The effects of telerehabilitation in adults with complex biventricular congenital heart conditions: protocol for a multi-centre, randomised controlled trial-CH-FIT.

BACKGROUND: Accumulated evidence suggests that exercise training exerts beneficial effects on people with congenital heart conditions. These findings are predominantly derived from small, single-centre exercise trials conducted in outpatient rehabilitation facilities. In recent years, the delivery of exercise interventions remotely has increased through digital communications technology (telerehabilitation). However, very little research to date has been conducted into the efficacy of telerehabilitation in people with a congenital heart condition. AIMS: To evaluate the effects of a telehealth-delivered exercise intervention in people with a history of a surgical biventricular repair due to a congenital heart condition. METHODS: One hundred eligible adolescent (≥ 16 years) and adult participants living with a complex biventricular congenital heart condition will be recruited from four Australian sites and randomised to either (1) a 16-week telehealth-delivered combined (aerobic and resistance) exercise training programme of moderate-to-vigorous intensity or (2) usual care (control group), in a 1:1 allocation, with an 8-month follow-up. OUTCOMES OF INTEREST: The primary outcome will be the change in aerobic capacity expressed as peak oxygen uptake (VO2peak). Secondary outcomes will include changes in vascular function, muscle oxygenation, metabolic profile, body composition and musculoskeletal fitness, neurohormonal activation, neurocognitive function, physical activity levels, dietary and nutritional status, and quality of life. Outcomes will be assessed at baseline, 16 weeks, and 12 months (to determine longer-term maintenance potential). DISCUSSION: If found to be efficacious, telerehabilitation may be an alternative option for delivering exercise, improving health outcomes, and increasing accessibility to exercise programmes. Efficacy data is required to quantify the clinical significance of this delivery mode of exercise. TRIAL REGISTRATION: ACTRN12622000050752 Trial registration date: 17 January 2022 Trial registration URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382635&showOriginal=true&isReview=true Trial registry name: Australian and New Zealand Clinical Trials Registry.

Aerobic, resistance, or combined exercise training and cardiovascular risk profile in overweight or obese adults: the CardioRACE trial.

BACKGROUND AND AIMS: To determine the comparative efficacy of resistance, aerobic, and combined resistance plus aerobic exercise on cardiovascular disease (CVD) risk profile. METHODS: This randomized controlled trial enrolled 406 adults aged 35-70 years with overweight or obesity and elevated blood pressure. Participants were randomly assigned to resistance (n = 102), aerobic (n = 101), combined resistance plus aerobic exercise (n = 101), or no-exercise control (n = 102). All exercise participants were prescribed 1 h of time-matched supervised exercise (the combination group with 30 min of each resistance and aerobic exercise) three times per week for 1 year. The primary outcome was the change from baseline to 1 year in the standardized composite Z-score of four well-established CVD risk factors: systolic blood pressure, low-density lipoprotein (LDL) cholesterol, fasting glucose, and per cent body fat. RESULTS: Among 406 participants (53% women), 381 (94%) completed 1-year follow-up. Compared with the control group, the composite Z-score decreased at 1 year, which indicates improved CVD risk profile, in the aerobic {mean difference, -0.15 [95% confidence interval (CI): -0.27 to -0.04]; P = .01} and combination [mean difference, -0.16 (95% CI: -0.27 to -0.04); P = .009] groups, but not in the resistance [mean difference, -0.02 (95% CI: -0.14 to 0.09); P = .69] group. Both aerobic and combination groups had greater reductions in the composite Z-score compared with the resistance group (both P = .03), and there was no difference between the aerobic and combination groups (P = .96). Regarding the four individual CVD risk factors, only per cent body fat decreased in all three exercise groups at 1 year, but systolic blood pressure, LDL cholesterol, and fasting glucose did not decrease in any exercise groups, compared with the control group. CONCLUSIONS: In adults with overweight or obesity, aerobic exercise alone or combined resistance plus aerobic exercise, but not resistance exercise alone, improved composite CVD risk profile compared with the control.

Cardiovascular Benefits of Resistance Training in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review.

Cardiovascular diseases pose a serious problem for health globally. Among these, congestive heart failure is the leading cause of mortality and morbidity worldwide. According to the recent census, heart failure contributes to a huge financial burden annually. Exercise therapy is an integral part of the non-pharmacological management of heart failure. Due to the availability of various types of exercise therapies and rapid advancements in the existing evidence, it is often challenging to prescribe an appropriate exercise program. Although there is unequivocal evidence supporting the cardiovascular benefits of aerobic therapy, the incorporation of resistance training into exercise regimens should also be encouraged due to its effects on muscular endurance and ameliorating skeletal myopathy in heart failure. In this study, we used a systematic literature review (SLR) approach to give an overview of the current literature and highlight the cardiovascular benefits of resistance training, alone or in combination with aerobic training. We reviewed articles from well-recognized journals published between 2013 and 2023, finally narrowing down to nine selected papers for a thorough analysis. The inclusion criteria comprise studies dealing with heart failure with reduced ejection fraction (HFrEF), resistance training alone or in combination with aerobic therapy, and studies available for free in either the PubMed or Google Scholar databases. The systematic review revealed that resistance training in combination with aerobic therapy has greater cardiovascular benefits than either resistance or aerobic therapy alone. A few unique approaches, like periodic intermittent muscular exercise (PRIME) and super circuit training (SCT), have demonstrated an improvement in cardiac and non-cardiac clinical outcomes compared to conventional exercise therapies. Moreover, various factors, like lack of motivation and lack of time, contribute to poor adherence to exercise therapy. Approaches like telerehabilitation and designing exercise regimens with activities that patients enjoy have led to improvements in long-term adherence rates. Nevertheless, further exploration and research by conducting randomized controlled trials on a larger scale is essential to explore the potential of resistance training in the rehabilitation of patients with heart failure with reduced ejection fraction and to develop the most effective exercise therapy.

Acute effect of combined exercise with aerobic and resistance exercises on executive function.

Objective: Recent studies indicate that acute exercise, whether aerobic exercise (AE) or resistance exercise (RE), improves cognitive function. However, the effects on cognitive function of combined exercise (CE), involving both AE and RE in an exercise session, remain unknown. The aim of this study was to investigate the effects of acute CE on cognitive function. Design: Within-subject design with counterbalancing. Methods: Fifteen healthy men with a sedentary lifestyle in the previous three months were recruited. The participants were assessed for muscular fitness after performing four upper body exercises for a 10-repetition maximum and underwent a submaximal aerobic fitness assessment for V̇O2peak and corresponding workload (watts). They were then assigned to a CE, RE, or sitting control (SC) session in counterbalanced order and were assessed with the Stroop Color and Word Test (SCWT) after each session. Results: Acute CE led to a significantly shorter response time compared to SC (p < .05) in the SCWT, wherein there were no significant differences between acute CE and RE (p = 1.00). Additionally, no significant differences in the accuracy rate were observed across the different sessions (ps > .05). Conclusion: A single session of moderate-intensity CE improved response time in the SCWT, comparable to RE. CE shows promise for enhancing cognitive function, warranting further research on its benefits and other exercise modalities.

Combined Exercise Training Promotes More Benefits on Cardiovascular Autonomic Modulation in Ovariectomized Rats Than Isolated Aerobic or Resistance Training.

Introduction: Cardiovascular risk increase after ovarian deprivation has been extensively demonstrated by our research group through cardiovascular autonomic analysis. Interventions involving different types of exercises, such as resistance exercises or combined exercises (aerobic and resistance) have been widely recommended to prevent or minimize neuromuscular decline in postmenopausal women, which is aggravated by a sedentary lifestyle. Experimentally, the cardiovascular effects of resistance or combined training, as well as comparison between aerobic, resistance, and combined training, in ovariectomized animals are scarce. Purpose: In this study, we hypothesized that the combination of aerobic and resistance training may be more effective in preventing muscle mass loss, as well as improving cardiovascular autonomic modulation and baroreflex sensitivity, than aerobic or resistance training individually in ovariectomized rats. Animals and Methods: Female rats were divided into 5 groups: sedentary (C); ovariectomized (Ovx); trained ovariectomized submitted to aerobic training (OvxAT); resistance training (OvxRT); combined training (OvxCT). Exercise training lasted 8 weeks, with the combined group alternating between aerobic training and resistance training every other day. At the end of the study, glycemia and insulin tolerance were evaluated. Arterial pressure (AP) was directly recorded. Baroreflex sensitivity was assessed by heart rate response to changes in arterial pressure. Cardiovascular autonomic modulation was evaluated by spectral analysis. Results: Combined training was the only training regime that increased baroreflex sensitivity for tachycardic response and reduced all systolic blood pressure variability parameters. Furthermore, all animals submitted to exercise training on a treadmill (OvxAT and OvxCT) presented lower systolic, diastolic, and mean pressure, as well as improvements in the autonomic modulation for the heart. Conclusion: Combined training showed to be more effective than isolated aerobic and resistance training, mixing the isolated benefits of each modality. It was the only modality able to increase baroreflex sensitivity to tachycardic responses, reduce arterial pressure and all parameters of vascular sympathetic modulation.

A comparison of the effects of remote coaching HIIT training and combined exercise training on the physical and mental health of university students.

Aim: To compare the differences in the effects of based on remote coached high intensity interval training and combined exercise training on the physical and mental health of university students. Method: Sixty university students were recruited from Shandong Normal University and randomly divided into HIIT group (n = 30) and AR group (n = 30), with the HIIT group using high-intensity interval training intervention and the AR group using combined exercise (aerobic combined with resistance) training intervention for 8 weeks. Mental health indicators, fitness indicators and body composition indicators were measured at the beginning and end of the intervention. Results: After 8 weeks, among the mental health indicators, the results of the Symptom Self-Rating Scale (SCL-90) test showed a significant improvement in the HIIT group in terms of total score, somatization, obsessive-compulsive, interpersonal sensitivity, depression, hostility, and psychoticism (p < 0.05); the AR group showed significant improvements in psychoticism (P < 0.05). There were no significant differences between the two groups. The results of the Pittsburgh Sleep Quality Index scale (PSQI) showed a significant difference in sleep efficiency in the HIIT group with an inverse improvement in scores; the AR group showed no significant improvement in each test item. The results of the between-group covariance showed significant differences in sleep efficiency and hypnotic drugs in the HIIT group (p < 0.05). Among the fitness indicators, the HIIT group showed significant improvements in maximum oxygen uptake, grip strength and flexibility (P < 0.05); the AR group showed significant improvements in back muscle strength and flexibility (P < 0.05). The results of the between-group covariance showed significant improvements in maximum oxygen uptake in the HIIT group (P < 0.01). Regarding body composition indicators, there was a significant improvement in Body weight, BMI, Body fat percentage and Waist-to-hip ratio in both the HIIT and AR groups (P < 0.01). There were no significant differences between the two groups. Conclusion: HIIT and combined exercise training based on remote coaching had some improvement on fitness level and body composition of university students, HIIT was more advantageous in improving aerobic endurance, and HIIT based on remote coaching may have better effect than combined exercise in mental health. Trial registration: Chinese Clinical Trial Register, ChiECRCT20220149. Registered on 16 May 2022.

Analysing the Effects of Different Types of Exercise on Dyspnoea and Fatigue in Adults through COPD-Systematic Review and Meta-Analysis of Randomised Clinical Trials.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition, the main symptoms of which are dyspnoea and fatigue. Though exercise has been recommended for subjects with COPD, its benefits remain unclear. The aim of this study was to summarise, through a systematic review and meta-analysis, the available evidence on the effects of aerobic, resistance, stretching, and combined exercise on the main symptoms of COPD. METHODS: Search was performed using the electronic databases PubMed and Web of Science. Randomised controlled trials (RCTs) with interventions based on aerobic, resistance and/or combined exercise published until July 2022 were identified. The effects were summarised based on standardised mean differences (95% confidence intervals) using random and fixed effect models. RESULTS: Eight studies were selected, including a total of 375 subjects. The results obtained showed that resistance exercise, aerobic exercise and combined exercise seem to improve dyspnoea and fatigue symptoms in COPD subjects. CONCLUSIONS: In general, we can conclude that exercise-based interventions appear to improve the main COPD symptoms and may benefit quality of life in this population.

Effect of Different Intensities of Aerobic Exercise Combined with Resistance Exercise on Body Fat, Lipid Profiles, and Adipokines in Middle-Aged Women with Obesity.

We aimed to investigate the effect of different intensities of aerobic exercise (VO2max: 50% vs. 80%) on body weight, body fat percentage, lipid profiles, and adipokines in obese middle-aged women after 8 weeks of combined aerobic and resistance exercise. The participants included 16 women aged >40 years with a body fat percentage of ≥30%; they were randomly assigned to the resistance and either moderate (RME, 50% VO2max, 200 kcal [n = 8]) or vigorous aerobic exercise groups (RVE, 80% VO2max, 200 kcal [n = 8]), respectively. After 8 weeks of exercise, we observed that body weight and body fat percentage decreased significantly in both groups (p < 0.01). The total cholesterol (p < 0.01) and LDL (p < 0.05) levels decreased significantly in the RME group, while triglyceride levels decreased significantly in both groups (p < 0.01). The HDL levels tended to increase only slightly in both groups. The adiponectin levels decreased significantly in the RVE group (p < 0.05), and the leptin levels decreased significantly in both groups (p < 0.05). To prevent and treat obesity in middle-aged women, combined exercise (aerobic and resistance) is deemed effective; additionally, aerobic exercise of moderate intensity during combined exercise could be more effective than that of vigorous intensity.

Effect of Combining Impact-Aerobic and Strength Exercise, and Dietary Habits on Body Composition in Breast Cancer Survivors Treated with Aromatase Inhibitors.

This study examines both the effect of a twice-weekly combined exercise-1 h session of strength and 1 h session of impact-aerobic-on body composition and dietary habits after one year of treatment with aromatase inhibitors (AI) in breast cancer survivors. Overall, forty-three postmenopausal women with a BMI ≤ 35 kg/m2, breast cancer survivors treated with AI, were randomized into two groups: a control group (CG) (n = 22) and a training group (IG) (n = 21). Body composition, i.e., abdominal, visceral, and subcutaneous adipose tissue) was measured by magnetic resonance. In addition, some questionnaires were used to gather dietary data and to measure adherence to the Mediterranean diet. After one year, women in the IG showed a significant improvement in body composition, indicated by decreases in subcutaneous and visceral adipose tissue, and total fat tissue. Furthermore, the dietary habits were compatible with moderate adherence to the Mediterranean diet pattern and a low dietary intake of Ca, Zn, Folic Ac, and vitamins D, A, and E. A twice-weekly training program combining impact aerobic exercise and resistance exercise may be effective in improving the body composition for postmenopausal women who have breast cancer treated with AI, and the results suggest the need for nutritional counselling for this population.

Advances in Exercise Therapy in Hemodialysis: A Systematic Review.

BACKGROUND: The main and common treatment of renal replacement therapy (RRT) for chronic kidney disease (CKD), especially in end-stage kidney disease (ESKD) patients, is hemodialysis (HD). Many reports have shown that exercise therapy is good for HD patients. This review aims to describe recent advances in exercise therapy in HD patients. OBJECTIVE: Our key opinions have focused on varied types of exercise therapy and identified barriers to exercise therapy among HD patients. Exercise implementation includes aerobic exercise training, resistance exercise training, combined exercise training, and novel exercise interventions. Barriers include internal and external distress, such as HD patients' restrictions and environmental problems. METHODS: This review is based on the novel/ most findings in PubMed, Web of Science, Google Scholar, and MEDLINE from the inception of every database until August 2022. RESULTS: The systematic search strategy identified 6 articles that met the inclusion criteria. Four were specific to exercise therapy in HD, and three were to exercise barriers in HD. Massive evidence has demonstrated exercise therapy for HD has specific benefits and neglectful causes of exercise barriers. CONCLUSION: In this review, we aimed to summarize recent advances in individual exercise therapy recommendations (type, intensity, time, and frequency) and exercise barriers in HD patients. In conclusion, Low/moderate-intensity exercise trained for at least thirty minutes five times per week, including aerobic exercise (Walking, Jogging, Swimming, and Health Exercises), resistance training (Dumbbells, Band training, and Knee extension), and combination exercise (both) during the first 2 hours of dialysis treatment or non-dialysis days is advisable treatment recommendation.

Influence of eight weeks of combined training on adipsin and lipoprotein profile and possible relations with depression, anxiety and stress in women with multiple sclerosis.

OBJECTIVES: Immobility and its physiological and psychological consequences are common problems in patients with multiple sclerosis. The aim of this study was to investigate the effect of 8 weeks of combined training on Adipsin and lipid profile and the possible relationship between these indicators and psychological function in women with multiple sclerosis. METHODS: In this quasi-experimental study, 40 women with multiple sclerosis were selected by purposeful sampling method and randomly divided into two equal control and exercise groups (n=20). Exercise was performed for 8 weeks (two resistance sessions and one endurance session per week). Before and after the intervention, blood samples were taken and the DASS-21 questionnaire was completed to assess anxiety, depression and stress. Data were analyzed using analysis of covariance, t-test, Bonferroni post hoc test and Pearson correlation test at a significance level of p≤0.05. RESULTS: In the exercise group, levels of Adipsin, total cholesterol, LDL, TG, weight, fat percentage, WHR, BMI, depression, anxiety and stress were significantly reduced and HDL levels were significantly increased after 8 weeks of combined exercise (p≤0.05). Also, BMI (p=0.01), fat percentage (p=0.01) and WHR (p=0.01) levels had significant positive correlation with Adipsin. There was a significant positive relationship between Total cholesterol level with depression index (p=0.04). CONCLUSIONS: Performing combination exercises through improving body composition can increase the risk of obesity and cardiovascular risk factors and improve the psychological function of patients with multiple sclerosis. Specialists can use these exercises as an adjunct to drug therapy for MS patients.

Combined physical exercise reverses the reduced expression of Bmal1 in the liver of aged mice.

Aging can modify the morphology and function of the liver, such as generating a decrease in the mitochondria content, autophagy, and cell senescence. Although exercise training has several beneficial effects on hepatic metabolism, its actions on autophagy processes, mitochondrial function, and cellular senescence need to be more widely explored. The present study verified the effects of aging and exercise on hepatic circadian markers, autophagy, and mitochondria activity in 24-month-old mice with a combined exercise training protocol. In addition, we used public datasets from human livers in several conditions and BMAL1 knockout mice. C57BL/6 mice were distributed into Control (CT, young, 6-month-old mice), sedentary old (Old Sed, sedentary, 24-month-old mice), and exercised old (Old Ex, 24-month-old mice submitted to a combined exercise training protocol). The exercise training protocol consisted of three days of endurance exercise - treadmill running, and two days of resistance exercise - climbing a ladder, for three weeks. At the end of the protocol, the liver was removed and prepared for histological analysis, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), immunoblotting technique, and oxygen consumption. Heatmaps were built using a human dataset and Bmal1 knockout samples. In summary, the Old Sed had reduced strength, coordination, and balance, as well as a decrease in Bmal1 expression and the presence of degenerated liver cells. Still, this group upregulated the transcription factors related to mitochondrial biogenesis. The Old Ex group had increased strength, coordination, and balance, improved glucose sensitivity, as well as restored Bmal1 expression and the mitochondrial transcription factors. The human datasets indicated that mitochondrial markers and autophagy strongly correlate with specific liver diseases but not aging. We can speculate that mitochondrial and autophagy molecular markers alterations may depend on long-term training.

Arterial Stiffness Response to Acute Combined Training with Different Volumes in Coronary Artery Disease and Heart Failure Patients.

Resistance training has been shown to acutely increase arterial stiffness (AS), while endurance training appears to decrease AS. However, the findings are from studies in apparently healthy subjects and have limited applicability to patients at low and high cardiovascular risk, for whom combined exercise is recommended. We compared the time course of changes in local and regional indices of AS in response to high-volume combined endurance training (CET) and high-volume combined resistance training (CRT) in patients with coronary artery disease (CAD) and heart failure (HF). We studied 20 men with CAD and HF (10 each) aged 68.3 ± 9.6 years. AS was measured by pulse wave velocity (PWV), and brachial and central blood pressure (BP) were determined after 15 min of rest and 5 and 15 min after the exercise session. All patients completed two sessions on nonconsecutive days. A protocol by time interaction effect was observed for carotid (η2 = 0.21, p = 0.02), aortic (η2 = 0.60, p < 0.001), and femoral (η2 = 0.46, p = 0.01) PWV after CET and CRT, suggesting that PWV decreased after CET and increased after CRT. Decreases in the brachial and central variables of BP across time points were observed in both protocols. CET decreased whereas CRT increased carotid, aortic, and femoral PWV at 15 min after exercise in patients with CAD and HF.

On the superiority of a combination of aerobic and resistance exercise for fibromyalgia syndrome: A network meta-analysis.

Background: Fibromyalgia syndrome is the second most common chronic diffuse pain disorder and can have a lasting negative impact on the quality of life, pain, and physical function of people. Exercise therapy is an important component of the treatment of fibromyalgia, but there was not a consensus understanding of the effect of various exercise programs on the quality of life, pain, and physical function of people with fibromyalgia syndrome. This study aimed to compare three exercise programs (aerobic exercise, resistance exercise, and a combination of aerobic and resistance exercise) in their effectiveness in improving quality of life, relieving muscle pain, and enhancing physical function in patients with fibromyalgia. Methods: A comprehensive search of databases, including China National Knowledge Internet, Wan fang, The Cochrane Library, PubMed, EMBASE, and Web of Science, was conducted to identify randomized controlled trials on exercise therapy for patients with fibromyalgia syndrome with outcome indicators including at least one of Fibromyalgia Impact Questionnaire (FIQ), Tender point count (TPC), and 6-minute walk test (6MWT) from the date of database creation on 20 April 2022. The included studies were evaluated for literature quality according to Cochrane Handbook criteria, and a network meta-analysis was performed using STATA 14.0. Result: Forty-five randomized controlled trials met all inclusion criteria and were analyzed. The network meta-analysis showed that a combination of aerobic and resistance exercise was ranked first in all three dimensions of quality of life improvement, pain alleviation, and physical function enhancement (Mean Rank = 1.6, 1.2, 5.9). Conclusion: The current meta-analysis demonstrates that the combination of aerobic and resistance exercise may be the best type of exercise to accentuate the quality of life, pain alleviation, and physical function for people with fibromyalgia syndrome.

Regular combined training and vitamins modulated the apoptosis process in diabetic rats: Bioinformatics analysis of heart failure's differential genes expression network correlated with anti-apoptotic process.

The apoptosis process could impose significantly by hyperglycemia. According to in silico language processing and high throughput raw data analysis, we recognized hub molecular mechanisms involved in the pathogenesis of diabetic hearts and suggested a new pharmaceutical approach for declining myocardial programed cell death. Fifty male Sprague-Dawley rats were classified into five groups: healthy rats as control, diabetic rats, diabetic combined resistance/endurance training, diabetic rats which consumed supplementation vitamins E and C, and the combined supplementation and training. Here, we calculated changes in gene expression based on artificial intelligence methods and evaluated gene expression in apoptotic influencing combined training and antioxidants vitamins consumption in heart injured models by streptozotocin via Real-Time PCR. Moreover, we assessed the binding affinity of the 3D structure of small molecules on macromolecule SIRT3 to a new compound pharmaceutical suggesting the decline in cell death program. The computational intelligence surveys revealed that the apoptosis process was a remarkable pathomechanism in the abnormality function of heart tissue in diabetic conditions. Furthermore, we showed that synchronizing antioxidant vitamin consumption and regular combined training could significantly decrease irreversible myocardial cell death in diabetic myocardiopathy. Hence, levels of antiapoptotic mRNA were modified in the combined training/vitamin consumption group compared with other classifications. We found that regular combined exercise and vitamin consumption could reverse the apoptosis process to enhance the survival of cardiac muscle cells in diabetes conditions. PRACTICAL APPLICATIONS: Machine learning and system biology indicated that the apoptosis process is a vital pathomechanism of hyperglycemia-induced heart failure. Sirt3/Fas/Bcl-2/Cycs and Bax, as a critical network of apoptosis, play an essential role in heart failure induced by hyperglycemia. Moreover, Type 2 diabetes and obesity increase the risk of heart failure by increasing high blood sugar levels. We calculated the binding power of the vitamins E and C on SIRT3 protein based on the drug software. In addition, this study assessed that regular combined training and vitamin consumption had an antiapoptotic effect. Also, our data might improve the hyperglycemia state.

The Effect of Low Glycemic Index Mediterranean Diet and Combined Exercise Program on Metabolic-Associated Fatty Liver Disease: A Joint Modeling Approach.

BACKGROUND: Excessive caloric intake and reduced energy expenditure are associated with the onset of metabolic-associated fatty liver disease (MAFLD). The aim of this study was to probe the benefits of a low glycemic index Mediterranean diet (LGIMD) and a combined exercise program (CEP) on MAFLD by monitoring the clinical process through anthropometric measurement, body mass index (BMI), and specific biomarkers, such as the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). METHODS: The study was conducted at the National Institute of Gastroenterology, 'S. de Bellis', Italy. Subjects were invited to join the study for 12 months. RESULTS: 54 participants were enrolled. Joint modeling of longitudinal and time-to-event data was applied. Overall, a statistically significant direct effect of LGIMD/CEP adherence on ln (BMI), a statistically significant direct effect of LGIMD/CEP adherence on time-to-event and a strong statistically significant direct effect of log (BMI) on time-to-event were observed. In addition, a statistically significant direct effect of LGIMD/CEP adherence on ln(HOMA-IR), a statistically significant direct effect of LGIMD/CEP adherence on time-to-event and a statistically significant direct effect of ln(HOMA-IR) on time-to-event were observed. CONCLUSIONS: LGIMD/CEP significantly improved MAFLD status; in addition, longitudinal BMI and HOMA-IR were good predictors of the disappearance of diagnostic criteria for MAFLD.

Effect of combined aerobic and resistance exercise on serum Klotho secretion in healthy young men -a pilot study.

The impact of combined aerobic and resistance exercise on Klotho (KL) secretion is unclear. Twelve healthy young men completed two randomized experimental trials: 1) resistance exercise (RE) and 2) resistance exercise with prior aerobic exercise (AE + RE). Following baseline blood pressure assessment and blood collection, the subjects in the RE trial maintained a supine position for 45 min, while the subjects in the AE + RE trial performed 45 min of aerobic exercise. After 45 min of resting or aerobic exercise, all subjects performed resistance exercise. Following resistance exercise, the subjects rested in a supine position for 60 min. Blood pressure assessment and blood collection were repeated. Aerobic and resistance exercise significantly increased serum KL concentrations, respectively (P < 0.05), and no additive effect of aerobic exercise on KL secretion was observed immediately after resistance exercise in the AE + RE trial compared with the RE trial. However, serum KL levels at 30 and 60 min after resistance exercise were significantly higher in the AE + RE trial than in the RE trial. Serum ET-1 concentrations were significantly increased only in the RE trial. In conclusion, combined aerobic and resistance exercise could maintain higher levels of serum KL secretion after exercise compared with resistance exercise only.

Effects of Cycling Intensity on Acute Signaling Adaptations to 8-weeks Concurrent Training in Trained Cyclists.

This study examined whether the intensity of endurance stimuli modifies the adaptation in strength and endurance following concurrent training and whether the acute molecular response to concurrent exercise is affected by training status. Using a parallel group design, trained cyclists were randomized to either resistance exercise followed by moderate intensity continuous training (RES + MICT, n = 6), or resistance exercise followed by work matched high intensity interval training (RES + HIIT, n = 7), across an 8 weeks training programme. A single RES + MICT or RES + HIIT exercise stimulus was completed 1 week before and within 5 days of completing the training programme, to assess phosphorylation of protein kinases of the mTOR and AMPK signaling pathways. There were no main effects of time or group on the phosphorylation of protein kinases in response to concurrent exercise stimulus pre- and post-training intervention (p > 0.05). Main effects of time were observed for all maximal strength exercises; back-squat, split-squat, and calf-raise (p < 0.001), with all improving post intervention. A time × group interaction was present for V̇O2peak, with the RES + MICT group displaying a preferential response to that of the RES + HIIT group (p = 0.010). No time nor group effects were observed for 5 min time trial performance, power at 2 and 4 mmol L-1 (p > 0.05). Whilst preliminary data due to limited sample size the intensity of endurance activity had no effect on performance outcomes, following concurrent training. Further, the acute molecular response to a concurrent exercise stimulus was comparable before and after the training intervention, suggesting that training status had no effect on the molecular responses assessed.

Eight weeks of combined exercise training do not alter circulating microRNAs-29a, -133a, -133b, and -155 in young, healthy men.

PURPOSE: Individuals with a family history of type 2 diabetes (FH +) have an increased risk of developing type 2 diabetes. Circulating microRNAs (miRNAs) have been implicated as biomarkers of type 2 diabetes risk. Here, we investigated if four circulating miRNAs related to glucose metabolism were altered in men with a FH + and we conducted a preliminary analysis to determine if miRNA expressions were responsive to 8 weeks of combined exercise training. METHODS: Sixteen young healthy men (mean ± SD; age 22.5 ± 2.5; BMI 26.4 ± 4.0) with FH + or without a family history of type 2 diabetes (FH -) underweight 8 weeks of combined endurance and resistance exercise training (n = 8 FH -; n = 8 FH +). The expression of miR-29a, miR-133a, miR-133b, and miR-155 were measured in serum before and after exercise training. QIAGEN's Ingenuity® Pathway Analysis was used to examine miRNA target genes and their involvement in glucose metabolism signaling pathways. RESULTS: There were no differences in miRNA expressions between FH - and FH + . Exercise training did not alter miRNA expressions in either FH - or FH + despite improvements in insulin sensitivity, aerobic capacity, and muscular strength. miR-29a and miR-155 were inversely related to fasting glucose, and miR-133a and miR-133b were negatively correlated with glucose tolerance; however, correlations were not observed with insulin sensitivity. CONCLUSIONS: The circulating miRNAs- miR-29a, miR-133a, miR-133b, and miR-155 are related to measures of glucose metabolism in healthy, normoglycemic men, but do not reflect peripheral insulin sensitivity or improvements in metabolic health following 8 weeks of combined exercise training.