Effect of aerobic exercise and low carbohydrate diet on pre-diabetic non-alcoholic fatty liver disease in postmenopausal women and middle aged men--the role of gut microbiota composition: study protocol for the AELC randomized controlled trial.

BACKGROUND: Pre-diabetes and non-alcoholic fatty liver disease (NAFLD) are associated with an unhealthy lifestyle and pose extremely high costs to the healthcare system. In this study, we aim to explore whether individualized aerobic exercise (AEx) and low carbohydrate diet (LCh) intervention affect hepatic fat content (HFC) in pre-diabetes via modification of gut microbiota composition and other post-interventional effects. METHODS/DESIGN: A 6-month randomized intervention with 6-month follow-up is conducted from January 2013 to December 2015. The target sample size for intervention is 200 postmenopausal women and middle-aged men aged 50-65 year-old with pre-diabetes and NAFLD. The qualified subjects are randomized into 4 groups with 50 subjects in each group: 1 = AEx, 2 = LCh, 3 = AEx + LCh, and 4 = control. In addition, two age-matched reference groups (5 = pre-diabetes without NAFLD (n = 50) and 6 = Healthy without pre-diabetes or NAFLD (n = 50)) are included. The exercise program consists of progressive and variable aerobic exercise (intensity of 60 to 75% of initial fitness level, 3-5 times/week and 30-60 min/time). The diet program includes dietary consultation plus supplementation with a special lunch meal (40% of total energy intake/day) which aims to reduce the amount of carbohydrate consumption (30%). The control and reference groups are advised to maintain their habitual habits during the intervention. The primary outcome measures are HFC, serum metabolomics and gut microbiota composition. The secondary outcome measures include body composition and cytokines. In addition, socio-psychological aspects, social support, physical activity and diet will be performed by means of questionnaire and interview. DISCUSSION: Specific individualized exercise and diet intervention in this study offers a more efficient approach for liver fat reduction and diabetes prevention via modification of gut microbiota composition. Besides, the study explores the importance of incorporating fitness assessment and exercise in the management of patients with pre-diabetes and fatty liver disorders. If our program is shown to be effective, it will open new strategies to combat these chronic diseases. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN42622771.

[Physical exercise and mental health: cognition, anxiety, depression and self-concept].

This review focuses on the benefits of regular physical activity participation have mainly focused on cognitive functioning, anxiety and depression, and self-concept. It is well documented that ex- ercise can enhance cognitive functioning, improve executive function at old age, and improve mental abil- ity of children labeled as educational subnormal or disability. Regular exercise has been used to reduce stress and ward off anxiety and feelings of depression. In addition, exercise can improve self-esteem and positive outlook in life. Studies in these three main areas were reviewed and issues and future directions were highlighted.

Music interventions for psychological and physical outcomes in cancer: a systematic review and meta-analysis.

PURPOSE: A systematic review and meta-analysis to examine the effect of music interventions on psychological and physical outcome measures in cancer patients. METHODS: We searched six English-language databases and three major Chinese-language databases in March 2011. Nine databases were reviewed from 1966 or the start of the database to March 2011. All randomized controlled trials comparing music intervention with standard care, other interventions, or placebo for psychological and physical outcomes in cancer were included. Study quality was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation Working Group. We then performed a meta-analysis of music interventions for psychological and physical outcomes in cancer. RESULTS: Of 322 total studies found, 32 randomized trials (3181 participants) met the inclusion criteria. Seven high-quality studies indicated music had positive effects on coping anxiety assessed by the Self-Rating Anxiety Scale. Two moderate-quality studies suggested music reduced anxiety assessed by the Hamilton Anxiety Scale. Eight moderate-quality studies revealed music lowered anxiety assessed by the Spielberger State-Trait Anxiety Inventory. Seven moderate-quality studies demonstrated that music improved depression. Seven moderate-quality studies observed that music had positive effects on pain management. Two moderate-quality studies suggested music worsened fatigue. Four moderate-quality studies indicated music lowered heart rate. Three low-quality studies suggested music could reduce respiratory rate. Two moderate-quality studies indicated that music improved quality of life. CONCLUSIONS: Individual randomized trials suggest that music intervention is accepted by patients and associated with improved psychological outcomes. The effects of music on vital signs especially blood pressure are small. High-quality trials are needed to further determine the effects of music intervention.