Correlates of functional physical capacity in physically active older adults: a conceptual-framework-based cross-sectional analysis of social determinants of health and clinical parameters.

BACKGROUND: Functional decline in older adults may be affected by clinical status, physical fitness, and social determinants of health. AIMS: This study aimed to explore social determinants of health and health/clinical determinants on two outcomes of functional physical capacity. METHODS AND RESULTS: Therefore, a population-based sample of 327 older adults (69 ± 7 years; 83.5% women) underwent demographical and clinical questionnaires, risk factors assessments, 6-min walk testing (walking capacity), and handgrip strength testing. Based on multivariable linear regression models, age ( - 4.05 m; - 5.3 to - 2.8), being men (71.40 m; 50.5-92.3), body mass index ( - 3.88 m; - 5.6 to - 2.1), and quality of life (18.48 m; 6.3-30.6) remained as predictive variables for walking capacity (R2 = 30.8%). In the final model for handgrip strength, age ( - 0.6% kgf; 0.89-0.2) and male sex (65.2% kgf; 55.3-75.8) remained as predictive variables. DISCUSSION: The mean values for our predicted outcomes were similar to those of healthy and physically active ones, which may be a consequence of the engagement of our sample in a lifestyle program. Also, although using the conceptual framework model to choose explanatory variables with a solid rationale, some of them may present reverse causality in this study setting, regardless of our efforts to annulate this type of bias. CONCLUSIONS: Despite exploratory analyses including contextual factors as potential predictors of walking capacity and handgrip strength, only outcomes at the individual levels were associated, either positively or negatively, with the variations presented by this studied sample of older adults.

Methodological quality and reporting standards in systematic reviews with meta-analysis of physical activity studies: a report from the Strengthening the Evidence in Exercise Sciences Initiative (SEES Initiative).

BACKGROUND: Several resources have been developed (e.g., reporting guidelines) to promote high-standard practices in health research. However, there was no continuous and systematic assessment of recommended practices in published systematic reviews with meta-analysis (SRMAs), which increases the usability of the available resources. Therefore, we aimed to assess the methodological and reporting standards in SRMAs of physical activity studies. This report presents the main results of the SEES Initiative in 2019. METHODS: Our approach is based on a prospective systematic review methodology to implement post-publication surveillance of research practices in exercise sciences. Briefly, during the year 2019, pre-specified searches were conducted monthly (PubMed/MEDLINE) in journals from the exercise sciences (n = 9) and medicine (n = 5). The assessments were independently conducted by two authors, based on 36 items/practices derived from established statements/tools (PRISMA, AMSTAR 2, ROBIS). To be eligible, SRMAs should summarize studies that had, at least, one arm consisting of physical activity interventions/exposures and one health or behavioral outcome. RESULTS: Out of 1028 studies assessed for eligibility, 103 SRMAs were included. The minimum adherence was 13/36 items, whereas only one SRMA adhered to all items. Some highly contemplated items included identification of title as SRMA (97.1%) and descriptions of the main outcome in the abstract (95.1%) and risk of bias (RoB) assessment (95.1%). Some poorly contemplated items included publicly available protocol (4.9%), discussion of the results in light of RoB in studies included (32.0%), and data sharing statements (35.9%). CONCLUSION: In summary, there is a suboptimal adherence to recommended practices on methodological quality and reporting standards in the SRMAs of physical activity intervention/exposure evaluated from the selected journals in 2019, which likely reduce the reproducibility and usefulness of these studies. This incipient evidence from our first 12 months of post-publication surveillance should serve as a call for attention and action for multiple stakeholders (e.g., authors, reviewers, editors, funders, academic institutions) in this important health research field.

Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis.

PURPOSE: The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS: We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CAD patients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS: The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS: Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.

Influence of the order of aerobic and resistance exercise on hemodynamic responses and arterial stiffness in young normotensive individuals.

AIMS: To investigate the effects of a combination of aerobic and resistance exercises and the inverse sequence on the hemodynamic parameters and indicators of arterial stiffness in healthy young adult subjects. METHODS: Fifteen subjects were randomized in a crossover procedure according to two experimental conditions: combined aerobic exercise (30 min of treadmill running, 75-80% - peak VO2) followed by resistance exercise (5 exercises, 3 sets - 10 RM) (AR) or vice versa (RA). Data of the hemodynamic parameters and arterial stiffness were obtained at baseline and after exercise (post-10, post-20, and post-30 min). Two-way ANOVA for repeated measurements was performed with the Newman-Keuls post-hoc. The significance level adopted was p < 0.05. RESULTS: The results of the two-way ANOVA for repeated measures were not statistically significant for brachial and central systolic and diastolic blood pressure, respectively, or arterial stiffness indicators: reflected wave indicators and pulse wave velocity (P > 0.05). Statistically significant interactions were observed before and after the exercise sessions for heart rate and rate pressure product (P = < 0.001). CONCLUSION: The performance order of aerobic exercise followed by resistance exercise (AR) and the reverse order (RA) present similar changes in blood pressure (BP) and arterial stiffness. However, resistance exercise before aerobic exercise promotes increases in heart rate and rate product pressure.

Arterial Stiffness is Associated With Moderate to Vigorous Physical Activity Levels in Post-Myocardial Infarction Patients.

PURPOSE: Arterial stiffness has shown independent predictive value for all-cause and cardiovascular mortalities, as well as fatal and nonfatal coronary events. Physical activity (PA) is associated with reduced cardiovascular morbidity and mortality. The study aims to analyze the cross-sectional association of arterial stiffness with objectively measured PA in patients following acute myocardial infarction. METHODS: One hundred patients were consecutively recruited after experiencing an acute myocardial infarction. Central arterial stiffness was measured through carotid-femoral pulse wave velocity (cf-PWV) and daily PA was assessed objectively during 7 consecutive days with accelerometers. To be valid, data required recordings of at least 8 hr/d on 5 d. RESULTS: The cf-PWV showed a negative and significant association with total weekly time spent in moderate to vigorous PA (MVPA) (r = -0.416, P < .001). Patients classified as having higher risk according to arterial stiffness values (cf-PWV ≥10 m/sec) showed significantly lower time spent in MVPA than those below that threshold. The cf-PWV was significantly lower in patients performing >300 min of MVPA/wk than in those performing <150 min/wk (8.53 ± 2.08 vs 10.3 ± 2.44 m/sec, P = .021). Differences remained significant after adjustment for several confounders. CONCLUSIONS: Moderate to vigorous PA was inversely associated with arterial stiffness and time spent in MVPA was lower in patients after acute myocardial infarction, with cf-PWV above the risk threshold value (≥10 m/sec). These results seem to reinforce the importance of PA as a nonpharmacological tool for secondary cardiovascular prevention.

Arterial Stiffness is Related to Impaired Exercise Capacity in Patients With Coronary Artery Disease and History of Myocardial Infarction.

BACKGROUND: Augmented arterial stiffness and reduced cardiorespiratory fitness are associated with increased morbidity and mortality from coronary artery disease (CAD). The relationship between exercise capacity and arterial stiffness is independent of known influencing variables in CAD. This study aimed to analyse the interaction between exercise capacity, arterial stiffness and early vascular ageing in patients with CAD. METHODS: This cross-sectional study included 96 CAD patients with myocardial infarction (55.9±10.9years, 81 men) referred to cardiac rehabilitation. Arterial stiffness was assessed using carotid-femoral pulse wave velocity (cf-PWV). Cardiopulmonary exercise test was performed to measure VO2peak. Comparisons of VO2peak across cf-PWV risk threshold values (high-risk cf-PWV≥10m/s) and tertile groups, and across cf-PWV threshold values and age groups (younger group<60 years) were performed. Correlation tests were used to study the association between pair of variables. RESULTS: Patients with high-risk cf-PWV had lower VO2peak than those with low-risk cf-PWV (p<0.001). VO2peak decreased across tertiles of cf-PWV, showing significantly lower values in the third tertile (p<0.001). There were no differences in the VO2peak between younger patients with high-risk cf-PWV and older patients irrespective of their cf-PWV values. VO2peak showed an upward trend in younger patients with low-risk cf-PWV compared to their age-mates with high-risk cf-PWV (p=0.09). VO2peak was strongly and inversely correlated with cf-PWV (r=-0.502, p<0.001). CONCLUSIONS: Arterial stiffening is associated with lower cardiorespiratory fitness in CAD patients with myocardial infarction. When its values are above risk threshold, exercise capacity is impaired regardless of the relationship between age and arterial stiffness.

Effect of exercise-based cardiac rehabilitation on arterial stiffness and inflammatory and endothelial dysfunction biomarkers: a randomized controlled trial of myocardial infarction patients.

BACKGROUND: Arterial stiffness have shown an independent predictive value for cardiovascular and all-cause mortality. OBJECTIVE: This study sought to evaluate the effects of an 8-week exercise-based cardiac rehabilitation program (ECR) on arterial stiffness, and on inflammatory and endothelial dysfunction biomarkers. Additionally, it was assessed two potential confounding variables, daily physical activity and dietary intake. METHODS: In this parallel-group trial, 96 patients (56 ± 10 years) were randomized to either the exercise group (EG) or control group (CG) 4 weeks after suffering acute myocardial infarction (MI). ECR consisted of 8 weeks of aerobic exercise at 70-85% of maximal heart rate during 3 sessions weekly, plus usual care. CG participants received only usual care. Baseline and final assessments included arterial stiffness through carotid-femoral pulse wave velocity (cf-PWV), inflammatory and endothelial dysfunction biomarkers, daily physical activity, and dietary intake. (ClinicalTrials.gov: NCT01432639). RESULTS: After 8 weeks, no significant changes were found between groups in cf-PWV, inflammatory and endothelial dysfunction biomarkers, daily physical activity, or dietary intake. Excluding those patients (n = 7) who did not attend, at least 80% of the exercise sessions provided similar results, excepting a significant reduction in cf-PWV in the EG compared to the CG. CONCLUSIONS: A short-term ECR does not seem to reduce arterial stiffness and inflammatory and endothelial dysfunction biomarkers of post-MI patients under optimized medication. Nevertheless, the decrease of cf-PWV observed in the EG, when considering only those patients who attended at least 80% of exercise sessions, warrants further investigation.

Aerobic versus resistance training effects on health-related quality of life, body composition, and function of older adults.

This study aimed to investigate the effects of training on health-related quality of life (HRQoL), body composition, and function in older adults. Fifty participants were randomized into aerobic training (AT--70%-80% HR reserve), resistance training (RT--80% 1RM), or controls. They had HRQoL, body composition, and function assessed before and after 8 months. Training groups reduced body fat, increased performance in the stair ascent, 8-ft up-and-go and sit-to-stand five-times tests, and improved their physical component score (PCS; p ≤ .03). AT increased performance in the 6MWT test, and improved general and mental health (MH) domains when compared to controls (p < .01). Finally, changes in stair ascent were associated with changes in bodily pain, MH, and mental component score (p ≤ .04), while changes in handgrip strength were associated with changes in physical role and MH (p = .03). AT and RT were effective interventions for decreasing body fat and improving functionality and the PCS in older adults.

Physiological adaptations to resistance training in prepubertal boys.

PURPOSE: The purpose of this study was to investigate the physiological adaptations of resistance training (RT) in prepubertal boys. METHODS: Eighteen healthy boys were divided into RT (n = 9, Mage = 10.4 ± 0.5 years) and control (CTR; n = 9, Mage = 10.9 ± 0.7 years) groups. The RT group underwent a resistance training during 12 weeks, 3 times per week, performing 3 sets of 6 to 15 repetitions at intensities ranging from 60% to 80% of maximal dynamic strength (1-repetition maximum [1-RM] values). Before and after the training, the groups were assessed in their body mass and composition (dual-energy X-ray absorptiometry), isokinetic dynamometry, 1-RM, and ergoespirometry. Moreover, force per unit of muscle volume was calculated by the quotient between 1-RM and lean mass. RESULTS: Both groups presented statistically significant (p < .05) increases in the 1-RM and force per unit of muscle volume in the knee extension and elbow flexion, but these strength increases were statistically significantly greater in the RT group (effect size [ES] = 2.83-9.00) than in the CTR group (ES = 0.72-1.00). Moreover, both groups statistically significantly increased in lean body mass variables (ES = 0.12-0.38). However, increases in the fat mass variables occurred only in the CTR group (ES = - 0.01-0.50), whereas no changes were observed in the RT group. Furthermore, there were statistically significant increases in all bone mineral content variables (ES = 0.13-0.43), without differences between groups. No cardiorespiratory changes were observed. CONCLUSION: Twelve weeks of RT was effective in improving strength and force per unit of muscle volume and prevented fat mass increases in boys.

Effect of 8-week exercise-based cardiac rehabilitation on cardiac autonomic function: A randomized controlled trial in myocardial infarction patients.

PURPOSE: The purpose of this study is to evaluate the effects of an 8-week exercise-based cardiac rehabilitation program on traditional and nonlinear heart rate variability (HRV) indexes, assessing the potential confounding influences of habitual physical activity (PA) and dietary intake. METHODS: In this parallel-group trial, 96 patients (56 ± 10 years old) were randomized to the exercise group (EG) or to the control group (CG) 4 weeks after an acute myocardial infarction. Exercise-based cardiac rehabilitation program consisted of aerobic exercise at 70% to 85% of maximal heart rate for 3 sessions per week plus usual care. The CG received only usual care. The baseline and final assessments comprised resting short-term HRV (primary outcome) by a Polar R-R recorder under controlled breathing (12 breaths per minute), habitual PA by accelerometers, and dietary intake by a 4-day food diary. RESULTS: Two patients in each group dropped out and were not included in the intention-to-treat analysis. In the remaining 92 patients (EG = 47 and CG = 45), at baseline, only a difference in the proportion of nitrate medication use was significant between groups. After 8 weeks, no significant changes were found between groups on traditional and nonlinear HRV indexes (eg, ln HF, EG from 5.7 ± 1.5 to 5.9 ± 1.3 and CG from 5.5 ± 1.6 to 5.5 ± 1.5), habitual PA, and dietary intake. CONCLUSION: Eight weeks of exercise-based cardiac rehabilitation program is an insufficient stimulus to improve cardiac autonomic function in post-myocardial infarction patients under optimal medication and with high levels of traditional and nonlinear HRV indexes at baseline.

The effects of exercise training on arterial stiffness in coronary artery disease patients: a state-of-the-art review.

The purpose of this state-of-the-art review was to examine the effects of exercise training on arterial stiffness (AS) in patients with coronary artery disease (CAD). A PubMed and SCOPUS literature search was conducted up to March of 2013. Two authors performed the selection of the studies and the subsequent data extraction (e.g. information on study design, exercise programme characteristics and outcome measures). Of 34 papers identified, only five studies met the inclusion criteria, with no one being a randomized controlled trial. Within the selected studies, the sample size varied between 28 and 119 patients, with mean ages ranging from 48 to 67 years old in patients with CAD after an acute myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty. Although all studies utilized the aerobic exercise mode, the other characteristics of the exercise programmes varied largely between the studies: programme length (from 6 to 20 weeks), exercise duration (15-20 to 50 min) and exercise intensity, which was based on heart rate reserve (40 to 85%) or heart rate at anaerobic threshold or ventilatory threshold. All the three studies evaluating pulse wave velocity, as well as one of two studies that assessed the augmentation index, reported significant reductions on those variables after exercise training. Results indicated that the majority of the AS and related measures improved after the different exercise training programmes. However, these results need to be confirmed in future randomized clinical studies controlling potential confounders.

Heart rate variability in myocardial infarction patients: effects of exercise training.

Heart rate variability (HRV) is a simple and noninvasive measure that estimates cardiac autonomic modulation, mainly the parasympathetic contribution. Increased sympathetic and/or decreased parasympathetic nervous activity is seen in post-myocardial infarction (MI) patients. Consequently, these patients present reduced HRV, which has been associated with increased risk of adverse events and mortality. Exercise training, recommended as a complementary therapy for patients with cardiovascular disease, has shown numerous beneficial effects. The main aim of the present manuscript was to provide a critical review of studies investigating the effects of exercise training on cardiac autonomic modulation, through HRV, in MI patients and the possible mechanisms involved. Despite conflicting evidence, exercise training appears to be a useful therapeutic intervention to improve the unbalanced autonomic function of MI patients. Finally, the mechanisms involved are not yet well understood, but nitric oxide bioavailability and angiotensin II levels seem to play an important role.