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Improvements in health parameters of a diabetic and hypertensive patient with only 40 minutes of exercise per week: a case study
Abstract
Purpose:
The present study aimed to report the effects of 15 weeks of a minimal dose resistance training on blood glucose levels, blood pressure, heart rate, physical capacity, and quality of life of a 67 old woman with type 2 diabetes mellitus, cardiopathy and hypertension.
Method:
The Patient was sedentary with a family history of heart failure and coronary artery disease. She suffered a heart attack in 2013 and was submitted to six cardiac catheterizations and one angioplasty between the 2015 and 2017. On April 2017, she was initially untrained in resistance training and was followed for 15 weeks with the performance of 31 resistance training sessions. Resistance training followed a minimal dose approach with 4 exercises performed with 2 sets to muscle failure, twice a week.
Results:
After follow up, the Patient presented a reduction in blood glucose, systolic and diastolic blood pressure, and heart rate at rest. There were also improvements on body mass index, cardiorespiratory fitness and quality of life. These results were accompanied by a reduction in the amount of antihypertensive and anti-diabetic medications.
Conclusions:
These results suggest that only 40 min of resistance training per week might help to improve general health and quality of life in a patient with hypertension and type 2 diabetes mellitus. Implications for Rehabilitation Minimal dose resistance training improved health parameters in a diabetic and hypertensive patient. Resistance training promoted a reduction in the drugs used to control blood pressure and blood glucose levels.
... Esta revisión muestra que las mediciones funcionales en pacientes con ECV es de interés en la comunidad científica. En los últimos 5 años ha cobrado mayor interés, especialmente en países como Alemania, Estados Unidos y Brasil, en los cuales se logró identificar que, tanto en estudios descriptivos como experimentales, el test de caminata es una de las pruebas de mayor uso, identificada en 12 estudios (60%) 11,12,13,14,15,16,17,18,19,20,21,22 , en países que posiblemente han mostrado mayor interés de profundizar en esta área debido a los factores de riesgo a los que se exponen las personas, como son: el consumo de tabaco, consumo de alcohol, hipertensión y obesidad. En 2017 en Alemania, el porcentaje de fumadores fue 15% en mujeres y 22,3% 22 en hombres. ...
... También se identificó en esta revisión dos estudios realizados solo con mujeres. Uno de ellos, un estudio de caso que buscó mostrar los efectos del entrenamiento de resistencia de dosis mínima durante 15 semanas, en una mujer con diabetes mellitus tipo 2, cardiopatía e hipertensión, analizando variables fisiológicas, bioquímicas y funcionales como capacidad física y calidad de vida, obteniendo como resultado disminución de la glucemia, presión arterial sistólica y diastólica y frecuencia cardíaca en reposo, índice de masa corporal, la aptitud cardiorrespiratoria y la calidad de vida 21 . A su vez estos resultados se acompañaron de una reducción en la cantidad de medicamentos antihipertensivos y antidiabéticos. ...
Introducción:
Un evento cardiovascular puede reducir o alterar la capacidad funcional de las personas y, por ende, afectar el desempeño adecuado en el ámbito físico, familiar, social y laboral. La OMS ha definido la salud de los adultos mayores por su capacidad funcional y no por sus limitaciones, discapacidades o enfermedades. Por lo tanto, la calidad de vida de los adultos mayores está estrechamente relacionada con la capacidad funcional y el conjunto de condiciones que le permiten participar en su propio autocuidado, en la vida social y familiar.
Objetivo:
El objetivo de este estudio es explorar la evidencia existente en la última década acerca de las pruebas y escalas de funcionalidad usadas en población adulta mayor con enfermedad cardiovascular durante su hospitalización y que reciben tratamiento de terapia física.
Métodos:
Se usó la metodología Scoping Review, usando los términos DeCS/MeSH: cardiac, rehabilitation, cardiovascular disease, physical therapy, elderly, inpatient, y functionality. La revisión siguió el modelo PRISMA para ordenar y sintetizar los resultados. Las bases de datos consultadas fueron: Pubmed, Scielo, Sciencedirect y Scopus, Lilacs, PeDro.
Resultados:
20 artículos fueron seleccionados en los cuales se identificó que las escalas de valoración funcional más utilizadas fueron: caminata de 6 minutos, escala de independencia (FIM), Percepción de salud SF -36.
Conclusiones:
La evidencia encontrada para guiar la rehabilitación física en paciente adulto mayor muestra cambios significativos en el incremento de la capacidad funcional.
... Here, it is important to note that training sessions lasting a few minutes have been suggested to promote muscle strength and size gains in different populations Souza et al., 2020). From a practical standpoint, previous studies showed that untrained young and older adults can obtain many health benefits (e.g., increased functionality and cardiovascular improvements) from minimal dose RT protocols involving two sets of three to four basic exercises with a training frequency of one or two sessions per week (Fisher et al., 2014;de Barbalho et al., 2017;Seguro et al., 2019;Souza et al., 2019;Dias et al., 2020). ...
... In this regard, there are consistent evidence that RT is associated with improvements in depression (Gordon et al., 2018), anxiety (Gordon et al., 2017), and sleep disorders (Kovacevic et al., 2018), including patients with chronic diseases (Ferreira et al., 2020) and during rehabilitation (McCartney, 1998;Vincent and Vincent, 2012;Chan and Cheema, 2016;Andrade et al., 2018; Frontiers in Physiology | www.frontiersin.org 4 March 2021 | Volume 12 | Article 637590 11 Seguro et al., 2019). The potential benefits of RT for COVID-19 patients are illustrated in Figure 1. ...
The second volume of the Research Topic entitled “Precision Physical Activity and Exercise Prescriptions for Disease Prevention: The Effect of Interindividual Variability Under Different Training Approaches” has been successfully completed, as expected. As stated in the preface to the first volume, this Research Topic was initially intended to address a challenge in this field, but this topic is becoming, over time, an important cornerstone for scientists who are exploring the fascinating subject of “Precision Physical Activity and Exercise Prescriptions for Disease Prevention” (Ramírez-Vélez et al., 2017). This Research Topic consists of 10 articles, of which seven contain original data, one is a systematic review with meta-analysis and two are opinion/hypothesis articles.
... Here, it is important to note that training sessions lasting a few minutes have been suggested to promote muscle strength and size gains in different populations Souza et al., 2020). From a practical standpoint, previous studies showed that untrained young and older adults can obtain many health benefits (e.g., increased functionality and cardiovascular improvements) from minimal dose RT protocols involving two sets of three to four basic exercises with a training frequency of one or two sessions per week (Fisher et al., 2014;de Barbalho et al., 2017;Seguro et al., 2019;Souza et al., 2019;Dias et al., 2020). ...
... In this regard, there are consistent evidence that RT is associated with improvements in depression (Gordon et al., 2018), anxiety (Gordon et al., 2017), and sleep disorders (Kovacevic et al., 2018), including patients with chronic diseases (Ferreira et al., 2020) and during rehabilitation (McCartney, 1998;Vincent and Vincent, 2012;Chan and Cheema, 2016;Andrade et al., 2018; Frontiers in Physiology | www.frontiersin.org 4 March 2021 | Volume 12 | Article 637590 11 Seguro et al., 2019). The potential benefits of RT for COVID-19 patients are illustrated in Figure 1. ...
The novel coronavirus disease (COVID-19) has emerged at the end of 2019 and caused
a global pandemic. The disease predominantly affects the respiratory system; however,
there is evidence that it is a multisystem disease that also impacts the cardiovascular
system. Although the long-term consequences of COVID-19 are not well-known,
evidence from similar diseases alerts for the possibility of long-term impaired physical
function and reduced quality of life, especially in those requiring critical care. Therefore,
rehabilitation strategies are needed to improve outcomes in COVID-19 survivors. Among
the possible strategies, resistance training (RT) might be particularly interesting, since it
has been shown to increase functional capacity both in acute and chronic respiratory
conditions and in cardiac patients. The present article aims to propose evidence-based
and practical suggestions for RT prescription for people who have been diagnosed with
COVID-19 with a special focus on immune, respiratory, and cardiovascular systems.
Based on the current literature, we present RT as a possible safe and feasible activity
that can be time-efficient and easy to be implemented in different settings.
... In considering persons with T2D, a recent publication of a case study suggests that very-low volume RT (2 sets of 4 exercises performed 2 x / week) performed over 15 weeks, improved the health and quality of life in a diabetic and hypertensive female (e.g. reduced blood glucose, systolic and diastolic blood pressure, and heart rate at rest, as well as improvements in body mass index, cardiorespiratory fitness, and a reduction in the amount of antihypertensive and anti-diabetic medications; Seguro, et al. 2020). Furthermore, empirical research has reported similar adaptations and HbA1c responses for different loading schemes (50% versus 75% 1RM; Yang, et al. 2017), and a recent meta-analysis and systematic review compared hypertrophy RT (e.g., 70-85% 1-repetition maximum; RM, for 1-3 sets of 8-12 repetitions) to muscular endurance RT (e.g., <70% 1RM, for 2-4 sets of 10-25 repetitions) as therapeutic interventions for persons with T2D. ...
... An improvement exceeding 10 points on the WHO-5 is considered to be the threshold for a clinically relevant change (Topp, et al. 2015) and so this improvement is likely to have been a meaningful effect. Previous studies assessing quality of life and general wellbeing (using the SF-36, and 22-item GWBS; which measure similar aspects), also report positive responses following a RT intervention (Seguro, et al. 2020;Arora, et al. 2009). This validates our present findings and is promising to know that RT can demonstrate improvement in mental wellbeing in persons suffering from diabetes. ...
Aims: The aims of this study were to consider the effects of supervised, low volume, high intensity of effort resistance training compared to continued routine care in persons with type II diabetes. Methods: This study utilized a randomized comparative interrupted time-series design. All participants completed baseline testing (T0) and then participated in an educational training intervention regarding management of their diabetes. They were followed up for six months during which they received routine care before being retested (T1). Following this they were randomly allocated to either continue with routine care (CON), or to receive the high intensity of effort resistance training intervention (HIT). The intervention lasted for six months after which participants from both groups were retested again (T2). After this all participants were followed up for a further 12 months before being finally tested (T3). Data was available from 57 participants who completed the whole duration of the study (HIT, n = 29; CON, n = 28) for (i). anthropometric outcomes (body mass, waist circumference, and BMI), (ii). body composition outcomes (body fat mass, body fat percentage, muscle mass, and visceral fat mass), (iii). water and blood outcomes (total body water, phase angle, HbA1c, and fasted blood glucose), and (iv). subjective wellbeing (WHO-5). Results: During the initial 6-month time epoch significant improvements were noted for waist circumference, body fat mass, muscle mass, body fat percentage, muscle mass percentage, visceral fat mass, HbA1c, fasted blood glucose, and subjective wellbeing. During the successive 6-and 18-month periods data suggest that many of these positive changes during the initial 6-months were negated or reversed for CON. In contrast participants engaging in HIT continued to show positive changes for waist circumference, body fat mass, muscle mass, body fat percentage, muscle percentage, and visceral fat. For blood markers and wellbeing, HbA1c continued to decrease, fasted blood glucose decreased, and subjective wellbeing continued to increase. These positive responses were still evidence and significantly different compared to CON after the 12-month follow-up. Conclusion: The results of this exploratory pragmatic trial suggest that the addition of high intensity of effort RT alongside routine care can have a positive impact on a range of outcomes in type 2 diabetics having undergone prior routine care.
... 8,9 In a case study, Seguro et al. reported that only 40 minutes of exercise per week was sufficient to promote positive cardiovascular and metabolic changes in a hypertensive and diabetic patient. 10 A similar approach adopted by Costa et al. 9 produced functional benefits in older women. Therefore, the use of such strategy might be useful as an adjunct in the treatment of hypertensive patients, especially considering that resistance training might reduce resting blood pressure, 11,12 and that muscle strength is associated with lower mortality in hypertensive patients. ...
... Workloads were adjusted whenever necessary to maintain the target range of repetitions. 8,10 Statistical Analysis According to the Shapiro-Wilk test, all variables presented a normal distribution (p > 0.05), except SBP measured after the first and last resistance training session and DBP measured after the first resistance training session. Student's paired t-tests were used to compare variables with normal distribution and Wilcoxon test to compare those without normal distribution. ...
Physical exercise has been shown to have an important role in the prevention and treatment of arterial hypertension. However, the general exercise recommendations are time consuming, which might be detrimental to exercise adoption. Based on this, minimal doses of exercise have been suggested as an alternative approach and this report investigates the feasibility and effects of low volume and high effort resistance training for hypertensive patients in a hospital setting. This is a pilot non-randomized prospective study where 15 sedentary hypertensive patients (11 women and 4 men) performed 24 resistance training sessions over 12 weeks at a public hospital. The resistance training sessions consisted of two sets of four exercises, with a rest interval of two minutes between sets. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 10 minutes before and 10 minutes after each training. No injuries or intercurrence were reported during the study. SBP decreased significantly when compared the first and last sessions, when the measures were performed at rest (152 ± 16 mmHg vs. 122 ± 9 mmHg vs, p<0.05), and after (137 ± 13 mmHg vs. 115 ± 5 mmHg, p<0.05) the resistance training session. Similarly, DBP also decreased significantly when the values from the last session were compared with the first session, when measured at rest (83 ± 14 mmHg vs 73 ± 9 mmHg, p<0.05). Low volume and high effort resistance training seems to be a feasible non-pharmacological strategy to help controlling blood pressure in hypertensive patients within a hospital.
... From a practical standpoint, previous studies showed that untrained young and older adults can obtain many health benefits (e.g. increased functionality and cardiovascular improvements) from minimal dose RT protocols involving two sets of 3 to 4 basic exercises with a training frequency of one or two session per week (Barbalho et al., 2017;Dias et al., 2020;Fisher et al., 2014;Seguro et al., 2019;Souza et al., 2019). ...
... Studies investigating COVID-19 patients found a high level of post-traumatic stress and depressive symptoms in comparison with noninfected people (Vindegaard and Eriksen Benros, 2020). In this regard, there are consistent evidence that RT is associated with improvements in depression (Gordon et al., 2018), anxiety (Gordon et al., 2017) and sleep disorders (Kovacevic et al., 2018), including patients with chronic diseases (Ferreira et al., 2020) and during rehabilitation (Andrade et al., 2018;Chan and Cheema, 2016;McCartney, 1998;Seguro et al., 2019;Vincent and Vincent, 2012). The potential benefits of RT for COVID-19 patients are illustrated on Figure 1. ...
The novel coronavirus disease (COVID-19) has emerged at the end of 2019 and caused a global pandemic. The disease predominantly affects respiratory system; however, also is a multisystem disease that affects the cardiovascular system. Although the long-term consequences of COVID-19 are not well-known, evidence from similar diseases alerts for the possibility of long term impaired physical function and reduced quality of life, especially in those requiring critical care. Therefore, rehabilitation strategies are needed to improve outcomes in COVID-19 survivors. Among the possible strategies, resistance training (RT) might be particularly interesting, since it has been shown to increase functional capacity both in acute and chronic respiratory conditions as well as in cardiac patients. The present article aims to propose evidence-based and practical suggestions for RT prescription for people that have been diagnosed with COVID-19 with a special focus on immune, respiratory, and cardiovascular systems. Based on the current literature, we present RT as a possible safe and feasible activity that can be time-efficient and easy to be implemented in different settings
... 8,9 In a case study, Seguro et al. reported that only 40 minutes of exercise per week was sufficient to promote positive cardiovascular and metabolic changes in a hypertensive and diabetic patient. 10 A similar approach adopted by Costa et al. 9 produced functional benefits in older women. Therefore, the use of such strategy might be useful as an adjunct in the treatment of hypertensive patients, especially considering that resistance training might reduce resting blood pressure, 11,12 and that muscle strength is associated with lower mortality in hypertensive patients. ...
... Workloads were adjusted whenever necessary to maintain the target range of repetitions. 8,10 Statistical Analysis According to the Shapiro-Wilk test, all variables presented a normal distribution (p > 0.05), except SBP measured after the first and last resistance training session and DBP measured after the first resistance training session. Student's paired t-tests were used to compare variables with normal distribution and Wilcoxon test to compare those without normal distribution. ...
Physical exercise has been shown to have an important role in the prevention and treatment of arterial hypertension. However, the general exercise recommendations are time consuming, which might be detrimental to exercise adoption. Based on this, minimal doses of exercise have been suggested as an alternative approach and this report investigates the feasibility and effects of low volume and high effort resistance training for hypertensive patients in a hospital setting. This is a pilot non-randomized prospective study where 15 sedentary hypertensive patients (11 women and 4 men) performed 24 resistance training sessions over 12 weeks at a public hospital. The resistance training sessions consisted of two sets of four exercises, with a rest interval of two minutes between sets. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured 10 minutes before and 10 minutes after each training. No injuries or intercurrence were reported during the study. SBP decreased significantly when compared the first and last sessions, when the measures were performed at rest (152 ± 16 mmHg vs. 122 ± 9 mmHg vs, p<0.05), and after (137 ± 13 mmHg vs. 115 ± 5 mmHg, p<0.05) the resistance training session. Similarly, DBP also decreased significantly when the values from the last session were compared with the first session, when measured at rest (83 ± 14 mmHg vs 73 ± 9 mmHg, p<0.05). Low volume and high effort resistance training seems to be a feasible non-pharmacological strategy to help controlling blood pressure in hypertensive patients within a hospital.
... This is the first study that examined the effect of moderate-intensity ET on MEF2C, HDAC4, and CaMKII gene expression and testosterone levels in diabetic hearts. It has been shown that exercise training improves glucose control and could affect both the structure and function of the myocardium, which could improve cardiovascular health in DM patients [41]. The results of the current study show significant weight loss in diabetic groups due to frequent urination, dehydration, and skeletal muscle atrophy. ...
Abstract: Exercise can ameliorate cardiovascular dysfunctions in the diabetes condition, but its precise
molecular mechanisms have not been entirely understood. The aim of the present study was to
determine the impact of endurance training on expression of angiogenesis-related genes in cardiac
tissue of diabetic rats. Thirty adults male Wistar rats were randomly divided into three groups (N
= 10) including diabetic training (DT), sedentary diabetes (SD), and sedentary healthy (SH), in which
diabetes was induced by a single dose of streptozotocin (50 mg/kg). Endurance training (ET) with
moderate-intensity was performed on a motorized treadmill for six weeks. Training duration and
treadmill speed were increased during five weeks, but they were kept constant at the final week,
and slope was zero at all stages. Real-time polymerase chain reaction (RT-PCR) analysis was used
to measure the expression of myocyte enhancer factor-2C (MEF2C), histone deacetylase-4 (HDAC4)
and Calmodulin-dependent protein kinase II (CaMKII) in cardiac tissues of the rats. Our results
demonstrated that six weeks of ET increased gene expression of MEF2C significantly (p < 0.05), and
caused a significant reduction in HDAC4 and CaMKII gene expression in the DT rats compared to
the SD rats (p < 0.05). We concluded that moderate-intensity ET could play a critical role in ameliorating
cardiovascular dysfunction in a diabetes condition by regulating the expression of some angiogenesis-
related genes in cardiac tissues.
Keywords: endurance training; angiogenesis; cardiac tissu
... This is the first study that examined the effect of moderate-intensity ET on MEF2C, HDAC4, and CaMKII gene expression and testosterone levels in diabetic hearts. It has been shown that exercise training improves glucose control and could affect both the structure and function of the myocardium, which could improve cardiovascular health in DM patients [41]. The results of the current study show significant weight loss in diabetic groups due to frequent urination, dehydration, and skeletal muscle atrophy. ...
Abstract: Exercise can ameliorate cardiovascular dysfunctions in the diabetes condition, but its precise
molecular mechanisms have not been entirely understood. The aim of the present study was to
determine the impact of endurance training on expression of angiogenesis-related genes in cardiac
tissue of diabetic rats. Thirty adults male Wistar rats were randomly divided into three groups (N
= 10) including diabetic training (DT), sedentary diabetes (SD), and sedentary healthy (SH), in which
diabetes was induced by a single dose of streptozotocin (50 mg/kg). Endurance training (ET) with
moderate-intensity was performed on a motorized treadmill for six weeks. Training duration and
treadmill speed were increased during five weeks, but they were kept constant at the final week,
and slope was zero at all stages. Real-time polymerase chain reaction (RT-PCR) analysis was used
to measure the expression of myocyte enhancer factor-2C (MEF2C), histone deacetylase-4 (HDAC4)
and Calmodulin-dependent protein kinase II (CaMKII) in cardiac tissues of the rats. Our results
demonstrated that six weeks of ET increased gene expression of MEF2C significantly (p < 0.05), and
caused a significant reduction in HDAC4 and CaMKII gene expression in the DT rats compared to
the SD rats (p < 0.05). We concluded that moderate-intensity ET could play a critical role in ameliorating
cardiovascular dysfunction in a diabetes condition by regulating the expression of some angiogenesis-
related genes in cardiac tissues.
Keywords: endurance training; angiogenesis; cardiac tissue
... only 40 minutes of resistance exercise a week may contribute to improvement in general health condition and quality of life in patients with type 2 diabetes and arterial hypertension. They supported that claim with a case study in which they proved decrease in blood glucose level, systolic and diastolic blood pressure and resting heart rate in patients with coronary artery disease, type 2 diabetes and arterial hypertension, subjected to 15 weeks of resistance exercise [6,12]. The influence of physical activity in cardiac patients was also investigated by Denegri et al., who proved that cardiac rehabilitation program has a positive impact on glycemic control [13]. ...
Introduction: Complex cardiac rehabilitation is a basic procedure of therapeutic treatment for patients after cardiac surgeries. The course of operations depends on many factors. The aim of this article is to investigate connections between type 2 diabetes and results of 6- minute walk test among patients after cardiac surgery. Materials and methods: This research was conducted among 111 patients who had cardiac surgery. Those patients were qualified to stay at a stationary cardiac rehabilitation facility. They were divided into two groups: patients with and without diabetes. In the analysis, patients’ medical data and 6-minute walk test results before and after complex rehabilitation were taken into consideration. Results: On the basis of our analysis it was found that patients who have diabetes achieve worse results of 6-minute walk test before (OR=0.995; p=0.005) and after (OR=0.994, p=0.006) complex cardiac rehabilitation in comparison with patients without diabetes. Conclusions: Type 2 diabetes has impact on physical effort tolerance among patients after cardiac surgery. Despite improvement of 6-minute walk test results thanks to complex cardiac rehabilitation, patients with type 2 diabetes walked shorter distance than patients without diabetes.
Keywords: cardiac rehabilitation, cardiology, 6-minute walk test, type 2 diabetes
... With that in mind, the adoption of time-efficient RT approaches might be attractive, especially if we consider those training sessions lasting few minutes can be efficient in promoting muscle strength and size gains in different populations [46,47]. For example, untrained young and older adults can benefit from minimal dose RT protocols that involve two sets of 3 to 4 exercises performed once or twice per week [48][49][50][51]. ...
In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.
... Despite the fact that this study suggested only 90 min of weekly exercise training, instead of the minimum of 150 min of exercise recommended by several sports medicine associations [5], a significant improvement in blood glucose level was observed in the participant. Our findings were in agreement with a recent case study in a woman of similar age and pathologies, where resistance training was beneficial for health and quality of life [10]. The present study could not discriminate which type of exercise, resistance or aerobic exercise, was more effective; however, the data confirmed the largest decrease in glucose level measurements at the end of the exercise. ...
Introduction : The aim of the present case study was to examine the effect of a 5-month exercise intervention on glucose and hypertension level of a patient with diabetes mellitus.
Material and methods : A 68-year-old woman (weight 70 kg, height 163 cm) with diabetes mellitus and hypertension performed a 5-month exercise program (two sessions per week with each session lasting 45 min).
Results : A decrease of blood glucose across time was observed, except for after exercise. No change was observed in pre-exercise levels of systolic and diastolic blood pressure across time.
Conclusions : In summary, the present case study showed that an adult woman with diabetes mellitus and hypertension benefited from a 5-month exercise program combining aerobic and resistance training in terms of blood glucose regulation, physical condition and quality of life.
... Such studies arise precisely from the lack of time to devote to exercise, which ends up being the justification for the sedentary lifestyle of most people. 615 Finally, there are still population actions aimed at improving people's diets. Such measures are extremely varied, but ultimately use mostly financial interventions to target dietary choices and habits that are associated with overweight/obesity. ...
Updated Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology – 2019
Development: Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia – SBC)
Norms and Guidelines Council: Fernando Bacal, Leandro Ioschpe Zimerman, Paulo Ricardo Avancini Caramori
and Pedro Alves Lemos Neto
Norms and Guidelines Coordinator: Ludhmila Abrahão Hajjar
General Coordinator: Dalton Bertolim Précoma
Writing Committee: Dalton Bertolim Précoma, Gláucia Maria Moraes de Oliveira
Editors: Dalton Bertolim Précoma, Gláucia Maria Moraes de Oliveira, Antonio Felipe Simão and Oscar Pereira Dutra
Introduction
Dalton Bertolim Précoma and Gláucia Maria Moraes de Oliveira
1. Risk Stratification
Coordinator: Francisco Antonio Helfenstein Fonseca
Authors: Emilio Hideyuki Moriguchi, Jamil Cherem Schneider, José Francisco Kerr Saraiva, Marcelo Heitor Vieira Assad, Sergio Emanuel Kaiser
2. Dyslipidemia
Coordinator: Maria Cristina de Oliveira Izar
Authors: Adriana Bertolami, Harry Correa Filho, Hermes Toros Xavier, José Rocha Faria-Neto, Marcelo Chiara Bertolami, Viviane Zorzanelli Rocha Giraldez
3. Diabetes and Metabolic Syndrome Coordinator: Otávio Rizzi Coelho
Authors: Andrei C. Sposito, Bruno Halpern, José Francisco Kerr Saraiva, Luiz Sergio Fernandes Carvalho, Marcos Antônio Tambascia, Otávio Rizzi Coelho Filho
4. Obesity and Overweight
Coordinator: Carlos Scherr
Authors: Dalton Bertolim Précoma, Thiago Veiga Jardim
5. Arterial Hypertension
Coordinator: Rui Manuel dos Santos Povoa
Authors: Andrea Araújo Brandão, Audes Diógenes de Magalhães Feitosa, Celso Amodeo, Dilma do Socorro Moraes de Souza, Eduardo Costa Duarte Barbosa, Marcus Vinícius Bolívar Malachias, Weimar Kunz Sebba Barroso de Souza
6. Vitamins and Omega-3 Fatty Acids
Coordinator: Raul Dias dos Santos Filho
Authors: Ana Maria Pita Lottenberg, Carlos Daniel Magnoni, Marcio Hiroshi Miname, Roberta Soares Lara
7. Smoking
Coordinator: Aristóteles Comte de Alencar Filho
Authors: Aloyzio Cechella Achutti, André Ribeiro Langowiski, Carla Janice Baister Lantieri, Jaqueline Ribeiro Scholz, Silvia Maria Cury Ismael
8. Physical Activity, Physical Exercise, and Sports Coordinator: Tales de Carvalho
Authors: Artur Haddad Herdy, Cláudio Gil Soares de Araújo, Mauricio Milani, Miguel Morita Fernandes da Silva, Ricardo Stein
9. Spirituality and Psychosocial Factors in Cardiovascular Medicine Coordinators: Álvaro Avezum Jr e Roberto Esporcatte
Authors: Emilio Hideyuki Moriguchi, Fernando Antonio Lucchese, Fernando Nobre, Hermilo Borba Griz, Lucélia Batista Neves Cunha Magalhães, Mario Henrique Elesbão de Borba, Mauro Ricardo Nunes Pontes, Ricardo Mourilhe-Rocha
10. Associated Diseases, Socioeconomic and Environmental Factors in Cardiovascular Prevention Coordinator: Glaucia Maria Moraes de Oliveira
Authors: Bruno Ramos Nascimento, David de Pádua Brasil, Gabriel Porto Soares, Paolo Blanco Villela, Roberto Muniz Ferreira, Wolney de Andrade Martins
11. Childhood and Adolescence
Coordinator: Isabela de Carlos Back
Authors: Ivan Romero Rivera, Lucia Campos Pellanda, Maria Alayde Mendonça da Silva
12. Population Approaches to Risk Factors for Cardiovascular Diseases Coordinator: Carlos Alberto Machado
Authors: Carlos Alberto Machado, José Carlos Aidar Ayoub, Luiz César Nazário Scala, Mario Fritsch Neves, Sandra Costa Fuchs, Paulo Cesar Veiga Jardim e Thiago Veiga Jardim
... Such studies arise precisely from the lack of time to devote to exercise, which ends up being the justification for the sedentary lifestyle of most people. 615 Finally, there are still population actions aimed at improving people's diets. Such measures are extremely varied, but ultimately use mostly financial interventions to target dietary choices and habits that are associated with overweight/obesity. ...
Cardiovascular disease (CVD) is the leading cause of death worldwide and in Brazil, leading to increased morbidity and disability-adjusted life year (DALY). Despite the decrease in mortality rates and DALY standardized by age in Brazil, possibly as a result of successful health policies, their total number is increasing, mainly due to aging and illnesses in the population.1
Classical risk factors (hypertension, dyslipidemia, obesity, sedentary lifestyle, smoking, diabetes, and family history) raise the pre-test probability of CVD - particularly of coronary artery disease (CAD) - and determine primary and secondary prevention. Several other factors, including sociodemographic, ethnic, cultural, dietary, and behavioral aspects, can also explain the differences in CVD burden among populations and their trends over the decades. The implementation of health policies, among them, encouraging healthy lifestyle habits and providing access to primary and secondary CVD prevention measures, associated with the treatment of cardiovascular (CV) events are essential to control CVD in all countries, including Brazil.
The I Brazilian Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia - SBC), published in 2013,2 aimed at helping reduce CV mortality, as established by the World Health Assembly in May 2012; SBC reaffirmed its commitment to decreasing the premature CVD mortality rate by 25%.3 However, the reduction in CVD mortality has reached a plateau in the past five years in Brazil, with significant regional variation, suggesting the need for renewing strategies to combat these diseases.4 With this purpose, SBC revisited its CV prevention guideline,2 proposing to update themes related to the primary prevention of CVD and suggesting strategies that could assist Brazilian cardiologists in reducing morbidity and mortality from these groups of causes.
The Brazilian Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology - 2019 updates the strategies that address classical risk factors and discusses new concepts, such as the need to gather knowledge about emerging risk factors - for instance, spirituality -, socioeconomic and environmental factors, as well as additional strategies, like the use of vaccines.
We hope to contribute to renew the SBC commitment with the Brazilian society and the Strategic Action Plan for tackling Chronic Non-Communicable Diseases (NCD),5 of which CVD is the main component, with an instrument that will allow systematized access to the current literature, disseminating the knowledge necessary to resume the decreasing trend in CV mortality in Brazil.
Introduction The most commonly used biomarker for long-term glycemic control and the diagnosis of diabetes mellitus is glycosylated hemoglobin. Determining its level may provide important information on the risk of complications related to this disease. Research literature review shows that glycosylated hemoglobin may also be prognostic in terms of postoperative outcomes in cardiac surgery patients. Aim The aim of this study is to assess the effect of an increased level of glycosylated hemoglobin on physical performance in patients after cardiac surgery. Materials and methods 109 patients participated in the study, divided into two groups: study – 27 people and control – 82 people. The decisive factor in belonging to the appropriate group was the level of glycated hemoglobin. Results Data analysis showed that there were statistically significant differences between the study group and the control group in the mean result of the 6-minute walking test before admission to the ward (p = 0.005), in the results of systolic blood pressure measurement before the test (p = 0.011), and after performing this test (p = 0.012), in the diastolic blood pressure results before (p < 0.001), and after the test (p = 0.001). The differences were statistically significant also in the heart rate measurement after the 6-minute walk test on admission (p = 0.019). Conclusions Elevated glycosylated hemoglobin levels may be a factor affecting exercise tolerance in patients after cardiac surgery, which results in reduced effectiveness of cardiac rehabilitation. Keywords: rehabilitation, cardiology, walking test
Purpose
This case report aimed to investigate the effects of supervised home-based resistance training (RT) on functional capacity and mental health on a man with idiopathic peripheral polyneuropathy (PP).
Method
A 50-year-old man diagnosed with PP with no previous experience in RT performed 24 session of home-based RT for 12 weeks. Resistance training consisted of 3 exercises performed with 3 sets and lasted approximately 30 min per session. Exercises were performed with minimal implements (e.g., elastic tubes and light dumbbells). The Patient was evaluated for muscle performance, functionality, anxiety levels, and depressive symptoms before and after intervention period. Muscle performance was evaluated though 30-s push up test (PU30), functional capacity was evaluated through functional tests [sit to stand test (SST), arm curl (AC), and 2-min step test (2-MST)] and anxiety levels and depressive symptoms were evaluated through the State-Trait Anxiety Inventory (STAI) and Beck's depression inventory (BDI), respectively.
Results
After 12 weeks, the performance on PU30 increased 40% (from 8 to 11 repetitions), while the performance on SST, AC and 2-MST increased 100% (from 4 to 8 repetitions), 44% (from 16 to 23 repetitions) and 157% (from 47 to 121 repetitions), respectively. Anxiety state and trait levels have been reduced 24% (from 42 to 32 scores) and 4% (from 47 to 45 scores), respectively. There was no change for BDI.
Conclusion
Supervised home-based RT using low cost and affordable equipment was a feasible strategy to provide functional capacity and mental health benefits in a patient with PP.
Abstract Background Individuals with arterial hypertension often have an autonomic nervous system (ANS) imbalance with predominance of sympathetic ANS. This predominance can lead to injury of several organs affecting its functioning. There is evidence that performing high intensity resistance training (RT) with heavier loads and a lower number of repetitions results in lower cardiovascular stress when compared with lighter loads and a higher number of repetitions. However, the effects of different protocols of RT in autonomic modulation are not known. Therefore, the aim of the study was to analyze and compare the effects of different protocols of high intensity of effort RT on autonomic cardiac modulation of hypertensive women. Methods A randomized crossover design clinical trial was conducted with 15 postmenopausal hypertensive women who underwent a control session and two high intensity RT protocols involving 6 and 15 repetition maximum (RM). Heart rate variability (HRV), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and double product (DP) were collected pre, immediately post, 1 h post, and 24 h post each protocol. Repeated-measures ANOVA were used. Results SBP was higher for 6RM than control immediately after session (p
Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.
High school blood drives are a unique opportunity to provide screening for cardiometabolic risk factors at low cost and minimum inconvenience to participants. We investigated the prevalence of risk factors (higher than ideal total cholesterol, blood pressure and HbA1c) in students at school blood drives. We also looked at the coexistence of multiple risk factors in the same individuals, with stratification by gender and ethnicity.
The present study aimed to compare the effects of equal-volume resistance training performed with single-joint (SJ) or multi-joint exercises (MJ) on VO2max, muscle strength and body composition in physically active males. Thirty-six participants were divided in two groups: SJ group (n = 18, 182.1 ± 5.2, 80.03 ± 2.78 kg, 23.5 ± 2.7 years) exercised with only SJ exercises (e.g., dumbbell fly, knee extension, etc.) and MJ group (n = 18, 185.3 ± 3.6 cm, 80.69 ± 2.98 kg, 25.5 ± 3.8 years) with only MJ exercises (e.g., bench press, squat, etc.). The total work volume (repetitions × sets × load) was equated between groups. Training was performed three times a week for 8 weeks. Before and after the training period, participants were tested for VO2max, body composition, 1 RM on the bench press, knee extension and squat. Analysis of covariance (ANCOVA) was used to compare post training values between groups, using baseline values as covariates. According to the results, both groups decreased body fat and increased fat free mass with no difference between them. Whilst both groups significantly increased cardiorespiratory fitness and maximal strength, the improvements in MJ group were higher than for SJ in VO2max (5.1 and 12.5% for SJ and MJ), bench press 1 RM (8.1 and 10.9% for SJ and MJ), knee extension 1 RM (12.4 and 18.9% for SJ and MJ) and squat 1 RM (8.3 and 13.8% for SJ and MJ). In conclusion, when total work volume was equated, RT programs involving MJ exercises appear to be more efficient for improving muscle strength and maximal oxygen consumption than programs involving SJ exercises, but no differences were found for body composition.
Cardiovascular disease is a leading cause of death, especially in individuals with diabetes mellitus, whose risk of morbidity and mortality due to cardiovascular disease is markedly increased compared with the general population. There has been growing interest in the identification of biomarkers of cardiovascular disease in people with diabetes. The present review focuses on the current and potential contributions of these biomarkers to predicting cardiovascular risk in individuals with diabetes. At present, certain biomarkers and biomarker combinations can lead to modest improvements in the prediction of cardiovascular disease in diabetes beyond traditional cardiovascular risk factors. Emerging technologies may enable the discovery of novel biomarkers and generate new information about known biomarkers (such as new combinations of biomarkers), which could lead to significant improvements in cardiovascular disease risk prediction. A critical question, however, is whether improvements in risk prediction will affect processes of care and decision making in clinical practice, as this will be required to achieve the ultimate goal of improving clinical outcomes in diabetes.
Objective:
To determine the association of resistance exercise, independent of and combined with aerobic exercise, with the risk of development of metabolic syndrome (MetS).
Patients and methods:
The study cohort included adults (mean ± SD age, 46±9.5 years) who received comprehensive medical examinations at the Cooper Clinic in Dallas, Texas, between January 1, 1987, and December, 31, 2006. Exercise was assessed by self-reported frequency and minutes per week of resistance and aerobic exercise and meeting the US Physical Activity Guidelines (resistance exercise ≥2 d/wk; aerobic exercise ≥500 metabolic equivalent min/wk) at baseline. The incidence of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III criteria. We used Cox regression to generate hazard ratios (HRs) and 95% CIs.
Results:
Among 7418 participants, 1147 (15%) had development of MetS during a median follow-up of 4 years (maximum, 19 years; minimum, 0.1 year). Meeting the resistance exercise guidelines was associated with a 17% lower risk of MetS (HR, 0.83; 95% CI, 0.73-0.96; P=.009) after adjusting for potential confounders and aerobic exercise. Further, less than 1 hour of weekly resistance exercise was associated with 29% lower risk of development of MetS (HR, 0.71; 95% CI, 0.56-0.89; P=.003) compared with no resistance exercise. However, larger amounts of resistance exercise did not provide further benefits. Individuals meeting both recommended resistance and aerobic exercise guidelines had a 25% lower risk of development of MetS (HR, 0.75; 95% CI, 0.63-0.89; P<.001) compared with meeting neither guideline.
Conclusion:
Participating in resistance exercise, even less than 1 hour per week, was associated with a lower risk of development of MetS, independent of aerobic exercise. Health professionals should recommend that patients perform resistance exercise along with aerobic exercise to reduce MetS.
Purpose: The present study examined the progressive implementation of a high effort resistance training (RT) approach in older adults over 6 months and through a 6 month follow-up on strength, body composition, function and wellbeing of older adults.
Methods: Twenty three older adults (aged 61 to 80 years) completed a 6 month supervised RT intervention applying progressive introduction of higher effort set end points. After completion of the intervention participants could choose to continue performing RT unsupervised until 6 months follow-up.
Results: Strength, body composition, function, and wellbeing all significantly improved over the intervention. Over the follow-up, body composition changes reverted to baseline values, strength was reduced though remained significantly higher than baseline, and wellbeing outcomes were mostly maintained. Comparisons over the follow-up between those who did, and those who did not, continue with RT revealed no significant differences for changes in any outcome measure.
Conclusions: Supervised RT employing progressive application of high effort set end points is well tolerated and effective in improving strength, body composition, function and wellbeing in older adults. However, whether participants continued, or did not, with RT unsupervised at follow-up had no effect on outcomes perhaps due to reduced effort employed during unsupervised RT.
Age-related declines in health and function make locomotion increasingly difficult leading to reductions in non-exercise activity thermogenesis (NEAT), skeletal muscle size and strength, and increased adiposity. Exercise is an important strategy to attenuate loss of function through the life cycle. Despite claims to the contrary, high-intensity exercise is important for the prevention of obesity and sarcopenia with advancing age. Therefore, the purpose of this mini-review is to present literature supporting the contention that low volume, high-intensity aerobic and/or resistance training can slow sarcopenia, sustain ease of movement, stimulate NEAT, and attenuate the accretion of fat mass.
Prior resistance training (RT) recommendations and position stands have discussed variables that can be manipulated when producing RT interventions. However, one variable that has received little discussion is set end points (i.e. the end point of a set of repetitions). Set end points in RT are often considered to be proximity to momentary failure and are thought to be a primary variable determining effort in RT. Further, there has been ambiguity in use and definition of terminology that has created issues in interpretation of research findings. The purpose of this paper is to: 1) provide an overview of the ambiguity in historical terminology around set end points; 2) propose a clearer set of definitions related to set end points; and 3) highlight the issues created by poor terminology and definitions. It is hoped this might permit greater clarity in reporting, interpretation, and application of RT interventions for researchers and practitioners.
Resistance exercises can be considered to be multi-joint (MJ) or single-joint (SJ) in nature. Many strength coaches, trainers, and trainees believe that adding SJ exercises to a resistance training (RT) program may be required to optimize muscular size and strength. However, given that lack of time is a frequently cited barrier to exercise adoption, the time commitment resulting from these recommendations may not be convenient for many people. Therefore, it is important to find strategies that reduce the time commitment without negatively affecting results. The aim of this review was to analyze and discuss the present body of literature considering the acute responses to and long-term adaptations resulting from SJ and MJ exercise selection. Studies were deemed eligible for inclusion if they were experimental studies comparing the effects of MJ, SJ, or MJ ? SJ on dependent variables; studies were excluded if they were reviews or abstracts only, if they involved clinical populations or persons with articular or musculoskeletal problems, or if the RT intervention was confounded by other factors. Taking these factors into account, a total of 23 studies were included. For the upper and lower limbs, analysis of surface electromyographic (sEMG) activation suggests that there are no differences between SJ and MJ exercises when comparing the prime movers. However, evidence is contrasting when considering the trunk extensor musculature. Only one study directly compared the effects of MJ and SJ on muscle recovery and the results suggest that SJ exercises resulted in increased muscle fatigue and soreness. Long-term studies comparing increases in muscle size and strength in the upper limbs reported no difference between SJ and MJ exercises and no additional effects when SJ exercises were included in an MJ exercise program. For the lumbar extensors, the studies reviewed tend to support the view that this muscle group may benefit from SJ exercise. People performing RT may not need to include SJ exercises in their program to obtain equivalent results in terms of muscle activation and long-term adaptations such as hypertrophy and strength. SJ exercises may only be necessary to strengthen lumbar extensors and to correct muscular imbalances.
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
Background:
Resistance training (RT) is effective for glycemic control in type 2 diabetes mellitus (T2DM) patients. However, the characteristics of an RT program that will maximize its effect and those of patients that will especially benefit from RT are unknown.
Objective:
The objectives of this systematic review were to identify via a comprehensive meta-analysis the characteristics of an RT program for patients with T2DM that might increase the patients' improvement in glycemic control and the characteristics of patients that will benefit from RT.
Data sources:
Electronic-based literature searches of MEDLINE and EMBASE entries from 1 January 1966 to 25 August 2014 were conducted to identify clinical trials examining the effect of RT on glycemic control among patients with T2DM. Study keywords were text words and thesaurus terms related to RT and T2DM.
Study selection:
Studies were included if they (1) were clinical trials consisting of two groups with and without RT exercise intervention; (2) had an intervention period of at least 5 weeks; (3) clarified that all patients had T2DM; and (4) reported or made it possible to estimate the effect size [i.e., change in glycosylated hemoglobin (HbA1c) in the RT group minus that in the control group] and its corresponding standard error.
Study appraisal and synthesis methods:
The effect size in each study was pooled with a random-effects model. Analyses were stratified by several key characteristics of the patients and RT exercise programs; meta-regression analysis was then used to detect a difference in the effect size among strata within each factor. Linear regression analyses were added by entering each of the following profiles: patients' baseline characteristics [mean baseline age, body mass index (BMI), and HbA1c levels] and exercise characteristics (total sets per week, total sets per bout of exercise, frequency, and intensity).
Results:
There were 23 eligible studies comprising 954 patients with T2DM. The pooled effect size (95 % confidence interval) was -0.34 % (-0.53 to -0.16). A program with multiple sets (≥21 vs. <21) per one RT bout was associated with a large effect size (P = 0.03); however, the linear correlation between the number of sets and effect size was not significant (P = 0.56). A larger effect size was observed in studies with participants with diabetes of a relatively short duration (<6 vs. ≥6 years; P = 0.04) or a high baseline HbA1c [≥7.5 % (58 mmol/mol) vs. <7.5 %; P = 0.01] while a smaller effect size was observed in studies with a particularly high mean baseline BMI value (≥32 vs. <32 kg/m(2); P = 0.03). Linear regression analyses predicted that each increment of 1 % in the baseline HbA1c would enlarge the effect size by 0.036 %, while each increment of 1 kg/m(2) in the baseline BMI decreased it by 0.070 % in the range between 22.3 and 38.8 kg/m(2).
Conclusion:
In terms of glycemic control, RT could be recommended in the early stage of T2DM, especially for patients with relatively poor glycemic control. More benefit would be elicited in less obese patients within a limited range of the BMI. A substantial amount of exercise might be required to stimulate post-exercise glucose uptake, although the dose-dependency was not specifically clarified.
Purpose:
Investigate hemodynamic responses of resistance exercise (RE) with moderate load (i.e. international guidelines for RE of patients) versus RE with high load in patients with coronary artery disease (CAD).
Methods:
Medically stable males (n=11) and females (n=4) treated with PCI or CABG a minimum of six months prior to this study, performed three sets of 15RM and 4RM RE in a randomized order on separate days. Beat-to-beat systolic (SBP), diastolic (DBP) blood pressure, heart rate (HR), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR) were monitored at pre-exercise, and continuously during RE.
Results:
Compared to pre-exercise, SBP and DBP (mean of three sets) increased 12-13 % (both; p < 0.001) and 35-40% following 15RM RE (both; p < 0.001). 15RM SBP and DBP were higher than 4RM SBP and DBP (both; p < 0.001). The SBP of the 4th repetition of 15 RM RE was similar to the SBP of the 4th repetition of 4RM RE. Compared to pre-exercise, SV increased moderately following 4RM and 15 RM RE, respectively (both, p < 0.001). HR increased more following 15RM compared to 4RM RE (p < 0.05), thus higher CO following 15RM (compared to 4RM RE; p < 0.05), was mainly caused by higher HR. SVR decreased 15% (p < 0.001) and 50 % (p < 0.01) following 4RM and 15RM RE.
Conclusion:
SBP and DBP increased significantly more during moderate load RE, thus the magnitude of the external load is not the prime determinant of the pressure response during RE. If management of blood pressure is of concern, high load/low rep RE is preferable to medium load/high rep RE.
The purpose of this study was to examine post-exercise hypotension (PEH) responses to three different resistance exercise velocities in female athletes. The 13 female subjects with experience of resistance training performed a series of resistance exercises with 80% of one repetition maximum for 3 sets with differing in velocity of movements: fast movement (FM; 1-second eccentric and 1-second concentric actions), moderate movement (MM; 1-second eccentric and 2-second concentric actions) and slow movement (SM; 2-second eccentric and 4-second concentric actions). After completing each training session, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were taken every 10 min for a period of 60 min of recovery. The results indicated significant increases in SBP at 10th min post-exercise in comparison to baseline. After 60-min recovery, all conditions showed statistically significant decreases in SBP when compared with pre-exercise. In all measured moments, there were no significant differences among experimental sessions in post-exercise levels of SBP and DBP. Therefore, resistance training with FM, MM, and SM can induce increases in SBP after exercise, whereas after 60-min recovery, can induce decreases in SBP or post-exercise hypotension.
Introduction
Aging involves a progressive reduction of respiratory muscle strength as well as muscle strength.
Purpose
Compare the effects of resistance training volume on the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), functional performance, and muscle strength in elderly women.
Methods
Thirty elderly women were randomly assigned to a group performing either single sets (1-SET) or three sets (3-SET) of exercises. The sit-to-stand test, MIP, MEP, and muscle strength were assessed before and after 24 training sessions. Progressive resistance training was performed two times per week for a total of 8–12 repetitions, using the main muscle groups of the upper and lower limbs.
Results
The main results showed that the participants significantly increased their MEP (P<0.05; 1-SET: 34.6%; 3-SET: 35.8%) and MIP (P<0.05; 1-SET: 13.7%; 3-SET: 11.2%). Both groups also improved in the sit-to-stand test (P<0.05; 1-SET: 10.6%; 3-SET: 17.1%). After 24 training sessions, muscle strength also significantly increased (P<0.0001; 40%–80%) in both groups. An intergroup comparison did not show any statistically significant differences between the groups in any of the parameters analyzed.
Conclusion
Single- and multiple-set resistance training programs increased MIP, MEP, muscle strength, and sit-to-stand test performance in elderly women after 24 sessions of training. In conclusion, our results suggested that elderly women who are not in the habit of physical activity may start with single-set resistance training programs as a short-term strategy for the maintenance of health.
Background:
Data on risk associated with 24-hour ambulatory diastolic (DBP24) versus systolic (SBP24) blood pressure are scarce.
Methods and results:
We recorded 24-hour blood pressure and health outcomes in 8341 untreated people (mean age, 50.8 years; 46.6% women) randomly recruited from 12 populations. We computed hazard ratios (HRs) using multivariable-adjusted Cox regression. Over 11.2 years (median), 927 (11.1%) participants died, 356 (4.3%) from cardiovascular causes, and 744 (8.9%) experienced a fatal or nonfatal cardiovascular event. Isolated diastolic hypertension (DBP24≥80 mm Hg) did not increase the risk of total mortality, cardiovascular mortality, or stroke (HRs≤1.54; P≥0.18), but was associated with a higher risk of fatal combined with nonfatal cardiovascular, cardiac, or coronary events (HRs≥1.75; P≤0.0054). Isolated systolic hypertension (SBP24≥130 mm Hg) and mixed diastolic plus systolic hypertension were associated with increased risks of all aforementioned end points (P≤0.0012). Below age 50, DBP24 was the main driver of risk, reaching significance for total (HR for 1-SD increase, 2.05; P=0.0039) and cardiovascular mortality (HR, 4.07; P=0.0032) and for all cardiovascular end points combined (HR, 1.74; P=0.039) with a nonsignificant contribution of SBP24 (HR≤0.92; P≥0.068); above age 50, SBP24 predicted all end points (HR≥1.19; P≤0.0002) with a nonsignificant contribution of DBP24 (0.96≤HR≤1.14; P≥0.10). The interactions of age with SBP24 and DBP24 were significant for all cardiovascular and coronary events (P≤0.043).
Conclusions:
The risks conferred by DBP24 and SBP24 are age dependent. DBP24 and isolated diastolic hypertension drive coronary complications below age 50, whereas above age 50 SBP24 and isolated systolic and mixed hypertension are the predominant risk factors.
The effects of resistance training on mitochondrial biogenesis and oxidative capacity in skeletal muscle are not fully characterized, and even less is known about alterations in adipose tissue. We aimed to investigate adaptations in oxidative metabolism in skeletal muscle and adipose tissue after 8 weeks of heavy resistance training in apparently healthy young men.
Expression of genes linked to oxidative metabolism in the skeletal muscle and adipose tissue was assessed before and after the training program. Body composition, peak oxygen uptake (VO2 peak), fat oxidation, activity of mitochondrial enzyme in muscle, and serum adiponectin levels were also determined before and after resistance training.
In muscle, the expression of the genes AdipoR1 and COX4 increased after resistance training (9 and 13 %, respectively), whereas the expression levels of the genes PGC-1α, SIRT1, TFAM, CPT1b, and FNDC5 did not change. In adipose tissue, the expression of the genes SIRT1 and CPT1b decreased after training (20 and 23 %, respectively). There was an increase in lean mass (from 59.7 ± 6.1 to 61.9 ± 6.2 kg), VO2 peak (from 49.7 ± 5.5 to 56.3 ± 5.0 ml/kg/min), and fat oxidation (from 6.8 ± 2.1 to 9.1 ± 2.7 mg/kg fat-free mass/min) after training, whereas serum adiponectin levels decreased significantly and enzyme activity of citrate synthase and 3-hydroxyacyl-CoA dehydrogenase did not change.
Despite significant increases in VO2 peak, fat oxidation, and lean mass following resistance training, the total effect on gene expression and enzyme activity linked to oxidative metabolism was moderate.
The concept of a "polypill" is receiving growing attention to prevent cardiovascular disease. Yet similar if not overall higher benefits are achievable with regular exercise, a drug-free intervention for which our genome has been haped over evolution. Compared with drugs, exercise is available at low cost and relatively free of adverse effects. We summarize epidemiological evidence on the preventive/therapeutic benefits of exercise and on the main biological mediators involved.
The purpose of the American College of Sports Medicine_s (ACSM) exercise preparticipation health screening process is to identify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. Recent studies have suggested that using the current ACSM exercise preparticipation health screening guidelines can result in excessive physician referrals, possibly creating a barrier to exercise participation. In addition, there is considerable evidence that exercise is safe for most people and has many associated health and fitness benefits; exercise-related cardiovascular events are often preceded by warning signs/symptoms; and the cardiovascular risks associated with exercise lessen as individuals become more physically active/fit. Consequently , a scientific roundtable was convened by the ACSM in June 2014 to evaluate the current exercise preparticipation health screening recommendations. The roundtable proposed a new evidence-informed model for exercise preparticipation health screening on the basis of three factors: 1) the individual_s current level of physical activity, 2) presence of signs or symptoms and/or known cardio-vascular, metabolic, or renal disease, and 3) desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events. Identifying cardiovascular disease risk factors remains an important objective of overall disease prevention and management, but risk factor profiling is no longer included in the exercise preparticipation health screening process. The new ACSM exercise preparticipation health screening recommendations reduce possible unnecessary barriers to adopting and maintaining a regular exercise program, a lifestyle of habitual physical activity, or both, and thereby emphasize the important public health message that regular physical activity is important for all individuals.
The aim of this study was to examine the effect of adding single-joint (SJ) exercises to a multi-joint (MJ) exercise resistance-training program on upper body muscle size and strength. Twenty-nine untrained young men participated in a 10-week training session. They were randomly divided in 2 groups: the MJ group performed only MJ exercises (lat pulldown and bench press); the MJ+SJ group performed the same MJ exercises plus SJ exercises (lat pulldown, bench press, elbow flexion, and elbow extension). Before and after the training period, the muscle thickness (MT) of the elbow flexors was measured with ultrasound, and peak torque (PT) was measured with an isokinetic dynamometer. There was a significant (p < 0.05) increase in MT (6.5% for MJ and 7.04% for MJ+SJ) and PT (10.40% for MJ and 12.85% for MJ+SJ) in both groups, but there were no between-group differences. Therefore, this study showed that the inclusion of SJ exercises in a MJ exercise training program resulted in no additional benefits in terms of muscle size or strength gains in untrained young men.
To investigate the antihypertensive effects of conventional resistance exercise (RE) on the blood pressure (BP) of hypertensive subjects, 15 middle-aged (46 ± 3 years) hypertensive volunteers, deprived of antihypertensive medication (reaching 153 ± 6/93 ± 2 mm Hg systolic/diastolic BP after a 6-week medication washout period) were submitted to a 12-week conventional RE training program (3 sets of 12 repetitions at 60% 1 repetition maximum, 3 times a week on nonconsecutive days). Blood pressure was measured in all phases of the study (washout, training, detraining). Additionally, the plasma levels of several vasodilators or vasoconstrictors that potentially could be involved with the effects of RE on BP were evaluated pre- and posttraining. Conventional RE significantly reduced systolic, diastolic, and mean BP, respectively, by an average of 16 (p < 0.001), 12 (p < 0.01), and 13 mm Hg (p < 0.01) to prehypertensive values. There were no significant changes of vasoactive factors from the kallikrein-kinin or renin-angiotensin systems. After the RE training program, the BP values remained stable during a 4-week detraining period. Taken together, this study shows for the first time that conventional moderate-intensity RE alone is able to reduce the BP of stage 1 hypertensive subjects free of antihypertensive medication. Moreover, the benefits of BP reduction achieved with RE training remained unchanged for up to 4 weeks without exercise.
Accurate measurement of blood pressure is of utmost importance in hypertension research. In the context of epidemiologic and clinical studies, oscillometric devices offer important advantages to overcome some of the limitations of the auscultatory method. Even though their accuracy has been evaluated in multiple studies in the clinical setting, there is little evidence of their performance in large epidemiologic studies.
We evaluated the accuracy of the Omron HEM-705-CP, an automatic device for blood pressure (BP) measurement, as compared to the standard auscultatory method with a mercury sphygmomanometer in a large cohort study.
We made three auscultatory measurements, followed by two measurements with the Omron device in 1,084 subjects. Bias was estimated as the average of the two Omron minus the average of the last two auscultatory measurements, with its corresponding 95% limits of agreement (LA).
The Omron overestimated systolic blood pressure (SBP) by 1.8 mmHg (LA:-10.1, 13.7) and underestimated diastolic blood pressure (DBP) by 1.6 mmHg (LA:-12.3, 9.2). Bias was significantly larger in men. Bias in SBP increased with age and decreased with BP level, while bias in DBP decreased with age and increased with BP level. The sensitivity and specificity of the Omron to detect hypertension were 88.2% and 98.6%, respectively. Minimum bias in the estimates of the effects of several factors resulted from the use of Omron measurements.
Our results showed that the Omron HEM-705-CP could be used for measuring BP in large epidemiology studies without compromising study validity or precision.
Exercise is recommended as prevention, management, and control of all stages of hypertension. There are still controversies about the optimal training dose, frequency, and intensity. We aimed to study the effect of aerobic interval training on blood pressure and myocardial function in hypertensive patients.
A total of 88 patients (52.0 ± 7.8 years, 39 women) with essential hypertension were randomized to aerobic interval training (AIT) (>90% of maximal heart rate, correlates to 85-90% of VO(2max)), isocaloric moderate intensity continuous training (MIT) (~70% of maximal heart rate, 60% of VO(2max)), or a control group. Exercise was performed on a treadmill, three times per week for 12 weeks. Ambulatory 24-hour blood pressure (ABP) was the primary endpoint. Secondary endpoints included maximal oxygen uptake (VO(2max)), mean heart rate/24 hour, flow mediated dilatation (FMD), total peripheral resistance (TPR), and myocardial systolic and diastolic function by echocardiography. Systolic ABP was reduced by 12 mmHg (p < 0.001) in AIT and 4.5 mmHg (p = 0.05) in MIT. Diastolic ABP was reduced by 8 mmHg (p < 0.001) in AIT and 3.5 mmHg (p = 0.02) in MIT. VO(2max) improved by 15% (p < 0.001) in AIT and 5% (p < 0.01) in MIT. Systolic myocardial function improved in both exercise groups, diastolic function in the AIT group only. TPR reduction and increased FMD were only observed in the AIT group.
This study indicates that the blood pressure reducing effect of exercise in essential hypertension is intensity dependent. Aerobic interval training is an effective method to lower blood pressure and improve other cardiovascular risk factors.
We compared early-phase effects between high- and low-volume moderate-intensity resistance training on lean muscle volume, maximal bilateral leg extension strength, maximal isometric torque, normalized maximal bilateral leg extension strength, normalized maximal isometric torque, and muscle recruitment of the right knee extensors in previously untrained young (23.8 ± 3.7 years, range 20-30 years; n = 16) and older women (67.6 ± 6.3 years, range 60-78 years; n = 15). Participants performed either one set or three sets of 10 repetitions for the bilateral leg extension and bilateral leg curl at an intensity of 50-75% of maximal strength 3 days per week for 10 weeks. Main effects were observed over time for all variables (P < 0.05) with increases ranging from 7.1% to 27.8% and effect sizes (Cohen's d) ranging from 0.45 to 1.38. No interactions between age and training volume over time were observed for any variable (P > 0.05). Our results provide a novel contribution to the literature demonstrating that additional neuromuscular adaptation during early-phase moderate-intensity resistance training in previously untrained young and older women may not be elicited through higher-volume training when training loads are matched provided that a minimal volume threshold is attained. These findings may have practical applications for the prescription of short-duration resistance training programmes to enhance muscle strength and achieve hypertrophic and non-hypertrophic adaptations in untrained women.
Patients in cardiac rehabilitation are typically advised to complete a period of supervised endurance training before beginning resistance training. In this study, however, we compared the peak rate-pressure product (RPP, a calculated indicator of myocardial work) of patients during two types of exercise-treadmill walking and chest press-from workout session 1 through completion of cardiac rehabilitation. Twenty-one patients (4 women and 17 men, aged 35 to 70 years) were enrolled in the study; they were referred for cardiac rehabilitation after myocardial infarction, percutaneous coronary intervention, or both. The participants did treadmill walking and chest press exercises during each workout session. Peak values for heart rate (HR) and systolic blood pressure (SBP) were recorded, and the peak RPP was calculated (peak HR multiply sign in box peak SBP). Paired t tests were used to compare the data collected during the two types of exercise across 19 workout sessions. The mean peak values for HR, SBP, and RPP were lower during resistance training than during endurance training; the differences were statistically significant (P < 0.05), with only one exception (the SBP for session 1). Across all 19 workout sessions, the participants performed more myocardial work, as indicated by the peak RPP, during treadmill walking than during the chest press.
Epidemiological studies have indicated an inverse association between cardiorespiratory fitness (CRF) and coronary heart disease (CHD) or all-cause mortality in healthy participants.
To define quantitative relationships between CRF and CHD events, cardiovascular disease (CVD) events, or all-cause mortality in healthy men and women.
A systematic literature search was conducted for observational cohort studies using MEDLINE (1966 to December 31, 2008) and EMBASE (1980 to December 31, 2008). The Medical Subject Headings search terms used included exercise tolerance, exercise test, exercise/physiology, physical fitness, oxygen consumption, cardiovascular diseases, myocardial ischemia, mortality, mortalities, death, fatality, fatal, incidence, or morbidity. Studies reporting associations of baseline CRF with CHD events, CVD events, or all-cause mortality in healthy participants were included.
Two authors independently extracted relevant data. CRF was estimated as maximal aerobic capacity (MAC) expressed in metabolic equivalent (MET) units. Participants were categorized as low CRF (< 7.9 METs), intermediate CRF (7.9-10.8 METs), or high CRF (> or = 10.9 METs). CHD and CVD were combined into 1 outcome (CHD/CVD). Risk ratios (RRs) for a 1-MET higher level of MAC and for participants with lower vs higher CRF were calculated with a random-effects model.
Data were obtained from 33 eligible studies (all-cause mortality, 102 980 participants and 6910 cases; CHD/CVD, 84 323 participants and 4485 cases). Pooled RRs of all-cause mortality and CHD/CVD events per 1-MET higher level of MAC (corresponding to 1-km/h higher running/jogging speed) were 0.87 (95% confidence interval [CI], 0.84-0.90) and 0.85 (95% CI, 0.82-0.88), respectively. Compared with participants with high CRF, those with low CRF had an RR for all-cause mortality of 1.70 (95% CI, 1.51-1.92; P < .001) and for CHD/CVD events of 1.56 (95% CI, 1.39-1.75; P < .001), adjusting for heterogeneity of study design. Compared with participants with intermediate CRF, those with low CRF had an RR for all-cause mortality of 1.40 (95% CI, 1.32-1.48; P < .001) and for CHD/CVD events of 1.47 (95% CI, 1.35-1.61; P < .001), adjusting for heterogeneity of study design.
Better CRF was associated with lower risk of all-cause mortality and CHD/CVD. Participants with a MAC of 7.9 METs or more had substantially lower rates of all-cause mortality and CHD/CVD events compared with those with a MAC of less 7.9 METs.
The incidence of hypertension increases with advancing age and represents a significant burden of disease. Lifestyle modification represents the first-line intervention in treatment algorithms; however, the majority of evidence for this comes from studies involving young participants using interventions that may not always be feasible in the elderly. This manuscript presents a systematic review of all randomized controlled trials involving participants with a mean age of 65 or over investigating nonpharmacological strategies to reduce blood pressure (BP). Fifty-three randomized controlled trials were included. The majority of interventions described aerobic exercise training, dynamic resistance exercise training, or combined aerobic and dynamic resistance exercise training (COM), with limited studies reporting isometric exercise training or alternative lifestyle strategies. Aerobic exercise training, dynamic resistance exercise training, COM, and isometric exercise training all elicited significant reductions in both systolic and diastolic BP, with no additional benefit of COM compared with single modality exercise training. Three months of traditional exercise-based lifestyle intervention may produce a reduction in BP of approximately 5 mmHg systolic and 3 mmHg diastolic in older individuals, similar to that expected in younger individuals.
Background and purpose:
Studies showed β-cell dysfunction was associated with increased risk of cardiovascular disease and subclinical carotid atherosclerosis. This study aimed to investigate the association between β-cell function and prognosis of nondiabetic patients with ischaemic stroke.
Methods:
Ischaemic stroke patients without diabetes in the Abnormal Glucose Regulation in Patients with Acute Stroke across China registry were included in this analysis. Homeostasis assessment of β-cell function (HOMA-β), was performed and classified it into four groups according to quartiles. The outcomes included stroke recurrence, poor functional outcome and all-cause mortality.
Results:
In a total of 1244 patients, the average age was 62.3 years, 63.1% patients were male. At one year, the 1st quartile of HOMA-β (< 54.0) was associated with increased stroke recurrence [adj. hazard ratio (HR) 2.04, 95% confidence intervals (CI) 1.32-3.17, P = 0.001], poor functional outcome [adj. odds ratio (OR) 3.04, 95% (CI) 1.90-4.88, P < 0.001] and mortality (adj.HR 4.12, 95% CI 2.24-7.59, P < 0.001), compared with the 4th quartile of HOMA-β (≥ 166.3) after adjustment for insulin resistance and other potential covariates. The 2nd and 3rd quartile of HOMA-β were significantly associated with an increased risk of poor functional outcome. Multivariable regression analysis with restricted cubic splines showed an L-shaped association between HOMA-β and outcomes at one year.
Conclusions:
Our study shows that lower HOMA-β level is associated with poor outcomes at one year in nondiabetic patients with ischaemic stroke. This article is protected by copyright. All rights reserved.
This letter is a commentary regarding the Mini review by Fisher et al. (2017), entitled “A minimal dose approach to resistance training for the older adult; the prophylactic for aging”, which was recently published in the Experimental Gerontology, 99, 80-86. Although we recognize the experience of the authors in the resistance training research field, as well as we agree with the main message of the article, that is, a minimal dose of resistance training provides several health benefits in elderly individuals, we would like to complement some provided information, and argue, based on strong scientific evidence, against some affirmations.
A plethora of research has supported the numerous health benefits of resistance training as we age, including positive relationships between muscular strength, muscle mass and reduced all-cause mortality. As such, resistance training has been referred to as medicine. However, participation and adherence remains low, with time constraints and perceived difficulty often cited as barriers to resistance training. With this in mind, we aimed to summarise the benefits which might be obtained as a product of a minimal dose approach. In this sense, participation in resistance training might serve as a prophylactic to delay or prevent the onset of biological aging. A short review of studies reporting considerable health benefits resulting from low volume resistance training participation is presented, specifically considering the training time, frequency, intensity of effort, and exercises performed. Research supports the considerable physiological and psychological health benefits from resistance training and suggests that these can be obtained using a minimal dose approach (e.g. ≤60min, 2d-wk(-1)), using uncomplicated equipment/methods (e.g. weight stack machines). Our hope is that discussion of these specific recommendations, and provision of an example minimal dose workout, will promote resistance training participation by persons who might otherwise have not engaged. We also encourage medical professionals to use this information to prescribe resistance exercise like a drug whilst having an awareness of the health benefits and uncomplicated methods.
Objectives:
To assess the prevalence of non-responders to different tests and to compare the effects of different resistance training (RT) volumes on muscle strength, anthropometric and functional performance of older women.
Methods:
Three hundred seventy six women performed 12weeks of RT with either low or high volume (LV, 71.29±5.77years and HV 69.73±5.88years, respectively). Both groups performed the same exercises, and all parameters were held constant except for the number of sets performed per week. LV performed 8-12 for upper and 4-6 for lower body, while HV performed 16-20 and 8-10, respectively. Before and after the training period, the participants were tested for bench press and leg press 1RM, 30-s chair stand, 30-s arm curl, six-minute walk test, sit and reach, body weight and waist circumference.
Results:
Both groups significantly improved in all strength and functional tests and reduced their body weight and waist circumference. ANOVA revealed higher gains in the leg press 1RM, 30-s arm curls and 6-min walk test for the HV group and higher increases in the results of the sit and reach test for the LV group. However, the differences were negligible and may be attributable to a type I error due to the large sample size. Non-responsiveness was not apparent in any subject, as a positive response on at least one outcome was present in every participant.
Conclusions:
Our results suggest that RT, even at low volume, improves waist circumference, muscle strength and physical function in the older population, with no evidence of non-responsiveness. Therefore, we should not be restrictive in prescribing this type of exercise to this population.
Background and purpose:
In older people with type 2 diabetes mellitus (T2DM), the effects of aging and T2DM may compromise the function of skeletal muscle, deteriorate metabolic status, and jeopardize physical performance, aerobic capacity, and quality of life (QoL). The purpose of this study was to investigate the effects of 12 weeks of resistance training (RT) on muscle function, physical performance, cardiometabolic risks, and QoL in older people with T2DM.
Methods:
This study was a randomized controlled trial that employed block randomization, assessor blinding, and the intention-to-treat principle. Thirty people 65 years or older with a diagnosis of T2DM were randomly assigned to either an exercise group or a control group and were further stratified by gender. The exercise group performed 8 RT exercises in 3 sets of 8 to 12 repetitions at 75% 1-repetition maximum (1-RM) 3 times per week for 12 weeks. The control group received usual care and maintained their daily activities and lifestyle. Muscle function (1-RM and muscle oxygenation responses), physical performance (5-repetition sit-to-stand test and Timed Up and Go test), cardiometabolic risks (aerobic capacity, blood pressure, body composition, glycemic control, lipids levels, and high-sensitivity C-reactive protein levels), and QoL (Audit of Diabetes-Dependent Quality of Life 19) were assessed at baseline (week 0) and after the 12-week interventions (week 12).
Results:
The 1-RM chest-press and leg-press strength and physical performance in 5-repetition sit-to-stand test were significantly improved in the exercise group compared with the controls after the interventions. The exercise group had significantly lower resting systolic blood pressure (by -12.1 mm Hg, P = .036) than did the controls after 12 weeks of RT, without any significant within-group change in either group after intervention. The waist circumference, fasting glucose levels, and peak diastolic blood pressure tended to favor RT over usual care after the interventions.
Conclusion:
Twelve weeks of RT increased the maximal strength in chest-press and leg-press tests, and improved 5-repetition sit-to-stand performance in older people with T2DM. Our study demonstrated that supervised, structured RT was able to promote muscle function and alleviate cardiometabolic risks in people with T2DM 65 years or older.
Aims:
Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. However, if prediction of insulin associated weight gain was possible on an individualized level, targeted initiatives could be implemented to reduce weight gain. The objective of this study was to identify predictors of weight gain in insulin treated patients with Type 2 diabetes mellitus.
Methods:
A total of 412 individuals with Type 2 diabetes mellitus were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analogue treatment regimens. Participants with excessive weight gain were defined as the group with weight gain in the 4(th) quartile. We developed a pattern classification method to predict individuals prone to excessive weight gain.
Results:
The median weight gain among all patients (n = 412) was 2.4 (95% prediction interval: -5.6 to 12.4) kg and 8.9 (95%: 6.3 to 15.2) kg for the upper 4(th) quartile (n = 103) during the 18 months. No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for the weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a ROC AUC of 0.80.
Conclusions:
We have developed a prediction model that could help to identify a substantial proportion of individuals with Type 2 diabetes prone to large weight gain during insulin therapy.
Abstract
Background
Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability.
Objectives
To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review.
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.
Selection criteria
Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors.
Data collection and analysis
Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses.
Main results
We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.
Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results.
Authors' conclusions
Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.
The aim of this study was compare changes in upper body muscle strength and size in trained men performing resistance training (RT) programs involving multi-joint plus single-joint (MJ+SJ) or only multi-joint (MJ) exercises. Twenty young men with at least two years of experience in RT were randomized in two groups: MJ+SJ (n = 10, 27.7 + 6.6 years) and MJ (n = 10, 29.4 + 4.6 years). Both groups trained for 8 weeks following a linear periodization model. Measures of elbow flexors and extensors 1RM, flexed arm circumference (FAC) and arm muscle circumference (AMC) were taken pre and post training period. Both groups significantly increased 1RM for elbow flexion (4.99 and 6.42% for MJ and MJ+SJ, respectively), extension (10.60 vs 9.79%, for MJ and MJ+SJ, respectively), FAC (1.72 vs 1.45%, for MJ and MJ+SJ, respectively) and AMC (1.33 vs 3.17% for MJ and MJ+SJ, respectively). Comparison between groups revealed no significant difference in any variable. In conclusion, eight weeks of RT involving MJ or MJ+SJ resulted in similar alterations in muscle strength and size in trained participants. Therefore, the addition of SJ exercises to a RT program involving MJ exercises does not seem to promote additional benefits to trained men suggesting MJ only RT to be a time efficient approach.
The global statistics of diabetes mellitus in year 2013 indicated, about 382 million people had this disease worldwide, with type 2 diabetes making up about 90 % of the cases. This is equal to 8.3 % of the adult population with equal rates in both women and men. In year 2012 and 2013 diabetes resulted in mortality of 1.5-5.1 million people per year, making it the 8th leading cause of death in the world. It is predicted that by year 2035 about 592 million people will die of diabetes. The economic cost of diabetes seems to have increased worldwide. An average age of onset of diabetes is 42.5 years and could be due to consumption of high sugar and high-calorie diet, low physical activity, genetic susceptibility, and lifestyle. Approximately 8 % children and about 26 % young adults have diabetes mellitus in the world. The results of epidemiological study of type 1 diabetes mellitus (T1D) are presented by demographic, geographic, biologic, cultural, and other factors in human populations. The prevalence of T1D has been increased by 2-5 % worldwide and its prevalence is approximately one in 300 in US by 18 years of age. The epidemiological studies are important to study the role, causes, clinical care, prevention, and treatment of type1 diabetes in pregnant women and their children before and after birth. In this article, causes, diagnosis, symptoms, treatment and medications, and epidemiology of diabetes will be described.
Abstract Skeletal muscle power decreases earlier than muscle strength with advancing age and is more strongly associated with functional test performance than muscle strength in elderly populations. In addition, some studies have been shown that resistance training designed to improve muscle power output (high-speed of motion) enhances several functional outcomes in healthy elderly. Therefore, muscle power has emerged as a factor that is potentially associated with functional limitations also in frail elderly adults. The purpose of this review was to provide recent evidences regarding the association between skeletal muscle power and functional capacity in physically frail individuals. Scielo, Science Citation Index, MEDLINE, Scopus, Sport Discus and ScienceDirect databases were searched from 1990 to 2014. Recently, it has been shown that functional capacity among frail elderly adults could be improved by performing resistance training at a high speed of motion with a loading stimulus that optimizes muscle power output. Routine multicomponent interventions that include muscle power training should be prescribed to institutionalized oldest old because such interventions improve the overall physical status of frail elderly individuals and prevent disability and other adverse outcomes. This result is especially important in frail subjects, who urgently need to improve their functional capacities to prevent adverse outcomes such as falls, hospitalizations, disability, or even death.
People with or who are at risk of developing type 2 diabetes mellitus (T2DM) could prevent or reduce T2DM-related complications through physical activity. A new study shows the effects of physical activity on mortality in T2DM and another compares the effects of aerobic exercise, weight training or a combined programme on risk of T2DM.
This study evaluated the effects of various resistance exercise protocols on 24-hour postexercise insulin sensitivity. Seventeen participants with impaired fasting glucose (100-125 mg/dL) completed 4 separate bouts of resistance exercise under moderate intensity (65% 1 repetition maximum [1RM]) or high intensity (85% 1RM) conditions within the confines of single set and multiple set protocols. Intravenous fasting blood was taken at baseline and 24 hours postexercise for each exercise condition to measure fasting plasma glucose (G0) and fasting serum insulin (I0) to calculate insulin sensitivity (homeostasis model assessment-insulin resistance = (G0*I0)/405). A minimum of 3 days washout was given between each exercise protocol. A 4 x 2 factorial analysis of variance was performed to compare insulin sensitivity and fasting glucose within subjects and between treatments. All of the exercise protocols improved subsequent insulin sensitivity (p = 0.002) and G0 (p = 0.001). In comparison with single set, there was a significantly greater decrease in G0 (p = 0.021) 24 hours after multiple set bouts. High intensity showed significant decreases in insulin sensitivity as compared with moderate intensity protocols (p = 0.046). Effect size data suggest a dose response relationship between program variables of volume and intensity and 24-hour postexercise insulin sensitivity. High-intensity protocols resulted in greater effect sizes for insulin sensitivity (0.83 multiple set; 0.53 single set) as compared with moderate-intensity protocols. The high-intensity, multiple set bout yielded the greatest treatment effect in both fasting glucose (0.61) and insulin sensitivity (0.83). Overall, single set protocols were less effective than multiple set protocols in lowering fasting blood glucose. Findings suggest a dose-response relationship between volume and intensity on insulin sensitivity and fasting blood glucose. Results indicate that resistance exercise is an effective treatment for acutely enhancing insulin sensitivity and regulating blood glucose in individuals with impaired fasting glucose.
The purpose of the present study was to compare the changes in muscle strength in nontrained young males performing resistance training under different supervision ratios. One hundred twenty-four young men were randomly assigned to groups trained under a high (HS, 1:5 coach to athlete ratio) or low (LS, 1:25) supervision ratio. Both groups performed identical resistance training programs. Subjects were tested for maximum bench press 1 repetition maximum (1RM) and knee extensor torque before and after 11 weeks of training. According to the results, only HS lead to a significant increase (11.8%) in knee extensor torque. Both groups significantly increased bench press 1RM load; the increases were 10.22% for LS and 15.9% for HS. The results revealed significant differences between groups for changes in knee extensor torque and 1RM bench press, with higher values for the HS group. There were no differences between groups for the increases in bench press and leg press work volume or training attendance. The proportion of subjects training with maximum intensity was higher in HS for both bench press and leg press exercises. In addition, the distribution of subjects training with maximal intensity was higher for the bench press than for the leg press exercise in both groups. The primary findings of the present study are that the strength gains for both lower- and upper-body muscles are greater in subjects training under higher supervision ratios, and this is probably because of higher exercise intensity. These results confirm the importance of direct supervision during resistance training.
The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.