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PURPOSE: Type 2 diabetes is associated with a higher risk of cardiovascular diseases, lowering the quality of life and increasing mortality rates of affected individuals. Circulating monocytes are tightly involved in the atherosclerosis process leading to cardiovascular diseases (CVD), and their inflammatory profile can be modified by exercise. The objective was to exploratory identify genes associated with CVD that could be regulated by high-intensity interval training (HIIT) in monocytes of type 2 diabetes patients. METHODS: Next-generation RNA sequencing (RNA-seq) analyses were conducted on isolated circulating monocytes (CD14+) of six women aged 60 and over with type 2 diabetes who completed a 12-week supervised HIIT intervention on a treadmill. RESULTS: Following the intervention, a reduction of resting diastolic blood pressure was observed. Concomitant with this result, 56 genes were found to be downregulated following HIIT intervention in isolated monocytes. A large proportion of the regulated genes was involved in cellular adhesion, migration and differentiation into an "atherosclerosis-specific" macrophage phenotype. CONCLUSION: The downregulation of transcripts in monocytes globally suggests a favorable cardiovascular effect of the HIIT in older women with type 2 diabetes. In the context of precision medicine and personalized exercise prescription, shedding light on the fundamental mechanisms underlying HIIT effects on the gene profile of immune cells is essential to develop efficient nonpharmacological strategies to prevent CVD in high-risk population.
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Diabetes Mellitus Tipo 2 , Treinamento Intervalado de Alta Intensidade , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Monócitos , Qualidade de Vida , TranscriptomaRESUMO
Intradialytic exercise is feasible and yields substantial clinical benefits in middle-aged patients. However, evidence is scarce in older hemodialysis patients. OBJECTIVE: To assess the feasibility and clinical benefits of supervised, intradialytic exercise in older patients. METHODS: Multicenter one-arm feasibility study. The main outcome was feasibility (ease of recruitment, dropout rate, adherence, affective valence, and adverse events). The secondary outcomes were physical capacity (five-repetition sit-to-stand, 60-s sit-to-stand tests, and grip strength), quality of life (36-Item Short-Form Health Survey), quality of sleep (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), and dialysis efficacy (Kt/V and urea reduction ratio). RESULTS: About 79% of the screened patients agreed to participate (n = 25, 73 [66-77] years). The dropout rate was high (32%), but adherence remained high among the participants who completed the study (94%). Improvements were found in the five-repetition sit-to-stand (p < .001), 60-s sit-to-stand tests (p = .028), 36-Item Short-Form Health Survey mental component score (p = .008), depressive symptoms (p = .006), and quality of sleep (p = .035). CONCLUSION: Supervised intradialytic exercise seems safe and beneficial in older patients.
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Falência Renal Crônica , Qualidade de Vida , Idoso , Terapia por Exercício , Estudos de Viabilidade , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise RenalRESUMO
BACKGROUND: Aging, cancer and its treatment all contribute to increase the risk of deconditioning and sedentary behaviors. Mixed exercise is recognized to counteract the effects of aging and deconditioning as well as improving physical capacity during cancer treatment in adults. AIMS: To determine the impact of a mixed exercise program (MXEP) to improve physical capacity and decrease sedentary behavior time (SBT) in older adults during cancer treatment. METHODS: Fourteen participants (68.8 ± 3.4 years) completed 12 weeks of a mixed exercise program (MEXP) (n = 6) or stretching (n = 8) while they were under cancer treatment. Five tests of the Senior Fitness Test (Chair Stand, 8-Foot Up & Go, Arm Curl, Sit & Reach, 6 min Walk Test), two maximal strength tests (leg press and handgrip) and a Global Physical Capacity Score (GPCS) were used to assess physical capacity. For the amount of SBT (min/day), we used question 1 of the Physical Activity Scale for the Elderly. RESULTS: Both groups presented significant pre- vs post-intervention differences for the Chair Stand, Arm Curl, 6 min Walk Tests and also GPCS. Nevertheless, this difference was significantly greater in the MEXP group only for the Chair Stand Test (4.3 ± 2.2 vs 1.0 ± 1.3 reps; p = 0.01) and the GPCS (4.0 ± 0.6 vs 1.5 ± 2.3 points; p = 0.047). A tend to display a greater decrease in SBT (- 295 ± 241 min/week vs - 11 ± 290 min/week; p = 0.079) was observed in favor of MEXP. CONCLUSION: A 12-week mixed exercise program led to significant improvements in physical capacity and may reduce SBT.
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Terapia por Exercício/métodos , Neoplasias/terapia , Aptidão Física/fisiologia , Comportamento Sedentário , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Modalidades de Fisioterapia , Projetos PilotoRESUMO
OBJECTIVES: To compare the effect of low-volume HIIT to moderate-intensity aerobic training (MICT) on fat mass, cardiometabolic profile and physical capacity and confirm its feasibility in older women. METHODS: Inactive older women (60-75 years) were randomly assigned to 8 weeks of either HIIT (75 min/week; n=9) or MICT (150 min/week; n=9). Body composition, fasting metabolic profile, cardiovascular risk (Framingham score), and physical capacity (senior fitness test, VO2peak) were assessed before and after the intervention. Feasibility was evaluated with completion rate (training compliance; dropout rate) and affective response (Feeling scale; pre- and post-exercise). RESULTS: Total cholesterol, non-HDL-C levels and the Framingham risk score decreased in both groups (all p≤0.03). Although VO2peak remained unchanged, the 6MWT distance increased (p<0.0001), irrespective of the group. Completion rate and affective responses were not different between groups (all p≥0.38). CONCLUSION: A short-term HIIT program is feasible and provides as much benefits as MICT in older women.
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Envelhecimento , Composição Corporal , Aptidão Cardiorrespiratória , Tolerância ao Exercício , Exercício Físico/fisiologia , Treinamento Intervalado de Alta Intensidade/métodos , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Fatores de Risco Cardiometabólico , Colesterol/sangue , Feminino , Estado Funcional , Humanos , Avaliação de Programas e Projetos de Saúde , Saúde da MulherRESUMO
BACKGROUND: Because of its satiating effect, it has been widely purported that a high-protein beverage may reduce subsequent appetite and food intake in healthy aged individuals, therefore annihilating any supplemental effect. AIMS: The goal of the study was to examine the impact of a post-exercise protein supplement from dairy products in the hours following resistance exercise on subsequent energy intake, sensation of hunger, appetite and satiety in sarcopenic older men. METHODS: A randomized double-blind crossover study with three experimental conditions was performed. Nine sarcopenic older (64 ± 3 years) men participated in three experimental conditions: post-exercise protein supplementation made from (1) cow's milk (13 g of proteins); (2) rice milk (isocaloric protein-free beverage) and (3) water (control). Subsequent energy intake was measured with a test buffet and a food record over the rest of the day. Assessment of appetite, satiety and hunger were obtained by visual analogue scales at various times before and after the buffet. RESULTS: Appetite, feeling of hunger and satiety and subsequent energy intake were not significantly different between the three experimental conditions. However, when participants were supplemented with cow's milk, total fat intake during the day of the intervention was significantly lower than with other supplements (p ≤ 0.05). CONCLUSION: Post-exercise consumption of protein supplements made from dairy products appear not to compromise daily nutritional behavior and does not confer the anticipated negative impact on nutritional intake in sarcopenic older men.
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Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Treinamento Resistido , Sarcopenia/fisiopatologia , Idoso , Apetite , Estudos Cross-Over , Suplementos Nutricionais , Método Duplo-Cego , Ingestão de Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , SaciaçãoRESUMO
BACKGROUND: Adapted boxing can help improve the physical functioning and health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD). Whether these benefits persist longitudinally is unclear. OBJECTIVE: The purpose of this retrospective study was to evaluate the impact of a community-based adapted boxing program on the physical functioning and HRQoL of individuals with PD over 1-1.5 years. METHODS: Twenty-six individuals with PD agreed to share their results on tests administered upon enrollment in the program (PRE) and â¼431 days later (POST). The tests included the Fullerton Advanced Balance scale, (FAB), the Timed Up-and-Go test (TUG), the 30-second Sit-to-Stand test (30-STS), and the PD questionnaire-39 (PDQ-39). RESULTS: From PRE to POST, performance significantly improved on the TUG and 30-STS tests (both pâ<â0.001), but not on the FAB (pâ=â0.79). Over the same period, PDQ-39 scores significantly increased (pâ=â0.05). No PRE to POST changes surpassed the minimal detectable change threshold. CONCLUSION: The results of this study suggest that adapted boxing is at worst non-detrimental and at best potentially beneficial for muscle strength, endurance, and functional mobility in individuals with PD. However, adapted boxing probably cannot fully counteract the HRQoL decrements that accompany PD progression.
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Doença de Parkinson , Equilíbrio Postural , Qualidade de Vida , Humanos , Doença de Parkinson/reabilitação , Doença de Parkinson/fisiopatologia , Doença de Parkinson/psicologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Equilíbrio Postural/fisiologia , Terapia por Exercício/métodos , Desempenho Físico FuncionalRESUMO
Cancer-related fatigue (CRF) is a prevalent and persistent issue affecting cancer patients, with a broad impact on their quality of life even years after treatment completion. The precise mechanisms underlying CRF remain elusive, yet its multifaceted nature involves emotional, physical, and cognitive dimensions. The absence of effective medical treatments has prompted researchers to explore integrative models for potential insights. Notably, physical exercise emerges as a promising strategy for managing CRF and related symptoms, as studies showed a reduction in CRF ranging from 19% to 40%. Current recommendations highlight aerobic training at moderate intensity as beneficial, although questions about a dose-response relationship and the importance of exercise intensity persist. Despite the positive impact of exercise on CRF, the underlying mechanisms remain elusive. This review aims to provide a theoretical model explaining how aerobic exercise may alleviate CRF. Focusing on acute exercise effects, this review delves into the potential influence on peripheral and neural inflammation, immune function dysregulation, and neuroendocrine system disruptions. The objective is to enhance our understanding of the intricate relationship between exercise and CRF, ultimately paving the way for tailored interventions and potential pharmacological treatments for individuals unable to engage in physical exercise.
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Exogenous ketone supplements have been suggested to have potential cardiovascular benefits, but their overall effect on blood pressure is unclear. Our objective was to perform a systematic review and meta-analysis on the effects of exogenous ketone supplements on blood pressure (BP) and concomitant changes in resting heart rate (HR). Five databases were searched on January 27th, 2023, for randomized and non-randomized studies. A random-effects model meta-analysis was performed including all studies jointly and separately for acute and chronic ingestion of ketone supplements. Out of 4012 studies identified in the search, 4 acute and 6 chronic studies with n = 187 participants were included. Pooled results (n = 10) showed no change in systolic (SMD [95% CI]= -0.14 [-0.40; 0.11]; I2= 30%; p = 0.17) or diastolic BP (-0.12 [-0.30; 0.05]; I2= 0%; p = 0.69), with a potential tendency observed toward increased resting heart rate (0.17 [-0.14; 0.47]; I2= 40%; p = 0.10). Similar results for systolic and diastolic BP were observed when assessing separately the effect of acute and chronic ingestion of ketone supplements (p ≥ 0.33). Supplement dosage was found to modulate the increase in resting heart rate (0.019 ± 0.006; p = 0.013; R2=100%), suggesting that higher supplement doses lead to a higher resting heart rate. Based on currently available data, acute or prolonged ingestion of ketone supplements does not seem to modulate BP. However, a tendency for HR to increase after acute ingestion was observed, particularly with higher doses. Higher quality studies with appropriate standardized measurements are needed to confirm these results.
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Pressão Sanguínea , Suplementos Nutricionais , Frequência Cardíaca , Cetonas , Humanos , Pressão Sanguínea/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Cetonas/administração & dosagem , Adulto , Feminino , Masculino , Pessoa de Meia-IdadeRESUMO
Background: It has been suggested that the acute natural killer (NK) cell response to aerobic exercise might contribute to the tumor suppressor effect of regular exercise observed in preclinical studies. Moreover, because this response is modulated by exercise intensity, high-intensity intervals exercise (HIIE) might represent an interesting therapeutic approach in cancer patients. However, this immune response remains unstudied in cancer patients currently undergoing chemotherapy. Objective: To characterize the acute NK cell response following a moderate-intensity continuous aerobic exercise session (MOD), and a HIIE session in metastatic cancer patients treated with chemotherapy. Methods: Twelve cancer patients (45-65 years old) underwent a MOD and a duration and work-matched HIIE trial, in a block-randomized order. Peripheral blood mononuclear cells (PBMC) were isolated before, after and 1h after each trial. NK cell subsets were enumerated using flow cytometry and complete blood counts. The surface expression of the cytotoxic NK cell (cNK; CD56dimCD16+) subset was evaluated for its expression of the differentiation markers CD57 and CD158a, the activating receptor NKG2D, the immune checkpoints TIM-3 and PD-1, and the chemokine receptors CXCR3, CXCR4 and CCR2. Results: cNK cell blood counts increased immediately following MOD (p < 0.001) and decreased back to pre-exercise values 1 h after exercise cessation (p < 0.001). The most responsive cNK cell subsets were expressing CD57, CD158a, NKG2D, TIM-3 and CXCR3. The HIIE trial elicited a similar biphasic response, without any difference between trials (all p ≥ 0.38). However, significant changes in the MFI values of CXCR4 and NKG2D were observed in the cNK cell subset following HIIE (all p ≤ 0.038), but not MOD. Conclusion: In metastatic cancer patients undergoing chemotherapy, both MOD and HIIE can elicit an acute mobilisation and egress of NK cells exhibiting phenotypic characteristics associated with high cytotoxicity and tumor homing. Future longitudinal trials are needed to determine if combining aerobic exercise training and chemotherapy will translate towards favorable immune and clinical outcomes.
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Achieving the three therapeutics targets known as ABC (A1c ≤ 7.0%, LDL-C < 2.0 mmol/L, and resting BP < 130/80 mmHg), limiting sedentary behaviors as well as accumulating a total of 150 min/week of moderate-to-vigorous aerobic exercise reduce the risk of cardiovascular disease in type 2 diabetes (T2D) individuals. However, more recent data regarding the achievement of ABC over time in Canada is needed and it remains to be determined how sedentary behaviors and physical activity levels can influence its achievement. Analyses were performed using a total of 17 582 individuals (18-79 years) from the 2007-2017 Canadian Health Measures Survey. Sedentary behaviors and physical activity levels were estimated using an accelerometer for a total of 7 consecutive days and quartiles of physical activity were used to categorize individuals. The prevalence of T2D has increased from 2007 to 2017 in the Canadian population (from 4.80% to 8.38%) with a considerable number of undiagnosed patients. The achievement of ABC went from 11.53% [11.49%-11.57%] in 2007 to 14.84% [14.80%-14.89%] in 2017 in T2D individuals. Moderate-to-vigorous physical activity (MVPA) levels were positively but weakly correlated to the achievement of the ABC (r = 0.044; p = 0.001), while sedentary time and light physical activity were not (r < -0.014; p = 0.266). Only 8.8% of individuals with the lowest level of MVPA (Q1) reached the ABC while 15.1% of the most active individuals (Q4) reached the triple target. In addition to physical activity, other important factors such as body mass index and medication use should also be considered as modifiable contributing factors.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Objetivos , Canadá/epidemiologia , Exercício FísicoRESUMO
INTRODUCTION: Despite extensive research on the effect of supervised exercise therapy on walking performance in patients with symptomatic peripheral arterial disease (PAD), it remains unclear which training modality provides the greatest improvement in walking capacity. The objective of this study was to compare the effect of different types of supervised exercise therapy on walking capacity in individuals with symptomatic PAD. METHODS: A random-effect network meta-analysis was performed. The following databases were searched from January 1966 to April 2021: SPORTDiscus, CINAHL, MEDLINE, AMED, Academic Search Complete and, Scopus. Trials had to include at least one type of supervised exercise therapy for patients with symptomatic PAD, with an intervention lasting ≥2 wk with ≥5 training sessions, and an objective measure of walking capacity. RESULTS: Eighteen studies were included for a total sample of 1135 participants. Interventions duration ranged from 6-24 wk and included aerobic exercise (treadmill walking, ergometer, and Nordic walking), resistance training (lower and/or upper body), a combination of both, and underwater exercise. Results showed that combined training improved treadmill walking capacity to a comparable extent to aerobic walking (+122.0 [24.2-219.8] m vs +106.8 [34.2-179.4] m), but with a larger effect size (1.20 [0.50-1.90] vs 0.67 [0.22-1.11]). Similar results were observed for the 6-min walk distance, with combined training being the most promising modality (+57.3 [16.2-98.5] m), followed by underwater training (+56.5 [22.4-90.5] m) and aerobic walking (+39.0 [12.8-65.1] m). CONCLUSION: While not statistically superior to aerobic walking, combined exercise seems to be the most promising training modality. Aerobic walking and underwater training also improved walking capacity for patients with symptomatic PAD.
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Claudicação Intermitente , Doença Arterial Periférica , Humanos , Claudicação Intermitente/terapia , Metanálise em Rede , Exercício Físico , Terapia por Exercício/métodos , Doença Arterial Periférica/terapia , Caminhada , Resultado do TratamentoRESUMO
Introduction: Chronic pain is a significant health problem and is particularly prevalent amongst the elderly. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has been proposed to reduce chronic pain. The aim of this study was to evaluate and compare the efficacy of active and sham tDCS in reducing pain in older individuals living with chronic musculoskeletal pain. Materials and Methods: Twenty-four older individuals (mean age: 68 ± 7 years) suffering from chronic musculoskeletal pain were randomized to receive either anodal tDCS over the contralateral motor cortex (2 mA, 20 min; n = 12) or sham tDCS (20 min; n = 12) for five consecutive days. Pain logbooks were used to measure pain intensity. Questionnaires (McGill Pain Questionnaire, Brief Pain Inventory, Beck Depression Inventory [BDI], Beck Anxiety Inventory, Pain Catastrophizing Scale [PCS], and Margolis Pain Drawing and Scoring System [MPDSS]) were also used to assess pain in its globality. Results: Analysis of pain logbooks revealed that active tDCS led to a reduction in daily average pain intensity (all p ≤ 0.04), while sham tDCS did not produce any change (p = 0.15). Between-group comparisons for change in pain intensity reduction between active and sham tDCS showed a trend during treatment (p = 0.08) which was significant at the follow-up period (p = 0.02). Active tDCS also improved scores of all questionnaires (all p ≤ 0.02), while sham tDCS only reduced MPDSS scores (p = 0.04). Between-group comparisons for the pain-related outcomes showed significant differences for BDI et PCS after the last tDCS session. Conclusions: These results suggest that anodal tDCS applied over the primary motor cortex is an effective modality to decrease pain in older individuals. tDCS can also improve other key outcomes, such as physical and emotional functioning, and catastrophic thinking.
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Aging and family history of type 2 diabetes (T2D) are known risk factors of T2D. Younger first-degree relatives (FDR) of T2D patients have shown early metabolic alterations, which could limit exercise's ability to prevent T2D. Thus, the objective was to determine whether exercise metabolism was altered during submaximal exercise in FDR postmenopausal women. Nineteen inactive postmenopausal women (control: 10, FDR: 9) aged 60 to 75 years old underwent an incremental test on a cycle ergometer with intensity ranging from 40 to 70% of peak power output. Participants consumed 50 mg of 13C-palmitate 2 h before the test. At the end of each stage, glucose, lactate, glycerol, non-esterified fatty acids and 13C-palmitate were measured in plasma, and 13CO2 was measured in breath samples. Gas exchanges and heart rate were both monitored continuously. There were no between-group differences in substrate oxidation, plasma substrate concentrations or 13C recovered in plasma or breath. Interestingly, despite exercising at a similar relative intensity to control, FDR were consistently at a lower percentage of heart rate reserve. Overall, substrate plasma concentration and oxidation are not affected by family history of T2D in postmenopausal women and therefore not a participating mechanism in the altered response to exercise previously reported. More studies are required to better understand the mechanisms involved in this response.
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Diabetes Mellitus Tipo 2 , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Pós-Menopausa , Exercício Físico/fisiologia , Consumo de Oxigênio/fisiologia , PalmitatosRESUMO
Results from a pilot project indicate that isoflavones and exercise could have an additive effect on body composition and clinical risk factors of CVD in postmenopausal women. The objective of the present study was to assess the combined effect of exercise and isoflavones in overweight-to-obese postmenopausal women. In this double-blind randomised controlled trial, 100 overweight-to-obese (BMI 29·9 (sd 3·2) kg/m2) postmenopausal women were assigned to four groups: (1) placebo (PLA); (2) isoflavones (ISO); (3) exercise and placebo (Ex+PLA); (4) exercise and isoflavones (Ex+ISO). The supplementation contained 70 mg/d of isoflavones. Exercise consisted of three weekly sessions of resistance training and aerobics. Outcome measures included fat mass (FM), lean body mass (LBM), bone mineral density, lipid profile, fasting glucose, fasting insulin and insulin resistance (homeostasis assessment model). The main effects of exercise were observed for total FM (P = 0·02), FM% (P < 0·01), trunk FM% (P = 0·05), arm FM% (P < 0·01), leg FM% (P = 0·02), arm LBM (P < 0·01), leg LBM (P = 0·02) and C-reactive protein (P < 0·01). A main effect was detected for isoflavones in improving leg FM% (P = 0·05). No interactions were observed between isoflavones and exercise. In conclusion, it was observed that 6 months of exercise brought favourable changes in total FM, FM% and LBM in overweight postmenopausal women. No synergistic effects were observed between exercise and isoflavones. However, isoflavones could have a beneficial effect on leg FM%.
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Composição Corporal , Doenças Cardiovasculares/prevenção & controle , Suplementos Nutricionais , Exercício Físico/fisiologia , Glycine max/química , Isoflavonas/uso terapêutico , Sobrepeso/terapia , Adiposidade , Idoso , Índice de Massa Corporal , Tamanho Corporal , Proteína C-Reativa/análise , Método Duplo-Cego , Feminino , Humanos , Perna (Membro) , Pessoa de Meia-Idade , Obesidade/dietoterapia , Obesidade/terapia , Sobrepeso/sangue , Sobrepeso/dietoterapia , Pós-Menopausa , Treinamento Resistido , Fatores de RiscoRESUMO
BACKGROUND: Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population. METHODS: Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m2 (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT). RESULTS: From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity. CONCLUSIONS: Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.
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Exercício Físico , Conhecimentos, Atitudes e Prática em Saúde , Motivação , Obesidade/reabilitação , Preferência do Paciente/psicologia , Caminhada , Índice de Massa Corporal , Humanos , Apoio SocialRESUMO
OBJECTIVES: First, to establish the respective ability of body mass index (BMI), waist circumference (WC), and relative fat mass index (RFM), to estimate body fat (BF%) measured by DXA (DXA-BF%) and correctly identify postmenopausal women living with obesity (BF%â>â35). Second, to identify the best indicator of successful weight-loss intervention in postmenopausal women living with obesity. METHODS: A total of 277 women (age: 59.8â±â5.3ây; BF%: 43.4â±â5.3) from five weight-loss studies with complete data for anthropometric measurements [BMIâ=âweight/height (kg/m2); WC (cm)] and BF% were pooled together. Statistical performance indicators were determined to assess ability of RFM [64-(20â×âheight/waist circumference) + (12â×âsex)], BMI and WC to estimate BF% before and after weight-loss intervention and to correctly identify postmenopausal women living with obesity. RESULTS: Compared with RFM (râ=â0.51; r2â=â0.27; RMSEâ=â4.4%; Lin's CCCâ=â0.46) and WC (râ=â0.49; r2â=â0.25; RMSEâ=â4.8%; Lin's CCCâ=â0.41), BMI (râ=â0.73; r2â=â0.52; RMSEâ=â3.7%; Lin's CCCâ=â0.71) was the best anthropometric index to estimate DXA-BF% and correctly identify postmenopausal women living with obesity (sensitivity + specificity: BMIâ=â193; RFMâ=â152; WCâ=â158), with lower misclassification error, before weight-loss intervention. After weight-loss, the change in BMI was strongly correlated with change in DXA-BF%, indicating that the BMI is the best indicator of success weight-loss intervention. CONCLUSION: In the absence of more objective measures of adiposity, BMI is a suitable proxy measure for BF% in postmenopausal women, for whom a lifestyle intervention is relevant. Furthermore, BMI can be used as an indicator to assess success of weight-loss intervention in this subpopulation.
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Adiposidade , Pós-Menopausa , Absorciometria de Fóton , Idoso , Composição Corporal , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/terapia , Circunferência da CinturaRESUMO
Objective: To examine the acute and chronic effects of structured exercise on glucose outcomes assessed by continuous glucose monitors in adults with type 2 diabetes. Methods: PubMed, Medline, EMBASE were searched up to January 2020 to identify studies prescribing structured exercise interventions with continuous glucose monitoring outcomes in adults with type 2 diabetes. Randomized controlled trials, crossover trials, and studies with pre- and post-designs were eligible. Short-term studies were defined as having exercise interventions lasting ≤2 weeks. Longer-term studies were defined as >2 weeks. Results: A total of 28 studies were included. Of these, 23 studies were short-term exercise interventions. For all short-term studies, the same participants completed a control condition as well as at least one exercise condition. Compared to the control condition, exercise decreased the primary outcome of mean 24-h glucose concentrations in short-term studies (-0.5 mmol/L, [-0.7, -0.3]; p < 0.001). In longer-term studies, mean 24-h glucose was not significantly reduced compared to control (-0.9 mmol/L [-2.2, 0.3], p = 0.14) but was reduced compared to pre-exercise values (-0.5 mmol/L, [-0.7 to -0.2] p < 0.001). The amount of time spent in hyperglycemia and indices of glycemic variability, but not fasting glucose, also improved following short-term exercise. Among the shorter-term studies, subgroup, and regression analyses suggested that the timing of exercise and sex of participants explained some of the heterogeneity among trials. Conclusion: Both acute and chronic exercise can improve 24-h glucose profiles in adults with type 2 diabetes. The timing of exercise and sex of participants are among the factors that may explain part of the heterogeneity in acute glycemic improvements following exercise.
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Automonitorização da Glicemia/métodos , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Exercício Físico , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/terapia , HumanosRESUMO
Cancer-related fatigue (CRF) is a major issue in older cancer patients as it is associated with functional decline and a lower quality of life, and an increased inflammatory activity during cancer therapy is suspected to play a key role in CRF etiology. Combined aerobic and resistance exercise training is known to reduce CRF, and this could be mediated by a protective effect against this increased inflammatory activity. Hence, the main objective was to measure the effect of a 12-week combined exercise training on the inflammatory profile of older cancer patients undergoing systemic therapy. A secondary objective was to verify if there was an association between inflammatory profile and CRF. Methods: Twenty older non-metastatic cancer patients initiating chemotherapy and/or hormone therapy were randomly assigned to 12 weeks of supervised, combined exercise or a control group (static stretching). Primary outcomes were the inflammatory profile, Indoleamine 2,3-deoxygenase activity (KYN/TRP ratio), and CRF (FACIT-F questionnaire). Control outcomes were the fasting nutritional and hormonal blood profiles, body composition (iDXA), physical activity habits (PASE questionnaire), nutritional habits (3-day log), and treatment-related variables. Results: No worsening of the inflammatory profile was observed in both arms of the study after the intervention. No significant change in CRF was observed, although there was a trend for a reduction in the experimental group (p â= â0.10). Significant correlations were found at both timepoints between the KYN/TRP ratio and the delay with the previous treatment received (p â≤ â0.03). Conclusion: These results suggest that exercise might have elicited a positive effect on CRF, which was not mediated by the modulation of the pro-inflammatory cytokine profile. However, the decrease in IL-6/IL-10 ratio in the exercise group might reflect a possible anti-inflammatory effect of exercise. Moreover, exploratory analyses suggest that an acute effect of chemotherapy treatments influenced the inflammatory profile measurements, which could explain the absence of change in the fasting inflammatory profile.
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AIM: To examine the effect of walking before dinner on 24-h glycemic control in individuals with type 2 diabetes using the standardized multi-site Exercise-Physical Activity and Diabetes Glucose Monitoring (E-PAraDiGM) Protocol. METHODS: Eighty participants were studied under two conditions (exercise vs. non-exercise control) separated by 72 h in a randomized crossover design. Each condition lasted 2 days during which standardized meals were provided. Exercise consisted of 50 min of treadmill walking at 5.0 km/h before the evening meal, while control involved 50 min of sitting. The primary outcome measure was mean glucose during the 24-h period following exercise (or sitting) measured by continuous glucose monitoring. RESULTS: Of the 80 participants who were initially randomized, 73 completed both exercise and control. Sixty-three participants [29 males, 34 females; age = 64 ± 8 years, body mass index = 30.5 ± 6.5 kg/m2 and HbA1c = 51 ± 8 mmol/mol (6.8 ± 0.7%), mean ± SD] complied with the standardized diets and had complete continuous glucose monitoring data. Exercise did not affect mean 24-h glucose compared to control (0.03 mmol/L; 95% CI - 0.17, 0.22, P = 0.778) but individual differences between conditions ranged from - 2.8 to +1.8 mmol/L. Exercise did not affect fasting glucose, postprandial glucose or glucose variability. Glucose concentrations measured by continuous glucose monitoring were reduced during the 50 min of walking in exercise compared to sitting in control (- 1.56 mmol/L; 95% CI - 2.18, - 0.95, p < 0.001). CONCLUSION: Contrary to previous acute exercise studies, 50 min of walking before dinner in the E-PAraDiGM protocol did not affect 24-h glucose profiles. However, highly heterogeneous responses to exercise were observed. TRIAL REGISTRATION: NCT02834689.
Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Refeições , Caminhada/fisiologia , Adulto , Idoso , Automonitorização da Glicemia , Estudos Cross-Over , Diabetes Mellitus Tipo 2/diagnóstico , Exercício Físico/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial/fisiologia , Fatores de TempoRESUMO
The contribution of adiposopathy to glucose-insulin homeostasis remains unclear. This longitudinal study examined the potential relationship between the adiponectin/leptin ratio (A/L, a marker of adiposopathy) and insulin resistance (IR: homeostasis model assessment (HOMA)), insulin sensitivity (IS: Matsuda), and insulin response to an oral glucose tolerance test before and after a 16-week walking program, in 29 physically inactive pre- and postmenopausal women with obesity (BMI, 29-35 kg/m2; age, 47-54 years). Anthropometry, body composition, VO2max, and fasting lipid-lipoprotein and inflammatory profiles were assessed. A/L was unchanged after training (p = 0.15), despite decreased leptin levels (p < 0.05). While the Matsuda index tended to increase (p = 0.07), HOMA decreased (p < 0.05) and fasting insulin was reduced (p < 0.01) but insulin area under the curve (AUC) remained unchanged (p = 0.18) after training. Body fatness and VO2max were improved (p < 0.05) while triacylglycerols increased and HDL-CHOL levels decreased after training (p < 0.05). At baseline, A/L was positively associated with VO2max, HDL-CHOL levels, and Matsuda (0.37 < ρ < 0.56; p < 0.05) but negatively with body fatness, HOMA, insulin AUC, IL-6, and hs-CRP levels (- 0.41 < ρ < - 0.66; p < 0.05). After training, associations with fitness, HOMA, and inflammation were lost. Multiple regression analysis revealed A/L as an independent predictor of IR and IS, before training (partial R2 = 0.10 and 0.22), although A/L did not predict the insulin AUC pre- or post-intervention. A significant correlation was found between training-induced changes to A/L and IS (r = 0.38; p < 0.05) but not with IR or insulin AUC. Although changes in the A/L ratio could not explain improvements to glucose-insulin homeostasis indices following training, a relationship with insulin sensitivity was revealed in healthy women with obesity.