Additional cardiovascular fitness when progressing from moderate- to high-intensity exercise training in previously trained breast cancer survivors.

PURPOSE: Cardiovascular disease, often secondary to chemotherapy, is the leading cause of death in BC survivors. Increased aerobic capacity improves post-rehabilitation survival; however, many cancer rehabilitation programs are limited to lower intensity training. High-intensity interval training (HIIT) is associated with the largest improvements in aerobic capacity; therefore, this study aimed to determine whether HIIT would cause a greater increase in VO2peak than continuous moderate-intensity (MICT) exercise in previously trained BC survivors. METHODS: Twenty BC survivors who had completed a low/moderate-intensity exercise rehabilitation program performed a VO2peak test and received a dual-energy X-ray absorptiometry (DXA) scan at baseline and after randomization into a 12-week HIIT or MICT program. ANOVA with repeated measures determined the effects of the different training programs on aerobic capacity and body composition. RESULTS: Both groups began the training program near or above age- and sex-matched VO2peak norms. Pre- to post-intervention improvements in VO2peak (P = 0.006) and waist circumference (P = 0.007) were found in both groups; however, there were no between-group differences. Minute ventilation and peak workload increased in the HIIT group (P < 0.05) but not the MICT group. Body composition was not different after either training program. CONCLUSIONS: These data suggest that transitioning from low/moderate-intensity exercise to moderate/high-intensity exercise causes further clinically relevant increases in VO2peak in previously trained BC survivors. HIIT did not cause a significantly greater improvement in VO2peak than MICT; however, future studies with greater intensity and frequency of training are encouraged.

Cancer survivors' experiences of an exercise program during treatment and while employed: A qualitative pilot study.

ISSUE ADDRESSED: This study examined breast cancer survivors' (BCS) views on the role of exercise therapy while they were working in employment during cancer treatment. METHODS: Research was undertaken with five participants who undertook an exercise programme as adjuvant care during treatment for breast cancer. Four female and one male client, the only clients who met the criteria for study in the clinic, were interviewed twice each during a two-month period. Participants wrote diaries to supplement the interview data and provide prompts for the second interview. An interpretive paradigm was used to identify themes for analysis. A multiple coding approach was used to interpret the data. The study was conducted at a small breast cancer recovery clinic, situated at a university in the South Island of New Zealand. RESULTS: Participants reported that exercise was essential to their ability to work through the active treatment phase and provided positive effects on social, mental and emotional well-being. CONCLUSIONS: Exercise therapy is an important element of enabling to work during treatment, for physical, mental and social well-being. SO WHAT?: Future research is required on support for employers to enable exercise therapy for employees; the needs of self-employed patients; tailoring exercise therapy for patients for whom social support is not a primary motivation; and the place of a clinic as a 'middle-ground' between social and emotional support and an exercise clinic.

Circuit resistance training and cardiovascular health in breast cancer survivors.

OBJECTIVE: Cardiovascular disease is the leading cause of death in breast cancer survivors. While evidence shows circuit resistance training (CRT) is effective for improving muscle and cardiorespiratory fitness, whether CRT is an efficacious therapy for decreasing cardiovascular risk in cancer survivors is unclear. METHODS: Fifty-one breast cancer survivors were recruited to either 12 weeks CRT (n = 26), or a non-exercising wait-list control (n = 25). Two supervised 60 min CRT sessions per week were undertaken, comprising resistance and functional exercises, and aerobic exercise stations. Primary outcome measure was the gold-standard assessment of arterial stiffness, aortic pulse wave velocity (PWV). Secondary outcomes included: cardiorespiratory fitness (CRF), upper and lower body strength, arterial wave reflections, central blood pressure and rate pressure product. RESULTS: Compared to the control group, the CRT group had a statistically significant medium effect decrease in PWV 0.9 m/s (95% CI: 0.1, 1.7). There were large effect improvements in VO2 max (4.3 ml kg-1  min-1 , 95% CI: 5.8, 2.8), upper and lower body strength (3.7 kg, 95% CI: 1.9, 5.6 and 10.4 kg, 1.6, 19.1) respectively. CONCLUSION: Findings support the existing literature demonstrating that 12 weeks CRT improves muscle and cardiorespiratory fitness and is also an effective strategy for decreasing a proven cardiovascular risk factor in breast cancer survivors.

Cardiovascular disease among breast cancer survivors: the call for a clinical vascular health toolbox.

With better detection and treatment, breast cancer is less likely to be the primary cause of death in the majority of breast cancer survivors; mortality due to cardiovascular disease (CVD) is now more common. Given the long latency periods between cancer treatment completion and potential symptomatic CVD, there is a need to detect vascular changes before symptoms appear. This short review provides an overview of non-invasive, widely available, and relatively inexpensive techniques for assessing endothelial function, central and regional arterial stiffness, central blood pressures, and intima-media thickness. These tools exhibit acceptable reliability and validity, and are relatively practical. Clinical assessment recommendations are also provided. There is sufficient evidence to encourage the use of these techniques as a component of routine serial assessments, and to help guide appropriate treatment strategies.

High-intensity interval aerobic and resistance training to counteract low relative lean soft tissue mass in middle age: A randomized controlled trial.

BACKGROUND: Age-related loss of skeletal muscle mass and function begins in early middle age, yet research to date has focused on older individuals, limiting our understanding of interventions earlier in the lifespan. To date, no high-intensity interval training studies have been conducted in middle-aged adults with low relative lean soft tissue mass. METHODS: Eighty-two middle-aged adults (40-50 years of age) with low appendicular lean soft tissue mass index confirmed with dual energy x-ray absorptiometry (DXA) were randomly allocated (1:1) to group-based, 20-week, three times a week, high-intensity aerobic and resistance training (HIART) program or 60-min education session (Control). The primary outcome was change in total lean soft tissue mass measured by DXA. Secondary outcomes included cardiorespiratory fitness, physical function (handgrip strength, gait speed, 30-seconds sit-to-stand, quadriceps strength and muscle quality). Measures were obtained at baseline (0 weeks), mid-intervention (10 weeks) and post-intervention (20 weeks). RESULTS: Mean age in HIART was 44.8 (SD 3.2) and 45.4 (SD 2.9) in Control group. The majority of the participants were female with 88 % in HIART and 83 % in Control group. Mean BMI in HIART was 25.8 kg/m2 (SD 3.5) and 26.4 kg/m2 (SD 4.1) Control group. Intention to treat analysis showed that post-intervention, HIART increased significantly more total lean soft tissue mass (0.8 kg, 95%CI 0.15, 1.46), appendicular lean soft tissue mass index (0.2 kg/m2, 95%CI 0.09, 0.33), peak oxygen uptake (5.18 mL/min/kg, 2.97 to 7.39 95%CI), grip strength (2.2 kg, 95%CI 0.09, 4.32), and 30-s sit-to-stand (1.3 times, 95%CI 0.43, 2.12) with significantly greater reductions in body fat percentage (-1.1 %, 95%CI -2.03, -0.10) and maximum gait speed (-0.2 m/s, 95 % CI -0.34, -0.03) compared Control. CONCLUSION: The HIART program is an effective exercise intervention to increase total lean soft tissue mass in middle-aged adults with low relative lean soft tissue mass compared to a waitlist control group.

Using the Integrative Model of Behavioral Prediction to Understand Female Breast Cancer Survivors' Barriers and Facilitators for Adherence to a Community-Based Group-Exercise Program.

OBJECTIVES: To identify facilitators and barriers associated with adherence to the EXPINKT exercise program for breast cancer survivors in a convenience sample of women. DATA SOURCES: Focus groups discussions; The Integrative Model of Behavioral Prediction. CONCLUSION: Findings suggest that program adherence could be achieved by the establishment, via staff and processes, of a positive and safe exercise environment, which instills a sense of accountability while developing exercise self-efficacy. Further, multiple referral pathways and promotion of exercise benefit during and following treatment by oncology nurses may assist in enrolment in the program. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses may play a unique role in informing and stimulating female breast cancer survivors to partake in breast cancer-specific exercise programs. Results of this study show that most women are unaware of the benefits related to exercising in relation to cancer recovery, as well as the existence of breast cancer-specific exercise programs. Therefore, oncology nurses may play an important role in creating this awareness. Furthermore, shaping a route to adherence to such exercise programs is essential for breast cancer survivors to become and stay sufficiently active.

High-Intensity Interval Aerobic Resistance Training to Counteract Low Relative Appendicular Lean Soft Tissue Mass in Middle Age: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Sarcopenia is the age-related loss of skeletal muscle mass and function and may exist in early middle age. Previous research in this area has focused on resistance training in older individuals; however, there is a lack of intervention trials in middle-aged adults with low relative appendicular lean soft tissue mass who may be at risk for sarcopenia in older age. OBJECTIVE: This randomized controlled trial aims to determine the effects of a high-intensity interval aerobic resistance training intervention on appendicular lean soft tissue mass in middle-aged adults with low relative appendicular lean soft tissue mass. METHODS: We will conduct a 40-week, single-blinded randomized controlled trial in 84 middle-aged adults with low appendicular lean soft tissue mass in the wider Dunedin area, New Zealand. We will randomly allocate participants to receive either a group-based, 20-week high-intensity interval aerobic resistance training intervention program or a single, 60-minute education session on current exercise recommendations. After the first 20 weeks, both groups will be given a 20-week home program. The study will assess primary and secondary outcome measures, including body composition (regional and whole-body lean soft tissue mass, fat mass, percentage body fat, measured by dual x-ray absorptiometry), blood biomarkers (cortisol, creatinine, C-reactive protein, lipid profile, hemoglobin), physical fitness (maximum oxygen consumption, blood pressure), physical activity (accelerometry), physical function (handgrip strength, sit-to-stand, gait speed, quadriceps strength), and self-reported questionnaires (health outcomes, self-efficacy, perceived enjoyment of physical activity, and multifactorial lifestyle), at baseline, 20 weeks, and 40 weeks. Physical function and self-reported questionnaires will also be measured at 10 weeks. We will assess the primary outcome measure, total body lean soft tissue mass, at baseline, 20 weeks, and 40 weeks. Analyses will be performed using intention-to-treat principles, comparing the outcomes resulting from the intervention, using linear mixed models. RESULTS: We obtained ethical approval for this study from The University of Otago Human Ethics Committee on December 10, 2018. Participant recruitment started on February 11, 2019 and was completed on May 14, 2019. Data collection started on February 25, 2019 and was completed on February 28, 2020. We expect to publish the results in January 2021. CONCLUSIONS: High-intensity interval aerobic resistance training is a time-efficient form of exercise, enabling busy middle-aged adults to meet physical activity recommendations while maximizing training results. The findings can inform the development of future prevention-focused interventions aimed at counteracting the high prevalence of sarcopenia in the aging population. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12618001778279); https://tinyurl.com/y555z6fz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/22989.

Plasma fatty acids as markers for desaturase and elongase activities in spinal cord injured males.

OBJECTIVE: To investigate the use of surrogate plasma fatty acid analysis to provide further insights into the underlying adiposity and the development of metabolic syndrome in men with spinal cord injury (SCI). DESIGN: Case-control, cross-sectional study. SETTING: Community-based individuals with spinal cord injury and healthy controls. PARTICIPANTS: Twenty men with SCI age, height and weight matched with 20 able-bodied controls. OUTCOME MEASURES: Lean tissue (LTM) and fat mass (FM) were determined using dual energy X-ray absorptiometry. Fasting blood samples were taken for analysis of fatty acids, adiponectin, insulin, glucose and leptin. Enzymatic indices were calculated using relevant fatty acids. RESULTS: Total FM, leptin, stearoyl coenzyme A desaturase (SCD) Δ9 (SCD-16, 16:1/16:0, and SCD-18, 18:1/18:0) indices and Δ6 desaturase index were significantly higher (P < 0.05) in the SCI group than the controls. Significant differences between the groups was observed for several individual fatty acids. Correlational analysis revealed a different pattern between blood biomarkers and indices of SCDs, de novo lipogenesis and elongase. Associations between the desaturase and elongase indices and biomarkers in the controls followed those reported elsewhere for able bodied participants; the same associations were not observed in the SCI group. CONCLUSION: We have identified disturbances in fatty acid biosynthesis in SCI individuals likely associated with the development of adipose tissue below the lesion and a decrease in LTM. Loss of LTM may disturb the normal skeletal muscle-fatty acid metabolic processes leading to the disruption of metabolic homeostasis, previously identified in persons with SCI.

Cardiorespiratory fitness predicts cardiovascular health in breast cancer survivors, independent of body composition, age and time post-treatment completion.

BACKGROUND: Breast cancer treatment may increase non-cancer related mortality risk due to unintended cardiovascular consequences. The aim of this study was to investigate the strongest correlate of cardiovascular health (CVH) in female breast cancer survivors, cardiorespiratory fitness or fatness. METHODS: Fifty-one women (59 ± 9 years, BMI 26.4 ± 4.8 kg/m2) previously diagnosed and treated for primary breast cancer were assessed using pulse wave analysis to determine central arterial wave reflection (augmentation index, AIx) and central systolic blood pressure (cSBP). A composite Z score calculated which incorporated central double product and AIx, as an indicator of CVH. Dual energy X-ray absorptiometry was used to obtain total body fat percentage (BF%). Cardiorespiratory fitness was determined using the single-stage walk test to predict maximal oxygen uptake ([Formula: see text]). RESULTS: Linear regression analysis revealed that fitness was associated with AIx after adjusting for BF %, age and time post-treatment completion (ß = - 0.271, p = 0.010). A significant association between BF% and AIx after adjusting for fitness and age was found (ß = 0.166, p = 0.0005); however, this association was lost when time post-treatment was included in the model (ß = 0.166, p = 0.167). Both fitness (ß = - 0.347, p = 0.0005) and BF% (ß = 0.333, p = 0.013) were independently associated with CVH in the fully adjusted model. CONCLUSIONS: This study provides evidence for an association between cardiorespiratory fitness and cardiovascular health in female breast cancer survivors. While fatness may be associated with cardiovascular health, it appears to be more strongly associated with age.

Maximal physiological responses between aquatic and land exercise in overweight women.

PURPOSE: To investigate the maximal physiological responses between aquatic and land-based graded exercise tests in overweight women. METHODS: Twenty healthy, overweight (body mass index (BMI) > or = 25 kg.m(-2)), Caucasian women (mean +/- SD; age 48 +/- 7 yr, BMI 30 +/- 4 kg.m(-2)) completed a deep water running (DWR) and treadmill walking (TMW) graded exercise test. Maximal responses during the DWR and TMW graded exercise tests were compared using paired t-tests. Comparisons were made in the incidence of achievement of maximal oxygen consumption (VO2max) criteria between DWR and TMW protocols. Criteria were a plateau in VO2 (change < 2.1 mL.kg.min(-1)), heart rate (HR) equal to or above the age-adjusted maximum, and respiratory exchange ratio (RER) > or = 1.15. RESULTS: Maximal responses for VO2max (22.5 +/- 4.86 vs 27.7 +/- 4.73 mL.kg.min(-1)), HRmax (159 +/- 16 vs 170 +/- 12 bpm), and RER (1.03 +/- 0.06 vs 1.10 +/- 0.06) were significantly lower (P < 0.01) for the DWR test compared with the TMW test, respectively. Achievement of various VO2max criteria was demonstrated more consistently during the TMW test than the DWR test. CONCLUSION: Maximal physiological responses of overweight women to DWR and TMW are significantly different but are comparable with other populations. As the maximal responses for DWR compared with TMW differ, the use of land-based criteria for VO2max is not recommended for a graded DWR exercise test.

Physical Activity Promotion, Beliefs, and Barriers Among Australasian Oncology Nurses.

PURPOSE/OBJECTIVES: To describe the physical activity (PA) promotion practices, beliefs, and barriers of Australasian oncology nurses and gain preliminary insight into how PA promotion practices may be affected by the demographics of the nurses.
. DESIGN: Cross-sectional survey.
. SETTING: Australia and New Zealand.
. SAMPLE: 119 registered oncology nurses.
. METHODS: Self-reported online survey completed once per participant.
. MAIN RESEARCH VARIABLES: Questions assessed the PA promotion beliefs (e.g., primary healthcare professionals responsible for PA promotion, treatment stage), PA benefits (e.g., primary benefits, evidence base), and PA promotion barriers of oncology nurses.
. FINDINGS: Oncology nurses believed they were the major providers of PA advice to their patients. They promoted PA prior to, during, and post-treatment. The three most commonly cited benefits of PA for their patients were improved quality of life, mental health, and activities of daily living. Lack of time, lack of adequate support structures, and risk to patient were the most common barriers to PA promotion. Relatively few significant differences in the oncology nurses' PA promotion practices, beliefs, and barriers were observed based on hospital location or years of experience.
. CONCLUSIONS: Despite numerous barriers, Australasian oncology nurses wish to promote PA to their patients with cancer across multiple treatment stages because they believe PA is beneficial for their patients.
. IMPLICATIONS FOR NURSING: Hospitals may need to better support oncology nurses in promoting PA to their patients and provide better referral pathways to exercise physiologists and physiotherapists.

Prediction Equations Overestimate the Energy Requirements More for Obesity-Susceptible Individuals.

Predictive equations to estimate resting metabolic rate (RMR) are often used in dietary counseling and by online apps to set energy intake goals for weight loss. It is critical to know whether such equations are appropriate for those susceptible to obesity. We measured RMR by indirect calorimetry after an overnight fast in 26 obesity susceptible (OSI) and 30 obesity resistant (ORI) individuals, identified using a simple 6-item screening tool. Predicted RMR was calculated using the FAO/WHO/UNU (Food and Agricultural Organisation/World Health Organisation/United Nations University), Oxford and Miflin-St Jeor equations. Absolute measured RMR did not differ significantly between OSI versus ORI (6339 vs. 5893 kJ·d-1, p = 0.313). All three prediction equations over-estimated RMR for both OSI and ORI when measured RMR was ≤5000 kJ·d-1. For measured RMR ≤7000 kJ·d-1 there was statistically significant evidence that the equations overestimate RMR to a greater extent for those classified as obesity susceptible with biases ranging between around 10% to nearly 30% depending on the equation. The use of prediction equations may overestimate RMR and energy requirements particularly in those who self-identify as being susceptible to obesity, which has implications for effective weight management.

Chemotherapy Agents Alter Plasma Lipids in Breast Cancer Patients and Show Differential Effects on Lipid Metabolism Genes in Liver Cells.

Cardiovascular complications have emerged as a major concern for cancer patients. Many chemotherapy agents are cardiotoxic and some appear to also alter lipid profiles, although the mechanism for this is unknown. We studied plasma lipid levels in 12 breast cancer patients throughout their chemotherapy. Patients received either four cycles of doxorubicin and cyclophosphamide followed by weekly paclitaxel or three cycles of epirubicin, cyclophosphamide and 5'-fluorouracil followed by three cycles of docetaxel. Patients demonstrated a significant reduction (0.32 mmol/L) in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (apoA1) levels (0.18 g/L) and an elevation in apolipoprotein B (apoB) levels (0.15 g/L) after treatment. Investigation of the individual chemotherapy agents for their effect on genes involved in lipoprotein metabolism in liver cells showed that doxorubicin decreased ATP binding cassette transporter A1 (ABCA1) via a downregulation of the peroxisomal proliferator activated receptor γ (PPARγ) and liver X receptor α (LXRα) transcription factors. In contrast, ABCA1 levels were not affected by cyclophosphamide or paclitaxel. Likewise, apoA1 levels were reduced by doxorubicin and remained unaffected by cyclophosphamide and paclitaxel. Doxorubicin and paclitaxel both increased apoB protein levels and paclitaxel also decreased low density lipoprotein receptor (LDLR) protein levels. These findings correlate with the observed reduction in HDL-C and apoA1 and increase in apoB levels seen in these patients. The unfavourable lipid profiles produced by some chemotherapy agents may be detrimental in the longer term to cancer patients, especially those already at risk of cardiovascular disease (CVD). This knowledge may be useful in tailoring effective follow-up care plans for cancer survivors.

Current nutrition promotion, beliefs and barriers among cancer nurses in Australia and New Zealand.

Rationale. Many cancer patients and survivors do not meet nutritional and physical activity guidelines, thus healthier eating and greater levels of physical activity could have considerable benefits for these individuals. While research has investigated cancer survivors' perspective on their challenges in meeting the nutrition and physical guidelines, little research has examined how health professionals may assist their patients meet these guidelines. Cancer nurses are ideally placed to promote healthy behaviours to their patients, especially if access to dieticians or dietary resources is limited. However, little is known about cancer nurses' healthy eating promotion practices to their patients. The primary aim of this study was to examine current healthy eating promotion practices, beliefs and barriers of cancer nurses in Australia and New Zealand. A secondary aim was to gain insight into whether these practices, beliefs and barriers were influenced by the nurses' hospital or years of work experience. Patients and Methods. An online questionnaire was used to obtain data. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (<25 or ≥25 years) using ANOVA and chi square analysis for continuous and categorical data respectively. Results. A total of 123 Australasian cancer nurses responded to the survey. Cancer nurses believed they were often the major provider of nutritional advice to their cancer patients (32.5%), a value marginally less than dieticians (35.9%) but substantially higher than oncologists (3.3%). The majority promoted healthy eating prior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses felt that healthy eating had positive effects on the cancer patients' quality of life (85.4%), weight management (82.9%), mental health (80.5%), activities of daily living (79.7%) and risk of other chronic diseases (79.7%), although only 75.5% agreed or strongly agreed that this is due to a strong evidence base. Lack of time (25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited by the cancer nurses as the most common barriers to promoting healthy eating to their patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses' healthy eating promotion practices, beliefs and barriers were largely unaffected by hospital location or years of experience. Conclusion. Australasian cancer nurses have favourable attitudes towards promoting healthy eating to their cancer patients across multiple treatment stages and believe that healthy eating has many benefits for their patients. Unfortunately, several barriers to healthy eating promotion were reported. If these barriers can be overcome, nurses may be able to work more effectively with dieticians to improve the outcomes for cancer patients.

Factor analysis of the metabolic syndrome in spinal cord-injured men.

Disturbances of carbohydrate and lipid metabolism in men with spinal cord injury are common, but poorly defined. Clustering of recognized risk factors for obesity and disorders of carbohydrate and lipid metabolism are characteristic of the metabolic syndrome. The purpose of this study was to investigate the presence of metabolic syndrome using modifications of the World Health Organization (WHO) definition and including total physical activity levels (minutes/week), in a group of active males with spinal cord injury who were carefully matched for age, height, and weight with active able-bodied males. Factor analysis is used widely to explore factors of the metabolic syndrome. This technique was used in this study of 20 spinal cord-injured (SCI) men and 20 able-bodied controls, matched for age, height, and weight. Three-factor models, each reflecting a different aspect of the metabolic syndrome, were identified for both study groups. The average communality score for the SCI group was 0.8 and 0.7 for the control group. For the SCI group, factor 1 reflected an interaction between adiposity measures, physical activity, and postload insulin and glucose, factor 2 was reflective of dyslipidemia, while factor 3 revealed an interaction between fasting levels of insulin and glucose. In the control group, factor 1 reflected an association between the adiposity measures and physical activity, factor 2 was reflective of postload glycemic control, with factor 3 reflecting an interaction between fasting insulin and dyslipidemia. By summation of the total variance of each factor, the 3-factor models explained 80% and 69% of the variance in the original 9 variables examined in the SCI and control groups, respectively. In summary, while the WHO definition for the metabolic syndrome appears suitable for use in identifying the incidence of this syndrome in SCI men, some modification of anthropometric and lipid measures may be required.

Inflammatory biomarkers for predicting cardiovascular disease.

The pathology of cardiovascular disease (CVD) is complex; multiple biological pathways have been implicated, including, but not limited to, inflammation and oxidative stress. Biomarkers of inflammation and oxidative stress may serve to help identify patients at risk for CVD, to monitor the efficacy of treatments, and to develop new pharmacological tools. However, due to the complexities of CVD pathogenesis there is no single biomarker available to estimate absolute risk of future cardiovascular events. Furthermore, not all biomarkers are equal; the functions of many biomarkers overlap, some offer better prognostic information than others, and some are better suited to identify/predict the pathogenesis of particular cardiovascular events. The identification of the most appropriate set of biomarkers can provide a detailed picture of the specific nature of the cardiovascular event. The following review provides an overview of existing and emerging inflammatory biomarkers, pro-inflammatory cytokines, anti-inflammatory cytokines, chemokines, oxidative stress biomarkers, and antioxidant biomarkers. The functions of each biomarker are discussed, and prognostic data are provided where available.

The effect of water-based exercise on glucose and insulin response in overweight women: a pilot study.

OBJECTIVE: The aim of this study was to investigate the effectiveness of a 12-week moderate intensity, water-based circuit-type training intervention on glucose and insulin responses in overweight women with normal or impaired glucose tolerance. METHODS: Fifteen overweight women (body mass index [BMI] > 25 kg/m(2)) with normal glucose tolerance (NGT; n = 7) or impaired glucose tolerance (IGT; n = 8) were recruited for this study. All women completed a 12-week training intervention utilizing a combination of aerobic and resistance exercises in an aquatic environment, 3 days per week and 60 min per session at 70-75% mode-specific maximum heart rate. A standard 75-g oral glucose tolerance test (OGTT) was administered pre- and post-intervention, from which fasting and post-load plasma insulin and glucose levels were assessed. RESULTS: Following the 12-week period, fasting insulin levels had decreased by 44% and 2-h glucose by 30.4% in the group with IGT. Waist circumference (WC) had decreased by 5.3% in this group at the end of the intervention. Only WC and waist-to-hip ratio (WHR) decreased (6.0% and 5.5%, respectively) following the intervention in the NGT group. CONCLUSIONS: Moderate intensity, water-based circuit-type exercises appear to be an effective exercise modality to improve glucose and insulin response to a glucose challenge in overweight women with IGT.

Healthy body mass index values often underestimate body fat in men with spinal cord injury.

OBJECTIVE: To examine the relation between body mass index (BMI) and adiposity in men with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: Outpatient study in 2 centers in New Zealand. PARTICIPANTS: Nineteen men with traumatic SCI were age-, height-, and weight-matched with 19 able-bodied men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMI (kg/m(2)) and dual-energy x-ray absorptiometry measures of total and regional lean tissue mass and fat mass. RESULTS: Although the groups had similar BMIs, the total lean tissue mass was 8.9kg lower (95% confidence interval [CI], -12.7 to -5.2; P<.001) whereas total fat mass was 7.1kg greater (95% CI, 1.3-12.8; P<.05) in the SCI group. Body fat percentage was 9.4% (95% CI, 3.6-15.1; P<.01) greater in the SCI group. Regional measures showed a similar pattern. Truncal fat mass increased 3.7kg (95% CI, 0.5-6.9; P<.05) in the SCI group compared with controls. CONCLUSIONS: Body fat mass was greater for any given BMI in the SCI group. Many patients with SCI do not appear to be obese, yet they carry large amounts of fat tissue. BMI is widely used to estimate adiposity, but it may underestimate body fat in men with SCI.