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The Effect of High-intensity Interval Training vs Moderate-intensity Continuous Training on Liver Fat: A Systematic Review and Meta-Analysis.
Sabag, A, Barr, L, Armour, M, Armstrong, A, Baker, CJ, Twigg, SM, Chang, D, Hackett, DA, Keating, SE, George, J, et al
The Journal of clinical endocrinology and metabolism. 2022;(3):862-881
Abstract
CONTEXT Non-alcoholic fatty liver disease, characterized by excess fat accumulation in the liver, is considered the hepatic manifestation of metabolic syndrome. Recent findings have shown that high-intensity interval training (HIIT) can reduce liver fat but it is unclear whether this form of exercise is superior to traditional moderate-intensity continuous training (MICT). OBJECTIVE The aim of this systematic review was to determine the effect of HIIT vs MICT on liver fat in adults. A secondary aim was to investigate the interaction between total weekly exercise volume and exercise-related energy expenditure and change in liver fat. METHODS Relevant databases were searched up to December 2020 for randomized trials, comparing HIIT to control, MICT to control, or HIIT to MICT. Studies were excluded if they did not implement 2 or more weeks' intervention or assess liver fat using magnetic resonance-based techniques. Weighted mean differences and 95% CIs were calculated. Regression analyses were undertaken to determine the interaction between weekly exercise volume in minutes and kilocalories (kcal) with change in liver fat content. RESULTS Of the 28 268 studies screened, 19 were included involving 745 participants. HIIT and MICT both elicited moderate reductions in liver fat content when compared to control (HIIT: -2.85%, 95% CI, -4.86 to -0.84, P = .005, I2 = 0%, n = 114, low-certainty evidence; MICT -3.14%, 95% CI, -4.45 to -1.82, P < .001, I2 = 5.2%, n = 533, moderate-certainty evidence). There was no difference between HIIT and MICT (-0.34%, 95% CI, -2.20 to 1.52, P = .721, I2 = 0%, n = 177, moderate-certainty evidence). Neither total exercise volume in minutes (β = .0002, SE = 0.0017, Z = 0.13, P = .89) nor exercise-related energy expenditure in kcal (β = .0003, SE = 0.0002, Z = 1.21, P = .23) were related to changes in liver fat content. CONCLUSION HIIT elicits comparable improvements in liver fat to MICT despite often requiring less energy and time commitment. Further studies should be undertaken to assess the relative importance of aerobic exercise prescription variables, such as intensity, on liver fat.
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A Comparative Study of Health Efficacy Indicators in Subjects with T2DM Applying Power Cycling to 12 Weeks of Low-Volume High-Intensity Interval Training and Moderate-Intensity Continuous Training.
Li, J, Cheng, W, Ma, H
Journal of diabetes research. 2022;:9273830
Abstract
This study is aimed at comparing the effects of different exercise intensities, namely, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on body composition, heart and lung fitness, and blood glucose, and blood pressure indices in patients with type 2 diabetes mellitus (T2DM), using power cycling. A total of 96 T2DM volunteers who met the inclusion criteria were recruited from a hospital in Yangpu, Shanghai. Based on the blood index data of their medical examination results which comprised blood pressure, fasting blood glucose, hemoglobin A1c (HbA1c), and insulin, 37 volunteers were included in the study. Exercise prescription was determined based on T2DM exercise guidelines combined with medical diagnosis and exercise test results, and the patients were randomly assigned to three groups: HIIT group, MICT group, and control (CON) group. HIIT involved one-minute power cycling (80%-95% maximal oxygen uptake (VO2max)), one-minute passive or active rest (25%-30% VO2max), and two-minute rounds of eight groups. MICT required the use of a power bike for 30 minutes of continuous training (50%-70% VO2max) five times a week. The CON group was introduced to relevant medicine, exercise, and nutrition knowledge. The exercise interventions were completed under the supervision of an exercise instructor and hospital doctors. The same indicators were measured after 12 weeks of intervention, and the results of the two tests within and between groups were analyzed for comparison. The weight index of the MICT intervention showed statistically significant within-group differences (difference = 3.52, 95% CI = 2.11-4.92, p = 0.001 < 0.01); group differences for the MICT and CON groups were also statistically significant (difference = 3.52 ± 2.09, Cd1 = -0.39 ± 1.25, p = 0.004 < 0.01). Body mass index (BMI) analysis revealed that the overall means of BMI indicators were not statistically different between groups (F = 0.369, p = 0.694 > 0.05) and the before and after values of the MICT and CON (difference = -1.30 ± 0.79, Cd1 = -0.18 ± 0.45, p = 0.001 < 0.01). No statistically significant difference was observed in the overall mean VO2max index between the groups after the 12-week intervention (F = 2.51, p = 0.100 > 0.05). A statistically significant difference was found in the overall means of the data between the two groups (difference = 0.32, 95% CI = 0.23-0.40, p = 0.001 < 0.01). Analysis of fasting blood glucose (FBG) indicators revealed statistically significant differences between the MICT and control groups (p = 0.028 < 0.05). Analysis of HbA1c and fasting insulin (FI) indicators revealed no statistically significant difference in the overall HbA1c index after the 12-week exercise intervention (F = 0.523, p = 0.598 > 0.05), and the overall difference before and after the experiment between the groups was statistically significant (F = 6.13, p = 0.006 < 0.01). No statistically significant difference was found in the FI index overall after the 12-week exercise intervention (F = 2.50, p = 0.1 > 0.05). Analysis of systolic blood pressure (SBP) revealed statistically significant difference before and after the HIIT and CON interventions (Hd7 = -1.10 ± 1.79, Cd7 = 1.2 ± 1.31, p = 0.018 < 0.05) and statistically significant difference before and after the MICT and CON interventions (Md7 = -0.99 ± 0.91, Cd7 = 1.40 ± 1.78, p = 0.02 < 0.05). The diastolic blood pressure (DBP) revealed no statistically significant within-group differences before and after. Exercise interventions applying both low-volume HIIT and MICT, with both intensity exercises designed for power cycling, improved health-related indicators in the participants; low-volume HIIT had more time advantage. The current experiment compared HIIT with MICT in a safe manner: 50% of the exercise time produced similar benefits and advantages in the two indicators of VO2max and FI. However, MICT was superior to HIIT in the two indicators of body weight (weight) and BMI. The effect of power cycling on FI has the advantages of both aerobic and resistance exercise, which may optimize the type, intensity, and time of exercise prescription according to the individual or the type of exercise program. Our results provide a reference for the personalization of exercise prescription for patients with T2DM.
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High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes.
de Azevedo, JRA, Lima, HCM, Frota, PHDB, Nogueira, IROM, de Souza, SC, Fernandes, EAA, Cruz, AM
BMC anesthesiology. 2021;(1):283
Abstract
BACKGROUND We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients. METHODS We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality). RESULTS We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS. CONCLUSION This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients. TRIAL REGISTRATION Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov ( NCT03469882 , March 19,2018).
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Exercise vs Conventional Treatment for Treatment of Primary Osteoporosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Yan, Y, Tan, B, Fu, F, Chen, Q, Li, W, Chen, W, He, H
Orthopaedic surgery. 2021;(5):1474-1487
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Abstract
OBJECTIVE Physical exercise has obvious effects on bone loss, pain relief, and improvement of bone metabolism indexes in patients with osteoporosis, but currently lacks sufficient evidence. The aim of this systematic review and meta-analysis was to synthesize and present the best available evidence on the effectiveness and safety of exercises in the treatment of primary osteoporosis. METHODS Publications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020. RESULTS A total of 20 studies with 1824 participants were included. The results of the meta-analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P < 0.00001, I2 = 85%; femoral neck BMD (SMD = 0.80, 95%CI: 0.34, 1.27, P = 0.0007, I2 = 88%), exercise therapy can significantly increase the lumbar spine BMD of patients with OP, especially in lumbar spine2-4 BMD (SMD = 0.47; 95%CI: 0.20, 0.75; P = 0.0008; I2 = 69%). Compared with conventional treatment, kinesitherapy also has significant differences in alleviating the pain of POP patients (SMD = -1.39, 95%CI: -2.47,-0.31, P = 0.01, I2 = 97%). Compared with conventional therapy, kinesitherapy has no significant difference in improving biochemical markers of bone metabolism such as bone glaprotein (BGP) (SMD = 2.59, 95%CI:0.90, 4.28, P = 0.003, I2 = 98%), N-terminal pro peptide of type I procollagen (PINP) (SMD = 0.77, 95%CI: -0.44 to 1.98, P = 0.21, I2 = 95%), serum phosphorus (SMD = 0.04, 95%CI: -0.13, 0.22, P = 0.61, I2 = 30%), alkaline phosphatase (ALP) (SMD = -0.08, 95%CI: -0.44, 0.27, P = 0.64, I2 = 76%), and serum calcium (SMD = 0.12, 95%CI: -0.18, 0.43, P = 0.42, I2 = 63%) in POP patients. CONCLUSIONS Kinesitherapy significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients.
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Effects of land- and water-based exercise programmes on postural balance in individuals with COPD: additional results from a randomised clinical trial.
de Castro, LA, Felcar, JM, de Carvalho, DR, Vidotto, LS, da Silva, RA, Pitta, F, Probst, VS
Physiotherapy. 2020;:58-65
Abstract
OBJECTIVE To investigate the effects of water-based exercise training on postural balance in individuals with chronic obstructive pulmonary disease (COPD), and compare the effects of two similar protocols of land- and water-based exercise programmes on postural balance in this population. DESIGN Randomised clinical trial. SETTING University-based, outpatient, physical therapy clinic. SUBJECTS Fifty individuals with COPD. INTERVENTIONS Participants were assigned at random to the land group (LG; n=27) or the water group (WG; n=23), and underwent high-intensity endurance and strength training three times per week for 3months. MAIN OUTCOME MEASURES Functional balance was assessed by the timed up and go test (TUG), and static balance was assessed with a force platform in the following conditions: standing with feet hip-width apart and eyes open; standing with feet hip-width apart and eyes closed; standing on a short base; and one-legged stance. RESULTS Seventeen subjects completed the intervention in the LG {nine males, mean age 64 [standard deviation (SD) 8] years, mean forced expiratory volume in 1 second (FEV1) 48 (SD 17) %predicted} compared with 14 subjects in the WG [nine males, mean age 65 (SD 8) years, FEV1 51 (SD 15) %predicted]. Water-based exercise training had a positive effect on functional balance [TUG: mean difference -1.17 (-1.93 to -0.41 95% confidence interval) seconds; P=0.006], whereas static balance remained unaltered for both groups. There was no between-group difference in postural balance after exercise training; however, a higher proportion of participants who had a clinically relevant improvement in the TUG were in the WG (LG 35%, WG 64%; P<0.001). CONCLUSION Functional balance improved after 3months of high-intensity exercise training performed in water. Despite the environment, non-specific training seems to be insufficient to improve static balance. CLINICAL TRIAL REGISTRATION NUMBER clinicalTrials.gov NCT01691131.
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Comparison of the effect of 12- and 24-session cardiac rehabilitation on physical, psychosocial and biomedical factors in ischemic heart disease patients.
Sadeghi, M, Izadi, A, Mahdi Hadavi, M, Rafati Fard, M, Roohafza, H
Hormone molecular biology and clinical investigation. 2020;(1)
Abstract
Background Cardiac rehabilitation (CR) is a key component of effective care for patients with a wide spectrum of cardiac problems. It seems that the short-term provision of these services can facilitate their use and meeting of related needs for patients participating in the CR programs. Materials and methods In this interventional study on patients with ischemic heart disease (IHD) referred to the Cardiac Rehabilitation Center of Chamran Hospital, Isfahan, Iran. One-hundred and twelve patients were randomly divided into two groups of 12 and 24 sessions of CR [mean age: 59.2 ± (9.02) and 60.7 ± (9.3) years, respectively] and underwent a CR program. All information was collected in two stages, before the beginning of the program and after completion of 12- and 24-session rehabilitation programs. The data collection tools were demographics questionnaire, the International Physical Activity Questionnaires (IPAQ), McNew Quality of Life Questionnaire, Beck Depression Inventory (BDI), and Zung Self-Rating Anxiety Scale (SAS). Results The results of this study showed that in both groups, total physical activity (PA) and functional capacity increased, and the quality of life (QOL) was statistically improved. Comparison of changes in mean differences at the end of the rehabilitation periods between the two groups, showed that only the weight, body mass index (BMI), waist circumference (WC) and high-density lipoprotein (HDL) in the 24-session group significantly decreased compared to the 12-session group and, but no significant difference in other variables was observed. Conclusion Overall, the findings of this study support the overall benefits of the CR program in both the short and the long term. Therefore it can be suggested that a short-term program can still be a valuable option for reducing the risk in cardiac patients and meeting their service needs.
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Acute effect of healthy walking on arterial stiffness in patients with type 2 diabetes and differences by age and sex: a pre-post intervention study.
Alonso-Domínguez, R, Recio-Rodríguez, JI, Patino-Alonso, MC, Sánchez-Aguadero, N, García-Ortiz, L, Gómez-Marcos, MA
BMC cardiovascular disorders. 2019;(1):56
Abstract
BACKGROUND Daily aerobic exercise such as healthy walking could have an immediate effect on parameters of arterial stiffness; however, there is little evidence in the diabetic population. Our aim, therefore, is to evaluate the association between healthy walking and acute effects on the parameters of arterial stiffness in subjects with type 2 diabetes. METHODS The Effectiveness of a multifactorial intervention in diabetics study (EMID), is a study based on an application for smartphones, healthy walking and a nutritional workshop in patients with type 2 diabetes in primary care, is a randomized controlled trial of two parallel groups. This is a subanalysis of the intervention group to evaluate the response to the healthy walking according to age and sex, in 89 subjects with type 2 diabetes, aged between 40 and 70 years. The intervention was a 4 km of a healthy walking at low-moderate intensity. To value our aim, the main study variables were measured before and after it. RESULTS The study population had an average age of 65.0 years (61.2-68.1). After the healthy walking, there was a decrease in the parameters of arterial stiffness: Cardio ankle vascular index (CAVI) of - 0.2 (95%CI:-0.4 to - 0.1) and pulse pressure (PP) of the lower extremities of - 3.9 mmHg (95%CI: -5.9 to - 2.0). Furthermore, in the lower extremities there was a decrease in systolic blood pressure of - 5.3 mmHg (95% CI: -7.3 mmHg to - 3.3 mmHg), in diastolic blood pressure of - 1.5 mmHg (95% CI: -2.6 mmHg to - 0.4 mmHg) (p < 0.05 for all). It is observed that males have an OR of 2.981 (IC = 95% 1.095 to 8.119) to achieve a reduction in the CAVI (p < 0.05) and an OR of 2.433 (95%CI: 0.871 to 6.794) in the ankle PP (p > 0.05), compared with females. CONCLUSIONS The findings of this study suggest that daily aerobic exercise at a low to moderate intensity, such as healthy walking, has an immediate beneficial effect on the cardio-ankle vascular index, especially in males. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02991079 .
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Exercising to offset muscle mass loss in hemodialysis patients: The disconnect between intention and intervention.
McKenna, CF, Salvador, AF, Hendriks, FK, Harris, APY, van Loon, LJC, Burd, NA
Seminars in dialysis. 2019;(4):379-385
Abstract
Skeletal muscle loss is the most important hallmark of protein energy wasting syndrome as it contributes to declines in physical independence, poor quality of life, and higher mortality risk in individuals with ESRD on maintenance hemodialysis (HD). As such, exercise and nutritional interventions have been investigated with the goal to preserve skeletal muscle mass and overall quality of life. Unfortunately, current efforts are unable to confirm the capacity of exercise to mitigate ESRD-associated muscle wasting. However, the inconclusive data are often accompanied by suboptimal exercise prescriptions. Exercise sessions are often implemented in-clinic during the catabolic and proinflammatory period of dialysis treatment and without concurrent nutritional support. Additionally, indirect considerations like exercise intolerance and exercise program compliance/adherence also inhibit exercise training potential. These shortcomings all stem from the current lack of understanding in skeletal muscle mass regulation within the context of ESRD and intermittent HD. As such, this review summarizes the current understanding of exercise regulation on skeletal muscle mass and ESRD-related obstacles of anabolism to contextualize the ineffectiveness of current exercise interventions for HD patients.
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Improved Disease-free Survival After Prehabilitation for Colorectal Cancer Surgery.
Trépanier, M, Minnella, EM, Paradis, T, Awasthi, R, Kaneva, P, Schwartzman, K, Carli, F, Fried, GM, Feldman, LS, Lee, L
Annals of surgery. 2019;(3):493-501
Abstract
OBJECTIVE The objective of this study was to investigate the effect of prehabilitation on survival after colorectal cancer surgery. SUMMARY OF BACKGROUND DATA Preoperative multimodal exercise and nutritional programs (prehabilitation) improve functional capacity and recovery following colorectal surgery. Exercise may also affect cancer outcomes by mediating the systemic inflammatory response. The effect of prehabilitation on cancer outcomes is unknown. METHODS Pooled data from 3 prehabilitation trials (2 randomized controlled trials, 1 cohort) in patients undergoing elective, biopsy-proven, primary non-metastatic colorectal cancer surgery from 2009 to 2014 within an enhanced recovery program were analyzed. Patients were grouped into +prehab or-prehab. The primary outcomes were 5-year disease-free (DFS) and overall survival (OS). DFS and OS were analyzed using Kaplan-Meier curves and multiple Cox regression. RESULTS A total of 202 patients were included (+prehab 104, -prehab 98). Median prehabilitation duration was 29 days (interquartile range 20-40). Patient and tumor characteristics were well-balanced (33% stage III). Postoperative complications and time to adjuvant chemotherapy were similar. Mean duration of follow-up was 60.3 months (standard deviation 26.2). DFS was similar for the combined group of stage I-III patients (P = 0.244). For stage III patients, prehabilitation was associated with improved DFS (73.4% vs 50.9%, P = 0.044). There were no differences in OS (P = 0.226). Prehabilitation independently predicted improved DFS (hazard ratio 0.45; 95% confidence interval, 0.21-0.93), adjusting for stage and other confounders. Prehabilitation did not independently predict OS. CONCLUSION In this report, prehabilitation is associated with improved 5-year DFS in stage III colorectal cancer. This finding should be confirmed in future trials.
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Metabolomics of Aerobic Exercise in Chronic Stroke Survivors: A Pilot Study.
Serra, MC, Accardi, CJ, Ma, C, Park, Y, Tran, V, Jones, DP, Hafer-Macko, CE, Ryan, AS
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2019;(12):104453
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BACKGROUND Understanding the metabolic response to exercise may aid in optimizing stroke management. Therefore, the purpose of this pilot study was to evaluate plasma metabolomic profiles in chronic stroke survivors following aerobic exercise training. METHODS Participants (age: 62 ± 1 years, body mass index: 31 ± 1 kg/m2, mean ± standard error of the mean) were randomized to 6 months of treadmill exercise (N = 17) or whole-body stretching (N = 8) with preintervention and postintervention measurement of aerobic capacity (VO2peak). Linear models for microarray data expression analysis was performed to determine metabolic changes over time, and Mummichog was used for pathway enrichment analysis following analysis of plasma samples by high-performance liquid chromatography coupled to ultrahigh resolution mass spectrometry. RESULTS VO2peak change was greater following exercise than stretching (18.9% versus -.2%; P < .01). Pathway enrichment analysis of differentially expressed metabolites results showed significant enrichment in 4 pathways following treadmill exercise, 3 of which (heparan-, chondroitin-, keratan-sulfate degradation) involved connective tissue metabolism and the fourth involve lipid signaling (linoleate metabolism). More pathways were altered in pre and post comparisons of stretching, including branched-chain amino acid, tryptophan, tyrosine, and urea cycle, which could indicate loss of lean body mass. CONCLUSIONS These preliminary data show different metabolic changes due to treadmill training and stretching in chronic stroke survivors and suggest that in addition to improved aerobic capacity, weight-bearing activity, like walking, could protect against loss of lean body mass. Future studies are needed to examine the relationship between changes in metabolomic profiles to reductions in cardiometabolic risk after treadmill rehabilitation.