Impact of Concurrent Exercise Training on Cardiac Autonomic Modulation, Metabolic Profile, Body Composition, Cardiorespiratory Fitness, and Quality of Life in Type 2 Diabetes with Cardiac Autonomic Neuropathy: A Randomized Controlled Trial.

Background: Type 2 diabetes mellitus (T2DM) often leads to cardiac autonomic neuropathy (CAN), a severe complication affecting cardiovascular health. Exercise training is a proven intervention for improving metabolic control and cardiovascular health in T2DM, but the effects of concurrent exercise training (CET), combining aerobic and resistance exercises, on CAN are not fully understood. Objective: This randomized controlled trial investigates the impact of a structured CET program on cardiac autonomic modulation, metabolic profile, body composition, cardiorespiratory fitness (CRF), and quality of life (QoL) in individuals with T2DM and CAN. Methods: A total of 96 participants, aged 35-70 years, with T2DM and CAN, were randomized into CET (n = 48) and control (n = 48) groups. The CET group engaged in combined aerobic and resistance training three times per week for 13 weeks, while the control group received standard care. Primary outcomes included heart rate variability (HRV) and heart rate recovery (HRR). Secondary outcomes were metabolic profile, body composition, CRF, and QoL, which were assessed using standardized protocols and validated questionnaires. The trial was registered with the Clinical Trials Registry-India (CTRI/2021/09/036711). Results: Significant improvements were noted in the CET group compared to controls. HRV metrics (SDNN, RMSSD, pNN50, TP, LF power, HF power, and LF/HF ratio) and HRR metrics (HRR30s, HRR1, HRR2, and HRR3) all showed significant enhancements (p < 0.01). The CET group also exhibited substantial reductions in fasting blood glucose, postprandial blood glucose, HbA1c, waist circumference, hip circumference, and percentage body fat (p < 0.01). Improvements were observed in lipid profile markers and CRF (VO2max) (p < 0.01). QoL scores improved significantly in the CET group as per the ADDQoL-19 (p < 0.01). Conclusions: CET significantly enhances cardiac autonomic modulation, metabolic profile, body composition, CRF, and QoL in individuals with T2DM and CAN. These findings support the integration of CET into standard T2DM management to improve clinical outcomes and QoL. Further research is needed to explore the long-term benefits and broader applicability of CET in diverse diabetic populations.

The effect of moderate-intensity exercises on physical fitness, adiposity, and cardiovascular risk factors in Saudi males university students.

Physical inactivity has been linked to several non-communicable diseases. This cross-sectional study investigated the impact of moderate-intensity exercise on physical fitness, adiposity, and cardiovascular risk factors in 284 Saudi male university students in the Eastern Province of Saudi Arabia between 2017 and 2019. The physical activity (PA) intervention comprised three (120 minutes each) sessions of moderate intensity on non-consecutive days each week, delivering a total of 360 minutes of PA per week for ten weeks. We measured physical fitness using VO2 max calculations and assessed adiposity and cardiovascular risk factors using a range of parameters, such as systolic/diastolic blood pressure, heart rate, mean arterial pressure, body mass index, waist circumference, waist-to-height ratio, waist-to-hip ratio, body adiposity index, and body fat percentage. Our study found a significant increase in VO2 max after ten weeks of moderate-intensity exercise (<0.001). Additionally, body adiposity indices were significantly reduced before and after the intervention (p<0.001), as were cardiovascular risk factors. Our findings suggest that regular moderate-intensity exercise effectively improves physical fitness, decreases adiposity, and lowers cardiovascular risk factors in Saudi male adults. We recommend that policymakers and public health practitioners increase physical activity among university students by launching a campaign on social media and through.

Maximal isokinetic elbow and knee flexor-extensor strength measures in combat sports athletes: the role of movement velocity and limb side.

BACKGROUND: Maximal isokinetic strength ratios of joint flexors and extensors are important parameters to indicate the level of muscular balance at the joint. Further, in combat sports athletes, upper and lower limb muscle strength is affected by the type of sport. Thus, this study aimed to examine the differences in maximal isokinetic strength of the flexors and extensors and the corresponding flexor-extensor strength ratios of the elbows and knees in combat sports athletes. METHOD: Forty male participants (age = 22.3 ± 2.5 years) from four different combat sports (amateur boxing, taekwondo, karate, and judo; n = 10 per sport) were tested for eccentric peak torque of the elbow/knee flexors (EF/KF) and concentric peak torque of the elbow/knee extensors (EE/KE) at three different angular velocities (60, 120, and 180°/s) on the dominant and non-dominant side using an isokinetic device. RESULTS: Analyses revealed significant, large-sized group × velocity × limb interactions for EF, EE, and EF-EE ratio, KF, KE, and KF-KE ratio (p ≤ 0.03; 0.91 ≤ d ≤ 1.75). Post-hoc analyses indicated that amateur boxers displayed the largest EE strength values on the non-dominant side at ≤ 120°/s and the dominant side at ≥ 120°/s (p < 0.03; 1.21 ≤ d ≤ 1.59). The largest EF-EE strength ratios were observed on amateur boxers' and judokas' non-dominant side at ≥ 120°/s (p < 0.04; 1.36 ≤ d ≤ 2.44). Further, we found lower KF-KE strength measures in karate (p < 0.04; 1.12 ≤ d ≤ 6.22) and judo athletes (p ≤ 0.03; 1.60 ≤ d ≤ 5.31) particularly on the non-dominant side. CONCLUSIONS: The present findings indicated combat sport-specific differences in maximal isokinetic strength measures of EF, EE, KF, and KE particularly in favor of amateur boxers on the non-dominant side. TRIAL REGISTRATION: This study does not report results related to health care interventions using human participants and therefore it was not prospectively registered.

Blood Pressure and Cardio-Metabolic Risk Profile in Young Saudi Males in a University Setting.

Background and Objectives: The prevalence of cardiovascular diseases (CVDs) poses significant clinical and public health challenges across the world. This study aimed to study the metabolic risk factors and the association with blood pressure alteration. Materials and Methods: This was a cross-sectional study conducted between 2017 and 2018 among 284 male university students in Eastern province, Saudi Arabia. The obesity and cardiovascular measurements were taken using standardized instruments, including blood pressure (BP), mean arterial pressure, body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and basal metabolic rate (BMR). Statistical Analysis: Blood pressure was classified according to the United States of America, Sixth Joint National committee (JNC-VI) guidelines. The mean and standard error were calculated for each hypertension group variable. Logistic regression was applied to predict associations. Results: The prevalence of hypertension in the present study was 61.6%., and that of overweight and obesity was 16.5% and 34.9%, respectively. The cut-off values of BMI and WC were 22.23 and 75.24, respectively. Conclusions: The results demonstrated that BMI, WC, WHR, and WHtR significantly predict hypertension and that WC has a greater discrimination capacity than other measures. The findings also emphasize the importance of cardiovascular risk screening for young adults to detect any alterations in blood pressure and thus identify the population that is vulnerable to CVDs at an early stage. The findings highlight the need for health and university policymakers to adopt measures to monitor and control hypertension and obesity at the university level.

Adiposity and Cardiometabolic Risk assessment Among University Students in Saudi Arabia.

Overweight and obesity have become a significant health hazard among adolescents on account of quick growth in its occurrence rate and its common comorbidities like cardiometabolic disease (CMD). The aim of this study was to evaluate the prevalence of adiposity and assess the risk of CMD among university students in Eastern Province, Saudi Arabia. A cross-sectional study was conducted during the academic year 2017-2018, in a sample of 310 subjects (127 males; 183 females). The measurements were taken using standardized instruments including Body Mass Index (BMI), Fat Mass Index (FMI), Body Fat Percentage BFP), Mass of Body Fat (MBF), Visceral Fat Area (VFA), Waist Circumference (WC), and Waist to Hip Ratio (WHR). Moreover, CMD risk indicators were calculated by Conicity index (C index), WC, and WHR. The findings showed that the majority was overweight and obese (16.8% and 21.6%, respectively). While evaluating obesity indicators, males were found to have higher adiposity (obese students 34.6%) compared to female students (12.6%; p < 0.001). Additionally, FMI showed that the mean was significantly higher among males (8.65 ± 6.06) compared to females (7.26 ± 3.30; p < 0.019). Analysis of the predictors' indices for cardiometabolic risk score highlighted a significantly higher percentage of WC, WHR, and C index among male students (50, 38.5, 59) compared to females (16.9, 14.2, 34; p < 0.001). Significant positive correlations were observed between C index quartiles and BMI with the other cardiometabolic indices (p < 0.001). This study highlighted a high prevalence of adiposity and CMD risk among university students. The prediction of CMD in early age is quite helpful in preventing adiposity related health issues. Decision makers need to spread awareness about healthy consumption as well as the relationship between physical inactivity and chronic diseases.

Effects of Neuromuscular Fatigue on Eccentric Strength and Electromechanical Delay of the Knee Flexors: The Role of Training Status.

Purpose: To examine the effects of fatiguing isometric contractions on maximal eccentric strength and electromechanical delay (EMD) of the knee flexors in healthy young adults of different training status. Methods: Seventy-five male participants (27.7 ± 5.0 years) were enrolled in this study and allocated to three experimental groups according to their training status: athletes (ATH, n = 25), physically active adults (ACT, n = 25), and sedentary participants (SED, n = 25). The fatigue protocol comprised intermittent isometric knee flexions (6-s contraction, 4-s rest) at 60% of the maximum voluntary contraction until failure. Pre- and post-fatigue, maximal eccentric knee flexor strength and EMDs of the biceps femoris, semimembranosus, and semitendinosus muscles were assessed during maximal eccentric knee flexor actions at 60, 180, and 300°/s angular velocity. An analysis of covariance was computed with baseline (unfatigued) data included as a covariate. Results: Significant and large-sized main effects of group (p ≤ 0.017, 0.87 ≤ d ≤ 3.69) and/or angular velocity (p < 0.001, d = 1.81) were observed. Post hoc tests indicated that regardless of angular velocity, maximal eccentric knee flexor strength was lower and EMD was longer in SED compared with ATH and ACT (p ≤ 0.025, 0.76 ≤ d ≤ 1.82) and in ACT compared with ATH (p = ≤0.025, 0.76 ≤ d ≤ 1.82). Additionally, EMD at post-test was significantly longer at 300°/s compared with 60 and 180°/s (p < 0.001, 2.95 ≤ d ≤ 4.64) and at 180°/s compared with 60°/s (p < 0.001, d = 2.56), irrespective of training status. Conclusion: The main outcomes revealed significantly higher maximal eccentric strength and shorter eccentric EMDs of knee flexors in individuals with higher training status (i.e., athletes) following fatiguing exercises. Therefore, higher training status is associated with better neuromuscular functioning (i.e., strength, EMD) of the hamstring muscles in fatigued condition. Future longitudinal studies are needed to substantiate the clinical relevance of these findings.

Sex-related differences in joint-angle-specific hamstring-to-quadriceps function following fatigue.

The purpose of this study was to examine the effect of fatiguing exercise on sex-related differences in the function of hamstring and quadriceps muscles at several angular velocities and joint angles. Physically active participants (50 male: 28.7 ± 4.5y, 1.82 ± 0.07 m, 82.3 ± 6.87 kg; 50 female: 27.0 ± 5.8y, 1.61 ± 0.08 m, 68.75 ± 9.24 kg) carried out an isokinetic assessment to determine concentric and eccentric torques during knee extension and flexion actions at three different angular velocities (60/180/300°/s). The H/QFUNCT was calculated using peak torque (PT) values at 3 different joint-angle-specific (15°, 30° and 45° of knee flexion). A repeated measures analysis of variance (ANOVA) was used to compare within group results. Between group comparisons of sex-related differences were assessed by independent T-tests. Fatiguing exercise in males resulted in a decrease in H/QFUNCT ratios for each angle of knee flexion at both 60°/s and 300°/s angular velocities (p < 0.05). In females, significant decreases in H/QFUNCT ratios were observed following fatiguing exercise for each angle of knee flexion and angular velocity (p < 0.01). Significant differences in H/QFUNCT ratios following fatiguing exercise were evident between males and females at each joint angle and angular velocity (p < 0.01). These findings indicate sex related differences in H/QFUNCT ratios following fatiguing exercise. Females have greater reductions in torque and H/QFUNCT ratios following fatigue than their male counterparts. This potentially exposes females to higher risks of injury, particularly when fatigued. Practitioners should attend to the imbalance in fatigue resistance of hamstring and quadriceps function, particularly in female athletes.

Cardio-Respiratory Endurance Responses Following a Simulated 3 × 3 Minutes Amateur Boxing Contest in Elite Level Boxers.

This study aimed at examining physiological responses (i.e., oxygen uptake [VO2] and heart rate [HR]) to a semi-contact 3 × 3-min format, amateur boxing combat simulation in elite level male boxers. Eleven boxers aged 21.4 ± 2.1 years (body height 173.4 ± 3.7, body mass 74.9 ± 8.6 kg, body fat 12.1 ± 1.9, training experience 5.7 ± 1.3 years) volunteered to participate in this study. They performed a maximal graded aerobic test on a motor-driven treadmill to determine maximum oxygen uptake (VO2max), oxygen uptake (VO2AT) and heart rate (HRAT) at the anaerobic threshold, and maximal heart rate (HRmax). Additionally, VO2 and peak HR (HRpeak) were recorded following each boxing round. Results showed no significant differences between VO2max values derived from the treadmill running test and VO2 outcomes of the simulated boxing contest (p > 0.05, d = 0.02 to 0.39). However, HRmax and HRpeak recorded from the treadmill running test and the simulated amateur boxing contest, respectively, displayed significant differences regardless of the boxing round (p < 0.01, d = 1.60 to 3.00). In terms of VO2 outcomes during the simulated contest, no significant between-round differences were observed (p = 0.19, d = 0.17 to 0.73). Irrespective of the boxing round, the recorded VO2 was >90% of the VO2max. Likewise, HRpeak observed across the three boxing rounds were ≥90% of the HRmax. In summary, the simulated 3 × 3-min amateur boxing contest is highly demanding from a physiological standpoint. Thus, coaches are advised to systematically monitor internal training load for instance through rating of perceived exertion to optimize training-related adaptations and to prevent boxers from overreaching and/or overtraining.

Sex-related differences in joint-angle-specific functional hamstring-to-quadriceps strength ratios.

PURPOSE: To examine and compare sex-related differences in the functioning of the hamstrings and quadriceps muscles and the isokinetic hamstrings eccentric-to-quadriceps concentric functional ratio (H/Q FUNC). METHODS: Fifty male and 46 female young adults completed this study. Each participant carried out an isokinetic assessment to determine isokinetic concentric and eccentric torques during knee extension and flexion actions at 3 different angular velocities (60, 180 and 300°/s) adopting a lying position. The H/Q FUNC was calculated using peak torque (PT) values and 3 different joint-angle-specific torque values (15°, 30° and 45° of knee extension). A repeated measures analysis of variance was used to compare the results, and post hoc analyses using Friedman correction were employed. RESULTS: There were statistically significant effects of angular velocity, joint angle and sex on the H/Q FUNC (p < 0.01). Thus, the H/Q FUNC ratio in both males and females decreases closer to full knee extension and with increasing movement velocity. The H/Q FUNC was also significantly lower in females compared to males, irrespective of moment velocity and joint angle. CONCLUSIONS: The findings of the current study reinforce the need to examine the H/Q FUNC ratio closer to full knee extension (where knee injury is most likely to occur) rather than using PT values which may not be as informative, as well as to focus preventive and rehabilitation training programmes on reducing quadriceps dominance by enhancing eccentric hamstring strength (especially in females who are at higher risk of injury). LEVEL OF EVIDENCE: III.

Associations between physical activity and health parameters in adolescent pupils in Egypt.

Physical activity (PA) could be protective against hypertension, atherosclerosis, coronary heart disease and cardiovascular disease. This quantitative study assessed the association between a PA intervention and three anthropometric parameters (weight, body mass index, body fat) and four physiological parameters (cholesterol level, systolic blood pressure, diastolic blood pressure, heart rate) among secondary school pupils (N = 160) in Egypt through the school term. The pupils were randomised to an intervention group (80 pupils) and controls (80 pupils). Measurements were obtained for all pupils twice: at baseline; and then again after three months. The PA intervention programme comprised an 'afterschool' one hour of moderate exercise three times a week for three months. Both the controls and the intervention pupils attended the 'normal' exercise schedule provided by the school; in addition, the intervention group attended afterschool PA programme from about 2-3 o'clock in the afternoon. At baseline, employing pupil's BMI, 27.5% and 28.8% of the intervention and control pupils respectively were classified as overweight. After three months, the percentage of overweight decreased to 12.5% in the intervention pupils, while it increased to 37.3% in the controls. At the end of the three months period, there were significant improvements across most anthropometric and physiological parameters of the intervention pupils when compared with the control children. The correlation coefficient of the improvements for the boys and the girls was 0.97, indicating clearly that the intervention was having nearly the same beneficial effect for boys and girls. A moderate PA programme for a modest period of 3 months could be effective in maintaining or enhancing pupil's anthropometric and physiological parameters in comparison to the controls where there was deterioration in both parameters. Policy makers and secondary schools in Egypt might need to pay more attention to PA programmes conducted on school days, in order to motivate pupils to attend such programmes. There is also an urgent need to look at current PA systems within schools in Egypt in order to assess PA outside school times.