Lifestyle intervention reduces risk score for cardiovascular mortality in company employees with pre-diabetes or diabetes mellitus - A secondary analysis of the PreFord randomized controlled trial with 3 years of follow-up.

Aim: To evaluate the effects of a multimodal intervention (including exercise training, psychosocial interventions, nutrition coaching, smoking cessation program, medical care) on the health and long-term cardiovascular disease (CVD) mortality risk of company employees with pre-diabetes or diabetes mellitus (DM) at high CVD risk. Methods: In the PreFord study, German company employees (n=4196) participated in a free-of-charge CVD mortality risk screening at their workplace. Based on their European Society of Cardiology - Systematic Coronary Risk Evaluation score (ESC-SCORE), they were subdivided into three risk groups. High-risk patients (ESC-SCORE≥5%) were randomly assigned to a 15-week lifestyle intervention or usual care control group. Data from patients with pre-DM/DM were analyzed intention-to-treat (ITT: n=110 versus n=96) and per protocol (PP: n=60 versus n=52). Results: Body mass index, glycated hemoglobin, total cholesterol, low-density lipoprotein, triglyceride levels as well as systolic and diastolic blood pressure improved through the intervention (ITT, PP: p<0.001). The ESC-SCORE markedly decreased from pre- to post-intervention (ITT, PP: p<0.001). ESC-SCORE changes from baseline differed significantly between the groups, with the intervention group achieving more favorable results in all follow-up visits 6, 12, 24 and 36 months later (at each time point: ITT: p<0.001; PP: p ≤ 0.010). Conclusion: The study demonstrates the feasibility of attracting employees with pre-DM/DM at high CVD mortality risk to participate in a multimodal lifestyle program following a free CVD mortality risk screening at their workplace. The lifestyle intervention used in the PreFord study shows high potential for improving health of company employees with pre-DM/DM in the long term. ISRCTN23536103.

The intranasal AlaxoLito Plus Nasal Stent: Improvement of NO-induced microrheology and oxygen uptake during exercise?

AIM: To investigate the influence of the intranasal AlaxoLito Plus Nasal Stent during exercise on nitric oxide (NO) synthesis, NO exhalation, red blood cell (RBC) deformability and oxygen uptake. METHODS: Parameters were measured before and after acute cycle ergometer test at different intensities. Spirometric, microrheological and NO parameters were determined for oral (OB), nasal (NB) and nasal-stent breathing (SB). RBC deformability was measured and elongation indices for 3.87 Pa and maximal deformability were calculated. RBC/plasma/exhaled NO, oxygen uptake and respiratory rate were determined. RESULTS: Exhaled NO was higher at rest during OB compared to SB and NB and decreased after exercise with NB and SB. Plasma and RBC NO remained unaltered during intervention. RBC deformability increased at moderate intensity during SB. Deformability decreased at moderate and medium intensity with NB. Respiratory rate for same oxygen uptake did not differ between breathing settings. CONCLUSION: The AlaxoLito Plus Nasal Stent may modulate deformability during moderate exercise and increase NO exhalation without major effects on oxygen uptake and performance.

Deformability of different red blood cell populations and viscosity of differently trained young men in response to intensive and moderate running.

BACKGROUND: Red blood cell (RBC) deformability and blood viscosity are essential to ensure optimal microcirculation and may contribute to athletic performance. OBJECTIVE: To investigate the acute responses of density fractionated young, middle old and old RBC, RBC viscosity (RBCV), plasma viscosity (PV) and hematological changes to two running modes (intensive and moderate). METHODS: 27 young and healthy men of different training status participated in this study and were grouped into three groups in accordance to their VO2peak and conducted an intensive and moderate running test, respectively (crossover design). Pre and Post exercise, RBC were fractionated via percoll density gradient centrifugation. RBC deformability of the entire RBC population and the fractionated RBC was determined. Viscosity, hematocrit and mean cellular volume were determined. RESULTS: Baseline results reveal that high trained subjects possess more young RBC and show increased deformability of un-fractioned RBC and middle aged RBC. Baseline PV, RBCV, hematocrit and mean cellular volume did not differ between groups. Applied running modes did not change RBC deformability of any sub-fractions. Viscosity only increased after intensive running. Hematological changes were observed after both exercises. CONCLUSIONS: Acute effects of exercise on RBC are marginal, but chronic differences can be observed in RBC function.

Effects of 12 weeks of Nordic Walking and XCO Walking training on the endurance capacity of older adults.

BACKGROUND: Several studies have already examined the positive effects of various forms of endurance training in patient groups and in healthy adults up to 60 years old. The aim of this study was to analyse the effects of Nordic Walking (NW) and XCO Walking (XCO) training on endurance capacity in healthy older adults, aged 60 years and older. METHODS: Twenty-three older participants (mean age: 69.9 ± 5.4 years) were randomly assigned to either the NW group or the XCO group. All participants were measured before and after the 12 weeks of endurance training (2 sessions/week) to examine oxygen uptake (VO2) and energy consumption during an outdoor field test. In addition, heart rates were recorded and lactate samples were collected. RESULTS: NW mainly demonstrated some significant (p < 0.05) decreases in heart rate, lactate concentration at lower to moderate walking speeds, whereas XCO Walking revealed significant (p < 0.05) decreases in lactate concentration and VO2 at low to higher walking speeds. CONCLUSIONS: NW as well as XCO training increase the efficiency of the cardio-vascular system in older subjects. Both training approaches are suitable options for endurance training, which may serve to counteract age- and inactivity-related decreases in cardio-vascular functioning as well as aid in maintaining overall performance in older adults.

Substantial improvement of primary cardiovascular prevention by a systematic score-based multimodal approach: A randomized trial: The PreFord-Study.

Trial design Prospective randomized multicentre interventional study. Methods Individual cardiovascular risk assessment in Ford Company, Germany employees ( n = 4.196), using the European Society of Cardiology-Systematic Coronary Risk Evaluation (ESC-SCORE) for classification into three risk groups. Subjects assigned to ESC high-risk group (ESC-SCORE ≥ 5%), without a history of cardiovascular disease were eligible for randomization to a multimodal 15-week intervention programme (INT) or to usual care and followed up for 36 months. Objectives Evaluation of the long-term effects of a risk-adjusted multimodal intervention in high-risk subjects. Primary endpoint: reduction of ESC-SCORE in INT versus usual care. Secondary endpoints: composite of fatal and non-fatal cardiovascular events and time to first cardiovascular event. STATISTICAL ANALYSIS: intention-to-treat and per-protocol analysis. Results Four hundred and forty-seven subjects were randomized to INT ( n = 224) or to usual care ( n = 223). After 36 months ESC-SCORE development favouring INT was observed (INT: 8.70% to 10.03% vs. usual care: 8.49% to 12.09%; p = 0.005; net difference: 18.50%). Moreover, a significant reduction in the composite cardiovascular events was observed: (INT: n = 11 vs. usual care: n = 27). Hazard ratio of intervention versus control was 0.51 (95% confidence interval 0.25-1.03; p = 0.062) in the intention-to-treat analysis and 0.41 (95% confidence interval 0.18-0.90; p = 0.026) in the per-protocol analysis, respectively. No intervention-related adverse events or side-effects were observed. Conclusions Our results demonstrate the efficiency of identifying cardiovascular high-risk subjects by the ESC-SCORE in order to enrol them to a risk adjusted primary prevention programme. This strategy resulted in a significant improvement of ESC-SCORE, as well as a reduction in predefined cardiovascular endpoints in the INT within 36 months. (ISRCTN 23536103.).

Heart Rate and Oxygen Uptake Kinetics in Type 2 Diabetes Patients - A Pilot Study on the Influence of Cardiovascular Medication on Regulatory Processes.

The aim of this pilot study was to investigate whether there are differences in heart rate and oxygen uptake kinetics in type 2 diabetes patients, considering their cardiovascular medication. It was hypothesized that cardiovascular medication would affect heart rate and oxygen uptake kinetics and that this could be detected using a standardized exercise test. 18 subjects were tested for maximal oxygen uptake. Kinetics were measured in a single test session with standardized, randomized moderate-intensity work rate changes. Time series analysis was used to estimate kinetics. Greater maxima in cross-correlation functions indicate faster kinetics. 6 patients did not take any cardiovascular medication, 6 subjects took peripherally acting medication and 6 patients were treated with centrally acting medication. Maximum oxygen uptake was not significantly different between groups. Significant main effects were identified regarding differences in muscular oxygen uptake kinetics and heart rate kinetics. Muscular oxygen uptake kinetics were significantly faster than heart rate kinetics in the group with no cardiovascular medication (maximum in cross-correlation function of muscular oxygen uptake vs. heart rate; 0.32±0.08 vs. 0.25±0.06; p=0.001) and in the group taking peripherally acting medication (0.34±0.05 vs. 0.28±0.05; p=0.009) but not in the patients taking centrally acting medication (0.28±0.05 vs. 0.30±0.07; n.s.). It can be concluded that regulatory processes for the achievement of a similar maximal oxygen uptake are different between the groups. The used standardized test provided plausible results for heart rate and oxygen uptake kinetics in a single measurement session in this patient group.

Effects of Cycling and Exergaming on Neurotrophic Factors in Elderly Type 2 Diabetic Men - A Preliminary Investigation.

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing neurodegenerative diseases. There is growing evidence that repeated exercise-induced transient increases in neurotrophic factors can augment neurogenesis and neuroplasticity. This pilot study compares the effects of 30-min submaximal cycling with those of exergaming (combining exercise and video gaming) at the same duration and same rating of perceived exertion (BORG RPE: 14-15) on serum neurotrophic factors in 8 elderly non-insulin-dependent T2DM patients (71±4 years) (2×2 crossover design). Brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and insulin-like growth factor (IGF)-1 levels were quantified using enzyme-linked immunosorbent assay (ELISA) kits. Heart rates were almost equal during cycling and exergaming, while lactate values were significantly higher during cycling (cycling versus exergaming: 3.7±1.1 versus 2.5±1.2 mmol/l, p<0.05). BDNF and VEGF levels were increased significantly post-cycling (+20%,+14%, p<0.05). No other significant pre-post changes were evident. This study demonstrates that acute exercise can increase neurotrophic factors (BDNF, VEGF) in elderly T2DM patients, depending on exercise mode.

Faster heart rate and muscular oxygen uptake kinetics in type 2 diabetes patients following endurance training.

Cardiorespiratory kinetics were analyzed in type 2 diabetes patients before and after a 12-week endurance exercise-training intervention. It was hypothesized that muscular oxygen uptake and heart rate (HR) kinetics would be faster after the training intervention and that this would be detectable using a standardized work rate protocol with pseudo-random binary sequences. The cardiorespiratory kinetics of 13 male sedentary, middle-aged, overweight type 2 diabetes patients (age, 60 ± 8 years; body mass index, 33 ± 4 kg·m-2) were tested before and after the 12-week exercise intervention. Subjects performed endurance training 3 times a week on nonconsecutive days. Pseudo-random binary sequences exercise protocols in combination with time series analysis were used to estimate kinetics. Greater maxima in cross-correlation functions (CCFmax) represent faster kinetics of the respective parameter. CCFmax of muscular oxygen uptake (pre-training: 0.31 ± 0.03; post-training: 0.37 ± 0.1, P = 0.024) and CCFmax of HR (pre-training: 0.25 ± 0.04; post-training: 0.29 ± 0.06, P = 0.007) as well as peak oxygen uptake (pre-training: 24.4 ± 4.7 mL·kg-1·min-1; post-training: 29.3 ± 6.5 mL·kg-1·min-1, P = 0.004) increased significantly over the course of the exercise intervention. In conclusion, kinetic responses to changing work rates in the moderate-intensity range are similar to metabolic demands occurring in everyday habitual activities. Moderate endurance training accelerated the kinetic responses of HR and muscular oxygen uptake. Furthermore, the applicability of the used method to detect these accelerations was demonstrated.

Impact of a half marathon on cellular immune system, pro-inflammatory cytokine levels, and recovery behavior of breast cancer patients in the aftercare compared to healthy controls.

INTRODUCTION: Exercise has beneficial effects on cancer prevention as well as on prognosis of patients with cancer. To optimize the outcomes of exercise programs, more knowledge about the underlying mechanisms is needed. This study investigates the short-term effects of a half marathon on immune cell proportions, pro-inflammatory cytokine levels, and recovery behavior of patients with breast cancer in the aftercare compared to healthy controls. METHODS: Nine patients with breast cancer in the aftercare and 9 healthy age-matched controls participated in a half marathon. Blood samples were collected before, after, and 24 h after the run. Immune status was measured by flow cytometer analysis, while serum levels of the pro-inflammatory cytokines TNF-α, IL-6, and MIF were assessed using ELISA. Recovery behavior was determined using an ADL monitor. RESULTS: Both groups showed a similar recovery behavior and time courses in changes of granulocytes, monocytes, lymphocytes, and cytokine serum levels. Patients revealed increased proportions of cytotoxic and memory T cells, whereas helper and naïve T cells were decreased compared to healthy controls. Naïve and memory T-cell proportions were not affected by the intervention. CONCLUSIONS: Patients with breast cancer in the aftercare and healthy subjects show a similarly recovery behavior and immune response to the intervention. The detected differences in T-cell subsets need further investigation. Based on the results of the study, we hypothesize that immune cell subsets with known relevance in cancer were mobilized through the intervention. We confirm that the hypothesis of a midterm anti-inflammatory effect of exercise is also valid for patients with breast cancer in the aftercare.