients with NAFLD. Recent Findings At least 150 min each week of moderate intensity exercise of any type can improve NAFLD, both with and without modest weight loss. Exercise training reduces hepatic steatosis and liver inflammation, favorably changes body composition, improves vascular endothelial function, increases cardiorespiratory fitness, and can lead to histologic response. To date, exercise-based NAFLD trials are limited by small sample size and significant heterogeneity. Summary While several key questions remain unanswered, exercise training will always be an important part of the medical management of patients with NAFLD.
... The advantage of the Olympians over the general population may be interpreted in light of a selection effect. Recent studies have related fitness and genetic predisposition to greater longevity, and human performance has been shown to be a strong predictor of mortality [31][32][33]. Nonetheless, the differences found relating type of effort and cardiovascular longevity show that the physical activity practiced by elite athletes may actually play a major role on their lifespan, besides solely genetic background or healthy lifestyle [34,35], commonly put forward to explain the athletes' survival advantage. ...
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To quantify the years of life saved from cardiovascular (CVD), cancer and overall deaths among elite athletes according to their main type of physiological effort performed in the Olympic Games. All French athletes participating in the Games from 1912 to 2012, with vital status validated and cause of death (if concerned) identified by the national registries were included (n = 2814, 455 died) and classified according to 6 groups of effort: POWER (continuous effort < 45 s); INTERMEDIATE (45 s ≤ continuous effort < 600 s); ENDURANCE (continuous effort ≥ 600 s); POLYVALENT (participating in different events entering different classifications), INTERMITTENT (intermittent effort, i.e. team sports); PRECISION (targeting events). The theoretical years-lost method was adapted to calculate gains in longevity (years-saved) according to specific-risks under the competing risks model and was implemented in R software. Considering overall-deaths, all groups significantly saved, on average, 6.5 years of life (95% CI 5.8–7.2) compared to the general population. This longevity advantage is mainly driven by a lower risk of cancer which, isolated, contributed to significantly save 2.3 years of life (95% CI 1.2–1.9) on average in each group. The risk of CVD-related mortality in the ENDURANCE and PRECISION groups is not significantly different from the general population. The other groups significantly saved, on average, 1.6 years of life (95% CI 1.2–1.9) from CVD death. The longevity benefits in elite athletes are associated with the type of effort performed during their career, mainly due to differences on the CVD-risk of death.
... The Cooper test was performed by running on a treadmill (Precor 966i, USA) for 12 min, and VO2max was calculated from the distance covered by running in this period of time (Tanaka et al 2000). According to the calculated VO2max expressed as ml/kg/min, the subjects were assigned to one of 5 categories of physical fitness (Strasser 2018): ...
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Purpose The effects of aerobic exercise on bone metabolism are still unclear. Thus, the main goal of this study was to explore if there was an effect of the short-term aerobic exercise program on the bone remodeling process and if there were sex differences in the effect of the training program on bone metabolism. Methods Twenty-one participants (men and women) aged 20–23 performed an 8-week aerobic exercise program three times per week in 1-h sessions with increases in the exercise load every 2 weeks. Bone density, bone mineral content and concentration of markers of bone metabolism: osteocalcin, C-terminal procollagen type I peptide, pyridinoline, parathyroid hormone, osteoprotegerin, and the receptor activator of nuclear kappa B ligand by ELISA were measured at the start and at the end of the study, while changes in body composition were assessed by a bioelectric impedance analysis method 6 times during the study. Results The aerobic exercise program increased the concentration of osteocalcin (11.34 vs 14.24 ng/ml), pyridinoline (67.51 vs 73.99 nmol/l), and the receptor activator of nuclear kappa B ligand (95.122 vs 158.15 pg/ml). A statistically significant increase in bone density at neck mean (1.122 vs 1.176 g/cm³) and in bone mineral content at dual femur (33.485 vs 33.700 g) was found in women, while there was no statistically significant change at any site in men. Conclusion 8 weeks of the aerobic exercise program with increment in intensity increased some of bone remodeling biomarkers and showed different effects for men and women.
... It is important to recognise the integrative pathophysiological processes following COVID-19 infection and subsequent long-COVID. Cardiorespiratory fitness is a key predictor of functional capacity, quality of life, and a strong predictor of mortality [73,74]. Aerobic capacity, quantified by maximal oxygen consumption (VO 2peak ), and ventilatory efficiency, is quantified by the minute ventilation/carbon dioxide production (VE/VCO 2 ) slope, are two established measures obtained through cardio-pulmonary exercise testing and several initial studies to date have reported the impact of COVID-19 on both [75]. ...
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... Aerobic training improves body composition, the functioning of the cardiovascular system, the cardiovascular lipid profile and insulin sensitivity 3 . Importantly, aerobic training increases aerobic fitness (VO2max) 3 , which is an independent predictor of health and protects against a range of chronic conditions including type 2 diabetes and cardiovascular disease 4 . Resistance training increases total muscle mass, muscle strength and power, neuromuscular firing rate 5 and recruitment and functioning of the fast twitch type 2 fibers which deteriorate with age 6 . ...
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Middle-aged (50-64yrs) and older adults (65-90yrs) in Laois predominantly undertook sufficient aerobic activities to improve health, but most did not meet the guidelines for resistance, balance or flexibility training. Thus, educating middle-aged and older adults on the benefits of multimodal PA and providing enjoyable opportunities for both populations within the community that focus on social inclusion is required.
... In the exercise physiology literature, two objective measures include maximal aerobic capacity V O 2max and aerobic economy [26,27].V O 2max represents the maximal amount of oxygen that can be consumed during exhaustive exercise, where a higherV O 2max is indicative of greater cardiorespiratory fitness. Aerobic economy represents the steady-state energy requirement of exercise conducted at a constant exercise intensity (e.g., running at a constant velocity). ...
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Objectives: Researchers have begun delivering mindfulness and aerobic exercise training concurrently on the premise that a combination intervention will yield salutary outcomes over and above each intervention alone. An estimate of the effect of combination training on chronic psychosocial stress in a nonclinical population has not been established. The objective of this study was to establish protocol feasibility in preparation of a definitive RCT targeting healthy individuals, and to explore the preliminary effect of combination training on reducing chronic psychosocial stress in this population. Methods: Twenty-four participants were allocated to a single-arm pre-post study and subjected to 16 weeks of concurrent mindfulness psychoeducation and aerobic exercise training. Feasibility criteria were collected and evaluated. Within-group changes in chronic psychosocial stress, mindfulness, emotion regulation, and cardiorespiratory fitness were also assessed. Primary analyses were based on 17 participants. Results: Retention rate, response rate, recruitment rate, and sample size analyses indicate a definitive trial is feasible for detecting most effects with precision. There was also a decline in our primary dependent measure of chronic psychosocial stress (dpretest = -0.56, 95% CI [ -1.14,-0.06]). With regard to secondary measures, there was an increase in the use of cognitive reappraisal, and a reduction in use of maladaptive emotion regulation strategies. We are insufficiently confident to comment on changes in mindfulness and aerobic capacity [Formula: see text]. However, there were subgroup improvements in aerobic economy at submaximal exercise intensities. Conclusions: We recommend a definitive trial is feasible and should proceed. Trial registration: ANZCTR (ID: ACTRN12619001726145 ). Retrospectively registered December 9, 2019.
... Indeed, even short distance travel by walking and cycling (less than 3 km) [20], shows little evidence to the effectiveness of active transport interventions for reducing obesity [21]. Higher relative VO2max values are associated with greater life expectancy [22]. ...
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The natural aging process is carried out by a progressive loss of homeostasis leading to a functional decline in cells and tissues. The accumulation of these changes stem from a multifactorial process on which both external (environmental and social) and internal (genetic and biological) risk factors contribute to the development of adult chronic diseases, including type 2 diabetes mellitus (T2D). Strategies that can slow cellular aging include changes in diet, lifestyle and drugs that modulate intracellular signaling. Exercise is a promising lifestyle intervention that has shown antiaging effects by extending lifespan and healthspan through decreasing the nine hallmarks of aging and age-associated inflammation. Herein, we review the effects of exercise to attenuate aging from a clinical to a cellular level, listing its effects upon various tissues and systems as well as its capacity to reverse many of the hallmarks of aging. Additionally, we suggest AMPK as a central regulator of the cellular effects of exercise due to its integrative effects in different tissues. These concepts are especially relevant in the setting of T2D, where cellular aging is accelerated and exercise can counteract these effects through the reviewed antiaging mechanisms.
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Zusammenfassung: Bergsport kann nahezu altersunabhängig zu allen Jahreszeiten in der einen oder anderen Form ausgeübt werden und zählt daher zu den beliebtesten sportlichen Tätigkeiten im Alpenraum. Allerdings stellt Bergsport auch relativ hohe Anforderungen an die individuelle Ausdauerleistungsfähigkeit, die durch regelmäßiges Training erreicht beziehungsweise aufrecht-erhalten werden kann. Im Vergleich zum Wandern in der Ebene ist bergauf gehen mit einem weit-aus größeren Energieaufwand verbunden, und zusätzlich ändern sich klimatische Bedingungen mit zunehmender Höhe markant. Um am Berg leistungsfähig zu bleiben und vorzeitige Ermüdung und damit verbundene Risiken zu vermeiden, kann durch eine adäquate Ernährung bedeutend unterstützt werden. Im Folgenden werden klimatische Bedingungen im Gebirge, Anforderungen an die individuelle Leistungsfähigkeit, sowie allgemeine und spezifische Stoffwechselgrundlagen als (hoffentlich) hilfreiche Basis für die Ernährungsgestaltung im Bergsport behandelt.
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We aimed to develop an artificial neural network (ANN) model to estimate the maximal oxygen uptake (VO2max) based on a multistage 10 m shuttle run test (SRT) in healthy adults. For ANN-based VO2max estimation, 118 healthy Korean adults (59 men and 59 women) in their twenties and fifties (38.3 ± 11.8 years, men aged 37.8 ± 12.1 years, and women aged 38.8 ± 11.6 years) participated in this study; data included age, sex, blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP)), waist circumference, hip circumference, waist-to-hip ratio (WHR), body composition (weight, height, body mass index (BMI), percent skeletal muscle, and percent body), 10 m SRT parameters (number of round trips and final speed), and VO2max by graded exercise test (GXT) using a treadmill. The best estimation results (R2 = 0.8206, adjusted R2 = 0.7010, root mean square error; RMSE = 3.1301) were obtained in case 3 (using age, sex, height, weight, BMI, waist circumference, hip circumference, WHR, SBP, DBP, number of round trips in 10 m SRT, and final speed in 10 m SRT), while the worst results (R2 = 0.7765, adjusted R2 = 0.7206, RMSE = 3.494) were obtained for case 1 (using age, sex, height, weight, BMI, number of round trips in 10 m SRT, and final speed in 10 m SRT). The estimation results of case 2 (using age, sex, height, weight, BMI, waist circumference, hip circumference, WHR, number of round trips in 10 m SRT, and final speed in 10 m SRT) were lower (R2 = 0.7909, adjusted R2 = 0.7072, RMSE = 3.3798) than those of case 3 and higher than those of case 1. However, all cases showed high performance (R2) in the estimation results. This brief report developed an ANN-based estimation model to predict the VO2max of healthy adults, and the model’s performance was confirmed to be excellent.
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Background: Transcripts from non-coding repetitive elements (RE) in the genome may be involved in aging. However, they are often ignored in transcriptome studies on healthspan and lifespan, and their role in healthy aging interventions has not been characterized. Methods: We analyze RE in RNA-seq datasets from mice subjected to robust healthspan- and lifespan-increasing interventions including calorie restriction, rapamycin, acarbose, 17-⍺-estradiol, and Protandim. We also examine RE transcripts in long-lived transgenic mice, and in mice subjected to a high-fat diet, and we use RNA-seq to investigate the influence of aerobic exercise on RE transcripts with aging in humans. Results: We find that: 1) healthy aging interventions/behaviors globally reduce RE transcripts, whereas aging and a high-fat diet increase RE expression; and 2) reduced RE expression with healthy aging interventions is associated with biological/physiological processes mechanistically linked with aging. Conclusions: RE transcript dysregulation and suppression are likely novel mechanisms underlying aging and healthy aging interventions, respectively.
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Regular physical exercise and a healthy diet are major determinants of a healthy lifespan. Although aging is associated with declining endurance performance and muscle function, these components can favorably be modified by regular physical activity and especially by exercise training at all ages in both sexes. In addition, age-related changes in body composition and metabolism, which affect even highly trained masters athletes, can in part be compensated for by higher exercise metabolic efficiency in active individuals. Accordingly, masters athletes are often considered as a role model for healthy aging and their physical capacities are an impressive example of what is possible in aging individuals. In the present review, we first discuss physiological changes, performance and trainability of older athletes with a focus on sex differences. Second, we describe the most important hormonal alterations occurring during aging pertaining regulation of appetite, glucose homeostasis and energy expenditure and the modulatory role of exercise training. The third part highlights nutritional aspects that may support health and physical performance for older athletes. Key nutrition-related concerns include the need for adequate energy and protein intake for preventing low bone and muscle mass and a higher demand for specific nutrients (e.g., vitamin D and probiotics) that may reduce the infection burden in masters athletes. Fourth, we present important research findings on the association between exercise, nutrition and the microbiota, which represents a rapidly developing field in sports nutrition.
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Un des enjeux majeurs nationaux de santé publique se joue à l'école primaire. Pratiquer tous les jours, dedans ou dehors, reste un objectif recommandé par les autorités de santé, pour enrayer les effets délétères de la sédentarité. Si les habitudes d'activité physique (AP) chez les adolescents et jeunes adultes sont documentés, celles concernant les enfants en école primaire restent encore mal connues. Quelques rares études mentionnent une baisse continue de la quantité d'AP depuis la seconde moitié du 20ème siècle, concomitant à une dégradation de leur capacités cardiorespiratoires. Il en découle ainsi, chez les enfants, la question des relations entre sédentarité, AP et EPS à l'école primaire. Si l'école est parfois le seul lieu de pratique d'AP pour les enfants, des rapports parlementaires ont souligné l'insuffisance des horaires effectifs d'EPS au regard des programmes de l’Éducation Nationale et les contraintes inhérentes à l'EPS aux cycles 1, 2 et 3. Au-delà de ce premier constat, nous tentons d'apporter quelques pistes pédagogiques à l'intention des Professeurs des Écoles pour maximiser la durée d'activité réelle des élèves.
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We analyzed whether male Spanish elite soccer players live longer than the general population. Secondly, we compared their mortality with a cohort of soccer players who continued working as soccer elite coaches after retirement. Using age and calendar-date adjusted life tables, we analyzed the mortality hazard ratio of 1333 Spanish male players born before 1950, and who played in elite leagues from 1939, compared with the Spanish population. Using Cox proportional hazards model we compared their mortality with a cohort of 413 players who continued as coaches. Players showed significantly lower mortality than the general population, but this advantage decreased with advanced age, disappearing after 80 years. Coaches showed a similar pattern. Comparing players versus coaches, date of birth and years as professional were associated with survival, but debut age and player position were not. Unadjusted median survival time was 79.81 years (IQR 72.37–85.19) for players and 81.8 years (IQR 74.55–86.73) for coaches. Kaplan-Meier estimator adjusted for covariables showed no difference between cohorts (p=0.254). In conclusion, former Spanish male players showed lower mortality than the general population, but this effect disappeared after 80 years of age. Continuing their career as coaches after retirement from playing did not confer major benefits.
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Reduced exercise capacity and impaired physical performance are observed in nearly all patients with liver cirrhosis. Physical activity and exercise are physiological anabolic stimuli that can reverse dysregulated protein homeostasis or proteostasis and potentially increase muscle mass and contractile function in healthy subjects. Cirrhosis is a state of anabolic resistance and unlike the beneficial responses to exercise reported in physiological states, there are few systematic studies evaluating the response to exercise in cirrhosis. Hyperammonemia is a mediator of the liver-muscle axis with net skeletal muscle ammonia uptake in cirrhosis causing signaling perturbations, mitochondrial dysfunction with decreased ATP content, modifications of contractile proteins and impaired ribosomal function, all of which contribute to anabolic resistance in cirrhosis and have the potential to impair the beneficial responses to exercise. English language publications in peer reviewed journals that specifically evaluated the impact of exercise in cirrhosis were reviewed. Most studies evaluated responses to endurance exercise and readouts included peak or maximum oxygen utilization, grip strength, and functional capacity. Endurance exercise for up to 12 weeks is clinically tolerated in well-compensated cirrhosis. Data on the safety of resistance exercise is conflicting. Nutritional supplements enhance the benefits of exercise in healthy subjects but have not been evaluated in cirrhosis. Whether the beneficial physiological responses with endurance exercise and increase in muscle mass with resistance exercise that occur in healthy subjects also occur in cirrhotics is not known. Specific organ-system responses, changes in body composition, or improved long-term clinical outcomes with exercise in cirrhosis need evaluation.
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Cardiorespiratory fitness, as assessed through peak oxygen uptake (VO2peak), is a powerful health indicator. We aimed to evaluate the influence of several candidate causal genetic variants on VO2peak level in untrained Han Chinese people. A total of 1009 participants (566 women; age [mean ± SD] 40 ± 14 years, VO2peak 29.9 ± 7.1 mL/kg/min) performed a maximal incremental cycling test for VO2peak determination. Genomic DNA was extracted from peripheral whole blood, and genotyping analysis was performed on 125 gene variants. Using age, sex, and body mass as covariates, and setting a stringent threshold p-value of 0.0004, only one single nucleotide polymorphism (SNP), located in the gene encoding angiotensin-converting enzyme (rs4295), was associated with VO2peak (β = 0.87; p < 2.9 × 10−4). Stepwise multiple regression analysis identified a panel of three SNPs (rs4295 = 1.1%, angiotensin II receptor type 1 rs275652 = 0.6%, and myostatin rs7570532 = 0.5%) that together accounted for 2.2% (p = 0.0007) of the interindividual variance in VO2peak. Participants carrying six ‘favorable’ alleles had a higher VO2peak (32.3 ± 8.1 mL/kg/min) than those carrying only one favorable allele (24.6 ± 5.2 mL/kg/min, p < 0.0001). In summary, VO2peak at the pre-trained state is partly influenced by several polymorphic variations in candidate genes, but they represent a minor portion of the variance.
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Transcripts from non-coding repetitive elements (RE) in the genome may be involved in aging. However, they are often ignored in transcriptome studies on healthspan and lifespan, and their role in healthy aging interventions has not been characterized. Here, we analyze RE in RNA-seq datasets from mice subjected to robust healthspan- and lifespan-increasing interventions including calorie restriction, rapamycin, acarbose, 17-α-estradiol, and Protandim. We also examine RE transcripts in long-lived transgenic mice, and in mice subjected to high-fat diet, and we use RNA-seq to investigate the influence of aerobic exercise on RE transcripts with aging in humans. We find that: 1) healthy aging interventions/behaviors globally reduce RE transcripts, whereas aging and age-accelerating treatments increase RE expression; and 2) reduced RE expression with healthy aging interventions is associated with biological/physiological processes mechanistically linked with aging. Thus, RE transcript dysregulation and suppression are likely novel mechanisms underlying aging and healthy aging interventions, respectively.
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PurposeTo examine the influence of post-exercise protein feeding upon the adaptive response to endurance exercise training.Methods In a randomised parallel group design, 25 healthy men and women completed 6 weeks of endurance exercise training by running on a treadmill for 30–60 min at 70–75% maximal oxygen uptake (VO2max) 4 times/week. Participants ingested 1.6 g per kilogram of body mass (g kg BM−1) of carbohydrate (CHO) or an isocaloric carbohydrate–protein solution (CHO-P; 0.8 g carbohydrate kg BM−1 + 0.8 g protein kg BM−1) immediately and 1 h post-exercise. Expired gas, blood and muscle biopsy samples were taken at baseline and follow-up.ResultsExercise training improved VO2max in both groups (p ≤ 0.001), but this increment was not different between groups either in absolute terms or relative to body mass (0.2 ± 0.2 L min−1 and 3.0 ± 2 mL kg−1 min−1, respectively). No change occurred in plasma albumin concentration from baseline to follow-up with CHO-P (4.18 ± 0.18 to 4.23 ± 0.17 g dL−1) or CHO (4.17 ± 0.17 to 4.12 ± 0.22 g dL−1; interaction: p > 0.05). Mechanistic target of rapamycin (mTOR) gene expression was up-regulated in CHO-P (+ 46%; p = 0.025) relative to CHO (+ 4%) following exercise training.Conclusion Post-exercise protein supplementation up-regulated the expression of mTOR in skeletal muscle over 6 weeks of endurance exercise training. However, the magnitude of improvement in VO2max was similar between groups.
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The main purpose of this study was to explore similarities and differences in the association between two capabilities affecting the cardiorespiratory system (overall and multifactorial cardiorespiratory fitness and inspiratory muscle strength) and the health-related quality of life (HRQoL), in a group of active healthy seniors. Sixty-five individuals (age, 73.01 ± 5.27 years; 53 women) who participated regularly in a multicomponent training program completed the EuroQol 5D-5L questionnaire, the 6-min walking test (6MWT), and the maximum inspiratory pressure test (MIP). Non-parametric correlations (Spearman's rho) were conducted to analyze the association between HRQoL indices (EQindex and EQvas), MIP, and 6MWT, considering both, the whole sample and men and women separately. Furthermore, partial correlation was made by controlling age and sex. We found a moderate association between HRQoL and cardiorespiratory fitness (EQvas: r = 0.324, p = 0.009; EQindex: r = 0.312, p = 0.011). Considering sex, relationship EQvas-6MWT decrease to small ( r = 0.275; p = 0.028) whereas EQindex-6MWT remained moderated ( r = 0.425; p = 0.000). When we considered women and men separately, the association between HRQoL and 6MWT appeared only in women, while the observed strong trend ( p = 0.051) toward a large and positive association between EQindex and MIP, mediated by the covariate age, appeared only in men. Conversely to the cardiorespiratory fitness, MIP is not a limiting factor of HRQoL in healthy active elderly. Moreover, MIP and HRQoL should be included in the assessment of exercise interventions because they provide different information about the cardiorespiratory system deterioration. Similarly, EQvas and EQindex confirm to be complementary in the assessment of HRQoL. Furthermore, like aging process is different for men and women, the association between MIP and cardiorespiratory fitness with HRQoL may behave differently, so keeping on research these associations could help to improve training programs for this population.
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Background International evidence-based guidelines recommend physical exercise to form part of standard care for all cancer survivors. However, at present, the optimum exercise intensity is unclear. Therefore, we aimed to evaluate the effectiveness of a high intensity (HI) and low-to-moderate intensity (LMI) resistance and endurance exercise program compared with a wait list control (WLC) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment, including chemotherapy. Methods Overall, 277 cancer survivors were randomized to 12 weeks of HI exercise (n = 91), LMI exercise (n = 95), or WLC (n = 91). Both interventions were identical with respect to exercise type, duration and frequency, and only differed in intensity. Measurements were performed at baseline (4–6 weeks after primary treatment) and post-intervention. The primary outcomes were cardiorespiratory fitness (peakVO2), muscle strength (grip strength and 30-second chair-stand test), and self-reported fatigue (Multidimensional Fatigue Inventory; MFI). Secondary outcomes included health-related quality of life, physical activity, daily functioning, body composition, mood, and sleep disturbances. Multilevel linear regression analyses were performed to estimate intervention effects using an intention-to-treat principle. Results In the HI and LMI groups, 74 % and 70 % of the participants attended more than 80 % of the prescribed exercise sessions, respectively (P = 0.53). HI (β = 2.2; 95 % CI, 1.2–3.1) and LMI (β = 1.3; 95 % CI, 0.3–2.3) exercise showed significantly larger improvements in peakVO2 compared to WLC. Improvements in peakVO2 were larger for HI than LMI exercise (β = 0.9; 95 % CI, −0.1 to 1.9), but the difference was not statistically significant (P = 0.08). No intervention effects were found for grip strength and the 30-second chair-stand test. HI and LMI exercise significantly reduced general and physical fatigue and reduced activity (MFI subscales) compared to WLC, with no significant differences between both interventions. Finally, compared to WLC, we found benefits in global quality of life and anxiety after HI exercise, improved physical functioning after HI and LMI exercise, and less problems at work after LMI exercise. Conclusions Shortly after completion of cancer treatment, both HI and LMI exercise were safe and effective. There may be a dose–response relationship between exercise intensity and peakVO2, favoring HI exercise. HI and LMI exercise were equally effective in reducing general and physical fatigue. Trial registration This study was registered at the Netherlands Trial Register [NTR2153] on the 5th of January 2010.
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Background Reduced muscular strength in the old age is strongly related to activity impairment and mortality. However, studies evaluating the gender-specific association between muscularity and mortality among older adults are lacking. Thus, the objective of the present study was to examine gender differences in the association between muscular strength and mortality in a prospective population-based cohort study. Methods Data used in this study derived from the Cooperative Health Research in the Region of Augsburg (KORA)-Age Study. The present analysis includes 1,066 individuals (mean age 76 ± 11 SD years) followed up over 3 years. Handgrip strength was measured using the Jamar Dynamometer. A Cox proportional hazard model was used to determine adjusted hazard ratios of mortality with 95% confidence intervals (95% CI) for handgrip strength. Potential confounders (i.e. age, nutritional status, number of prescribed drugs, diseases and level of physical activity) were pre-selected according to evidence-based information. ResultsDuring the follow-up period, 56 men (11%) and 39 women (7%) died. Age-adjusted mortality rates per 1,000 person years (95% CI) were 77 (59–106), 24 (13–41) and 14 (7–30) for men and 57 (39–81), 14 (7–27) and 1 (0–19) for women for the first, second and third sex-specific tertile of muscular strength, respectively. Low handgrip strength was significantly associated with all-cause mortality among older men and women from the general population after controlling for significant confounders. Hazard ratios (95% CI) comparing the first and second tertile to the third tertle were 3.33 (1.53–7.22) and 1.42 (0.61-3.28), respectively. Respective hazard ratios (95% CI) for mortality were higher in women than in men ((5.23 (0.67–40.91) and 2.17 (0.27–17.68) versus 2.36 (0.97–5.75) and 0.97 (0.36–2.57)). Conclusions Grip strength is inversely associated with mortality risk in older adults, and this association is independent of age, nutritional status, number of prescribed drugs, number of chronic diseases and level of physical activity. The association between muscular strength and all-cause mortality tended to be stronger in women. It seems to be particularly important for the weakest to enhance their levels of muscular strength in order to reduce the risk of dying early.
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Background: Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications. Methods: Patients with operable lung cancer were randomly assigned to usual care (UC, N=77) or preoperative rehabilitation based on HIIT (Rehab, N=74). Maximal cardiopulmonary exercise testing and the six-minute walk test were performed twice before surgery. The primary outcome measure was a composite of death and in-hospital postoperative complications. Results: Groups were well balanced in terms of patient characteristics. During the preoperative waiting period (median 25 days), the peak oxygen consumption (peakVO2) and the six-minute walking distance increased (respectively, median +15 % [IQ 25-75%, +9 to +22%] P=0.003 and +15% [IQ25-75, +8 to +28%], P<0.001) in the Rehab group whereas VO2peak declined in the UC group (median -8% [IQ25-75, -16 to 0%], P=0.005). The primary endpoint did not differ significantly between the two groups: 27 of the 74 patients (35.5%) in the Rehab group and 39 of 77 patients (50.6%) in the UC group developed at least one postoperative complication (P=0.080). Noteworthy, the incidence of pulmonary complications was lower in the Rehab compared with the UC group (23% vs 44%, P=0.018), owing to a significant reduction in atelectasis (12.2% vs 36.4%, P<0.001) and this was accompanied by a shorter length of stay in the postanesthesia care unit (median -7 hours, IQ25-75% -4 to -10). Conclusions: In this RCT, preoperative HIIT resulted in significant improvement in aerobic performances but failed to reduce early complications after lung cancer resection.
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Few studies have investigated long-term changes in cardiorespiratory fitness (CRF), defined by indirect measures of CRF, and all-cause mortality. We aimed to investigate whether long-term change in CRF, as assessed by the gold standard method of respiratory gas exchange during exercise, is associated with all-cause mortality. A population-based sample of 579 men aged 42 to 60 years with no missing data at baseline examination (V1) and at reexamination at 11 years (V2) were included. Maximal oxygen uptake (VO2max) was measured at both visits using respiratory gas exchange during maximal exercise testing, and the difference (ΔVO2max) was calculated as VO2max (V2) − VO2max (V1). Deaths were ascertained annually using national death certificates during 15 years of follow-up after V2. The mean ΔVO2max was −5.2 mL/min*kg. During median follow-up of 13.3 years (interquartile range, 12.5-14.0 years), 123 deaths (21.2%) were recorded. In a multivariate analysis adjusted for baseline age, VO2max, systolic blood pressure, smoking status, low- and high-density lipoprotein cholesterol and triglyceride levels, C-reactive protein level, body mass index, alcohol consumption, physical activity, socioeconomic status, and history of type 2 diabetes mellitus and ischemic heart disease, a 1 mL/min*kg higher ΔVO2max was associated with a 9% relative risk reduction of all-cause mortality (hazard ratio, 0.91; 95% CI, 0.87-0.95). This study suggested that in this population, long-term CRF reduction was associated with an increased risk of mortality, emphasizing the importance of maintaining good CRF over the decades.
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Background: Considerable debate continues to surround the concept of mitochondrial dysfunction in aging muscle. We tested the overall hypothesis that age per se does not influence mitochondrial function and markers of mitochondria quality control, that is, expression of fusion, fission, and autophagy proteins. We also investigated the influence of cardiorespiratory fitness (VO2max) and adiposity (body mass index) on these associations. Methods: Percutaneous biopsies of the vastus lateralis were obtained from sedentary young (n = 14, 24±3 years), middle-aged (n = 24, 41±9 years) and older adults (n = 20, 78±5 years). A physically active group of young adults (n = 10, 27±5 years) was studied as a control. Mitochondrial respiration was determined in saponin permeabilized fiber bundles. Fusion, fission and autophagy protein expression was determined by Western blot. Cardiorespiratory fitness was determined by a graded exercise test. Results: Mitochondrial respiratory capacity and expression of fusion (OPA1 and MFN2) and fission (FIS1) proteins were not different among sedentary groups despite a wide age range (21 to 88 years). Mitochondrial respiratory capacity and fusion and fission proteins were, however, negatively associated with body mass index, and mitochondrial respiratory capacity was positively associated with cardiorespiratory fitness. The young active group had higher respiration, complex I and II respiratory control ratios, and expression of fusion and fission proteins. Finally, the expression of fusion, fission, and autophagy proteins were linked with mitochondrial respiration. Conclusions: Mitochondrial respiration and markers of mitochondrial dynamics (fusion and fission) are not associated with chronological age per se, but rather are more strongly associated with body mass index and cardiorespiratory fitness.
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Purpose Following colorectal cancer diagnosis and anti-cancer therapy, declines in cardiorespiratory fitness and body composition lead to significant increases in morbidity and mortality. There is increasing interest within the field of exercise oncology surrounding potential strategies to remediate these adverse outcomes. This study compared 4 weeks of moderate-intensity exercise (MIE) and high-intensity exercise (HIE) training on peak oxygen consumption (V̇O2peak) and body composition in colorectal cancer survivors. Methods Forty seven post-treatment colorectal cancer survivors (HIE = 27 months post-treatment; MIE = 38 months post-treatment) were randomised to either HIE [85–95 % peak heart rate (HRpeak)] or MIE (70 % HRpeak) in equivalence with current physical activity guidelines and completed 12 training sessions over 4 weeks. Results HIE was superior to MIE in improving absolute (p = 0.016) and relative (p = 0.021) V̇O2peak. Absolute (+0.28 L.min−1, p < 0.001) and relative (+3.5 ml.kg−1.min−1, p < 0.001) V̇O2 peak were increased in the HIE group but not the MIE group following training. HIE led to significant increases in lean mass (+0.72 kg, p = 0.002) and decreases in fat mass (−0.74 kg, p < 0.001) and fat percentage (−1.0 %, p < 0.001), whereas no changes were observed for the MIE group. There were no severe adverse events. Conclusions In response to short-term training, HIE is a safe, feasible and efficacious intervention that offers clinically meaningful improvements in cardiorespiratory fitness and body composition for colorectal cancer survivors. Implications for Cancer Survivors HIE appears to offer superior improvements in cardiorespiratory fitness and body composition in comparison to current physical activity recommendations for colorectal cancer survivors and therefore may be an effective clinical utility following treatment.
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Muscular strength, an important component of physical fitness, has an independent role in the prevention of chronic diseases whereas muscular weakness is strongly related to functional limitations and physical disability. Our purpose was to investigate the role of muscular strength as a predictor of mortality in health and disease. We conducted a systematic search in EMBASE and MEDLINE (1980-2014) looking for the association between muscular strength and mortality risk (all-cause and cause-specific mortality). Selected publications included 23 papers (15 epidemiological and 8 clinical studies). Muscular strength was inversely and independently associated with all-cause mortality even after adjusting for several confounders including the levels of physical activity or even cardiorespiratory fitness. The same pattern was observed for cardiovascular mortality; however more research is needed due to the few available data. The existed studies failed to show that low muscular strength is predictive of cancer mortality. Furthermore, a strong and inverse association of muscular strength with all-cause mortality has also been confirmed in several clinical populations such as cardiovascular disease, peripheral artery disease, cancer, renal failure, chronic obstructive pulmonary disease, rheumatoid arthritis and patients with critical illness. However, future studies are needed to further establish the current evidence and to explore the exact independent mechanisms of muscular strength in relation to mortality. Muscular strength as a modifiable risk factor would be of great interest from a public health perspective. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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Background: Mortality risk decreases beyond a certain fitness level. However, precise definition of this threshold is elusive and varies with age. Thus, fitness-related mortality risk assessment is difficult. Methods and results: We studied 18 102 male veterans (8305 blacks and 8746 whites). All completed an exercise test between 1986 and 2011 with no evidence of ischemia. We defined the peak metabolic equivalents (METs) level associated with no increase in all-cause mortality risk (hazard ratio, 1.0) for the age categories of <50, 50 to 59, 60 to 69, and ≥70 years. We used this as the threshold group to form additional age-specific fitness categories based on METs achieved below and above it: least-fit (>2 METs below threshold; n=1692), low-fit (2 METs below threshold; n=4884), moderate-fit (2 METs above threshold; n=4646), fit (2.1-4 METs above threshold; n=1874), and high-fit (>4 METs above threshold; n=1301) categories. Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality across fitness categories. During follow-up (median=10.8 years), 5102 individuals died. Mortality risk for the cohort and each age category increased for the least-fit and low-fit categories (HR, 1.51; 95% CI, 1.37-1.66; and HR, 1.21; 95% CI, 1.12-1.30, respectively) and decreased for the moderate-fit; fit and high-fit categories (HR, 0.71; 95% CI, 0.65-0.78; HR, 0.63; 95% CI, 0.56-0.78; and HR, 0.49; 95% CI, 0.41-0.58, respectively). The trends were similar for 5- and 10-year mortality risk. Conclusion: We defined age-specific exercise capacity thresholds to guide assessment of mortality risk in individuals undergoing a clinical exercise test.
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Purpose: The aim of this work was to investigate cardiorespiratory fitness in breast cancer patients at different time points of anti-cancer treatment. Patients and methods: Non-metastatic breast cancer patients (n = 222, mean age 55 years) were categorized into four subgroups according to their treatment status. Cardiopulmonary exercise testing (CPET) was used to measure patients' cardiorespiratory fitness, including oxygen delivery and metabolic muscle function. Testing was performed by bicycle ergometry, and maximal oxygen uptake (VO2peak) was measured. Heart rate during exercise at 50 watts (HR50) was assessed as a cardiocirculatory parameter and ventilatory threshold (VT) was used as an indicator of the O2 supply to muscle. Analysis of covariance was used to estimate the impact of different cancer treatments on cardiorespiratory fitness with adjustment for clinical factors. Results: Submaximal measures were successfully assessed in 220 (99%) and 200 (90%) patients for HR50 and VT, while criteria for maximal exercise testing were met by 176 patients (79%), respectively. The mean VO2peak was 20.6 ± 6.7 ml/kg/min, mean VT 10.7 ± 2.9 ml/min/kg and mean HR50 112 ± 16 beats/min. Chemotherapy was significantly associated with decreased VO2peak, with significantly lower adjusted mean VO2peak among patients post adjuvant chemotherapy compared to patients with no chemotherapy or those who just started chemotherapy regime (all p < 0.01). Patients post adjuvant chemotherapy reached only 63% of the VO2peak level expected for their age- and BMI-category (mean VO2peak 15.5 ± 4.8 ml/kg/min). Similarly, HR50 was significantly associated with treatment. However, VT was not associated with treatment. Conclusion: Breast cancer patients have marked and significantly impaired cardiopulmonary function during and after chemotherapy. Hereby, chemotherapy appears to impair cardiorespiratory fitness by influencing the oxygen delivery system rather than impacting metabolic muscle function. Our findings underline the need of exercise training in breast cancer patients to counteract the loss of cardiorespiratory fitness during the anti-cancer treatment.
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Muscle wasting and cachexia are the ultimate consequence of aging and a variety of acute and chronic illnesses. Significant efforts are made by many stakeholders to develop effective therapies. An important aspect of successful therapeutic development research is a common nomenclature for effective communication between researchers and clinicians, to the public, and also with regulatory bodies. Despite several efforts to develop consensus definitions for cachexia and sarcopenia, including such new terms for muscle wasting as myopenia, a common conceptual approach and acceptable vocabulary and classification system are yet to be established. Notwithstanding the potential need to translate such disease definitions and terminologies into different languages, we advocate the use of the term "muscle wasting" as the unifying entity that represents the single most common disease process across a large spectrum of cachexia and in sarcopenia-associated disorders. In this paper, we outline a first proposal for the disease nomenclature and classification of "Muscle Wasting Diseases." This concept can be applied in acute and chronic disease settings. It is pertinent for wasting diseases, cachexia, and sarcopenia of any severity and due to any underlying illness. The concept of muscle wasting disease underscores the most common denominator of the underlying wasting processes, i.e., muscle wasting, without ignoring the advanced disease states that are also accompanied by fat tissue wasting. The term muscle wasting disease is easily understood by both the scientific community and the lay public. This may promote its general use and efforts to heighten education and awareness in the field.
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BACKGROUND: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
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To systematically evaluate the effects of physical activity in adult patients after completion of main treatment related to cancer. Meta-analysis of randomised controlled trials with data extraction and quality assessment performed independently by two researchers. Pubmed, CINAHL, and Google Scholar from the earliest possible year to September 2011. References from meta-analyses and reviews. Randomised controlled trials that assessed the effects of physical activity in adults who had completed their main cancer treatment, except hormonal treatment. There were 34 randomised controlled trials, of which 22 (65%) focused on patients with breast cancer, and 48 outcomes in our meta-analysis. Twenty two studies assessed aerobic exercise, and four also included resistance or strength training. The median duration of physical activity was 13 weeks (range 3-60 weeks). Most control groups were considered sedentary or were assigned no exercise. Based on studies on patients with breast cancer, physical activity was associated with improvements in insulin-like growth factor-I, bench press, leg press, fatigue, depression, and quality of life. When we combined studies on different types of cancer, we found significant improvements in body mass index (BMI), body weight, peak oxygen consumption, peak power output, distance walked in six minutes, right handgrip strength, and quality of life. Sources of study heterogeneity included age, study quality, study size, and type and duration of physical activity. Publication bias did not alter our conclusions. Physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancer other than breast cancer were also included, physical activity was associated with reduced BMI and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.
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The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.
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The time-course and mechanisms of adaptation of cardiorespiratory fitness were examined in 8 older (O) (68 +/- 7 yr old) and 8 young (Y) (23 +/- 5 yr old) men pretraining and at 3, 6, 9, and 12 wk of training. Training was performed on a cycle ergometer three times per week for 45 min at approximately 70% of maximal oxygen uptake (Vo(2 max)). Vo(2 max) increased within 3 wk with further increases observed posttraining in both O (+31%) and Y (+18%), (P < 0.05). Maximal cardiac output (Q(max), open-circuit acetylene) and stroke volume were higher in O and Y after 3 wk with further increases after 9 wk of training (P < 0.05). Maximal arterial-venous oxygen difference (a-vO(2 diff)) was higher at weeks 3 and 6 and posttraining compared with pretraining in O and Y (P < 0.05). In O, approximately 69% of the increase in Vo(2 max) from pre- to posttraining was explained by an increased Q(max) with the remaining approximately 31% explained by a widened a-vO(2 diff). This proportion of Q and a-vO(2 diff) contributions to the increase in Vo(2 max) was consistent throughout testing in O. In Y, 56% of the pre- to posttraining increase in Vo(2 max) was attributed to a greater Q(max) and 44% to a widened a-vO(2 diff). Early adaptations (first 3 wk) mainly relied on a widened maximal a-vO(2 diff) (approximately 66%) whereas further increases in Vo(2 max) were exclusively explained by a greater Q(max). In conclusion, with short-term training O and Y significantly increased their Vo(2 max); however, the proportion of Vo(2 max) increase explained by Q(max) and maximal a-vO(2 diff) throughout training showed a different pattern by age group.
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Background: Aging is associated with loss in both muscle mass and the metabolic quality of skeletal muscle. A major part of these changes is associated with an age-related decrease in the level of physical activity and may be counteracted by endurance training (ET) and resistance training (RT). Objective: Since both muscle strength and aerobic power decrease with age, we investigated what form of training might be best for improvements in physical performance in the elderly. In detail, we wanted to know whether systematic ET can augment muscle strength and/or whether systematic RT can augment the aerobic power of healthy elderly adults. Methods: Forty-two volunteers (32 women, 10 men) were recruited for the study and randomized into three groups: 13 persons undertook a continuous 6-month ET program, 15 undertook a continuous 6-month RT program and 14 served as a control group. All persons performed a cycling test to measure aerobic power (VO(2max)) and maximum workload (W(max)) before and after the training period. Maximum strength was determined from one repetition maximum (1-RM). Results: After 6 months of RT, maximum strength increased by an average of 15% for leg press (P < 0.01), 25% for bench press (P < 0.01) and 30% for bench pull (P < 0.001); ET showed no effect on maximum strength except for the 1-RM in bench pull. Aerobic power improved by 6% in the ET group and by 2.5% in the RT group, neither of which was significant. Maximum workload improved significantly by 31% in the ET group (P < 0.001) and by 6% in the RT group (P = 0.05). ET resulted in a significant 5.3% reduction of body fat (P < 0.05), whereas only RT increased lean body mass by 1.0 +/- 0.5 kg. Conclusion: RT leads to a genuine increase in lean body mass and muscle strength in healthy elderly adults and is therefore the best method for treatment of amyotrophia. ET appears to be the most efficacious training mode for maintaining and improving maximum aerobic power in the elderly and should be viewed as a complement to RT. The loading intensity to promote hypertrophy should approach 60-80% of 1-RM with an exercise volume ranging from 3 to 6 sets per muscle group per week of 10-15 repetitions per exercise. ET should be performed on two days per week controlled by a heart rate according to 60% of VO(2max) and an exercise volume ranging from 30 to 60 minutes per week.
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Exercise training reduces the symptoms of chronic heart failure. Which exercise intensity yields maximal beneficial adaptations is controversial. Furthermore, the incidence of chronic heart failure increases with advanced age; it has been reported that 88% and 49% of patients with a first diagnosis of chronic heart failure are >65 and >80 years old, respectively. Despite this, most previous studies have excluded patients with an age >70 years. Our objective was to compare training programs with moderate versus high exercise intensity with regard to variables associated with cardiovascular function and prognosis in patients with postinfarction heart failure. Twenty-seven patients with stable postinfarction heart failure who were undergoing optimal medical treatment, including beta-blockers and angiotensin-converting enzyme inhibitors (aged 75.5+/-11.1 years; left ventricular [LV] ejection fraction 29%; VO2peak 13 mL x kg(-1) x min(-1)) were randomized to either moderate continuous training (70% of highest measured heart rate, ie, peak heart rate) or aerobic interval training (95% of peak heart rate) 3 times per week for 12 weeks or to a control group that received standard advice regarding physical activity. VO2peak increased more with aerobic interval training than moderate continuous training (46% versus 14%, P<0.001) and was associated with reverse LV remodeling. LV end-diastolic and end-systolic volumes declined with aerobic interval training only, by 18% and 25%, respectively; LV ejection fraction increased 35%, and pro-brain natriuretic peptide decreased 40%. Improvement in brachial artery flow-mediated dilation (endothelial function) was greater with aerobic interval training, and mitochondrial function in lateral vastus muscle increased with aerobic interval training only. The MacNew global score for quality of life in cardiovascular disease increased in both exercise groups. No changes occurred in the control group. Exercise intensity was an important factor for reversing LV remodeling and improving aerobic capacity, endothelial function, and quality of life in patients with postinfarction heart failure. These findings may have important implications for exercise training in rehabilitation programs and future studies.
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Cardiorespiratory fitness (CRF) has been one of the most widely examined physiological variables, particularly as it relates to functional capacity and human performance. Over the past three decades, CRF has emerged as a strong, independent predictor of all-cause and disease-specific mortality. The evidence supporting the prognostic use of CRF is so powerful that the American Heart Association recently advocated for the routine assessment of CRF as a clinical vital sign. Interestingly, the continuity of evidence of the inverse relationship between CRF and mortality over the past decade exists despite a wide variation of methods used to assess CRF in these studies, ranging from the gold-standard method of directly measured maximal oxygen uptake (VO2max) during cardiopulmonary exercise testing to estimation from exercise tests and non-exercise prediction equations. This review highlights new knowledge and the primary advances since 2009, with specific reference to the impact variations in CRF have on all-cause and disease-specific mortality.
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In this review we argue that several key features of maximal oxygen uptake (VO2max) should underpin discussions about the biological and reductionist determinants of its inter-individual variability: 1) Training induced increases in VO2max are largely facilitated by expansion of red blood cell volume and an associated improvement in stroke volume, which also adapts independent of changes in red blood cell volume. These general concepts are also informed by cross sectional studies in athletes that have very high values for VO2max. Therefore, 2) variations in VO2max improvements with exercise training are also likely related to variations in these physiological determinants. 3) All previously untrained individuals will respond to endurance exercise training in terms of improvements in VO2max provided the stimulus exceeds a certain volume and/or intensity. Thus genetic analysis and/or reductionist studies performed to understand or predict such variations might focus specifically on DNA variants or other molecular phenomena of relevance to these physiological pathways. This article is protected by copyright. All rights reserved.
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Objective: Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality. Methods: Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis. Results: Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04). Conclusion: Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.
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Exercise training enhances physical performance and confers health benefits, largely through adaptations in skeletal muscle. Mitochondrial adaptation, encompassing coordinated improvements in quantity (content) and quality (structure and function), is increasingly recognized as a key factor in the beneficial outcomes of exercise training. Exercise training has long been known to promote mitochondrial biogenesis, but recent work has demonstrated that it has a profound impact on mitochondrial dynamics (fusion and fission) and clearance (mitophagy), as well. In this review, we discuss the various mechanisms through which exercise training promotes mitochondrial quantity and quality in skeletal muscle.—Drake, J. C., Wilson, R. J., Yan, Z. Molecular mechanisms for mitochondrial adaptation to exercise training in skeletal muscle. FASEB J. 30, 000–000 (2016). www.fasebj.org
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Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.
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Background Although running is a popular leisure-time physical activity, little is known about the long-term effects of running on mortality. The dose-response relations between running, as well as the change in running behaviors over time, and mortality remain uncertain. Objectives We examined the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, 18 to 100 years of age (mean age 44 years). Methods Running was assessed on a medical history questionnaire by leisure-time activity. Results During a mean follow-up of 15 years, 3,413 all-cause and 1,217 cardiovascular deaths occurred. Approximately 24% of adults participated in running in this population. Compared with nonrunners, runners had 30% and 45% lower adjusted risks of all-cause and cardiovascular mortality, respectively, with a 3-year life expectancy benefit. In dose-response analyses, the mortality benefits in runners were similar across quintiles of running time, distance, frequency, amount, and speed, compared with nonrunners. Weekly running even <51 min, <6 miles, 1 to 2 times, <506 metabolic equivalent-minutes, or <6 miles/h was sufficient to reduce risk of mortality, compared with not running. In the analyses of change in running behaviors and mortality, persistent runners had the most significant benefits, with 29% and 50% lower risks of all-cause and cardiovascular mortality, respectively, compared with never-runners. Conclusions Running, even 5 to 10 min/day and at slow speeds <6 miles/h, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate healthy but sedentary individuals to begin and continue running for substantial and attainable mortality benefits.
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Background: Epidemiologic studies have reported that cardiorespiratory fitness is inversely associated with mortality from cancer. However, the evidence relating cardiorespiratory fitness to cancer mortality has not yet been quantitatively summarized. Methods: Following the preferred reporting items for sytematic reviews and meta-analyses (PRISMA) checklist, we conducted a systematic review and meta-analysis of the association between cardiorespiratory fitness and total cancer mortality. Relevant studies were identified through a literature search in PubMed up to August 2013 and by screening reference lists of qualifying articles. Data extraction was carried out independently by both authors and summary risk estimates were obtained using random-effects models. Results: Six prospective studies with an overall number of 71 654 individuals and 2002 cases of total cancer mortality were included. The median follow-up time in the studies was 16.4 years. Cardiorespiratory fitness showed a strong, graded, inverse association with total cancer mortality. Using low cardiorespiratory fitness as the reference group, intermediate and high levels of cardiorespiratory fitness were related to statistically significant decreased summary relative risks (RRs) of total cancer mortality of 0.80 [95% confidence interval (CI) 0.67-0.97] and 0.55 (95% CI 0.47-0.65), respectively. Studies that adjusted for adiposity yielded similar results to those that did not adjust for adiposity. Conclusion: Increased cardiorespiratory fitness represents a strong predictor of decreased total cancer mortality risk, independent of adiposity.
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-We evaluated the individual and joint associations among cardiorespiratory fitness (CRF), body mass index (BMI), and heart failure (HF) mortality as well as the additive effect of increasing number of cardiovascular risk factors on HF mortality in fit versus unfit men. -44 674 men without a history of cardiovascular disease underwent a baseline examination between 1971-2010. Measures included BMI and CRF quantified as duration of maximal treadmill exercise testing. Participants were divided into age-specific low, moderate, and high CRF categories. Hazard ratios (HRs) were computed with Cox regression analysis. During a mean follow-up of 19.8±10.4 years, 153 HF deaths occurred. Adjusted HRs across high, moderate, and low CRF categories were 1.0, 1.63, and 3.97 respectively, while those of normal, overweight, and obese BMI categories were 1.0, 1.56, and 3.71 respectively (P for trend <0.0001 for each). When grouped into categories of fit and unfit (upper 80% and lower 20% of CRF distribution respectively), HRs were significantly lower in fit compared with unfit men in normal and overweight BMI strata (P<0.002), but not in obese men. Within men matched for number of HF risk factors, fit men had significantly lower HF mortality than unfit men (P<0.02). -Higher baseline CRF is associated with lower HF mortality risk in men, regardless of the number of HF risk factors present. Men should be counseled on physical activity with the goal of achieving at least a moderate level of CRF, thereby presumably decreasing their risk of HF mortality.
Article
This study sought to elucidate the mechanisms responsible for the benefits of small muscle mass exercise training in patients with chronic heart failure (CHF). How central cardiorespiratory and/or peripheral skeletal muscle factors are altered with small muscle mass training in CHF is unknown. We studied muscle structure, and oxygen (O(2)) transport and metabolism at maximal cycle (whole-body) and knee-extensor exercise (KE) (small muscle mass) in 6 healthy controls and 6 patients with CHF who then performed 8 weeks of KE training (both legs, separately) and repeated these assessments. Pre-training cycling and KE peak leg O(2) uptake (Vo(2peak)) were ~17% and ~15% lower, respectively, in the patients compared with controls. Structurally, KE training increased quadriceps muscle capillarity and mitochondrial density by ~21% and ~25%, respectively. Functionally, despite not altering maximal cardiac output, KE training increased maximal O(2) delivery (~54%), arterial-venous O(2) difference (~10%), and muscle O(2) diffusive conductance (D(M)O(2)) (~39%) (assessed during KE), thereby increasing single-leg Vo(2peak) by ~53%, to a level exceeding that of the untrained controls. Post-training, during maximal cycling, O(2) delivery (~40%), arterial-venous O(2) difference (~15%), and D(M)O(2) (~52%) all increased, yielding an increase in Vo(2peak) of ~40%, matching the controls. In the face of continued central limitations, clear improvements in muscle structure, peripheral convective and diffusive O(2) transport, and subsequently, O(2) utilization support the efficacy of local skeletal muscle training as a powerful approach to combat exercise intolerance in CHF.
Article
The health benefits of leisure-time physical activity are well known, but whether less exercise than the recommended 150 min a week can have life expectancy benefits is unclear. We assessed the health benefits of a range of volumes of physical activity in a Taiwanese population. In this prospective cohort study, 416,175 individuals (199,265 men and 216,910 women) participated in a standard medical screening programme in Taiwan between 1996 and 2008, with an average follow-up of 8·05 years (SD 4·21). On the basis of the amount of weekly exercise indicated in a self-administered questionnaire, participants were placed into one of five categories of exercise volumes: inactive, or low, medium, high, or very high activity. We calculated hazard ratios (HR) for mortality risks for every group compared with the inactive group, and calculated life expectancy for every group. Compared with individuals in the inactive group, those in the low-volume activity group, who exercised for an average of 92 min per week (95% CI 71-112) or 15 min a day (SD 1·8), had a 14% reduced risk of all-cause mortality (0·86, 0·81-0·91), and had a 3 year longer life expectancy. Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4% (95% CI 2·5-7·0) and all-cancer mortality by 1% (0·3-4·5). These benefits were applicable to all age groups and both sexes, and to those with cardiovascular disease risks. Individuals who were inactive had a 17% (HR 1·17, 95% CI 1·10-1·24) increased risk of mortality compared with individuals in the low-volume group. 15 min a day or 90 min a week of moderate-intensity exercise might be of benefit, even for individuals at risk of cardiovascular disease. Taiwan Department of Health Clinical Trial and Research Center of Excellence and National Health Research Institutes.
Article
The aim of this study was to test the hypotheses that 1) skeletal muscles of elderly subjects can adapt to a single endurance exercise bout and 2) endurance trained elderly subjects have higher expression/activity of oxidative and angiogenic proteins in skeletal muscle than untrained elderly people. To investigate this, lifelong endurance trained elderly (ET; n = 8) aged 71.3 ± 3.4 years and untrained elderly subjects (UT; n = 7) aged 71.3 ± 4 years, performed a cycling exercise bout at 75% VO(2max) with vastus lateralis muscle biopsies obtained before (Pre), immediately after exercise (0 h) and at 2 h of recovery. Capillarization was detected histochemically and oxidative enzyme activities were determined on isolated mitochondria. GLUT4, HKII, Cyt c and VEGF protein expression was measured on muscle lysates from Pre-biopsies, phosphorylation of AMPK and P38 on lysates from Pre and 0 h biopsies, while PGC-1α, VEGF, HKII and TFAM mRNA content was determined at all time points. ET had ~40% higher PDH, CS, SDH, α-KG-DH and ATP synthase activities and 27% higher capillarization than UT, reflecting increased skeletal muscle oxidative capacity with lifelong endurance exercise training. In addition, acute exercise increased in UT PGC-1α mRNA 11-fold and VEGF mRNA 4-fold at 2 h of recovery, and AMPK phosphorylation ~5-fold immediately after exercise, relative to Pre, indicating an ability to adapt metabolically and angiogenically to endurance exercise. However, in ET PGC-1α mRNA only increased 5 fold and AMPK phosphorylation ~2-fold, while VEGF mRNA remained unchanged after the acute exercise bout. P38 increased similarly in ET and UT after exercise. In conclusion, the present findings suggest that lifelong endurance exercise training ensures an improved oxidative capacity of skeletal muscle, and that skeletal muscle of elderly subjects maintains the ability to respond to acute endurance exercise.
Article
The purpose of this study was to determine the association between fitness and lifetime risk for cardiovascular disease (CVD). Higher levels of traditional risk factors are associated with marked differences in lifetime risks for CVD. However, data are sparse regarding the association between fitness and the lifetime risk for CVD. We followed up 11,049 men who underwent clinical examination at the Cooper Institute in Dallas, Texas, before 1990 until the occurrence of CVD death, non-CVD death, or attainment of age 90 years (281,469 person-years of follow-up, median follow-up 25.3 years, 1,106 CVD deaths). Fitness was measured by the Balke protocol and categorized according to treadmill time into low, moderate, and high fitness, with further stratification by CVD risk factor burden. Lifetime risk for CVD death determined by the National Death Index was estimated for fitness levels measured at ages 45, 55, and 65 years, with non-CVD death as the competing event. Differences in fitness levels (low fitness vs. high fitness) were associated with marked differences in the lifetime risks for CVD death at each index age: age 45 years, 13.7% versus 3.4%; age 55 years, 34.2% versus 15.3%; and age 65 years, 35.6% versus 17.1%. These associations were strongest among persons with CVD risk factors. A single measurement of low fitness in mid-life was associated with higher lifetime risk for CVD death, particularly among persons with a high burden of CVD risk factors.
Article
Twenty years ago, the term 'sarcopenia' has been introduced to describe the ageing related loss of skeletal muscle mass. Since then, sarcopenia has been intensively studied and prevalence values have been reported in fifteen papers covering several continents and races. However, consistency regarding the outcome measures and corresponding cut-off values defining sarcopenia is lacking. Most approaches are based on estimations of muscle mass and proposed cut-off values might be too strict, thus reducing their use in daily practice. From a clinical viewpoint, the assessment of muscle performance (grip strength and endurance) can be proposed as a screening tool showing sufficient sensitivity. The pathophysiology of sarcopenia is multifactorial, and important changes at the tissue level have been identified. Close relationships with inflammatory processes have been demonstrated and there is strong evidence for the involvement of a chronic low-grade inflammatory activity. Sarcopenia is aggravated by a complex interaction of several factors among which aging, disuse, immobilization, disease and malnutrition. A comprehensive geriatric assessment should allow the clinician to estimate the relative contribution of these factors and to elaborate appropriate management. From all interventions studied, intensive resistance training seems the most efficient to counter sarcopenia, even in the very old geriatric patients. Significant ameliorations (up to >50% strength gain) can be expected after six weeks of training at a rhythm of 2-3 sessions per week. From a preventive viewpoint, all elderly patients should be advised to start such an exercise program and continue it as long as possible. To date, most pharmacological interventions to counter sarcopenia include drugs with anabolic effects. Unfortunately, their effect is questionable and no clear guidelines exist for the prescription of these products in the context of sarcopenia.
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Physical activity may protect against breast cancer. Few prospective studies have evaluated breast cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of physiologic response to physical activity habits. We examined the association between CRF and risk of death from breast cancer in the Aerobics Center Longitudinal Study. Women (N = 14,811), aged 20 to 83 yr with no prior breast cancer history, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1970 and 2001. Mortality surveillance was completed through December 31, 2003. CRF was quantified as maximal treadmill exercise test duration and was categorized for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%). At baseline, all participants were able to complete the exercise test to at least 85% of their age-predicted maximal heart rate. A total of 68 breast cancer deaths occurred during follow-up (mean = 16 yr). Age-adjusted breast cancer mortality rates per 10,000 woman-years were 4.4, 3.2, and 1.8 for low, moderate, and high CRF groups, respectively (trend P = 0.008). After further controlling for body mass index, smoking, drinking, chronic conditions, abnormal exercise ECG responses, family history of breast cancer, oral contraceptive use, and estrogen use, hazard ratios (95% CI) for breast cancer mortality across incremental CRF categories were 1.00 (referent), 0.67 (0.35-1.26), and 0.45 (0.22-0.95) (trend P = 0.04). These results indicate that CRF is associated with a reduced risk of dying from breast cancer in women.