Exercise improves surrogate measures of liver histological response in metabolic dysfunction-associated steatotic liver disease.

BACKGROUND AND AIMS: Exercise is recommended for the management of metabolic dysfunction-associated steatotic liver disease (MASLD), yet effects on liver histology remain unknown, especially without significant weight loss. We aimed to examine changes in surrogate measures of liver histological response with exercise training. METHODS: We conducted a post hoc pooled analysis of three randomised controlled trials (duration: 12-20 weeks) comparing aerobic exercise interventions with controls. The primary outcome measure was a ≥30% relative reduction in (MRI-measured) liver fat, as a surrogate measure of liver histological response (the threshold necessary for fibrosis improvement). Secondary outcome measures were changes in other biomarkers of liver fibrosis, anthropometry, body composition and aerobic fitness. RESULTS: Eighty-eight adults (exercise: 54, control: 34; male: 67%) were included with mean (SD) age 51 (11) years and body mass index 33.3 (5.2) kg/m2. Following the intervention, exercise had ~5-fold (OR [95%CI]: 4.86 [1.72, 13.8], p = .002) greater odds of ≥30% relative reduction in MRI-measured liver fat compared with control. This paralleled the improvements in anthropometry (waist and hip circumference reduction), body composition (body fat, visceral and subcutaneous adipose tissue) and aerobic fitness (V̇O2peak, ventilatory threshold and exercise capacity). Importantly, these effects were independent of clinically significant body weight loss (<3% body weight). CONCLUSION: Exercise training led to clinically meaningful improvements in surrogate serum- and imaging-based measures of liver histological change, without clinically meaningful body weight reduction. These data reinforce the weight-neutral benefit of exercise training and suggest that aerobic training may improve liver fibrosis in patients with MASLD.

Effect of low-volume combined aerobic and resistance high-intensity interval training on vascular health in people with type 2 diabetes: a randomised controlled trial.

PURPOSE: We compared the effects of low-volume combined aerobic and resistance high-intensity interval training (C-HIIT), combined moderate-intensity continuous training (C-MICT) and waitlist control (CON) on vascular health after 8-weeks of supervised training, and an additional 10-months of self-directed training, in adults with type 2 diabetes (T2D). METHODS: Sixty-nine low active adults with T2D were randomised to 8-weeks of supervised C-HIIT (3 times/week, 78-min/week), C-MICT (current exercise guidelines, 4 times/week, 210-min/week) or CON. CON underwent usual care for 8-weeks before being re-randomised to C-HIIT or C-MICT. This was followed by 10-months of self-directed training for participants in C-HIIT and C-MICT. Vascular outcomes were evaluated at baseline, 8-weeks, and 12-months. RESULTS: After 8-weeks, supervised C-HIIT significantly improved relative flow-mediated dilation (FMD) compared with CON (mean difference [MD] 0.8% [0.1, 1.4], p = 0.025). Although not significantly different from CON, the magnitude of change in relative FMD following 8-weeks of supervised C-MICT was similar (MD 0.8% [-0.1, 1.7], p = 0.080). There were no differences in haemodynamic indices, carotid-femoral pulse wave velocity (cfPWV), or aortic reservoir pressure between groups at 8-weeks. After 12-months, there was a significant reduction in haemodynamic indices (time effect, p < 0.05) for both C-HIIT and C-MICT, with no between-group difference. The reduction in cfPWV over 12-months was significantly greater in C-MICT than C-HIIT (group × time effect, p = 0.018). There was no difference in FMD over time or between groups at 12-months. CONCLUSIONS: Short-term supervised C-HIIT and C-MICT both increased brachial artery FMD compared with CON. Long-term C-HIIT and C-MICT were beneficial for improving haemodynamic indices, but not brachial artery FMD. C-MICT was superior to C-HIIT for improving cfPWV at 12-months. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier ACTRN12615000475549.

High-Intensity Interval Training is Safe, Feasible and Efficacious in Nonalcoholic Steatohepatitis: A Randomized Controlled Trial.

BACKGROUND: High-Intensity Interval Training (HIIT) involves bursts of high-intensity exercise interspersed with lower-intensity exercise recovery. HIIT may benefit cardiometabolic health in people with nonalcoholic steatohepatitis (NASH). AIMS: We aimed to examine the safety, feasibility, and efficacy of 12-weeks of supervised HIIT compared with a sham-exercise control (CON) for improving aerobic fitness and peripheral insulin sensitivity in biopsy-proven NASH. METHODS: Participants based in the community [(n = 14, 56 ± 10 years, BMI 39.2 ± 6.7 kg/m2, 64% male), NAFLD Activity Score 5 (range 3-7)] were randomized to 12-weeks of supervised HIIT (n = 8, 4 × 4 min at 85-95% maximal heart rate, interspersed with 3 min active recovery; 3 days/week) or CON (n = 6, stretching; 3 days/week). Safety (adverse events) and feasibility determined as ≥ 70% program completion and ≥ 70% global adherence (including session attendance, interval intensity adherence, and duration adherence) were assessed. Changes in cardiorespiratory fitness (V̇O2peak), exercise capacity (time-on-test) and peripheral insulin sensitivity (euglycemic hyperinsulinemic clamp) were assessed. Data were analysed using ANCOVA with baseline value as the covariate. RESULTS: There were no HIIT-related adverse events and HIIT was globally feasible [program completion 75%, global adherence 100% (including adherence to session 95.4 ± 7.3%, interval intensity 95.3 ± 6.0% and duration 96.8 ± 2.4%)]. A large between-group effect was observed for exercise capacity [mean difference 134.2 s (95% CI 19.8, 248.6 s), ƞ2 0.44, p = 0.03], improving in HIIT (106.2 ± 97.5 s) but not CON (- 33.4 ± 43.3 s), and for peripheral insulin sensitivity [mean difference 3.4 mg/KgLegFFM/min (95% CI 0.9,6.8 mg/KgLegFFM/min), ƞ2 0.32, p = 0.046], improving in HIIT (1.0 ± 0.8 mg/KgLegFFM/min) but not CON (- 3.1 ± 1.2 mg/KgLegFFM/min). CONCLUSIONS: HIIT is safe, feasible and efficacious for improving exercise capacity and peripheral insulin sensitivity in people with NASH. CLINICAL TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trial Registry (anzctr.org.au) identifier ACTRN12616000305426 (09/03/2016).

A mixed-methods exploration of attitudes towards pregnant Facebook fitness influencers.

BACKGROUND: Exercise during pregnancy is associated with various health benefits for both mother and child. Despite these benefits, most pregnant women do not meet physical activity recommendations. A known barrier to engaging in exercise during pregnancy is a lack of knowledge about appropriate and safe exercise. In our current era of social media, many pregnant women are turning to online information sources for guidance, including social media influencers. Little is known about attitudes towards pregnancy exercise information provided by influencers on social media platforms. This study aimed to explore attitudes towards exercise during pregnancy depicted by social media influencers on Facebook, and user engagement with posted content. METHODS: A mixed-methods approach was used to analyse data from 10 Facebook video posts of social media influencers exercising during pregnancy. Quantitative descriptive analyses were used to report the number of views, shares, comments and emotive reactions. Qualitative analysis of user comments was achieved using an inductive thematic approach. RESULTS: The 10 video posts analysed were viewed a total of 12,117,200 times, shared on 11,181 occasions, included 13,455 user comments and 128,804 emotive icon reactions, with the most frequently used icon being 'like' (81.48%). The thematic analysis identified three themes associated with attitudes including [1] exercise during pregnancy [2] influencers and [3] type of exercise. A fourth theme of community was also identified. Most user comments were associated with positive attitudes towards exercise during pregnancy and the influencer. However, attitudes towards the types of exercise the influencer performed were mixed (aerobic and body weight exercises were positive; resistance-based exercise with weights were negative). Finally, the online community perceived by users was mostly positive and recognised for offering social support and guidance. CONCLUSIONS: User comments imply resistance-based exercise with weights as unsafe and unnecessary when pregnant, a perception that does not align with current best practice guidelines. Collectively, the findings from this study highlight the need for continued education regarding exercise during pregnancy and the potential for social media influencers to disseminate evidence-based material to pregnant women who are highly receptive to, and in need of reliable health information.

Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study.

BACKGROUND: The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. OBJECTIVE: This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). METHODS: Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. RESULTS: A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the "relational space" are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. CONCLUSIONS: Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted.

Safety and efficacy of exercise training in children and adolescents with congenital heart disease: A systematic review and descriptive analysis.

BACKGROUND: While exercise training is beneficial in the prevention and management of many chronic diseases, the role of exercise training in children and adolescents with congenital heart disease is less understood. We sought to determine the safety and efficacy of exercise training in children and adolescents with congenital heart disease. METHODS: We conducted a systematic search of the following databases: PubMed, CINAHL, EMBASE, Web of Science and SportDiscus. We included randomised controlled trials that incorporated an exercise intervention compared with a non-exercising comparator group and examined safety and efficacy in children and adolescents with congenital heart disease. A descriptive analysis of the included trials was then conducted. RESULTS: A total of 9 articles from 6 trials (642 participants with varying conditions and disease severity) were included. Significant variability of study participants and outcomes were observed across the trials. No adverse events linked to the exercise interventions were stated. The articles reported numerous positive changes to clinically relevant fitness measures. Exercise capacity improved with exercise training in 3 of 4 trials in which it was measured. Cardiorespiratory fitness showed improvements in 3 of 4 trials. Neuromuscular fitness increased in 1 of 2 trials. Physiological and metabolic parameters were improved, and negative changes were not observed to several clinically important measures (e.g. muscular oxygenation, cardiac measures) in 2 of 2 trials. Physical activity increased in 1 of 3 trials. No articles reported on changes in measures of body composition. Outcomes are varied with little consensus on measurements or assessment methods. CONCLUSIONS: Exercise training appears to be safe and efficacious for improving physical fitness in children and adolescents with congenital heart disease who have been appropriately screened by their medical team. However, the certainty of the evidence for these findings is low to moderate.

The effects of exercise on the bone health of people with cancer: a systematic review and meta-analysis.

PURPOSE: To determine the pooled effect of exercise on the bone health of people diagnosed with cancer. METHODS: Four electronic databases were systematically searched. Controlled trials that assessed the effect of exercise on the bone mineral density (BMD) or content (BMC) measured by dual-energy x-ray absorptiometry or peripheral quantitative computed tomography in people who had been diagnosed with cancer were included in the study. Random-effect meta-analyses of effect size (ES) were conducted. Sub-group analyses were performed to explore the influence of intervention duration, prescription and participant characteristics. RESULTS: Of 66 full-text articles screened, 22 studies, from 21 interventions, were included (primarily breast/prostate cancer, sample range n = 36-498). When all interventions were grouped, a significant pooled ES was observed for exercise on hip (ES = 0.112, 95% CI: 0.026 to 0.198; p = 0.011) and lumbar spine BMD (ES = 0.269, 95% CI: 0.036 to 0.501; p = 0.024) compared to control. There was also an influence of sex, where females had greater improvements in hip (ES = 0.120, 95% CI: 0.017 to 0.223; p = 0.022) and spine BMD (ES = 0.415, 95% CI: 0.056 to 0.774; p = 0.23) compared to males. CONCLUSION: Overall, exercise regimens of studies included in this review appear to improve bone health at the hip and spine in people diagnosed with cancer. Sub-analyses suggest some influence of sex, where females had greater improvements in BMD compared to males. It is essential that future studies evaluate the dose-response of exercise training on bone health and create exercise protocols that better align with the laws of bone modelling to enhance osteogenic potential.

Comparison of high intensity interval training with standard cardiac rehabilitation on vascular function.

OBJECTIVES: To compare the short- and long-term effects of high-intensity interval training (HIIT) with usual care moderate intensity continuous training (MICT) on systemic vascular function and stiffness in patients with coronary artery disease undergoing a cardiac rehabilitation program. DESIGN: Randomized controlled trial. METHODS: Fifty-four patients (age = 63 ± 8 years, 93% male) were randomized to complete 3 sessions/week (2 supervised, 1 home-based) of either (1) 4 × 4-min HIIT or (2) 40-min MICT, for 4 weeks. Patients then continued 3 unsupervised home-based sessions/week of their allocated training for 11 months. Brachial artery flow-mediated dilation, pulse wave velocity, and blood pressure were measured at baseline, 4 weeks, 3 months, 6 months, and 12 months. Data were analyzed using linear mixed modeling and are presented as mean change from baseline (95% CI). RESULTS: HIIT showed a greater improvement in flow-mediated dilation compared to MICT after 4 weeks [1.5% (0.9, 2.1) vs 0.1% (-0.5, 0.8); p = 0.004) but not 12 months [1.2% (-0.2, 2.5) vs 0.4% (-0.8, 1.7); p = 0.153). There were no short- or long-term group differences for changes in pulse wave velocity, peripheral or central blood pressure between HIIT and MICT after 4 weeks, or over 12 months. CONCLUSIONS: A 4-week HIIT program was superior to MICT for improving vascular function, but not arterial stiffness or blood pressure. Over 12 months, changes in vascular function, blood pressure, and arterial stiffness were similar for HIIT and MICT.

Effectiveness of exercise via telehealth for chronic disease: a systematic review and meta-analysis of exercise interventions delivered via videoconferencing.

OBJECTIVE: To investigate the effectiveness of videoconferencing exercise interventions for people with chronic diseases. DESIGN: Systematic review incorporating meta-analysis. DATA SOURCES: PubMed, Cinahl, MEDLINE, Web of Science, Embase and Scopus. ELIGIBILITY CRITERIA: The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Trials analysing participants with chronic disease undergoing aerobic and/or resistance exercise training over videoconferencing, with exercise capacity and/or quality of life outcomes were included. Meta-analyses were conducted for between-group comparisons of exercise capacity and quality of life. Risk of bias was analysed using the Downs and Black quality checklist and the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS: Thirty-two trials were included in this review, of which 12 were comparator trials. Small-moderate between-group (videoconferencing vs comparator) effects favouring videoconferencing were seen for studies using a non-exercising comparator for exercise capacity (standardised mean difference (SMD)=0.616, 95% CI 0.278 to 0.954; p=<0.001) and quality of life (SMD=0.400, 95% CI 0.099 to 0.701; p=0.009). Small effects favouring videoconferencing were observed for studies using an exercising comparator for quality of life (SMD=0.271, 95% CI 0.028 to 0.515; p=0.029) and exercise capacity (SMD=0.242, 95% CI 0.059 to 0.426; p=0.009). Moderate risk of bias was identified for included studies (16.3±3.6/28), with GRADE certainty ratings of 'low' (quality of life) and 'moderate' (exercise capacity). Session attendance was 70% and was reported in 23 trials. No serious adverse events relating to videoconferencing were found. Nine trials documented the total number of technical issues that occurred in 17% of the sessions. Positive satisfaction outcomes were associated with ease of access and usefulness of technology. CONCLUSION: In patients with chronic disease, videoconferencing exercise interventions appear to be feasible and effective for improving exercise capacity and quality of life. More robust methodology is needed in future studies to improve the certainty of the evidence. PROSPERO REGISTRATION NUMBER: CRD42020191243.

Effects of one-year once-weekly high-intensity interval training on body adiposity and liver fat in adults with central obesity: Study protocol for a randomized controlled trial.

Objective: This study aims to examine the effects of one-year, once-weekly high-intensity interval training (HIIT) on body adiposity and liver fat in adults with central obesity. Methods: One-hundred and twenty adults aged 18-60 years with central obesity (body mass index ≥25, waist circumference ≥90 cm for men and ≥80 cm for women). This is an assessor-blinded randomized controlled trial. Participants will be randomly assigned to the HIIT group or the usual care control group. Each HIIT session will consist of 4 × 4-min bouts at 85%-95% maximal heart rate, interspersed with 3-min bouts at 50%-70% maximal heart rate. The HIIT group will complete one session per week for 12 months, whereas the usual care control group will receive health education. The primary outcomes of this study are total body adiposity and intrahepatic triglyceride content. The secondary outcomes include abdominal visceral adipose tissue, subcutaneous adipose tissue, body mass index, waist circumference, hip circumference, cardiorespiratory fitness, lean body mass, bone mineral density, blood pressure, fasting blood glucose, insulin, triglycerides, glycated hemoglobin, cholesterol profile, liver function enzymes, medications, adherence to exercise, adverse events, quality of life, and mental health. Outcome measure will be conducted at baseline, 12 months (post-intervention), and 24 months (one-year follow-up). Impact of the project: This study will explore the benefits of long-term once-weekly HIIT with a follow-up period to assess its effectiveness, adherence, and sustainability. We expect this intervention will enhance the practical suitability of HIIT in inactive adults with central obesity, and provide insights on low-frequency HIIT as a novel exercise option for the management of patients with central obesity and liver fat. Trial registration: ClinicalTrials.gov (NCT03912272) registered on 11 April 2019.

Trajectories and determinants of weight gain in two cohorts of young adult women born 16 years apart.

BACKGROUND: The aims were to compare: (1) baseline weights and weight gain trajectories; (2) sociodemographic, behavioural and health characteristics driving weight gain; and (3) estimated average weight in 20 years' time, in two cohorts of young women. METHODS: Data were from 16066 participants in two population-based cohorts of young adult women, born in 1973-78 ("GenX") and 1989-95 ("millennials"). Weight was reported at baseline (age 18-23 in both cohorts) and 4 years later. High weight gain was defined as >2.5% per year. Data were analysed in 2020. RESULTS: Women born in 1989-95 were almost 4 kg heavier at age 18-23 and gained weight over 4 years 1.7 times faster than those born in 1973-78. Prevalence of high weight gain was 34.2% in the 1989-95 cohort and 24% in the 1973-78 cohort. In both cohorts, older age, higher education and high physical activity were associated with lower odds of high weight gain, and more hours in paid work, poorer self-rated health and higher baseline BMI were associated with higher odds of high weight gain. Five factors (outer regional areas, one child, ex or current smoker, high stress and depression) were determinants of high weight gain in the 1989-95 cohort, but not in the 1973-78 cohort. Based on average weight at age 21 and annual percentage weight gain, we estimate that women born in 1989-95 will, on average, be 16.7 kg heavier at age 41 (93.2 kg), than women in the 1973-78 cohort (76.5 kg). CONCLUSION: High weight gain was evident in every sociodemographic group in both cohorts but most evident in millennial women with high levels of stress and depression. Without effective weight gain prevention strategies we estimate that more than 50% of the millennial women will be in the obese BMI category in 20 years. This will have serious economic, health and societal consequences.

Accuracy of dual-energy x-ray absorptiometry for assessing longitudinal change in visceral adipose tissue in patients with coronary artery disease.

BACKGROUND/OBJECTIVE: Visceral adipose tissue (VAT) is a key target of interventions for obesity-related diseases. Dual-energy x-ray absorptiometry (DXA) can estimate VAT, however its accuracy to measure longitudinal change in VAT compared to gold-standard techniques such as magnetic resonance imaging (MRI), has not been studied in adults. This study aimed to determine the accuracy of DXA compared with gold-standard MRI for cross-sectional VAT assessment, and for detecting longitudinal change in VAT. METHODS: Adults with coronary artery disease (64 ± 8 years; BMI 27.8 ± 3.5 kg/m2; 88% male) were assessed for VAT by DXA and MRI at baseline (n = 34) and during implementation of an exercise intervention study at 3- and 12-months (n = 29). To match the 5.2 cm DXA measurement site for Hologic software (InnerCoreTM), VAT cross-sectional area (CSA) was measured by MRI using a single slice at L4/L5 junction, and VAT volume measured by 10 × 5 mm slices over the L4/L5 junction. MRI slices were quantified for VAT using semi-automated specialised software. Relationships between DXA and MRI for cross-sectional VAT and longitudinal change in VAT were determined by linear regression. Accuracy between the methods was assessed by Bland-Altman analysis, with data presented as mean difference (95% confidence interval), lower and upper limits of agreement (LoA). RESULTS: Strong correlations were found between DXA-VAT and MRI-VAT at baseline (r = 0.90; p < 0.001), and longitudinal change in DXA-VAT and MRI-VAT over 3- and 12-months (r = 0.67; p < 0.001). In contrast, Bland-Altman analysis revealed significant overestimation by DXA-VAT volume at baseline by 13% [-104 cm3 (-157, -52 cm3), p < 0.001; LoA (-398, 189 cm3)], and underestimation of change in DXA-VAT volume over 3-months by 33% [-41 cm3 (-77, -4 cm3), p = 0.030; LoA (-228, 147 cm3)] and 12-months by 47% [-65 cm3 (-114, -17 cm3), p = 0.010; LoA (-316, 185 cm3)]. Results were similar for VAT CSA. CONCLUSIONS: Compared with MRI, DXA substantially underestimated longitudinal changes in VAT. Therefore, DXA is not currently a valid alternative to MRI for quantifying VAT changes and may under-represent the effectiveness of interventions for obesity management.

Genome wide association study of response to interval and continuous exercise training: the Predict-HIIT study.

BACKGROUND: Low cardiorespiratory fitness (V̇O2peak) is highly associated with chronic disease and mortality from all causes. Whilst exercise training is recommended in health guidelines to improve V̇O2peak, there is considerable inter-individual variability in the V̇O2peak response to the same dose of exercise. Understanding how genetic factors contribute to V̇O2peak training response may improve personalisation of exercise programs. The aim of this study was to identify genetic variants that are associated with the magnitude of V̇O2peak response following exercise training. METHODS: Participant change in objectively measured V̇O2peak from 18 different interventions was obtained from a multi-centre study (Predict-HIIT). A genome-wide association study was completed (n = 507), and a polygenic predictor score (PPS) was developed using alleles from single nucleotide polymorphisms (SNPs) significantly associated (P < 1 × 10-5) with the magnitude of V̇O2peak response. Findings were tested in an independent validation study (n = 39) and compared to previous research. RESULTS: No variants at the genome-wide significance level were found after adjusting for key covariates (baseline V̇O2peak, individual study, principal components which were significantly associated with the trait). A Quantile-Quantile plot indicates there was minor inflation in the study. Twelve novel loci showed a trend of association with V̇O2peak response that reached suggestive significance (P < 1 × 10-5). The strongest association was found near the membrane associated guanylate kinase, WW and PDZ domain containing 2 (MAGI2) gene (rs6959961, P = 2.61 × 10-7). A PPS created from the 12 lead SNPs was unable to predict V̇O2peak response in a tenfold cross validation, or in an independent (n = 39) validation study (P > 0.1). Significant correlations were found for beta coefficients of variants in the Predict-HIIT (P < 1 × 10-4) and the validation study (P < × 10-6), indicating that general effects of the loci exist, and that with a higher statistical power, more significant genetic associations may become apparent. CONCLUSIONS: Ongoing research and validation of current and previous findings is needed to determine if genetics does play a large role in V̇O2peak response variance, and whether genomic predictors for V̇O2peak response trainability can inform evidence-based clinical practice. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), Trial Id: ACTRN12618000501246, Date Registered: 06/04/2018, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374601&isReview=true .

The effect of heat therapy on blood pressure and peripheral vascular function: A systematic review and meta-analysis.

NEW FINDINGS: What is the topic of this review? We have conducted a systematic review and meta-analysis on the current evidence for the effect of heat therapy on blood pressure and vascular function. What advances does it highlight? We found that heat therapy reduced mean arterial, systolic and diastolic blood pressure. We also observed that heat therapy improved vascular function, as assessed via brachial artery flow-mediated dilatation. Our results suggest that heat therapy is a promising therapeutic tool that should be optimized further, via mode and dose, for the prevention and treatment of cardiovascular disease risk factors. ABSTRACT: Lifelong sauna exposure is associated with reduced cardiovascular disease risk. Recent studies have investigated the effect of heat therapy on markers of cardiovascular health. We aimed to conduct a systematic review with meta-analysis to determine the effects of heat therapy on blood pressure and indices of vascular function in healthy and clinical populations. Four databases were searched up to September 2020 for studies investigating heat therapy on outcomes including blood pressure and vascular function. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess the certainty of evidence. A total of 4522 titles were screened, and 15 studies were included. Healthy and clinical populations were included. Heat exposure was for 30-90 min, over 10-36 sessions. Compared with control conditions, heat therapy reduced mean arterial pressure [n = 4 studies; mean difference (MD): -5.86 mmHg, 95% confidence interval (CI): -8.63, -3.10; P < 0.0001], systolic blood pressure (n = 10; MD: -3.94 mmHg, 95% CI: -7.22, -0.67; P = 0.02) and diastolic blood pressure (n = 9; MD: -3.88 mmHg, 95% CI: -6.13, -1.63; P = 0.0007) and improved flow-mediated dilatation (n = 5; MD: 1.95%, 95% CI: 0.14, 3.76; P = 0.03). Resting heart rate was unchanged (n = 10; MD: -1.25 beats/min; 95% CI: -3.20, 0.70; P = 0.21). Early evidence also suggests benefits for arterial stiffness and cutaneous microvascular function. The certainty of evidence was moderate for the effect of heat therapy on systolic and diastolic blood pressure and heart rate and low for the effect of heat therapy on mean arterial pressure and flow-mediated dilatation. Heat therapy is an effective therapeutic tool to reduce blood pressure and improve macrovascular function. Future research should aim to optimize heat therapy, including the mode and dose, for the prevention and management of cardiovascular disease.

The inter- and intrarater reliability and feasibility of dietetic assessment of sarcopenia and frailty in potential liver transplant recipients: A mixed-methods study.

Sarcopenia and frailty are associated with poorer outcomes in potential liver transplant (LT) recipients. We examined the reliability and feasibility of dietitians assessing sarcopenia and frailty. Seventy-five adults referred for LT underwent assessments of muscle mass (abdominal CTs), physical function (handgrip strength; HGS, short physical performance battery; SPPB), and frailty (Liver Frailty Index; LFI). Inter- and intrarater reliability and agreement were assessed in subsets of patients using intraclass correlation coefficients (ICCs) and Bland-Altman plots. CTs were analyzed by a dietitian and two independent experts, two dietitians assessed function and frailty. Feasibility assessed system, patient, and profession factors (staff survey). Inter- and intrarater reliability for CT-defined low muscle were excellent (ICCs > 0.97). Reliability between dietitians was excellent for HGS (0.968, 95% CI, 0.928-0.986), SPPB (0.932, 95% CI, 0.798-0.973), and LFI (0.938, 95% CI 0.861-0.973). Bland-Altman analysis indicated excellent agreement for HGS. All transplant clinicians valued sarcopenia and frailty in LT assessments and considered the dietitian appropriate to perform them. Seven saw no barriers to implementation into practice, while five queried test standardization, learning from repeat testing, and resource cost. Dietetic assessments of sarcopenia and frailty are reliable, feasible, and valued measures in the assessment of potential LT recipients.

High intensity interval training does not result in short- or long-term dietary compensation in cardiac rehabilitation: Results from the FITR heart study.

The aim of this study was to investigate short- and long-term compensatory effects on dietary intake following high intensity interval training (HIIT) compared with usual care moderate intensity continuous training (MICT) during and following a cardiac rehabilitation program. This study investigates secondary outcomes of a clinical trial. Ninety-three participants with coronary artery disease enrolled in a 4-week cardiac rehabilitation program, were randomised to 1) 4x4-minute HIIT; or 2) 40-min of MICT (usual care). Patients were instructed to complete 3 weekly sessions (2 supervised, 1 home-based) for 4-weeks, and 3 weekly home-based sessions thereafter for another 48-weeks. Dietary intake was measured by telephone-based 24-h recall over 2 day at baseline, 4-weeks, 3-months, 6-months, and 12-months. Three-Factor Eating Questionnaire was used to measure dietary behaviour and Leeds Food Preference Questionnaire used to measure food preferences. Appetite was assessed by a visual analogue scale and appetite-regulating hormones. There was no change over the study period or differences between groups for daily energy intake at 4-weeks or 12-months. There were also no group differences for any other measures of dietary intake, fasting hunger or appetite-related hormones, dietary behaviour, or food preferences. These findings suggest that compared to moderate intensity exercise, HIIT does not result in compensatory increases of energy intake or indicators of poor diet quality. This finding appears to be the same for patients with normal weight and obesity. HIIT can therefore be included in cardiac rehabilitation programs as an adjunct or alterative to MICT, without concern for any undesirable dietary compensation.

The Role of Exercise in Patients with Obesity and Hypertension.

PURPOSE OF REVIEW: This review sought to evaluate the role of exercise in patients with obesity and comorbid hypertension, with a focus on contemporary literature (since January 2015). RECENT FINDINGS: No reviews have included patients classified with both obesity and hypertension and there is a paucity of randomised controlled trials examining the benefits of exercise in this population. Moreover, just one of 19 reviews examining the role of exercise on blood pressure included studies that met pre-defined inclusion criterion for hypertension, although seven conducted subgroup analyses stratified by mean baseline blood pressure. These demonstrated significantly larger reductions in blood pressure in hypertensive than pre-hypertensive and normotensive samples. There is a significant research-practice gap for understanding and influencing the role of exercise for patients with obesity and hypertension. This review provides recommendations for future research and consensus-based recommendations that promote exercise as a principle therapy for patients with obesity and hypertension.

Same-Day Vs Consecutive-Day Precision Error of Dual-Energy X-Ray Absorptiometry for Interpreting Body Composition Change in Resistance-Trained Athletes.

The application of dual-energy X-ray absorptiometry (DXA) in sport science settings is gaining popularity due to its ability to assess body composition. The International Society for Clinical Densitometry (ISCD) recommends application of the least significant change (LSC) to interpret meaningful and true change. This is calculated from same-day consecutive scans, thus accounting for technical error. However, this approach does not capture biological variation, which is pertinent when interpreting longitudinal measurements, and could be captured from consecutive-day scans. The aims of this study were to investigate the impact short-term biological variation has on LSC measures, and establish if there is a difference in precision based on gender in a resistance-trained population. Twenty-one resistance-trained athletes (age: 30.6 ± 8.2 yr; stature: 174.2 ± 7.2 cm; mass: 74.3 ± 11.6 kg) with at least 12 mo consistent resistance training experience, underwent 2 consecutive DXA scans on 1 d of testing, and a third scan the day before or after. ISCD-recommended techniques were used to calculate same-day and consecutive-day precision error and LSC values. There was high association between whole body (R2 = 0.98-1.00) and regional measures (R2 = 0.95-0.99) for same-day (R2 = 0.98-1.00), and consecutive-day (R2 = 0.95-0.98) measurements. The consecutive-day precision error, in comparison to same-day precision error, was significantly different (p < 0.05), and almost twice as large for fat mass (1261 g vs 660 g), and over 3 times as large for lean mass (2083 g vs 617 g), yet still remained within the ISCD minimum acceptable limits for DXA precision error. No whole body differences in precision error were observed based on gender. When tracking changes in body composition, the use of precision error and LSC values calculated from consecutive-day analysis is advocated, given this takes into account both technical error and biological variation, thus providing a more accurate indication of true and meaningful change.

Longitudinal Changes in Body Composition Assessed Using DXA and Surface Anthropometry Show Good Agreement in Elite Rugby Union Athletes.

Rugby union athletes have divergent body composition based on the demands of their on-field playing position and ethnicity. With an established association between physique traits and positional requirements, body composition assessment is routinely undertaken. Surface anthropometry and dual-energy X-ray absorptiometry (DXA) are the most common assessment techniques used, often undertaken synchronously. This study aims to investigate the association between DXA and surface anthropometry when assessing longitudinal changes in fat-free mass (FFM) and fat mass (FM) in rugby union athletes. Thirty-nine elite male rugby union athletes (age: 25.7 ± 3.1 years, stature: 187.6 ± 7.7 cm, and mass: 104.1 ± 12.2 kg) underwent assessment via DXA and surface anthropometry multiple times over three consecutive international seasons. Changes in the lean mass index, an empirical measure to assess proportional variation in FFM, showed large agreement with changes in DXA FFM (r = .54, standard error of the estimate = 1.5%, p < .001); the strength of association was stronger among forwards (r = .63) compared with backs (r = .38). Changes in the sum of seven skinfolds showed very large agreement with changes in DXA FM (r = .73, standard error of the estimate = 5.8%, p < .001), with meaningful differences observed regardless of ethnicity (Whites: r = .75 and Polynesians: r = .62). The lean mass index and sum of seven skinfolds were able to predict the direction of change in FFM and FM 86% and 91% of the time, respectively, when DXA change was >1 kg. Surface anthropometry measures provide a robust indication of the direction of change in FFM and FM, although caution may need to be applied when interpreting magnitude of change, particularly with FM.

Preseason Body Composition Adaptations in Elite White and Polynesian Rugby Union Athletes.

During preseason training, rugby union (RU) athletes endeavor to enhance physical performance characteristics that are aligned with on-field success. Specific physique traits are associated with performance; therefore body composition assessment is routinely undertaken in elite environments. This study aimed to quantify preseason physique changes in elite RU athletes with unique morphology and divergent ethnicity. Twenty-two White and Polynesian professional RU athletes received dual-energy X-ray absorptiometry assessments at the beginning and conclusion of an 11-week preseason. Interactions between on-field playing position and ethnicity in body composition adaptations were explored, and the least significant change model was used to evaluate variations at the individual level. There were no combined interaction effects with the variables position and ethnicity and any body composition measure. After accounting for baseline body composition, Whites gained more lean mass during the preseason than Polynesians (2,425 ± 1,303 g vs. 1,115 ± 1,169 g; F = 5.4, p = .03). Significant main effects of time were found for whole body and all regional measures with fat mass decreasing (F = 31.1-52.0, p < .01), and lean mass increasing (F = 12.0-40.4, p < .01). Seventeen athletes (nine White and eight Polynesian) had a reduction in fat mass, and eight athletes (six White and two Polynesian) increased lean mass. This study describes significant and meaningful physique changes in elite RU athletes during a preseason period. Given the individualized approach applied to athletes in regard to nutrition and conditioning interventions, a similar approach to that used in this study is recommended to assess physique changes in this population.