Sex differences in arterial hypertension.

There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.

The effect of morning vs evening exercise training on glycaemic control and serum metabolites in overweight/obese men: a randomised trial.

AIMS/HYPOTHESIS: We determined whether the time of day of exercise training (morning vs evening) would modulate the effects of consumption of a high-fat diet (HFD) on glycaemic control, whole-body health markers and serum metabolomics. METHODS: In this three-armed parallel-group randomised trial undertaken at a university in Melbourne, Australia, overweight/obese men consumed an HFD (65% of energy from fat) for 11 consecutive days. Participants were recruited via social media and community advertisements. Eligibility criteria for participation were male sex, age 30-45 years, BMI 27.0-35.0 kg/m2 and sedentary lifestyle. The main exclusion criteria were known CVD or type 2 diabetes, taking prescription medications, and shift-work. After 5 days, participants were allocated using a computer random generator to either exercise in the morning (06:30 hours), exercise in the evening (18:30 hours) or no exercise for the subsequent 5 days. Participants and researchers were not blinded to group assignment. Changes in serum metabolites, circulating lipids, cardiorespiratory fitness, BP, and glycaemic control (from continuous glucose monitoring) were compared between groups. RESULTS: Twenty-five participants were randomised (morning exercise n = 9; evening exercise n = 8; no exercise n = 8) and 24 participants completed the study and were included in analyses (n = 8 per group). Five days of HFD induced marked perturbations in serum metabolites related to lipid and amino acid metabolism. Exercise training had a smaller impact than the HFD on changes in circulating metabolites, and only exercise undertaken in the evening was able to partly reverse some of the HFD-induced changes in metabolomic profiles. Twenty-four-hour glucose concentrations were lower after 5 days of HFD compared with the participants' habitual diet (5.3 ± 0.4 vs 5.6 ± 0.4 mmol/l, p = 0.001). There were no significant changes in 24 h glucose concentrations for either exercise group but lower nocturnal glucose levels were observed in participants who trained in the evening, compared with when they consumed the HFD alone (4.9 ± 0.4 vs 5.3 ± 0.3 mmol/l, p = 0.04). Compared with the no-exercise group, peak oxygen uptake improved after both morning (estimated effect 1.3 ml min-1 kg-1 [95% CI 0.5, 2.0], p = 0.003) and evening exercise (estimated effect 1.4 ml min-1 kg-1 [95% CI 0.6, 2.2], p = 0.001). Fasting blood glucose, insulin, cholesterol, triacylglycerol and LDL-cholesterol concentrations decreased only in participants allocated to evening exercise training. There were no unintended or adverse effects. CONCLUSIONS/INTERPRETATION: A short-term HFD in overweight/obese men induced substantial alterations in lipid- and amino acid-related serum metabolites. Improvements in cardiorespiratory fitness were similar regardless of the time of day of exercise training. However, improvements in glycaemic control and partial reversal of HFD-induced changes in metabolic profiles were only observed when participants exercise trained in the evening. TRIAL REGISTRATION: anzctr.org.au registration no. ACTRN12617000304336. FUNDING: This study was funded by the Novo Nordisk Foundation (NNF14OC0011493).

Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway.

BACKGROUND: Although it is known that winter inclusive of the Christmas holiday period is associated with an increased risk of dying compared to other times of the year, very few studies have specifically examined this phenomenon within a population cohort subject to baseline profiling and prospective follow-up. In such a cohort, we sought to determine the specific characteristics of mortality occuring during the Christmas holidays. METHODS: Baseline profiling and outcome data were derived from a prospective population-based cohort with longitudinal follow-up in Central Norway - the Trøndelag Health (HUNT) Study. From 1984 to 1986, 88% of the target population comprising 39,273 men and 40,353 women aged 48 ± 18 and 50 ± 18 years, respectively, were profiled. We examined the long-term pattern of mortality to determine the number of excess (all-cause and cause-specific) deaths that occurred during winter overall and, more specifically, the Christmas holidays. RESULTS: During 33.5 (IQR 17.1-34.4) years follow-up, 19,879 (50.7%) men and 19,316 (49.3%) women died at age-adjusted rate of 5.3 and 4.6 deaths per 1000/annum, respectively. Overall, 1540 (95% CI 43-45 deaths/season) more all-cause deaths occurred in winter (December to February) versus summer (June to August), with 735 (95% CI 20-22 deaths per season) of these cardiovascular-related. December 25th-27th was the deadliest 3-day period of the year; being associated with 138 (95% CI 96-147) and 102 (95% CI 72-132) excess all-cause and cardiovascular-related deaths, respectively. Accordingly, compared to 1st-21st December (equivalent winter conditions), the incidence rate ratio of all-cause mortality increased to 1.22 (95% CI 1.16-1.27) and 1.17 (95% 1.11-1.22) in men and women, respectively, during the next 21 days (Christmas/New Year holidays). All observed differences were highly significant (P < 0.001). A less pronounced pattern of mortality due to respiratory illnesses (but not cancer) was also observed. CONCLUSION: Beyond a broader pattern of seasonally-linked mortality characterised by excess winter deaths, the deadliest time of year in Central Norway coincides with the Christmas holidays. During this time, the pattern and frequency of cardiovascular-related mortality changes markedly; contrasting with a more stable pattern of cancer-related mortality. Pending confirmation in other populations and climates, further research to determine if these excess deaths are preventable is warranted.

It is never too late to start: adherence to physical activity recommendations for 11-22 years and risk of all-cause and cardiovascular disease mortality. The HUNT Study.

OBJECTIVES: To examine associations between long-term (11-22 years) adherence to physical activity recommendations and mortality from all causes and from cardiovascular disease. DESIGN: Prospective population-based study with repeated assessments of self-reported physical activity (1984-86, 1995-97 and 2006-08) and follow-up until the end of 2013. SETTING: County of Nord-Trøndelag, Norway. PARTICIPANTS: Men and women aged ≥20 years; 32 811 who participated in 1984-86 and 1995-97; 22 058 in 1984-86 and 2006-08; 31 948 in 1995-97 and 2006-09 and 19 349 in all three examinations (1984-1986, 1995-95 and 2006-08). MAIN OUTCOME MEASURES: All-cause mortality and cardiovascular disease mortality from the national Cause of Death Registry. RESULTS: Compared with the reference category comprising individuals who adhered to the physical activity recommendations (≥150 min of moderate intensity or ≥60 min of vigorous intensity physical activity per week) over time, individuals who remained inactive (reporting no or very little physical activity) from 1984-86 to 1995-97 had HRs (95% CI) of 1.56 (1.40 to 1.73) for all-cause mortality and 1.94 (1.62 to 2.32) for cardiovascular disease mortality. Individuals who were inactive in 1984-86 and then adhered to recommendations in 2006-08 had HRs of 1.07 (0.85 to 1.35) for all-cause mortality and 1.31 (0.87 to 1.98) for cardiovascular disease mortality. In a subsample of individuals who participated at all three time points, those who were inactive or physically active below the recommended level across three decades (1984-86, 1995-97 and 2006-2008) had an HR of 1.57 (1.22 to 2.03) for all-cause mortality and 1.72 (1.08 to 2.73) for cardiovascular disease mortality. CONCLUSION: Individuals who remained, or became, physically inactive had substantially greater risk of all-cause and cardiovascular disease mortality compared with those who met the physical activity recommendations throughout the lifespan.

Exercise training during pregnancy reduces circulating insulin levels in overweight/obese women postpartum: secondary analysis of a randomised controlled trial (the ETIP trial).

BACKGROUND: The primary aim was to investigate if supervised exercise training during pregnancy could reduce postpartum weight retention (PPWR) three months after delivery in overweight and obese women. We also measured circulating markers of cardiometabolic health, body composition, blood pressure, and physical activity level. METHODS: This was a secondary analysis of a randomised controlled trial in which 91 women with BMI ≥ 28 kg/m2 were allocated 1:1 to an exercise program or a control group. Women in the exercise group were prescribed three weekly, supervised sessions of 35 min of moderate intensity walking/running followed by 25 min of resistance training. The control group received standard maternal care. Assessments were undertaken in early pregnancy, late pregnancy, and three months postpartum. PPWR was defined as postpartum body weight minus early pregnancy weight. RESULTS: Seventy women participated three months after delivery, and PPWR was -0.8 kg in the exercise group (n = 36) and -1.6 in the control group (n = 34) (95% CI, -1.83, 3.84, p = 0.54). Women in the exercise group had significantly lower circulating insulin concentration; 106.3 pmol/l compared to the control group; 141.4 pmol/l (95% CI, -62.78, -7.15, p = 0.01), and showed a tendency towards lower homeostatic measurement of insulin resistance (HOMA2-IR) (3.5 vs. 5.0, 95% CI, -2.89, 0.01, p = 0.05). No women in the exercise group compared to three women in the control group were diagnosed with type 2 diabetes postpartum (p = 0.19). Of the women in the exercise group, 46.4% reported of exercising regularly, compared to 25.0% in the control group (p = 0.16). CONCLUSIONS: Offering supervised exercise training during pregnancy among overweight/obese women did not affect PPWR three months after delivery, but reduced circulating insulin levels. This was probably due to a higher proportion of women being active postpartum in the exercise group. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01243554 ), registration date: September 6, 2010.

Exercise Training and Weight Gain in Obese Pregnant Women: A Randomized Controlled Trial (ETIP Trial).

BACKGROUND: The effectiveness of exercise training for preventing excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) is still uncertain. As maternal obesity is associated with both GWG and GDM, there is a special need to assess whether prenatal exercise training programs provided to obese women reduce the risk of adverse pregnancy outcomes. Our primary aim was to assess whether regular supervised exercise training in pregnancy could reduce GWG in women with prepregnancy overweight/obesity. Secondary aims were to examine the effects of exercise in pregnancy on 30 outcomes including GDM incidence, blood pressure, blood measurements, skinfold thickness, and body composition. METHODS AND FINDINGS: This was a single-center study where we randomized (1:1) 91 pregnant women with a prepregnancy body mass index (BMI) ≥ 28 kg/m2 to exercise training (n = 46) or control (standard maternity care) (n = 45). Assessments were done at baseline (pregnancy week 12-18) and in late pregnancy (week 34-37), as well as at delivery. The exercise group was offered thrice weekly supervised sessions of 35 min of moderate intensity endurance exercise and 25 min of strength training. Seventeen women were lost to follow-up (eight in the exercise group and nine in the control group). Our primary endpoint was GWG from baseline testing to delivery. The principal analyses were done as intention-to-treat analyses, with supplementary per protocol analyses where we assessed outcomes in the women who adhered to the exercise program (n = 19) compared to the control group. Mean GWG from baseline to delivery was 10.5 kg in the exercise group and 9.2 kg in the control group, with a mean difference of 0.92 kg (95% CI -1.35, 3.18; p = 0.43). Among the 30 secondary outcomes in late pregnancy, an apparent reduction was recorded in the incidence of GDM (2009 WHO definition) in the exercise group (2 cases; 6.1%) compared to the control group (9 cases; 27.3%), with an odds ratio of 0.1 (95% CI 0.02, 0.95; p = 0.04). Systolic blood pressure was significantly lower in the exercise group (mean 120.4 mm Hg) compared to the control group (mean 128.1 mm Hg), with a mean difference of -7.73 mm Hg (95% CI -13.23, -2.22; p = 0.006). No significant between-group differences were seen in diastolic blood pressure, blood measurements, skinfold thickness, or body composition in late pregnancy. In per protocol analyses, late pregnancy systolic blood pressure was 115.7 (95% CI 110.0, 121.5) mm Hg in the exercise group (significant between-group difference, p = 0.001), and diastolic blood pressure was 75.1 (95% CI 71.6, 78.7) mm Hg (significant between-group difference, p = 0.02). We had planned to recruit 150 women into the trial; hence, under-recruitment represents a major limitation of our results. Another limitation to our study was the low adherence to the exercise program, with only 50% of the women included in the intention-to-treat analysis adhering as described in the study protocol. CONCLUSIONS: In this trial we did not observe a reduction in GWG among overweight/obese women who received a supervised exercise training program during their pregnancy. The incidence of GDM in late pregnancy seemed to be lower in the women randomized to exercise training than in the women receiving standard maternity care only. Systolic blood pressure in late pregnancy was also apparently lower in the exercise group than in the control group. These results indicate that supervised exercise training might be beneficial as a part of standard pregnancy care for overweight/obese women. TRIAL REGISTRATION: ClinicalTrials.gov NCT01243554.

Current physical activity guidelines for health are insufficient to mitigate long-term weight gain: more data in the fitness versus fatness debate (The HUNT study, Norway).

BACKGROUND: To promote and maintain health, all adults are recommended to do moderate-intensity aerobic activity a minimum of 30 min on 5 days, or vigorous-intensity activity of 20 min on 3 days, each week. Whether these levels prevent long-term weight gain is uncertain. OBJECTIVE: To assess the relationship between physical activity and long-term weight gain. STUDY DESIGN: An observational prospective cohort study. METHODS: Weight and physical activity were measured in the Nord-Trøndelag Health Study in 1984-1986, 1995-1997 and 2006-2008. Participants (n=19 127) were classified based on physical activity into inactive, below recommended level, recommended level or above recommended level. We carried out adjusted mixed model regression analyses with weight as outcome. RESULTS: Men maintaining physical activity above the recommendations for 33 years increased 5.6 kg, while inactive men increased 9.1 kg. For women, corresponding numbers were 3.8 kg in those above recommended physical activity levels, and 9.5 kg in inactive. In adjusted analyses, physical activity above the recommendations was associated with 2.1 kg (95% CI 1.8 to 2.4) less weight gain in men over any 11-year period, compared with inactive. Women exceeding the recommendations gained 1.8 kg (CI 1.5 to 2.2) less than inactive. Compared with inactive, the ORs of gaining meaningful weight of ≥2.3 kg were 0.79 (CI 0.69 to 0.91) and 0.70 (CI 0.60 to 0.81) if exceeding the recommendations in men and women, respectively. CONCLUSIONS: Physical activity above the current recommendations for health benefits was associated with significantly lower risk of weight gain.

Exercised breastmilk: a kick-start to prevent childhood obesity?

Exercise has systemic health benefits through effects on multiple tissues, with intertissue communication. Recent studies indicate that exercise may improve breastmilk composition and thereby reduce the intergenerational transmission of obesity. Even if breastmilk is considered optimal infant nutrition, there is evidence for variations in its composition between mothers who are normal weight, those with obesity, and those who are physically active. Nutrition early in life is important for later-life susceptibility to obesity and other metabolic diseases, and maternal exercise may provide protection against the development of metabolic disease. Here we summarize recent research on the influence of maternal obesity on breastmilk composition and discuss the potential role of exercise-induced adaptations to breastmilk as a kick-start to prevent childhood obesity.

A randomized feasibility trial of time-restricted eating during pregnancy in people with increased risk of gestational diabetes.

Time-restricted eating (TRE) is a nutritional intervention that confines the daily time-window for energy intake. TRE reduces fasting glucose concentrations in non-pregnant individuals, but whether this eating protocol is feasible and effective for glycemic control in pregnancy is unknown. The aim of this randomized controlled trial was to investigate the adherence to and effect of a 5-week TRE intervention (maximum 10 h daily eating window) among pregnant individuals at risk of gestational diabetes mellitus (GDM), compared with a usual-care control group. Participants underwent 2-h oral glucose tolerance tests and estimation of body composition, before and after the intervention. Interstitial glucose levels were continuously measured, and adherence rates and ratings of hunger were recorded daily. Thirty of 32 participants completed the trial. Participants allocated to TRE reduced their daily eating window from 12.3 (SD 1.3) to 9.9 (SD 1.0) h, but TRE did not affect glycemic measures, blood pressure, or body composition, compared with the control group. TRE increased hunger levels in the evening, but not in the morning, and induced only small changes in dietary intake. Adhering to a 5-week TRE intervention was feasible for pregnant individuals with increased risk of GDM but had no effect on cardiometabolic outcomes.

Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients.

BACKGROUND: Exercise performed at higher relative intensities has been found to elicit a greater increase in aerobic capacity and greater cardioprotective effects than exercise at moderate intensities. An inverse association has also been detected between the relative intensity of physical activity and the risk of developing coronary heart disease, independent of the total volume of physical activity. Despite that higher levels of physical activity are effective in reducing cardiovascular events, it is also advocated that vigorous exercise could acutely and transiently increase the risk of sudden cardiac death and myocardial infarction in susceptible persons. This issue may affect cardiac rehabilitation. METHODS AND RESULTS: We examined the risk of cardiovascular events during organized high-intensity interval exercise training and moderate-intensity training among 4846 patients with coronary heart disease in 3 Norwegian cardiac rehabilitation centers. In a total of 175 820 exercise training hours during which all patients performed both types of training, we found 1 fatal cardiac arrest during moderate-intensity exercise (129 456 exercise hours) and 2 nonfatal cardiac arrests during high-intensity interval exercise (46 364 exercise hours). There were no myocardial infarctions in the data material. Because the number of high-intensity training hours was 36% of the number of moderate-intensity hours, the rates of complications to the number of patient-exercise hours were 1 per 129 456 hours of moderate-intensity exercise and 1 per 23 182 hours of high-intensity exercise. CONCLUSIONS: The results of the current study indicate that the risk of a cardiovascular event is low after both high-intensity exercise and moderate-intensity exercise in a cardiovascular rehabilitation setting. Considering the significant cardiovascular adaptations associated with high-intensity exercise, such exercise should be considered among patients with coronary heart disease.

Diet, Exercise and Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is defined as hyperglycaemia with blood glucose values above normal, but below those diagnostic of diabetes, and is the most common metabolic disease in pregnancy [...].

Overview of Cardiac Rehabilitation following post-acute myocardial infarction in European Society of Cardiology member countries.

AIMS: Cardiovascular disease (CVD) is still a leading cause of death and morbidity in Europe and must be addressed through approaches beyond therapeutic interventions and pharmacological management. Cardiac rehabilitation (CR) is a comprehensive, individualized, and patient-tailored programme, comprising multidisciplinary interventions. Despite its clinical benefits, cost-effectiveness, and existing guidelines, CR uptake in Europe remains suboptimal and detailed information on its current state is lacking. This centralized pan-European study (Overview of Cardiac Rehabilitation-OCRE) aimed to characterize and advance the knowledge about European Society of Cardiology (ESC) affiliated national CR settings. METHODS AND RESULTS: An online survey about provision and quality indicators from CR was sent to the network of National CVD Prevention Coordinators of ESC member states, whose answers were supported by published evidence and/or national experts. The OCRE study had a high participation rate (82%). Current positive aspects of CR include low dropout rates and short average start time after myocardial infarction, as well as public funding being standard practice. However, the uptake rate and average duration of CR are still suboptimal, and several countries lack CR mandatory rotation in Cardiology training, guidance documents, national accreditation, and electronic database registries. We also found several barriers to CR guideline implementation, at patient, staff, and healthcare levels. CONCLUSIONS: This study provides a comprehensive characterization of CR in Europe, generating important insight on the current provision and quality of CR in Europe, highlighting its sucesses and shortcomings, and discussing important strategies to overcome current obstacles.

Since cardiovascular disease (CVD) is a leading cause of mortality and morbidity, this work sought to characterize the current state of cardiac rehabilitation (CR), an important therapeutic tool comprising multidisciplinary interventions to manage cardiovascular risk, in Europe. Current positive aspects of CR in Europe include low dropout rates and short average start time after myocardial infarction, as well as public funding being standard practice. Suboptimal aspects of CR in Europe include low uptake rates and short average duration, a lack of CR mandatory rotation in cardiology training, guidance documents, lack of national accreditation, and electronic database registries. Although provision of CR is at an encouraging level in Europe, it often is of suboptimal quality, signalling the need for improvement in the allocation of human and monetary resources. This study also highlighted the following major barriers to the implementation and use of the cardiovascular prevention and rehabilitation guidelines: low socioeconomic status and educational level, older age, lack of benefit awareness, presence of comorbidities, transportation problems and financial concern (at patient level), lack of automatic referral, no financial incentives, lack of multidisciplinary teams and time consumption (at staff level), and reimbursement issues, lack of preventive culture, lack of specialized locations, and geographical issues (at healthcare level).

High-intensity exercise increases breast milk adiponectin concentrations: a randomised cross-over study.

Introduction: Adiponectin plays a role in glucose and fat metabolism and is present in human breast milk. It has been postulated that higher breast milk adiponectin concentrations may prevent rapid weight gain in infancy. Prior research indicates that circulating adiponectin increases acutely after endurance exercise, but no prior research has investigated the effect of exercise on breast milk adiponectin concentrations. The purpose of this randomised, cross-over study was to determine the acute effects of endurance exercise on adiponectin concentrations in human breast milk. Methods: Participants who were exclusively breastfeeding a 6-12 week-old term infant (N = 20) completed three conditions in the laboratory: (1) Moderate-intensity continuous training (MICT), (2) High-intensity interval training (HIIT), and (3) No activity (REST). At each condition, we collected breast milk at 07:00 h (before exercise/rest), 11:00 h (immediately after exercise/rest), 12:00 h (1 h after exercise/rest), and 15:00 h (4 h after exercise/rest) and determined adiponectin concentrations using enzyme-linked immunosorbent assay. We compared changes in adiponectin concentrations after MICT and HIIT, adjusted for the morning concentration on each test day, with those after REST, using paired t-tests. Results: Adiponectin concentrations increased 1 h after HIIT, from 4.6 (± 2.2) µg/L in the 07:00 h sample to 5.6 (± 2.6) µg/L. This change was 0.9 µg/L (95% confidence interval 0.3 to 1.5) greater than the change between these two timepoints in the REST condition (p = 0.025). There were no other statistically significant changes in adiponectin concentrations. Conclusion: HIIT may increase adiponectin concentrations in breast milk acutely after exercise. Further studies should determine the impact of exercise-induced elevations in breast milk adiponectin concentrations on growth and metabolism in infancy.

Effect of high-fat diet and morning or evening exercise on lipoprotein subfraction profiles: secondary analysis of a randomised trial.

We investigated the effect of a high-fat diet (HFD) on serum lipid subfractions in men with overweight/obesity and determined whether morning or evening exercise affected these lipid profiles. In a three-armed randomised trial, 24 men consumed an HFD for 11 days. One group of participants did not exercise (n = 8, CONTROL), one group trained at 06:30 h (n = 8, EXam), and one group at 18:30 h (n = 8, EXpm) on days 6-10. We assessed the effects of HFD and exercise training on circulating lipoprotein subclass profiles using NMR spectroscopy. Five days of HFD induced substantial perturbations in fasting lipid subfraction profiles, with changes in 31/100 subfraction variables (adjusted p values [q] < 0.05). Exercise training induced a systematic change in lipid subfraction profiles, with little overall difference between EXam and EXpm. Compared with CONTROL, exercise training reduced serum concentrations of > 20% of fasting lipid subfractions. EXpm reduced fasting cholesterol concentrations in three LDL subfractions by ⁓30%, while EXam only reduced concentration in the largest LDL particles by 19% (all q < 0.05). Lipid subfraction profiles changed markedly after 5 days HFD in men with overweight/obesity. Both morning and evening exercise training impacted subfraction profiles compared with no exercise.

Randomised controlled trial of exercise training during lactation on breast milk composition in breastfeeding people with overweight/obesity: a study protocol for the MILKSHAKE trial.

Breast milk from people with overweight/obesity may differ in composition compared with that from normal-weight people. Exercise training can modify breast milk composition in rodent models, with a beneficial impact demonstrated on the offspring's metabolism, but whether these findings translate to humans is unclear. This trial aims to determine the effect of an exercise intervention on breast milk composition and whether an exercise-induced modification of breast milk impacts the infants' growth and body composition. Effect of Exercise Training on Breastmilk Composition is a randomised, controlled trial with two parallel groups, one exercise group and one control group, with a 1:1 allocation. We will include a minimum of 62 exclusively breastfeeding participants, 6 weeks postpartum. The exercise intervention lasts 8 weeks and comprises 25 supervised endurance exercise sessions with moderate or high intensity. The primary outcome measure is the change in the relative concentration of the human milk oligosaccharide 3'sialyllactose in breast milk from baseline at 6 weeks postpartum to the end of the intervention period. Secondary outcomes include breast milk concentrations of other metabolites, cytokines, hormones and microRNA, maternal health outcomes, infant growth, infant gut microbiome and infant circulating microRNA. Maternal and infant outcomes will be measured before, during and after the intervention period, with a follow-up of the infants until they are 24 months old. Trial registration number NCT05488964.

Randomised controlled trial of preconception lifestyle intervention on maternal and offspring health in people with increased risk of gestational diabetes: study protocol for the BEFORE THE BEGINNING trial.

INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes in the mother and cardiometabolic diseases in the child. The preconception period is an optimal window to adapt the lifestyle for improved outcomes for both mother and child. Our aim is to determine the effect of a lifestyle intervention, initiated before and continued throughout pregnancy, on maternal glucose tolerance and other maternal and infant cardiometabolic outcomes. METHODS AND ANALYSIS: This ongoing randomised controlled trial has included 167 females aged 18-39 years old at increased risk for GDM who are contemplating pregnancy. The participants were randomly allocated 1:1 to an intervention or control group. The intervention consists of exercise (volume is set by a heart rate-based app and corresponds to ≥ 1 hour of weekly exercise at ≥ 80% of individual heart rate maximum), and time-restricted eating (≤ 10 hours/day window of energy intake). The primary outcome measure is glucose tolerance in gestational week 28. Maternal and offspring outcomes are measured before and during pregnancy, at delivery, and at 6-8 weeks post partum. Primary and secondary continuous outcome measures will be compared between groups based on the 'intention to treat' principle using linear mixed models. ETHICS AND DISSEMINATION: The Regional Committees for Medical and Health Research Ethics in Norway has approved the study (REK 143756). The anonymised results will be submitted for publication and posted in a publicly accessible database of clinical study results. TRIAL REGISTRATION NUMBER: Clinical trial gov NCT04585581.

Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group.

There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.

Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study.

OBJECTIVE: Exercise capacity strongly predicts survival and aerobic interval training (AIT) increases peak oxygen uptake effectively in cardiac patients. Usual care in Norway provides exercise training at the hospitals following myocardial infarction (MI), but the effect and actual intensity of these rehabilitation programmes are unknown. DESIGN: Randomized controlled trial. SETTING: Hospital cardiac rehabilitation. SUBJECTS: One hundred and seven patients, recruited two to 12 weeks after MI, were randomized to usual care rehabilitation or treadmill AIT. INTERVENTIONS: Usual care aerobic group exercise training or treadmill AIT as 4 × 4 minutes intervals at 85-95% of peak heart rate. Twice weekly exercise training for 12 weeks. MAIN MEASURES: The primary outcome measure was peak oxygen uptake. Secondary outcome measures were endothelial function, blood markers of cardiovascular disease, quality of life, resting heart rate, and heart rate recovery. RESULTS: Eighty-nine patients (74 men, 15 women, 57.4 ± 9.5 years) completed the programme. Peak oxygen uptake increased more (P = 0.002) after AIT (from 31.6 ± 5.8 to 36.2 ± 8.6 mL·kg(-1)·min(-1), P < 0.001) than after usual care rehabilitation (from 32.2 ± 6.7 to 34.7 ± 7.9 mL·kg(-1)·min(-1), P < 0.001). The AIT group exercised with significantly higher intensity in the intervals compared to the highest intensity in the usual care group (87.3 ± 3.9% versus 78.7 ± 7.2% of peak heart rate, respectively, P < 0.001). Both programmes increased endothelial function, serum adiponectin, and quality of life, and reduced serum ferritin and resting heart rate. High-density lipoprotein cholesterol increased only after AIT. CONCLUSIONS: AIT increased peak oxygen uptake more than the usual care rehabilitation provided to MI patients by Norwegian hospitals.

High-intensity exergaming for improved cardiorespiratory fitness: A randomised, controlled trial.

ABSTRACTExergaming has been proposed as a promising alternative to traditional endurance training since many experience exergaming as more enjoyable. Therefore, the aim of this trial was to determine the exergaming-induced effect on cardiorespiratory fitness. This parallel-group randomised controlled trial, investigated the effects of regular exergaming among healthy adults (aged ≥ 18 years) who were not endurance-trained. Participants allocated to the exergaming group (n = 13) used the Playpulse exergaming platform for a minimum of 45 min twice weekly for eight weeks, whereas the control group (n = 17) received no intervention. The primary outcome measure was the between-group difference in peak oxygen uptake (V̇O2peak) after the intervention. V̇O2peak increased significantly from baseline (43.9 [SD 7.0]) to after the intervention (45.3 [SD 8.2] mL kg-1 min-1) in the exergaming group, compared to the control group (42.4 [SD 7.0] to 42.0 [SD 5.7] mL·kg-1·min-1) with a between-group difference of 2.1 mL kg-1 min-1 (95% CI: 0.2-4.1; p = 0.04). The average score on the Feeling Scale reported during exergaming was 3.4 (95% CI 3.2-3.6), with 3 being "good" and 5 "very good" and was not related to the participants' exergaming skills. There were no adverse events during this trial. Two weekly sessions using the Playpulse exergaming platform can improve V̇O2peak. This finding suggests that exergaming can be an efficient form of endurance training. Furthermore, our findings indicate that participants' enjoyed exergaming irrespective of exergaming skills.Trial registration: ClinicalTrials.gov identifier: NCT04112329..