Efficacy of morning versus afternoon aerobic exercise training on reducing metabolic syndrome components: A randomized controlled trial.

A supervised intense aerobic exercise program improves the health of individuals with metabolic syndrome (MetS). However, it is unclear whether the timing of training within the 24 h day would influence those health benefits. The present study aimed to determine the influence of morning vs. afternoon exercise on body composition, cardiometabolic health and components of MetS. One hundred thirty-nine individuals with MetS were block randomized into morning (AMEX; n = 42) or afternoon (PMEX; n = 59) exercise training groups, or a non-training control group (Control; n = 38). Exercise training was comprised of 48 supervised high-intensity interval sessions distributed over 16 weeks. Body composition, cardiorespiratory fitness (assessed by V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ), maximal fat oxidation (FOmax ), blood pressure and blood metabolites were assessed before and after the intervention. Compared with the non-training Control, both exercise groups improved similarly body composition (-0.7% fat loss; P = 0.002), waist circumference (-2.1 cm; P < 0.001), diastolic blood pressure (-3.8 mmHg; P = 0.004) and V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ (3.5 mL kg-1   min-1 ; P < 0.001) with no differences between training groups. AMEX, in comparison with PMEX, reduced systolic blood pressure (-4% vs. -1%; P = 0.019), plasma fasting insulin concentration (-12% vs. -5%; P = 0.001) and insulin resistance (-14% vs. -4%; P = 0.006). Furthermore, MetS Z score was further reduced in the AMEX compared to PMEX (-52% vs. -19%; P = 0.021) after training. In summary, high-intensity aerobic exercise training in the morning in comparison to training in the afternoon is somewhat more efficient at reducing cardiometabolic risk factors (i.e. systolic blood pressure and insulin sensitivity). KEY POINTS: The effect of exercise time of day on health promotion is an area that has gained interest in recent years; however, large-scale, randomized-control studies are scarce. People with metabolic syndrome (MetS) are at risk of developing cardiometabolic diseases and reductions in this risk with exercise training can be precisely gauged using a compound score sensitive to subtle evolution in each MetS component (i.e. Z score). Supervised aerobic exercise for 16 weeks (morning and afternoon), without dietary restriction, improved cardiorespiratory and metabolic fitness, body composition and mean arterial pressure compared to a non-exercise control group. However, training in the morning, without changes in exercise dose or intensity, reduced systolic blood pressure and insulin resistance further compared to when training in the afternoon. Thus, high-intensity aerobic exercise training in the morning is somewhat more efficient in improving the health of individuals with metabolic syndrome.

Acute Statin Withdrawal Does not Interfere With the Improvements of a Session of Exercise in Postprandial Metabolism.

BACKGROUND: The risk for atherogenic plaque formation is high after ingestion of meals in individuals with high blood lipid levels (ie, dyslipidemia). Statins and exercise reduce the rise of blood triglyceride concentrations after a meal, but the effect of their combination is unclear. METHODS: In a randomized crossover design, 11 individuals with dyslipidemia and metabolic syndrome treated with statins underwent a mixed-meal (970 ± 111 kcal, 24% fat, and 34% carbohydrate) tolerance test. Plasma lipid concentrations, fat oxidation, glucose, and glycerol kinetics were monitored immediately prior and during the meal test. Trials were conducted with participants under their habitual statin treatment and 96 hours after blinded statin withdrawal. Trials were duplicated after a prolonged bout of low-intensity exercise (75 minutes at 53 ± 4% maximal oxygen consumption) to study the interactions between exercise and statins. RESULTS: Statins reduced postprandial plasma triglycerides from 3.03 ± 0.85 to 2.52 ± 0.86 mmol·L-1 (17%; P = .015) and plasma glycerol concentrations (ie, surrogate of whole-body lipolysis) without reducing plasma free fatty acid concentration or fat oxidation. Prior exercise increased postprandial plasma glycerol levels (P = .029) and fat oxidation rates (P = .024). Exercise decreased postprandial plasma insulin levels (241 ± 116 vs 301 ± 172 ρmol·L-1; P = .026) but not enough to increase insulin sensitivity (P = .614). Neither statins nor exercise affected plasma glucose appearance rates from exogenous or endogenous sources. CONCLUSIONS: In dyslipidemic individuals, statins reduce blood triglyceride concentrations after a meal, but without limiting fat oxidation. Statins do not interfere with exercise lowering the postprandial insulin that likely promotes fat oxidation. Last, statins do not restrict the rates of plasma incorporation or oxidation of the ingested glucose.

Effects of statin therapy on glycemic control and insulin resistance: A systematic review and meta-analysis.

AIMS: To update the evidence about the diabetogenic effect of statins. METHODS: We searched for randomized-controlled trials reporting the effects of statin therapy on glycosylated hemoglobin (HbA1c) and/or homeostatic model insulin resistance (i.e., HOMA-IR) as indexes of diabetes. Studies were classified between the ones testing normal vs individuals with already altered glycemic control (HbA1c ≥ 6.5%; and HOMA-IR ≥ 2.15). Furthermore, studies were separated by statin type and dosage prescribed. Data are presented as mean difference (MD) and 95% confidence intervals. RESULTS: A total of 67 studies were included in the analysis (>25,000 individuals). In individuals with altered glycemic control, statins increased HbA1c levels (MD 0.21%, 95% CI 0.16-to-0.25) and HOMA-IR index (MD 0.31, 95% CI 0.24-to-0.38). In individuals with normal glycemic control, statin increased HbA1c (MD 1.33%, 95% CI 1.31-to-1.35) and HOMA-IR (MD 0.49, 95% CI 0.41-to-0.58) in comparison to the placebo groups. The dose or type of statins did not modulate the diabetogenic effect. CONCLUSIONS: Statins, slightly but significantly raise indexes of diabetes in individuals with adequate or altered glycemic control. The diabetogenic effect does not seem to be influenced by the type or dosage of statin prescribed.

Chronic Statin Treatment Does Not Impair Exercise Lipolysis or Fat Oxidation in Exercise-Trained Individuals With Obesity and Dyslipidemia.

OBJECTIVE: To determine whether statin medication in individuals with obesity, dyslipidemia, and metabolic syndrome affects their capacity to mobilize and oxidize fat during exercise. METHODS: Twelve individuals with metabolic syndrome pedaled during 75 min at 54 ± 13% V˙O2max (5.7 ± 0.5 metabolic equivalents) while taking statins (STATs) or after 96-hr statin withdrawal (PLAC) in a randomized double-blind fashion. RESULTS: At rest, PLAC increased low-density lipoprotein cholesterol (i.e., STAT 2.55 ± 0.96 vs. PLAC 3.16 ± 0.76 mmol/L; p = .004) and total cholesterol blood levels (i.e., STAT 4.39 ± 1.16 vs. PLAC 4.98 ± 0.97 mmol/L; p = .008). At rest, fat oxidation (0.99 ± 0.34 vs. 0.76 ± 0.37 µmol·kg-1·min-1 for STAT vs. PLAC; p = .068) and the rates of plasma appearance of glucose and glycerol (i.e., Ra glucose-glycerol) were not affected by PLAC. After 70 min of exercise, fat oxidation was similar between trials (2.94 ± 1.56 vs. 3.06 ± 1.94 µmol·kg-1·min-1, STA vs. PLAC; p = .875). PLAC did not alter the rates of disappearance of glucose in plasma during exercise (i.e., 23.9 ± 6.9 vs. 24.5 ± 8.2 µmol·kg-1·min-1 for STAT vs. PLAC; p = .611) or the rate of plasma appearance of glycerol (i.e., 8.5 ± 1.9 vs. 7.9 ± 1.8 µmol·kg-1·min-1 for STAT vs. PLAC; p = .262). CONCLUSIONS: In patients with obesity, dyslipidemia, and metabolic syndrome, statins do not compromise their ability to mobilize and oxidize fat at rest or during prolonged, moderately intense exercise (i.e., equivalent to brisk walking). In these patients, the combination of statins and exercise could help to better manage their dyslipidemia.

Effects of Statins on Fat Oxidation Improvements After Aerobic Exercise Training.

CONTEXT: Statins blunt cardiorespiratory fitness improvements after exercise training and may affect fat oxidation adaptations to training. OBJECTIVE: To determine if long-term statin use in dyslipidemic individuals restricts the improvements in fat oxidation typically observed after an intense exercise-training program. METHODS: A total of 106 metabolic syndrome individuals either chronically medicated with statins (ie, statin group; n = 46) or statin naive (ie, control group; n = 60) completed a 16-week supervised high-intensity interval training program. Maximal rates of oxygen consumption (V˙O2MAX), fat oxidation (FOMAX), and the shape of the workload-fat oxidation curve were assessed before and 48 hours after training in an overnight fasted state. RESULTS: Starting from a similar value at baseline, both groups increased V˙O2MAX after training, but the increase was larger in the control than in the statin group (19.4% vs 12.6%; P = .013). Before training, FOMAX in the statin group was lower (0.19 ± 0.08 vs 0.23 ± 0.07 g·min-1; P = .023) and took place at a lower workload (33 ± 21 vs 37 ± 19 W; P = .015) than in the control group. After training, FOMAX improved similarly in both groups (0.06 ± 0.08; 95% CI, 0.03-0.08 g·min-1 and 0.05 ± 0.09; 95% CI, 0.03-0.07 g·min-1, for statin and control groups, respectively; (P < .001). Still, after training, FOMAX occurred at a 28% lower workload in the statin group (38 ± 26 vs 53 ± 32 W; P = .048). The V˙O2-workload slope decreased after training in both groups (both P < .001) along with reductions in the respiratory exchange ratio-workload slope. Fat oxidation increased at all workloads after training regardless of the use of statins. CONCLUSION: Long-term statin treatment is associated with blunted exercise fat oxidation before exercise training. However, statin use does not attenuate the improvements in exercise fat oxidation (FOMAX) derived from intense aerobic exercise training. This finding should encourage statin users to exercise-train to benefit from increased fat oxidation once their fitness level improves.

Effect of Yearly Exercise on Medication Expense and Benefit-Cost Ratio in Individuals with Metabolic Syndrome: A Randomized Clinical Trial.

INTRODUCTION: Lifestyle modification through incorporation of exercise training could improve metabolic syndrome (MetS) clinical components (hypertension, dyslipidemia, hyperglycemia, and visceral abdominal obesity). We aimed to assess if long-term exercise training could restrain the increased pharmacological cost of the clinical management of the MetS. METHODS: Medicine cost during a 5-yr-long randomized controlled exercise intervention trial was analyzed. After a per-protocol analysis, a group of 64 individuals 53 ± 2 yr old, with overweight (body mass index, 33.4 ± 0.9 kg·m -2 ) and MetS (3.6 ± 0.2 factors) were randomized to a training (4 months·yr -1 for 5 yr; EXERCISE, n = 25) or to a control group (CONTROL, n = 26). Subjects were studied on three occasions during the 5-yr follow-up. Participants continued their routine medication managed by their general practitioner. The main outcome is the 5-yr evolution of medication cost to treat MetS (hyperglycemia, hypertension, and hyperlipidemia). A secondary outcome is the benefit-cost ratio of the exercise intervention. RESULTS: In CONTROL, medicine cost increased 160% from baseline ( P < 0.001), whereas in EXERCISE, it remained unchanged (33%; P = 0.25). After the 5-yr follow-up, medicine use was 60% and medicine cost 74% higher in CONTROL than EXERCISE ( P < 0.05 in both cases). However, MetS z score was similarly reduced over time in both groups ( P = 0.244 for group-time interaction). The number of prescribed medications increased after 5 yr in CONTROL (89%; P < 0.001), whereas it remained stable with yearly training (17%; P = 0.72 in EXERCISE). Ten-year atherosclerotic cardiovascular disease risk estimation increased only in CONTROL (15%; P = 0.05 for group-time interaction). The benefit in medicine savings (€153 per year and patient) triplicated the estimated cost (€50.8 per year and patient) of the exercise intervention. CONCLUSIONS: A 5-yr-long supervised exercise training program in middle-age individuals with MetS prevents the need for increasing medicine use. The savings in pharmacological therapy outweighs the estimated costs of implementing the exercise program.

Aerobic exercise training improves nocturnal blood pressure dipping in medicated hypertensive individuals.

OBJECTIVE: The absence of nocturnal blood pressure (BP) reduction at night in hypertensive individuals is associated with an increased cardiovascular risk. The main purpose of the present study was to investigate the effects of an aerobic training intervention on nocturnal BP dipping in medicated hypertensive individuals. METHODS: At baseline, hypertensive individuals under pharmacological treatment underwent 24-h ambulatory BP monitoring and a morning urine sample to analyze albumin creatinine ratio (UACR). Then, participants were divided into nocturnal dippers ( N = 15; 59 ± 6 years) and nondippers ( N = 20; 58 ± 5 years) according to a day-to-night BP reduction of >10% or <10%, respectively. Next, participants underwent a 3-weekly, 4-month aerobic interval training intervention. RESULTS: Follow-up measurements revealed a reduction in daytime diastolic BP in dippers and nondippers ( Ptime < 0.001), whereas nighttime systolic BP was reduced only in nondippers ( P = 0.004). Regarding dipping pattern, nocturnal systolic BP dipping increased after training in nondippers (5 ± 3 to 9 ± 7%; P = 0.018), whereas in dippers, there was a decrease in nocturnal dipping after training (14 ± 4 to 10 ± 7%, P = 0.016). Nocturnal diastolic BP dipping did not change in nondippers (8 ± 5 to 10 ± 7%; P = 0.273) but decreased in dippers (17 ± 6 to 12 ± 8%; P = 0.004). In addition, UACR was significantly reduced in both groups after training ( Ptime = 0.020). CONCLUSION: Aerobic exercise training is associated with nocturnal BP dipping as nighttime BP was lower than before the program in medicated hypertensive individuals with an initial nondipping phenotype. The lack of improvement in individuals with a dipping phenotype warrants further investigation to discern whether dipping phenotypes influence BP responses to exercise training.

Effectiveness of statins vs. exercise on reducing postprandial hypertriglyceridemia in dyslipidemic population: A systematic review and network meta-analysis.

BACKGROUND: Individuals at risk of suffering cardiovascular disease (CVD) present with larger increases in blood triglyceride (TG) concentration after a high-fat meal than do healthy individuals. These postprandial hypertriglyceride levels are an independent risk factor for CVD. Prescription of statins and a bout of prolonged exercise are both effective in lowering postprandial hypertriglyceride levels. We aimed to evaluate the comparative effectiveness of statins vs. a bout of aerobic exercise in reducing fasting and postprandial TG (PPTG) concentrations in individuals at high risk of developing CVD. METHODS: Thirty-seven studies from a systematic literature search of the PubMed, EMBASE, and Cochrane databases were included in this review. The selected studies conducted trials involving statin therapy (n = 20) or a bout of aerobic exercise (n = 19) and measured their impact on PPTG levels as the outcome. Two studies analyzed both treatments and were included in duplicate. The meta-analysis was constructed using a random-effects model to calculate the mean difference (MD). The Student t test was used to compare the data sets for statins vs. exercise. RESULTS: Overall, statin and exercise interventions showed similar reductions in PPTG levels, with an MD of -0.65 mmol/L for statins (95% confidence interval (95%CI): -0.54 to -0.77; p < 0.001) and -0.46 mmol/L for exercise (95%CI: -0.21 to -0.71; p < 0.01). However, statins lowered fasting TG levels more than exercise (MD = -1.54 mmol/L, 95%CI: -2.25 to -0.83; p = 0.009). CONCLUSION: Although aerobic exercise is effective in lowering blood TG levels, statins seem to be more efficient, especially in the fasted state. A combination of exercise and statins might reveal a valuable approach to the treatment and prevention of CVD. More studies are required to determine the underlying mechanisms and the possible additive effects of these interventions.

Longitudinal atlantoaxial dislocation associated with type III odontoid fracture due to high-energy trauma. Case report and literature review.

INTRODUCTION: Traumatic upper cervical spine injuries are frequently associated with high-energy trauma. The potential injuries to vital organs associated to a possible neurological damage marks the severity of this pathology. The neurological structures can be affected by a primary injury, spinal cord, cranial nerves and spinal nerves; or secondary to a vascular compromise, mainly the vertebral arteries. The dislocation of the atlantoaxial joint causes an unstable cervical spine that could be often associated with fracture of the Atlas and Axis. Evidently, these have a high morbimortality rate. CASE PRESENTATION: A young woman who suffered a severe polytrauma secondary to a motor vehicle collision was diagnosed with a sagittal plane atlantoaxial joint dislocation associated with a type III odontoid fracture, despite an adequate initial polytrauma management, the neurological damage was too critical, ultimately the decease of the patient. DISCUSSION: The atlantoaxial joint dislocation is a rare condition of the upper cervical spine and is usually secondary to a high-energy traumatism. The disruption of the atlantoaxial ligaments originates the considered most unstable cervical spine lesion and with the highest mortality. Attributable to the kinetic the bone fracture of the Atlas and Axis are commonly related, specially the odontoid process. Early immobilization followed by surgical decompression and stabilization is primordial. Typically, these injuries have an ominous prognosis, that is aggravated if added a polytrauma affecting adjacent neurological structures and other vital organs.

Effects of antihypertensive medication and high-intensity interval training in hypertensive metabolic syndrome individuals.

Pharmacological and non-pharmacological therapies are simultaneously prescribed when treating hypertensive individuals with elevated cardiovascular risk (ie, metabolic syndrome individuals). However, it is unknown if the interactions between antihypertensive medication (AHM) and lifestyle interventions (ie, exercise training) may result in a better ambulatory blood pressure (ABP) control. To test this hypothesis, 36 hypertensive individuals with metabolic syndrome (MetS) under long-term prescription with AHM targeting the renin-angiotensin-aldosterone system (RAAS) were recruited. Before and after 4 months of high-intensity interval training (HIIT), participants completed two trials in a double-blind, randomized order: (a) placebo trial consisting of AHM withdrawal for 3 days and (b) AHM trial where individuals held their habitual dose of AHM. In each trial, 24-h mean arterial pressure (MAP) was monitored and considered the primary study outcome. Secondary outcomes included plasma renin activity (PRA) and aldosterone concentration to confirm withdrawal effects on RAAS, along with the analysis of urine albumin-to-creatinine ratio (UACR) to assess kidney function. The results showed main effects from AHM and HIIT reducing 24-h MAP (-5.7 mmHg, p < 0.001 and -2.3 mmHg, p = 0.007, respectively). However, there was not interaction between AHM and HIIT on 24-h MAP (p = 0.240). There was a main effect of AHM increasing PRA (p < 0.001) but no effect on plasma aldosterone concentration (p = 0.368). HIIT did not significantly improve RAAS hormones or the UACR. In conclusion, AHM and HIIT have independent and additive effects in lowering ABP. These findings support the combination of habitual AHM with exercise training with the goal to reduce ABP in hypertensive MetS individuals.

Exercise Reduces Medication for Metabolic Syndrome Management: A 5-Year Follow-up Study.

PURPOSE: This study aimed to determine the effects of a 5-yr exercise intervention on metabolic syndrome (MetS) and health-related variables and medication use for MetS management. METHODS: Participants were randomly assigned to an exercise intervention (n = 25, 54 ± 2 yr, 20% women) or control group (n = 26, 54 ± 2 yr, 38% women). The intervention lasted 4 months per year and consisted of high-intensity interval training on a cycloergometer thrice a week. Outcomes were MetS z-score and medication use score, MetS-related variables (including blood pressure, blood glucose homeostasis, and lipid profile), and cardiorespiratory fitness (CRF, as determined by maximal oxygen uptake). RESULTS: MetS z-score was similarly reduced over time in both groups (P = 0.244 for group-time interaction). A quasi-significant and significant group-time interaction was found for MetS number of factors (P = 0.004) and CRF (P < 0.001), respectively. Thus, MetS factors tended to decrease over time only in the exercise group with no change in the control group, whereas CRF increased from baseline to 5-yr assessment in the exercise group (by 1.1 MET, P < 0.001) but decreased in the control group (-0.5 MET, P = 0.025). Medicine use score increased twofold from baseline to 5-yr follow-up in the control group (P < 0.001) but did not significantly change (10%, P = 0.52) in the exercise group (P < 0.001 for group-time interaction). The proportion of medicated patients who had to increase antihypertensive (P < 0.001), glucose-lowering (P = 0.036), or total medication (P < 0.0001) over the 5-yr period was lower in the exercise than that in the control group. CONCLUSIONS: Exercise training can attenuate the increase in medication that would be otherwise required to manage MetS over a 5-yr period.

Effects of statins and exercise on postprandial lipoproteins in metabolic syndrome vs metabolically healthy individuals.

AIMS: To determine if the combination of exercise and statin could normalize postprandial triglyceridaemia (PPTG) in hypercholesteraemic individuals. METHODS: Eight hypercholesteraemic (blood cholesterol 182 ± 38 mg dL-1 ; low-density lipoprotein-cholesterol [LDL-c] 102 ± 32 mg dL-1 ) overweight (body mass index 30 ± 4 kg m-2 ) individuals with metabolic syndrome (MetS) were compared to a group of 8 metabolically healthy (MetH) controls (blood cholesterol 149 ± 23 mg dL-1 ; LDL-c 77 ± 23 mg dL-1 , and body mass index 23 ± 2 kg m-2 ). Each group underwent 2 PPTG tests, either 14 hours after a bout of intense exercise or without previous exercise. Additionally, MetS individuals were tested 96 hours after withdrawal of their habitual statin medication to study medication effects. RESULTS: A bout of exercise before the test meal did not reduce PPTG in MetS (P = .347), but reduced PPTG by 46% in MetH (413 ± 267 to 224 ± 142 mg dL-1 for 5 h incremental area under the curve; P = .02). In both trials (i.e., either after a bout of intense exercise or without previous exercise), statin withdrawal in MetS greatly increased PPTG (average 65%; P < .01), mean LDL-c (average 25%; P < .01), total cholesterol (average 16%; P < .01) and apolipoprotein (Apo) B48 (24%; P < .01), without interference from exercise. However, Apo B100 was not affected by statin withdrawal. CONCLUSION: Hypercholesteraemic MetS individuals (compared to MetH controls) fail to show an effect of exercise on reducing PPTG. However, chronic statin medication blunts the elevations in triglyceride after a fat meal (i.e., incremental area under the curve of PPTG) reducing their cardiovascular risk associated with their atherogenic dyslipidaemia. Statin decreases PPTG by reducing the secretion or accelerating the catabolism of intestinal Apo B48.

Exercise Training Adaptations in Metabolic Syndrome Individuals on Chronic Statin Treatment.

BACKGROUND: Statins reduce atherogenic dyslipidemia and cardiovascular disease (CVD) risk in metabolic syndrome (MetS) individuals. Exercise training could also contribute to reduce CVD by improving cardiorespiratory fitness and fat oxidation. However, statin use could interfere with training adaptations. METHODS: A total of 106 MetS individuals were divided into statin users (statin group, n = 46) and statin-naïve (control group, n = 60). Groups were matched by age, weight, and MetS components. Subjects completed 16 weeks of high intensity interval training (HIIT). Before and after HIIT, muscle biopsies were collected to assess mitochondrial content (citrate synthase [CS] activity) and the activity of the rate limiting ß-oxidation enzyme (3-hydroxyacyl-CoA-dehydrogenase [HAD]). Fasting plasma glucose, insulin, TG, HDL-c, and LDL-c concentrations were measured. Exercise maximal fat oxidation (FOMAX) and oxygen uptake (VO2PEAK) were determined. RESULTS: Training improved MetS similarly in both groups (MetS z-score -0.26 ± 0.38 vs. -0.22 ± 0.31; P < 0.001 for time and P = 0.60 for time x group). Before training, the statin group had reduced muscle HAD activity and whole body FOMAX compared to the control group. However, 16 weeks of HIIT increased HAD and FOMAX in both groups (P < 0.03, time-effect). The statin group did not prevent the increases in CS with HIIT observed in the control group (38% vs 64%, respectively; P < 0.001, time-effect). Conversely, with training VO2PEAK improved less in the statin than in the control group (12% vs. 19%, respectively; P = 0.013, time × group effect). CONCLUSION: Chronic statin use in MetS does not interfere with exercise training improvements in MetS components, FOMAX, or mitochondrial muscle enzymes (ie, CS and HAD). However, the statin group attenuated the improvements in VO2PEAK with training. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov identifier no. NCT03019796, January 13, 2017.

Importance of a verification test to accurately assess V̇O2 max in unfit individuals with obesity.

BACKGROUND: To determine the trustworthiness of graded exercise test to exhaustion (GXT) to assess maximal oxygen uptake ( V ˙ O 2 max ) in metabolic syndrome individuals with obesity and poor cardiorespiratory fitness. METHODS: V ˙ O 2 max was assessed in 100 metabolic syndrome adults (57 ± 8 years; 34% women), with obesity (BMI 32 ± 5 kg·m-2 ) using GXT followed by supramaximal constant-load verification test (VerT) at 110% of maximal GXT work rate. V ˙ O 2 data from GXT and VerT were compared using paired t test and plotted for Bland-Altman analysis. GXT sensitivity and specificity to detect V ˙ O 2 max were also calculated. RESULTS: Seventy individuals did not achieve V ˙ O 2 plateau during GXT. GXT underestimated V ˙ O 2 max in 40 subjects. In these subjects, the magnitude of V ˙ O 2 max underestimation with GXT was 9% (167 mLO2 ·min-1 ; P < .001). In the whole sample (n = 100), bias error differences between GXT and VerT was 63 mLO2 ·min-1 (3% underestimation). This error was constant regardless of differences in fitness levels among individuals (R = -0.07; homoscedasticity). GXT results were unreliable in 62% of the sample with 16% of false-positive and 46% of false-negative results. Sensitivity and specificity of GTX to assess V ˙ O 2 max were low (ie, 23% and 60%, respectively). CONCLUSION: Our data indicate that the magnitude (3%-9%) and prevalence (40% of subjects) of V ˙ O 2 max underestimation with the use of a GXT alone is high in a large sample of unfit metabolic syndrome individuals with obesity. Our data advocate for the need of using VerT after GXT to avoid significant cardiorespiratory fitness underestimation in metabolic syndrome individuals with obesity and low fitness level.

Differing Water Intake and Hydration Status in Three European Countries-A Day-to-Day Analysis.

Adequate hydration is essential for maintaining health and functionality of the human body. Studies assessing both daily water intake and hydration status are lacking. This study explored data from the European Hydration Research Study (EHRS) and focused on total water intake (TWI), 24 h hydration status, and day-to-day variations in a sample of 573 healthy adults. TWI was assessed by food records and hydration status (urine osmolality and urine volume) was measured from 24 urine samples collected over seven consecutive days. On all weekdays, mean TWI was higher (p < 0.001 for all days) for the German subjects compared to the Greek and Spanish participants. In 37% of the male and 22% of the female subjects, the individual mean TWI was below the European Food Safety Authority (EFSA) recommendation, with 16% men (4% women) being below the EFSA recommendation on every testing day. Twenty-four hour urine osmolality was lower in women compared to men (595 ± 261 vs. 681 ± 237 mOsmol/kg; p < 0.001). More men (40%) showed a urine osmolality ≥800 mOsmol/kg at least on four days of the study period compared to women (26%) and more participants from Spain (46%) compared to Greece (29%) and Germany (11%). A large number of individuals showed an inadequate hydration status on several days per week, which may have a negative health and cognitive impact on daily life.

Synchronized Pedaling with Martial Arts Improves Quality of Life of Women with Breast Cancer.

Physical exercise improves the physical condition of women who have been undergone surgery for breast cancer. This study evaluated the effect of a new martial arts program that combined aerobic endurance and muscle strength exercises on improving upper limb function and aerobic performance of women who have undergone breast cancer surgery. Fifty-three women who had previously undergone breast cancer surgery with axillary lymph node dissection, radiotherapy and/or chemotherapy participated in the twelve-week program. Participants were randomly assigned to two groups; a study group (28 participants) in which participants carried out a synchronized pedaling with martial arts routine of 2 sessions per week, and a control group (22 participants) who received usual care. Study group participants demonstrated a significant increase in right hand and quadriceps strength, maximum oxygen consumption, max power-to-weight ratio, muscle mass percentage and a decrease in fat mass percentage (p≤0.05). A controlled training system like synchronized pedaling with martial arts, which combines aerobic and strength exercises, appears suitable for improving the muscle strength and aerobic capacity of these breast cancer participants.

Changes in markers for cardio-metabolic disease risk after only 1-2 weeks of a high saturated fat diet in overweight adults.

PURPOSE: Diets high in saturated fat acids (SFA) have been linked with cardio-metabolic disease risk. The purpose of this study was to determine whether only 1-2 weeks of a high SFA diet could impact disease risk factors in overweight adults who normally eat a relatively low proportion of SFA (i.e., <40% of dietary fat). METHODS: Twelve overweight (BMI: 27±1 kg/m2) young adults were studied before and after a 2-week diet that increased the proportion of SFA (<40% to 60% of dietary fat), while maintaining their daily intake of total fat, carbohydrate, protein, and calories. Insulin resistance, blood pressure, plasma markers of liver damage, total plasma cholesterol concentrations, and fatty acid profile within plasma and skeletal muscle lipid pools were assessed before and after the intervention. RESULTS: Total plasma cholesterol concentration increased (148±5 vs. 164±8 mg/dl; P<0.05) after only one week, due exclusively to an increase in LDL-cholesterol (78±4 vs. 95±7 mg/dl; P<0.05). After two weeks, plasma aspartate amino transferase (AST) concentration increased (P<0.05) but we found no change in insulin resistance, or resting blood pressure. The diet increase the proportion of SFA in plasma (35±1% vs. 39±2%; P<0.05) and the intramyocellular triglyceride pool (32±1% vs. 37±1%; P<0.05) suggesting the fatty acids in these pools may readily exchange. CONCLUSIONS: Although blood lipids remain within normal clinical range, increasing saturated fat in diet for only 2 weeks raises plasma markers of cardiovascular risk (LDL-cholesterol) and liver damage (AST). In overweight, but healthy-young adults SFA accumulate in plasma and muscle after only 1-2 weeks of dietary increase.

Intense aerobic exercise lowers blood pressure in individuals with metabolic syndrome taking antihypertensive medicine.

OBJECTIVE: There is a growing tendency for physicians to prescribe exercise in accordance with the 'exercise is medicine' global health initiative. However, the exercise-pharmacologic interactions for controlling blood pressure are not well described. Our purpose was to study whether angiotensin II receptor type 1 blocker (ARB) antihypertensive medicine enhances the blood pressure-lowering effects of intense exercise. PARTICIPANTS AND METHODS: Fifteen hypertensive individuals with metabolic syndrome chronically medicated with ARB underwent two exercise trials in a blind randomized order. One trial was conducted after taking their habitual dose of ARB (ARB MED trial) and another after 48 h of placebo medicine (i.e. dextrose; PLAC trial). RESULTS: After placebo medication, brachial systolic blood pressure increased by 5.5 mmHg [P=0.009; effect size (ES)=0.476] and diastolic by 2.5 mmHg (P=0.030; ES=0.373). Exercise reduced systolic and diastolic blood pressures to the same extent in ARB MED and PLAC trials (7 and 8 mmHg, respectively, for systolic and 5 and 4 mmHg, respectively, for diastolic, all P<0.05). Pulsatile measures of arterial stiffness did not reveal an interaction effect between exercise and medication. However, postocclusion reactive hyperemia increased after exercise only in the ARB MED trial (361±169 to 449±240% from baseline; P=0.033; ES=0.429). CONCLUSION: ARBs and a bout of intense exercise each have an independent effect on lowering blood pressure in hypertensive individuals, and these effects are additive.

Hormonal and neuromuscular responses during a singles match in male professional tennis players.

We sought to measure the response of cortisol concentrations around a professional tennis match and its association with hydration status and neuromuscular performance. Nine professional male tennis players were tested in a rest day, and 2-week after, during the first match of a professional tournament played in a clay-court. Salivary concentrations of cortisol (SalCC) were measured in a resting day (9:00 am and 8:00 pm), at the match day (9:00 am and 8:00 pm) and immediately before and after the match. Hydration status was assessed before the match (urine specific gravity; USG) while fluid turnover was tracked during the match. Finally, counter movement jump (CMJ) and handgrip isometric strength (HS) were measured before and after the match. SalCC, either in the morning (P = 0.161) and afternoon (P = 0.683) was similar in rest and match days. However, SalCC increased after the match (P = 0.033). Participants started the match hypohydrated (USG = 1.026±0.002) and during the match lost 1.0±0.3% of body weight despite 1.035±0.124 L/h of fluid ingested. CMJ and HS did not change post-match (P = 0.210 and P = 0.881, respectively). Correlations between the elevations in SalCC and dehydration (% BW loss) during the match were significant (r = -0.632; P = 0.034). Professional male tennis players did not show an anticipatory increase in SalCC the day of the match and neither signs of neuromuscular fatigue after it. During the match, the mild dehydration (i.e., <1.5%) was associated with the increases in cortisol levels which suggests that dehydration may be an added stress to be considered.