The Role of Exercise in Reducing Hyperlipidemia-Induced Neuronal Damage in Apolipoprotein E-Deficient Mice.

Hyperlipidemia causes nervous system-related diseases. Exercise training has developed into an established evidence-based treatment strategy that is beneficial for neuronal injury. This study investigated the effect of exercise on hyperlipidemia-induced neuronal injury in apolipoprotein E-deficient (ApoE-/-) mice. Male ApoE-/- mice (age: 8 weeks) were randomly divided into four groups as follows: mice fed a normal diet (ND), normal diet+swimming training (ND+S), high-fat diet (HD), and high-fat diet+swimming (HD+S). Exercise training consisted of swimming for 40 min/day, 5 days/week for 12 weeks. After 12 weeks, we measured serum levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-c). We also evaluated glial fibrillary acidic protein (GFAP) expression levels using immunohistochemistry, real-time PCR, and immunoblotting. In addition, NLR family pyrin domain-containing 3 (NLRP3), interleukin- (IL-) 18, caspase-1, Bax, Bcl-2, and phosphorylated extracellular signal-regulated kinase (p-ERK) expression levels were measured using immunoblotting. Serum levels of TG, TC, and LDL-c were lower in ApoE-/- HD+S mice than in ApoE-/- HD mice. Immunohistochemistry, real-time PCR, and immunoblotting showed increased levels of GFAP in the ApoE-/- HD group. Immunoblotting revealed increased levels of NLRP3, IL-18, caspase-1, Bax, Bcl-2, and p-ERK in the ApoE-/- HD group; however, they were significantly suppressed in the ApoE-/- HD+S group. Therefore, exercise has protective effects against neuronal injury caused by hyperlipidemia.

Resistance exercise at variable volume does not reduce postprandial lipemia in postmenopausal women.

The aim of this study was to investigate the acute effects of resistance exercise sessions (RESs) performed at different levels of high-volume resistance exercise (HVRE) and low-volume resistance exercise (LVRE) on postprandial lipemia (PPL) in postmenopausal women. Thirty-nine healthy unconditioned postmenopausal women (59.5 ± 4.8 years of age, body mass 69.6 ± 9.1 kg, height 157.9 ± 7.2 cm, BMI 27.6 ± 4.1 kg m(-2), waist circumference 76.1 ± 9.7 cm, VO2max 18.7 ± 1.4 mL kg(-1) min(-1)) were assigned to a LVRE (n = 12), HVRE (n = 14), and control group (CG, n = 13). Experimental groups performed one RES involving eight exercises. The HVRE group performed three sets with a maximum of 15 repetitions, and the LVRE group performed one set with a maximum of 15 repetitions. Approximately 16 h after a RES, all of the groups were given an oral fat tolerance test (OFTT). During the RES, we evaluated the energy expenditure (EE) of the resistance session and excess postexercise oxygen consumption (EPOC); following the RES and the OFTT, we evaluated lipid profiles (total cholesterol, HDL, LDL, and triglycerides). While the study groups did not demonstrate significant differences in lipid profiles, the total energy expenditure (EE + EPOC) of the session exercise treatments was significantly higher for HVRE than for LVRE (0.60 ± 0.12 and 0.31 ± 0.11 MJ, respectively, p < 0.001). Different levels of resistance exercise do not lower basal triglyceride concentration and postprandial lipid profile parameters at approximately 16 h following resistance exercise in untrained postmenopausal women.

The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites.

PURPOSE: The purpose of this study is to test the efficacy and effectiveness of an intensive cardiac rehabilitation program in improving health outcomes in multiple sites. METHODS: This study employs a nonexperimental (prospective time series) design to investigate changes in cardiovascular disease in 2974 men and women from 24 socioeconomically diverse sites who participated in an intensive cardiac rehabilitation program at baseline, 12 weeks, and 1 year. Paired t-tests were used to assess differences by comparing baseline values to those after 12 weeks, baseline values to those after 1 year, and values after 12 weeks to those after 1 year. RESULTS: Eighty-eight percent of patients remained enrolled in the program after 12 weeks, and 78.1% remained enrolled in the program after 1 year. Patients showed statistically significant improvements after 12 weeks in body mass index (BMI), triglycerides, low density lipoprotein cholesterol, total cholesterol, hemoglobin A1c, systolic blood pressure, diastolic blood pressure, depression, hostility, exercise, and functional capacity. These differences also remained significant after 1 year. There was additional significant improvement between 12 weeks and 1 year only in BMI, high density lipoprotein cholesterol, functional capacity, and hostility, and significant recidivism between 12 weeks and 1 year in all other measures (except triglycerides) and depression, yet improvements from baseline to 1 year remained significant in all measures (except HDL, which was unchanged) (p < .005). CONCLUSIONS: This intensive cardiac rehabilitation program was feasible and sustainable for most patients who enrolled and was associated with numerous subjective and objective improvements in health outcomes. It demonstrates that the intervention works when it is administered by staff at multiple clinical/commmunity sites in four different states. These improvements were also seen in patients 65 years of age or older.

Nutrition evidence-based guidelines for treating hyperlipidemia in children with type 1 diabetes: a case presentation.

PURPOSE: The purpose of this case presentation is to review the current nutrition evidence-based guidelines and treatment goals for hyperlipidemia in children with type 1 diabetes. The American Heart Association (AHA) places children with type 1 diabetes in the highest tier for cardiovascular risk. METHODS: Early screening for hyperlipidemia in children with diabetes is recommended to identify those children at risk. If the fasting low-density lipoprotein cholesterol (LDL-C) level is > or = 100 mg/dL (2.6 mmol/L), medical nutrition therapy is recommended as the first line of treatment to reach the desired goal (LDL-C <100 mg/dL). Medical nutrition therapy includes the following: decreasing saturated fat (<7% total calories), avoiding trans fatty acids, decreasing total cholesterol to <200 mg daily, increasing soluble fiber, and adding phytosterols daily. RESULTS: The patient discussed in this case presentation achieved a desired LDL-C level <100 mg/dL (2.6 mmol/L) by following the recommended heart-healthy guidelines. Statin therapy was not considered unless the LDL-C goal, <130 mg/dL (3.38 mmol/L), was not achieved by diet alone. CONCLUSIONS: In this case study, evidence-based nutrition guidelines have been evaluated and reviewed to demonstrate heart-healthy eating for children with hyperlipidemia and type 1 diabetes. It is known that approximately 40% to 50% of children with elevated lipids will continue to have abnormal lipids into adolescence and early adulthood. Therefore, early screening is recommended by the AHA to track lipid changes during childhood and adolescence and to begin treating abnormal LDL-C levels to prevent the development of atherosclerosis.

Specific profile and referral bias of rehabilitated patients after an acute coronary syndrome.

PURPOSE: Cardiac rehabilitation after acute coronary syndrome is an important but underused therapeutic intervention. The aim of the French nationwide PREVENIR survey was to improve knowledge on the management of cardiovascular risk factors, especially during cardiac rehabilitation after acute coronary syndrome. The purpose of this study was to specify the characteristics of patients referred to cardiac rehabilitation. METHODS: The survey was performed in 77 of 501 (15.4%) public or private French coronary care units. All French regions were involved. All the patients admitted to the hospital during January 1998 who survived an acute coronary syndrome were included in the survey. Data on rehabilitation practice were collected from patient medical records, either during an outpatient consultation or from the patient and the general practitioner during the 6-month follow-up period. RESULTS: Of the 1394 patients included in the study (779 with myocardial infarction and 615 with unstable angina), only 310 (22%) underwent cardiac rehabilitation. Significant differences in patient characteristics were found between the cardiac rehabilitation and non-cardiac rehabilitation groups, respectively, in terms of gender (82% male vs 68%; P <.001), age younger than 65 years (56% vs 39%; P <.001), type of acute coronary syndrome (75% myocardial infarction vs 50%; P <.001), left ventricular ejection fraction less than 35% (6% vs 13%; P <.0004), and prevalence of percutaneous intervention (54% vs 46%; P <.02). Two risk factors were more common in the rehabilitated group: dyslipidemia (52% vs 44%; P <.02) and current smoking (51% vs 37%; P <.0001). In the multivariate analysis, female gender (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.44-0.87) and older age (>75 years vs. <65 years; OR, 0.40; 95% CI, 0.3-0.7) predicted decreased cardiac rehabilitation prescription. Conversely, previous history of dyslipidemia (OR,1.4; 95% CI, 1.04-1.8), post-myocardial infarction (OR, 2.8; 95% CI, 2.13-3.89), and a percutaneous intervention (OR,1.9; 95% CI, 1.3-2.7) predicted increased cardiac rehabilitation prescription. Severe left ventricular impairment (< or =35% vs >50%) was not an independent factor for cardiac rehabilitation prescription. At 6-month follow-up assessment, rehabilitation patients had a lower rate of hypertension (18% vs 27%), elevated low-density lipoprotein cholesterol (54% vs 62%), and continued smoking (34% vs 50%). CONCLUSIONS: The results of the PREVENIR survey underscore the low level of cardiac rehabilitation prescription in France, and the relative exclusion of women and elderly people. Among the risk factors, dyslipidemia and current smoking are more frequent among rehabilitated patients. These findings may help to modify the strategy for using cardiac rehabilitation after acute coronary syndrome, although it is an effective intervention for secondary prevention.

Exercise in the treatment of lipid disorders.

As a result of scientific evaluation, we know that exercise has a positive impact on the lipid and lipoprotein profile, and we have a greater understanding for the necessary amount of exercise needed to cause these changes. In the case of hyperlipidemic disorders, we know the primary means for intervention is pharmacological, and that diet, weight loss, and exercise are viewed as adjunctive therapies. Because much is known about the exercise training-induced plasma lipid and lipoprotein modifications as well as the lipoprotein enzyme changes, future research should continue to focus on the molecular basis for these changes. For example by knowing a person's apo E genotype, we gain better comprehension as to why some individuals respond to exercise, while others do not. Another area for further investigation is the assessment of drug and exercise interaction. Presently, little is known regarding the use of lipid-lowering drugs and the impact of exercise. Finally, these investigations could provide new insights for better understanding the exercise CAD protective effects. The future challenge is to better understand the impact that regular exercise participation has in optimizing the lipid and lipoprotein profile with individuals with special lipid disorders.

A review of long-term studies evaluating the efficacy of weight loss in ameliorating disorders associated with obesity.

Obesity leads to and exacerbates many serious disorders, including hypertension, dyslipidemia, cardiovascular disease, non-insulin-dependent diabetes mellitus, gallbladder disease, respiratory dysfunction, gout, and osteoarthritis. Many short-term studies have shown that weight loss can ameliorate or, in some cases, reverse such disorders. Fewer long-term studies-defined as those whose combined acute intervention and follow-up phases extend for at least 1 year-of the therapeutic benefits of weight loss on specific disorders have been undertaken. Those long-term studies that have been performed tend to confirm the results of briefer studies. Even when weight loss has been comparatively modest or some degree of weight regain has occurred, weight loss is generally associated with a decrease in risk factors and the alleviation of clinical symptoms.

[Effects of 4-week ergometry training at an intensity of 30% versus 50% of maximum performance in an inpatient setting]. / Effekte eines vierwöchigen Ergometertrainings mit einer Intensität von 30% versus 50% der maximalen Leistungsfähigkeit unter stationären Bedingungen.

We investigated the effects of bicycle ergometer training (BET, weekly training time: 120 min, consisting of 8 units of 15 min). In a centre for cardiovascular rehabilitation two groups of 15 patients with coronary heart disease and/or hypertension and/or hyperlipidaemia underwent a four-weeks training period. All patients avoided other training exercises, they all had the same physiotherapy such a massage and the same diet of 800-1200 kcal/day. Current medication was kept constant. The main differences between the groups was the intensity of the training regimes: 30% versus 50% of the individual maximal physical working capacity (PWC), as determined by symptom-limited bicycle ergometry and controlled by an individual training heart rate. The higher intensity of training led to a highly significant increase of 16% in PWC (p < 0.001), whereas the group with the lower training intensity improved by only 5% (p < 0.05). The main effects on body weight (reduction in both groups of about 6%), fat metabolism (significant reduction in cholesterol and low density lipoprotein (LDL) levels in both groups), heart rate and blood pressure (significant decrease in both groups) showed no significant differences between the two groups. In general it can be assumed that the main effects of the 4-week indoor rehabilitation on fat metabolism and blood pressure are due to the diet and weight loss. The 4-week period of endurance training was obviously too short to produce any additional effects. The more intensive aerobic training, which was more effective on PWC, did not reveal better results on fat metabolism, heart rate or blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term cardiac rehabilitation]. / Rehabilitación cardíaca a largo plazo.

Cardiac rehabilitation for life-time in a patient who has suffered coronary pathology is considered as appropriate. The reasons for such an opinion are given, as well as the two most indicated courses of action, being this rehabilitation at home and coronary clubs.

[Relationship between lipid metabolism disorders and age of first manifestations of coronary heart disease]. / Untersuchungen zur Beziehung zwischen Lipidstoffwechselstörungen und Erstmanifestationsalter der koronaren Herzkrankheit (KHK).

In 509 male patients, age less than 45 years, with angiographically documented coronary artery disease (CHD) we found (in contrast to age-matched controls: 459 participants of the PROCAM study) an increased amount of total cholesterol (259 vs. 221 mg/dl), LDL-cholesterol (185 vs. 142 mg/dl), Apo-B (138 vs. 118 mg/dl), lipoprotein(a) (12 vs. 5 mg/dl) and uric acid (6.4 vs. 5.8 mg/dl); HDL-cholesterol (40.5 vs. 46.8 mg/dl), Apo-A-I (122 vs. 143 mg/dl) and Apo-A-II (38 vs. 43 mg/dl) were significantly lower. These differences in lipid-metabolism between CHD-patients and controls in the younger group were essentially more pronounced than in older individuals of a group of 423 male patients over the age of 45 years who suffered from CHD and 545 age-matched PRO-CAM participants. Among the extent of the disorder in lipid metabolism, the apolipoprotein E-polymorphism, and the age of onset of CHD there exists a significant correlation which proves the special importance to therapeutically influence disorders of lipid metabolism especially in younger patients.

[Changes in uric acid and blood lipids in patients with asymptomatic hyperuricemia treated with diet therapy in a rehabilitation procedure]. / Veränderungen der Harnsäure und der Blutfette bei Patienten mit asymptomatischer Hyperurikämie unter diätetischer Therapie während eines Rehabilitationsverfahrens.

More than 300 patients with asymptomatic hyperuricaemia had been included in lipometabolic analysis performed before and after 4 weeks of a special low-cholesterol, low-triglyceride and low-purine dietetic regimen. Remarkable in almost the entire hyperuricaemic population (96.7%) had been the presence of serum cholesterol levels of more than 200 mg/dl. Lipoprotein analysis showed that 87% of the patients had increased LDL- and 69% increased VLDL-levels; HDL-levels were pathologically lowered to below 40mg/dl in 41% of the group. After a four-week rehabilitation programme, all lipometabolic parameters and serum urate concentrations were found to have been significantly reduced by the special diet. The results therefore are impressive proof of the major health benefits of purposive nutritional behaviour.