Physical activity during early life and the risk of all-cause mortality in midlife: findings from a birth cohort study.

BACKGROUND: The objective of this study was to examine the association between physical activity during childhood and adolescence and the risk of all-cause mortality in midlife. We analyzed data from a birth cohort (The 1958 National Child Development Survey), including births in England, Wales and Scotland. METHODS: Physical activity was assessed using questionnaires at ages 7, 11 and 16. Death certificates defined all-cause mortality. Cumulative exposure, sensitive and critical periods, and physical activity trajectory from childhood to adolescence were tested using multivariate Cox proportional hazard models. The sweep the death was confirmed was defined as the time event. RESULTS: From age 23 to 55, 8.9% of participants (n = 9398) died. Physical activity in childhood and adolescence affected the risk of all-cause mortality in midlife. In men, physical activity at ages 11 [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.60-0.98] and 16 (HR: 0.60; 95% CI: 0.46-0.78) was associated with reduced risk of all-cause mortality. In women, physical activity at age 16 (HR: 0.68; 95% CI: 0.48-0.95) was associated with reduced risk of all-cause mortality. Physical activity in adolescence eliminated the risk of all-cause mortality associated with physical inactivity in adulthood in women. CONCLUSIONS: Physical activity during childhood and adolescence was associated with reduced risk of all-cause mortality with different effects by sex.

Correlates of functional physical capacity in physically active older adults: a conceptual-framework-based cross-sectional analysis of social determinants of health and clinical parameters.

BACKGROUND: Functional decline in older adults may be affected by clinical status, physical fitness, and social determinants of health. AIMS: This study aimed to explore social determinants of health and health/clinical determinants on two outcomes of functional physical capacity. METHODS AND RESULTS: Therefore, a population-based sample of 327 older adults (69 ± 7 years; 83.5% women) underwent demographical and clinical questionnaires, risk factors assessments, 6-min walk testing (walking capacity), and handgrip strength testing. Based on multivariable linear regression models, age ( - 4.05 m; - 5.3 to - 2.8), being men (71.40 m; 50.5-92.3), body mass index ( - 3.88 m; - 5.6 to - 2.1), and quality of life (18.48 m; 6.3-30.6) remained as predictive variables for walking capacity (R2 = 30.8%). In the final model for handgrip strength, age ( - 0.6% kgf; 0.89-0.2) and male sex (65.2% kgf; 55.3-75.8) remained as predictive variables. DISCUSSION: The mean values for our predicted outcomes were similar to those of healthy and physically active ones, which may be a consequence of the engagement of our sample in a lifestyle program. Also, although using the conceptual framework model to choose explanatory variables with a solid rationale, some of them may present reverse causality in this study setting, regardless of our efforts to annulate this type of bias. CONCLUSIONS: Despite exploratory analyses including contextual factors as potential predictors of walking capacity and handgrip strength, only outcomes at the individual levels were associated, either positively or negatively, with the variations presented by this studied sample of older adults.

Recruitment methods and yield rates in a clinical trial of physical exercise for older adults with hypertension-HAEL Study: a study within a trial.

BACKGROUND: Although the prevalence of hypertension is high in older adults, clinical trial recruitment is a challenge. Our main aim was to describe the HAEL Study recruitment methods and yield rates. The secondary objectives were to explore the reasons for exclusion and to describe the characteristics of the enrolled participants. METHODS: This is a descriptive study within a trial. The HAEL Study was a Brazilian randomized two-center, parallel trial with an estimated sample of 184 participants. The recruitment strategy was based on four methods: electronic health records, word of mouth, print and electronic flyer, and press media. The yield rate was the ratio of the number of participants who underwent randomization to the total number of volunteers screened, calculated for overall, per recruitment method, by study center and by age group and sex. Additionally, we described the reasons for exclusion in the screening phase, as well as the demographic characteristics of those enrolled. The data are presented in absolute/relative frequencies and mean ± standard deviation. RESULTS: A total of 717 individuals were screened, and 168 were randomized over 32 months. The yield rate was higher for word of mouth (30.1%) in the overall sample. However, press media contributed the most (39.9%) to the absolute number of participants randomized in the trial. The coordinating center and participating center differed in methods with the highest yield ratios and absolute numbers of randomized participants. The main reason for exclusion in the screening phase was due to the physically active status in those intending to participate in the study (61.5%). Out of 220 participants included, 52 were excluded mainly because they did not meet the eligibility criteria (26.9%). Most of the screened volunteers were women (60.2%) age 60-69 years (59.5%), and most of the randomized participants were Caucasian/white (78.0%). CONCLUSIONS: Multiple recruitment methods constituted effective strategies. We observed that approximately one of every four individuals screened was allocated to an intervention group. Even so, there were limitations in obtaining a representative sample of older Brazilian adults with hypertension. Data show an underrepresentation of race and age groups. TRIAL REGISTRATION: This SWAT was not registered.

Multimorbidity and leisure-time physical activity over the life course: a population-based birth cohort study.

BACKGROUND: We aimed to test which life course model best described the association between leisure-time physical activity (LTPA) and multimorbidity at age 55. We analyzed data from birth to age 55 using the database from the 1958 National Child Development Survey. METHODS: Multimorbidity was considered as the presence of more than one chronic condition. LTPA was measured through questionnaires from 1965 (age 7) to 2013 (age 55), which were applied in eight different occasions. We compared the fit of a series of nested adjusted logistic regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. Data were reported as odds ratio (OR) and 95% confidence interval (CI). RESULTS: From an eligible sample of 15,613 cohort members, 9137 were interviewed in the latest sweep (58.5%). Men were more physically active than women at ages 11, 16, and 23 (p < 0.001). LTPA every day in the week was more frequent in women than men in ages 33, 42, and 50 (p < 0.001). The prevalence of multimorbidity at age 55 was 33.0% (n = 2778). The sensitive analysis revealed that LTPA during adolescence (OR: 0.83; 95% CI: 0.70, 0.98) and mid adult life (age 50 and 55; OR: 0.82; 95%CI: 0.69, 0.98) have a stronger effect on the risk for multimorbidity at age 55 considering all other life stages in the model. Also, adolescence showed a critical independent effect on the risk for multimorbidity (OR: 0.82; 95%CI: 0.70, 0.97). No difference was found between those models. CONCLUSIONS: These data support the notion of a protective physical activity "legacy" at early ages of childhood against multimorbidity at older ages. We highlight the need for LTPA promotion through intervention tailored especially on schooling and older ages in order to reduce the burden of multimorbidity.

Effects of Resistance Training Performed to Failure or Not to Failure on Muscle Strength, Hypertrophy, and Power Output: A Systematic Review With Meta-Analysis.

ABSTRACT: Vieira, AF, Umpierre, D, Teodoro, JL, Lisboa, SC, Baroni, BM, Izquierdo, M, and Cadore, EL. Effects of resistance training performed to failure or not to failure on muscle strength, hypertrophy, and power output: A systematic review with meta-analysis. J Strength Cond Res 35(4): 1165-1175, 2021-The aim of this review was to summarize the evidence from longitudinal studies assessing the effects induced by resistance training (RT) performed to failure (RTF) vs. not to failure (RTNF) on muscle strength, hypertrophy, and power output in adults. Three electronic databases were searched using terms related to RTF and RTNF. Studies were eligible if they met the following criteria: randomized and nonrandomized studies comparing the effects of RTF vs. RTNF on muscle hypertrophy, maximal strength, and muscle power in adults, and RT intervention ≥6 weeks. Results were presented as standardized mean differences (SMDs) between treatments with 95% confidence intervals, and calculations were performed using random effects models. Significance was accepted when p < 0.05. Thirteen studies were included in this review. No difference was found between RTF and RTNF on maximal strength in overall analysis (SMD: -0.08; p = 0.642), but greater strength increase was observed in RTNF considering nonequalized volumes (SMD: -0.34; p = 0.048). Resistance training performed to failure showed a greater increase in muscle hypertrophy than RTNF (SMD: 0.75; p = 0.005), whereas no difference was observed considering equalized RT volumes. No difference was found between RTF and RTNF on muscle power considering overall analysis (SMD: -0.20; p = 0.239), whereas greater improvement was observed in RTNF considering nonequalized RT volumes (SMD: -0.61; p = 0.025). Resistance training not to failure may induce comparable or even greater improvements in maximal dynamic strength and power output, whereas no difference between RTF vs. RTNF is observed on muscle hypertrophy, considering equalized RT volumes.

The "Hypertension Approaches in the Elderly: a Lifestyle study" multicenter, randomized trial (HAEL Study): rationale and methodological protocol.

BACKGROUND: Hypertension is a clinical condition highly prevalent in the elderly, imposing great risks to cardiovascular diseases and loss of quality of life. Current guidelines emphasize the importance of nonpharmacological strategies as a first-line approach to lower blood pressure. Exercise is an efficient lifestyle tool that can benefit a myriad of health-related outcomes, including blood pressure control, in older adults. We herein report the protocol of the HAEL Study, which aims to evaluate the efficacy of a pragmatic combined exercise training compared with a health education program on ambulatory blood pressure and other health-related outcomes in older individuals. METHODS: Randomized, single-blinded, multicenter, two-arm, parallel, superiority trial. A total of 184 subjects (92/center), ≥60 years of age, with no recent history of cardiovascular events, will be randomized on a 1:1 ratio to 12-week interventions consisting either of a combined exercise (aerobic and strength) training, three times per week, or an active-control group receiving health education intervention, once a week. Ambulatory (primary outcome) and office blood pressures, cardiorespiratory fitness and endothelial function, together with quality of life, functional fitness and autonomic control will be measured in before and after intervention. DISCUSSION: Our conceptual hypothesis is that combined training intervention will reduce ambulatory blood pressure in comparison with health education group. Using a superiority framework, analysis plan prespecifies an intention-to-treat approach, per protocol criteria, subgroups analysis, and handling of missing data. The trial is recruiting since September 2017. Finally, this study was designed to adhere to data sharing practices. TRIAL REGISTRATION: NCT03264443 . Registered on 29 August, 2017.

Effect of exercise on glucose variability in healthy subjects: randomized crossover trial.

The aim of this study was to evaluate the acute effect of aerobic (AER) and eccentric (ECC) exercise on glucose variability, correlating it with circulating markers of inflammation and oxidative stress in healthy subjects. Sixteen healthy subjects (32 ± 12 years old) wore a continuous glucose monitoring system for three days. Participants randomly performed single AER and ECC exercise sessions. Glucose variability was evaluated by glucose variance (VAR), glucose coefficient of variation (CV%) and glucose standard deviation (SD). Blood samples were collected to evaluate inflammatory and oxidative stress markers. When compared with the pre-exercise period of 0-6 h, all the indices of glucose variability presented comparable reductions 12-18 h after both exercises (∆AER: VAR= 151.5, ∆CV% = 0.55 and ∆SD = 3.1 and ECC: ∆VAR = 221.2 , ∆CV% = 3.7 and ∆SD = 6.5). Increased interleukin-6 (IL-6) levels after AER (68.5%) and ECC (30.8%) (P<0.001) were observed, with no differences between sessions (P = 0.459). Uric acid levels were increased after exercise sessions (3% in AER and 4% in ECC, P = 0.001). In conclusion, both AER and ECC exercise sessions reduced glucose variability in healthy individuals. Inflammatory cytokines, such as IL-6, and stress oxidative markers might play a role in underlying mechanisms modulating the glucose variability responses to exercise (clinicalTrials.gov NCT02262208).

Physical activity levels and hepatic steatosis: A longitudinal follow-up study in adults.

BACKGROUND AND AIM: This study aimed to evaluate the impact of physical activity (PA) on the course of hepatic steatosis (HS) in adults. METHODS: Hepatic steatosis status (ultrasonography) and PA levels were evaluated in 5860 subjects at baseline and after approximately 2.5 years (range: 19-50 months). At follow up, possible exposures to different PA levels were those who remained inactive, became inactive, became active, and remained active. After follow up, subjects were then classified according to the four possible states (outcomes): "remained without HS," "developed HS" (subjects without HS at baseline), "remained with HS," or "reverted HS." RESULTS: After multivariate adjustments, individuals without HS that became or remained physically active were less likely to develop HS compared with those who remained physically inactive (odds ratio = 0.75, P = 0.04 and 0.75, P = 0.03, respectively). Among those with HS at baseline, becoming and remaining physically active beneficially improved the HS status (odds ratio = 0.64, P = 0.01 and 0.66, P = 0.01, respectively). However, the significance was lost when adjusted for changes in body mass index. CONCLUSION: Higher levels of PA were associated with prevention and treatment of HS, with evidence of effect mediation by changes in body mass index.

Muscle Damage and Muscle Activity Induced by Strength Training Super-Sets in Physically Active Men.

Brentano, MA, Umpierre, D, Santos, LP, Lopes, AL, Radaelli, R, Pinto, RS, and Kruel, LFM. Muscle damage and muscle activity induced by strength training super-sets in physically active men. J Strength Cond Res 31(7): 1847-1858, 2017-In strength training, muscle activity is often analyzed by surface electromyography (EMG) and muscle damage through indirect markers, such as plasma concentrations of creatine kinase (CK) after exercise. However, there is little information about the influence of the strength exercises order on these parameters. The purpose of this study is to analyze the effect of strength exercises order (super-sets) in muscle activity and indirect markers of muscle damage. Twenty men were randomly assigned to one of the strength training sessions (TS). Each TS (5 sets × 8-10 repetition maximum) consisted of 2 exercises for the knee extensor muscles and 2 exercises for the horizontal shoulder flexors performed in a different order: exercises for the same muscle group grouped (grouped exercises [GE]: n = 10; 26.6 ± 3.4 years; 17.4 ± 3.4 body fat) or separated (separated exercises [SE]: n = 10; 24.9 ± 2.6 years; 15.4 ± 5.9 body fat). Muscle activity was analyzed by surface EMG (vastus lateralis [VL], vastus medialis [VM], rectus femoris [RF], pectoralis major [PM], and anterior deltoid [AD]), and the main indirect marker of muscle damage was the CK, evaluated immediately before and after the first 5 days of each TS. There was a higher EMG activity of GE in the RF (GE: 88.4% × SE: 73.6%) and AD (GE: 176.4% × SE: 100.0%), in addition to greater concentration of CK (GE: 632.4% × SE: 330.5%) after exercise. Our findings suggest that, in physically active men, implementing super-sets with GE promotes greater muscle effort and muscle damage, wherein 5 days are not enough to recover the trained muscle groups.

Supersets do not change energy expenditure during strength training sessions in physically active individuals.

BACKGROUND/OBJECTIVE: The energy expenditure (EE) in strength training (ST) is analyzed both during and after each training session. However, little information exists about the influence of strength exercises supersets on EE. We aimed to determine whether supersets of ST exercises influenced EE during and after one strength exercise session. METHODS: Twenty men were randomly divided to perform either a session with grouped exercises for the same muscle (GE: 26.6 ± 3.4 years; 17.4 ± 3.4 body fat) or a session with separated exercises (SE: 24.9 ± 2.6 years; 15.4 ± 5.9 body fat). Four exercises (5 sets of 8-10 maximum repetitions) for knee extensor muscles and shoulder horizontal flexor muscles were executed in both training sessions. The EE of each experimental session was obtained through the analysis of oxygen uptake during and after exercise (60 minutes postsession). RESULTS: Total work during the session and increases in lactate concentrations were similar between the GE and SE Groups. During exercise, EE was greater in the SE Group when compared with the GE Group (GE: 123.8 ± 14.36 kcal vs. SE: 131.77 ± 20.91 kcal). During the postexercise period, GE induced greater EE when compared with SE (GE: 25.12 ± 7.86 kcal vs. SE: 19.76 ± 5.53 kcal). However, the exercise sequence did not influence overall EE (GE: 148.92 ± 18.72 kcal vs. SE: 151.53 ± 17.97 kcal, p = 0.920). CONCLUSION: Our findings indicate that, in physically active men, ST supersets do not influence total EE during and 60 minutes after a single session.

Effect of dietary lipids on circulating adiponectin: a systematic review with meta-analysis of randomised controlled trials.

Different dietary interventions have been identified as potential modifiers of adiponectin concentrations, and they may be influenced by lipid intake. We identified studies investigating the effect of dietary lipids (type/amount) on adiponectin concentrations in a systematic review with meta-analysis. A literature search was conducted until July 2013 using databases such as Medline, Embase and Scopus (MeSH terms: 'adiponectin', 'dietary lipid', 'randomized controlled trials (RCT)'). Inclusion criteria were RCT in adults analysing adiponectin concentrations with modification of dietary lipids. Among the 4930 studies retrieved, fifty-three fulfilled the inclusion criteria and were grouped as follows: (1) total dietary lipid intake; (2) dietary/supplementary n-3 PUFA; (3) conjugated linoleic acid (CLA) supplementation; (4) other dietary lipid interventions. Diets with a low fat content in comparison to diets with a high-fat content were not associated with positive changes in adiponectin concentrations (twelve studies; pooled estimate of the difference in means: -0·04 (95% CI -0·82, 0·74) µg/ml). A modest increase in adiponectin concentrations with n-3 PUFA supplementation was observed (thirteen studies; 0·27 (95% CI 0·07, 0·47) µg/ml). Publication bias was found by using Egger's test (P= 0·01) and funnel plot asymmetry. In contrast, CLA supplementation reduced the circulating concentrations of adiponectin compared with unsaturated fat supplementation (seven studies; -0·74 (95% CI -1·38, -0·10) µg/ml). However, important sources of heterogeneity were found as revealed by the meta-regression analyses of both n-3 PUFA and CLA supplementation. Results of new RCT would be necessary to confirm these findings.

Hemodynamic responses to resistance exercise with restricted blood flow in young and older men.

Exercise with blood flow restriction promotes significant improvements, and it has been considered an attractive exercise strategy, especially for older individuals. However, the acute cardiovascular responses to resistance exercise with blood flow restriction (BFR) are not fully known. The purpose of this study was to evaluate the hemodynamic responses during resistance exercise with BFR in young and older individuals. We compared hemodynamic responses in 15 young (30 ± 3 years) and 12 older (66 ± 7 years) subjects during low-intensity resistance biceps curl exercise with (BFR-RE) or without (RE) BFR in a random and crossover design. Heart rate (HR), mean blood pressure (MBP), calf blood flow (CBF), and calf vascular resistance (CVR) were evaluated. Both groups presented similar values at baseline. Compared with RE, HR and MBP were higher during BFR-RE for both the groups, and these changes were maintained during the recovery period. In both the groups, BFR-RE elicited larger decreases in CBF and increased CVR. Both groups showed a significant increase in double product during BFR-RE. In conclusion, resistance exercise with BFR elicits greater hemodynamic changes in healthy young and older subjects, with responses of similar magnitudes in both groups. The safety of BFR in clinical practice demands further study in vulnerable populations.

Exercise characteristics and blood pressure reduction after combined aerobic and resistance training: a systematic review with meta-analysis and meta-regression.

OBJECTIVE: The purpose of this systematic review with meta-analysis was to determine the efficacy of combined aerobic and strength training in adults with hypertension and the influence of exercise training characteristics on blood pressure (BP) reduction. METHODS: Randomized clinical trials of interventions involving combined aerobic and strength training versus nonexercise control groups (Control) in adults with hypertension were included. The literature search was conducted on PubMed, Cochrane Central, EMBASE, Scopus, and LILACS until December 2021. A random effects meta-analysis was performed using the mean difference in BP changes from baseline, comparing combined aerobic and strength training vs. Control as the effective measure. A multivariate meta-regression analysis was also performed to evaluate the relationship between exercise training characteristics and magnitudes of BP reductions. RESULTS: Thirty-seven studies with 41 exercise interventions (1942 participants) were analyzed. The pooled mean differences with a 95% confidence interval (95% CI) showed significant reductions in SBP (-6.4 mmHg; 95% CI, -9.1 to -3.6) and DBP (-3.7 mmHg; 95% CI, -4.9 to -2.4). Meta-regression analysis revealed that greater exercise intensity and a greater number of sets in resistance training were associated with greater reductions in SBP. Greater exercise intensity was also associated with greater decreases in DBP. CONCLUSION: Combined aerobic and resistance training is an effective intervention in reducing both SBP and DBP in adults with hypertension, with greater hypotensive effects expected with higher intensity and more volume.

Cardiorespiratory fitness in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis.

Objective: To conduct a systematic review and meta-analysis assessing the cardiorespiratory fitness (CRF) among individuals with and without type 2 diabetes. Materials and methods: The current review was registered in PROSPERO under the number CRD42018082718. MEDLINE, EMBASE, and Cochrane Library databases were searched from inception through February 2022. Eligibility criteria consisted of observational or interventional studies that evaluated CRF through cardiopulmonary exercise testing or six-minute walk test in individuals with type 2 diabetes compared with individuals without type 2 diabetes. For data extraction, we used baseline CRF assessments of randomized clinical trials or follow-up CRF assessments in observational studies. We performed a meta-analysis using maximal oxygen consumption (VO2 max), and distance walked in the 6MWT as primary outcomes. They were extracted and expressed as mean differences (MDs) and 95% CIs between treatment and comparator groups. The meta-analysis was conducted using Review Manager (RevMan) software. Results: Out of 8,347 studies retrieved, 77 were included. Compared with individuals without type 2 diabetes, individuals with diabetes achieved a lower VO2 max (-5.84 mL.kg-1.min-1, 95% CI -6.93, -4.76 mL.kg-1.min-1, p = <0.0001; I2 = 91%, p for heterogeneity < 0.0001), and a smaller distance walked in 6MWT (-93.30 meters, 95% CI -141.2, -45.4 meters, p > 0.0001; I2: 94%, p for heterogeneity < 0.0001). Conclusion: Type 2 diabetes was associated with lower cardiorespiratory fitness, as observed by lower VO2 max on maximal tests, and smaller distance walked in 6MWT, however the quality of studies was low.

The "home-based exercise for breast and prostate cancer patients during treatment-a feasibility trial" (BENEFIT CA trial): rationale and methodological protocol.

BACKGROUND: Physical activity has been shown to benefit patients undergoing adjuvant cancer therapy. Although exercise interventions may be applied in several settings, most trials have focused on specialized facilities for their interventions. While these approaches benefit the access for individuals living near exercise centers, it hampers the assessment of real-world effectiveness. Therefore, evaluating the feasibility and implementation of home-based models of exercise training, especially in low-to-middle-income settings, may inform future physical activity trials and programs. In this article, we present the protocol for the BENEFIT CA trial, which aims to assess the implementation of a remote exercise intervention for patients with breast cancer or prostate cancer, primarily quantifying adherence to an exercise program. METHODS: This is a 12-week study, utilizing a non-randomized, single-arm design to assess the feasibility of a home-based exercise training. The intervention is remotely guided, and participants also receive an educational component about cancer and exercise. The study aims to recruit 40 patients diagnosed with breast cancer and 40 patients diagnosed with prostate cancer, all of whom undergoing active hormonal treatment. The primary outcome is the level of adherence, indicated as the proportion of performed exercise episodes. Secondary outcomes include recruitment rates, fatigue, quality of life, and functional capacity. Adverse events will be monitored throughout the study. Because this is a feasibility trial, the statistical analysis plan is based on descriptive statistics, which encompasses an intention-to-treat analysis and a plan for handling missing data. DISCUSSION: This is a low-cost feasibility study to orient the design of a wide-range, pragmatic phase 3 trial based on remote exercise intervention. With this study, we aim to better understand the adherence and implementation strategies regarding home-based exercise for the proposed population and, in the near future, move forward to a randomized clinical trial. In addition, this trial may contribute to engage patients with cancer in exercise programs throughout their treatment and beyond. TRIAL REGISTRATION: This trial has been approved by the Hospital de Clínicas de Porto Alegre Ethics Committee/IRB (48,869,621.9.0000.5327), and it is registered at Clinicaltrials.gov (NCT05258526), registered on February 25, 2022, prior to the beginning of the study.

Impact of Resistance Training Volume on Physical and Perceptual Outcomes of Breast Cancer Survivors Submitted to a Combined Training Program: A Randomized, Single-Blinded Study.

BACKGROUND: To determine the effect of resistance training volume on physical and perceptual outcomes of breast cancer survivors submitted to a combined training program. DESIGN: Randomized single-blinded study. METHODS: Nineteen breast cancer survivor women were randomized to a single-set (SS) or a multiple-set (MS) group. Both groups completed an 8-week combined training intervention in which the SS and MS groups performed 1 and 3 sets per resistance exercise, respectively. The following outcomes were assessed preintervention and postintervention: maximal knee extension dynamic strength (1-repetition maximum), quadriceps muscle thickness, peak oxygen uptake, time to exhaustion, cancer-related fatigue, and quality of life. RESULTS: Both interventions increased knee extension 1-repetition maximum (SS: 29.8% [37.5%]; MS: 19.3% [11.8%]), quadriceps muscle thickness (9.4% [4.1%]; 8.9% [5.9%]), and quality of life (4.3% [6.3%]; 7.9% [9.0%]), with no difference between the groups. However, only MS improved cancer-related fatigue (-2.1% [1.7%]) and time to exhaustion (21.3% [14.9%]), whereas peak oxygen uptake remained unchanged in both groups. CONCLUSIONS: Cancer-related fatigue and time to exhaustion, improved only in the MS group after the intervention. On the other hand, similar knee extension 1-repetition maximum, quadriceps muscle thickness, and quality of life improvements were observed in breast cancer survivors irrespective of the resistance training volume performed.

Effect of transcutaneous electrical nerve stimulation on muscle metaboreflex in healthy young and older subjects.

Transcutaneous electrical nerve stimulation (TENS) increases local blood flow. It is not known whether increase in blood flow may be caused by inhibition of sympathetic activity, mediated by muscle metaboreflex activity. The purpose of this study was to evaluate the effect of TENS on metaboreflex activation and heart rate variability (HRV) in young and older individuals. Eleven healthy young (age 25 ± 1.3 years) and 11 healthy older (age 63 ± 4.2 years) were randomized to TENS (30 min, 80 Hz, 150 µs) or placebo (same protocol without electrical output) applied on the ganglion region. Frequency domain indices of HRV and hemodynamic variables were evaluated during the pressor response to static handgrip exercise at 30% of maximal voluntary contraction, followed by recovery with (PECO+) or without (PECO-) circulatory occlusion, in a randomized order. At the peak exercise, the increase in mean blood pressure was attenuated by TENS (P < 0.05), which was sustained during PECO+ and PECO-. TENS promoted a higher calf blood flow and lower calf vascular resistance during exercise and recovery. Likewise, TENS induced a reduction in the estimated muscle metaboreflex control both in young (placebo: 28 ± 4 units vs. TENS: 6 ± 3, P < 0.01) and in older individuals (placebo: 13 ± 3 units vs. TENS: 5 ± 3, P < 0.01). HRV analysis showed similar improvement in sympatho-vagal balance with TENS in young and older individuals. We conclude that application of TENS attenuates blood pressure and vasoconstrictor responses during exercise and metaboreflex activation, associated with improved sympatho-vagal balance in healthy young and older individuals.

Association Between Physical Exercise Interventions Participation and Functional Capacity in Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Controlled Trials.

BACKGROUND: The prevalence of type 2 diabetes mellitus increases with age, and people with type 2 diabetes are more affected by reductions in functional performance. Although exercise interventions are recommended for people with diabetes, it is relevant to assess the effects of different training modes on the available functional outcomes. Therefore, our purpose was to systematically assess the effect of different physical exercise modalities in patients with type 2 diabetes with an average age of 45 years or older on outcomes used to measure functional capacity. METHODS: A systematic review and meta-analysis of controlled trials was conducted. Seven databases were searched from January 1987 to December 2021 (PubMed, Physiotherapy Evidence Database, Cochrane Library, SPORTDiscus, and in grey literature: Open Grey and Google Scholar). Eligible studies should last 8 weeks or longer, comparing structured exercise training and non-exercise control for one out of six pre-specified functional capacity outcomes (Timed Up and Go test, chair stands, walking performance, upper-limb muscle strength, lower-limb muscle strength, physical fitness parameter), in patients with type 2 diabetes, aged ≥ 45 years. The risk of bias was assessed with the Downs & Black checklist. Pooled mean differences were calculated using a random-effects model, followed by sensitivity and meta-regression analyses. RESULTS: Of 18,112 references retrieved, 29 trials (1557 patients) were included. Among these, 13 studies used aerobic training, 6 studies used combined training, 4 studies used resistance training, 3 studies had multiple intervention arms and 3 studies used other types of training. Exercise training was associated with an increase in functional capacity outcomes, as reflected by changes in 6-min walk test (n = 8) [51.6 m; 95% CI 7.6% to 95.6%; I2 92%], one-repetition maximum leg-press (n = 3) [18.0 kg; 95% CI 4.0% to 31.9%; I2 0%], and maximum oxygen consumption (VO2max) (n = 20) [2.41 mL/kg·min; 95% CI 1.89% to 2.92%; I2 100%] compared with control groups. In sensitivity and subgroup analyses using VO2max as outcome and stratified by type of study (randomized and non-randomized controlled clinical trials), duration of diabetes diagnosis, and sex, we observed overlapping confidence intervals. Meta-regression showed no association between glycated hemoglobin (HbA1C) levels and VO2max [p = 0.34; I2 99.6%; R2 = 2.6%]. In addition, the quality of the included studies was mostly low. CONCLUSION: The results indicate that structured physical exercise programs might improve functional capacity in patients with type 2 diabetes, except for the upper-limb muscle strength. However, we could not identify potential effect predictors associated with directional summary estimates. Trial registration This systematic review was registered in the PROSPERO international prospective register of systematic reviews (CRD42020162467); date of registration: 12/15/2019. The review protocol is hosted at the Open Science Framework (OSF) (Preprint https://doi.org/10.31219/osf.io/kpg2m ).

Physical Activity Guidelines for the Brazilian Population: Recommendations Report.

BACKGROUND: This article presents the recommendations from the Physical Activity Guidelines for the Brazilian Population. METHODS: A steering committee composed of a chair, 6 experts in physical activity, and representatives from the Ministry of Health/Brazil, Pan American Health Organization, Brazilian Society of Physical Activity and Health designed the guidelines, which was implemented by 8 working groups, as follows: (1) understanding physical activity, (2) children up to 5 years old, (3) children and youth from 6 to 17 years old, (4) adults, (5) older adults (60 years and above), (6) physical education at school, (7) pregnant and postpartum women, and (8) people with disabilities. The methodological steps included evidence syntheses, hearings with key stakeholders, and public consultation. RESULTS: Across 8 chapters, the guidelines provide definitions of physical activity and sedentary behavior, informing target groups on types of physical activity, dosage (frequency, intensity, and duration), benefits, and supporting network for physical activity adoption. The guidelines are openly available in Portuguese, Spanish, English, and Braille and in audio versions, with a supplementary guide for health professionals and decision makers, and a report about the preparation and references. CONCLUSIONS: The Physical Activity Guidelines for the Brazilian Population provide evidence-based recommendations, being a public-directed resource to contribute to the physical activity promotion in Brazil.