Microvascular endothelial dysfunction in heart failure patients: An indication for exercise treatment?

BACKGROUND: Endothelial dysfunction represents a diagnostic marker to differentiate disease severity in chronic heart failure (CHF) patients. Retinal vessel phenotyping was applied in CHF patients as it has been acknowledged as a sensitive diagnostic tool to quantify microvascular health and overall cardiovascular risk. METHODS: The central retinal arteriolar (CRAE) and venular diameter equivalents (CRVE) as well as the retinal microvascular function, quantified by arteriolar (aFID) and venular flicker-light induced dilatation (vFID), were analyzed in 26 CHF patients. These data were compared with 26 age- and sex-matched healthy peers. The effects of an exercise intervention on retinal microvascular health in one CHF patient were investigated to demonstrate potentially beneficial effects of exercise treatment in a case report format as proof of concept. RESULTS: CHF patients showed narrower CRAE (170 ± 16 µm vs. 176 ± 16 µm, p = 0.237) and wider CRVE (217 ± 20 µm vs. 210 ± 17 µm, p = 0.152), resulting in a significantly lower arteriolar-to-venular diameter ratio (AVR, 0.79 ± 0.07 vs. 0.84 ± 0.06, p = 0.004) compared to controls. More strikingly, CHF patients showed significantly lower mean aFID (1.24 ± 1.14% vs. 3.78 ± 1.85%, p < 0.001) and vFID (2.89 ± 1.33% vs. 3.88 ± 1.83%, p = 0.033). Twelve weeks of exercise therapy induced wider CRAE (143 ± 1.0 µm vs. 153 ± 0.9 µm), narrower CRVE (183 ± 3.1 µm vs. 180 ± 2.4 µm) and improved aFID (0.67% vs. 1.25%) in a male 78 years old CHF patient. CONCLUSIONS: aFID is a sensitive diagnostic tool to quantify microvascular impairments in CHF patients. Exercise treatment in CHF patients has high potential to improve retinal microvascular health as a marker for vascular regeneration and overall risk reduction, which warrants further examination by randomized controlled trials.

Programming and supervision of resistance training leads to positive effects on strength and body composition: results from two randomised trials of community fitness programmes.

BACKGROUND: Many sedentary adults have high body fat along with low fitness, strength, and lean body mass (LBM) which are associated with poor health independently of body mass. Physical activity can aid in prevention, management, and treatment of numerous chronic conditions. The potential efficacy of resistance training (RT) in modifying risk factors for cardiovascular and metabolic disease is clear. However, RT is under researched in public health. We report community-based studies of RT in sedentary (Study 1), and overweight and pre-diabetic (Study 2) populations. METHODS: Study 1 - A semi randomised trial design (48-weeks): Participants choosing either a fitness centre approach, and randomised to structured-exercise (STRUC, n = 107), or free/unstructured gym use (FREE, n = 110), or not, and randomised to physical-activity-counselling (PAC, n = 71) or a measurement only comparator (CONT, n = 76). Study 2 - A randomised wait list controlled trial (12-weeks): Patients were randomly assigned to; traditional-supervised-exercise (STRUC, n = 30), physical-activity-counselling (PAC, n = 23), either combined (COMB, n = 39), or a wait-list comparator (CONT, n = 54). Outcomes for both were BF mass (kg), LBM (kg), BF percentage (%), and strength. RESULTS: Study 1: One-way ANCOVA revealed significant between group effects for BF% and LBM, but not for BF mass or strength. Post hoc paired comparisons revealed significantly greater change in LBM for the STRUC group compared with the CONT group. Within group changes using 95%CIs revealed significant changes only in the STRUC group for both BF% (- 4.1 to - 0.9%) and LBM (0.1 to 4.5 kg), and in FREE (8.2 to 28.5 kg) and STRUC (5.9 to 26.0 kg) for strength. Study 2: One-way ANCOVA did not reveal significant between group effects for strength, BF%, BF mass, or LBM. For strength, 95%CIs revealed significant within group changes for the STRUC (2.4 to 14.1 kg) and COMB (3.7 to 15.0 kg) groups. CONCLUSION: Strength increased in both studies across all RT treatments compared to controls, yet significant improvements in both strength and body-composition occurred only in programmed and/or supervised RT. As general increases in physical activity have limited impact upon body-composition, public health practitioners should structure interventions to include progressive RT. TRIAL REGISTRATION: Study 1: ISRCTN13024854 , retrospectively registered 20/02/2018. Study 2: ISRCTN13509468 , retrospectively registered 20/02/2018).

Response of Central Nervous System Biomolecules and Systemic Biomarkers to Aerobic Exercise Following Concussion: A Scoping Review of Human and Animal Research.

The purpose of this study was to identify the response of biomolecules and biomarkers that are associated with the central nervous system to aerobic exercise in human and pre-clinical models of concussion or mild traumatic brain injury (TBI), and to highlight the knowledge gaps in the literature. A systematic scoping review was conducted following a search of EMBASE, MEDLINE, SCOPUS, BIOSIS, and Cochrane Libraries performed on September 8, 2023 (from data base inception). The scoping review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Duplicates were removed and article screening was performed using an online systematic review management system. The search resulted in a total of 2,449 articles being identified, with 14 articles meeting the inclusion/exclusion criteria and having their data extracted. One study was conducted in humans, while the remainder of identified studies utilized murine models. The current literature is limited and evaluated many different biomolecules and biomarkers with brain-derived neurotrophic factor being the most researched. Further studies on this topic are needed to better understand the biomarker response to exercise after concussion and mild TBI, especially in the human population.

Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments.

Background: The back pain screening tool Risk-Prevention-Index Social (RPI-S) identifies the individual psychosocial risk for low back pain chronification and supports the allocation of patients at risk in additional multidisciplinary treatments. The study objectives were to evaluate (1) the prognostic validity of the RPI-S for a 6-month time frame and (2) the clinical benefit of the RPI-S. Methods: In a multicenter single-blind 3-armed randomized controlled trial, n = 660 persons (age 18-65 years) were randomly assigned to a twelve-week uni- or multidisciplinary exercise intervention or control group. Psychosocial risk was assessed by the RPI-S domain social environment (RPI-SSE) and the outcome pain by the Chronic Pain Grade Questionnaire (baseline M1, 12-weeks M4, 24-weeks M5). Prognostic validity was quantified by the root mean squared error (RMSE) within the control group. The clinical benefit of RPI-SSE was calculated by repeated measures ANOVA in intervention groups. Results: A subsample of n = 274 participants (mean = 38.0 years, SD 13.1) was analyzed, of which 30% were classified at risk in their psychosocial profile. The half-year prognostic validity was good (RMSE for disability of 9.04 at M4 and of 9.73 at M5; RMSE for pain intensity of 12.45 at M4 and of 14.49 at M5). People at risk showed significantly stronger reduction in pain disability and intensity at M4/M5, if participating in a multidisciplinary exercise treatment. Subjects at no risk showed a smaller reduction in pain disability in both interventions and no group differences for pain intensity. Regarding disability due to pain, around 41% of the sample would gain an unfitted treatment without the back pain screening. Conclusion: The RPI-SSE prognostic validity demonstrated good applicability and a clinical benefit confirmed by a clear advantage of an individualized treatment possibility.

Biceps Disorder Rehabilitation for the Athlete: A Continuum of Moderate- to High-Load Exercises.

BACKGROUND: Progressive biceps loading is recommended in the nonoperative and operative rehabilitation of biceps-related disorders. Previous researchers have proposed a continuum of exercises with low to moderate biceps loads to be used in the early and intermediate phases of rehabilitation. A progression of exercises with moderate to high biceps loads to be used in the more advanced phases of rehabilitation is lacking. PURPOSE: To describe a progression of exercises with progressive moderate to high loads on the biceps brachii (BB) based on electromyographic (EMG) analysis. STUDY DESIGN: Controlled laboratory study. METHODS: The EMG activity of BB and triceps brachii; upper trapezius, middle trapezius, and lower trapezius; and serratus anterior was determined with surface electromyography in 30 asymptomatic participants during 11 exercises. RESULTS: Of the 11 exercises, 4 (arm shake with an Xco-trainer, lateral pull-down in pronation, chest shake with an Xco-trainer, lateral pull-down in supination) showed low (<20% maximal voluntary isometric contraction [MVIC]), 5 (pull-up in pronation with Redcord, air punch, forward flexion in supination, pull-up in supination with Redcord, inclined biceps curl) showed moderate (between 20%-50% MVIC), and 2 (throwing forward flexion, reverse punch) showed high (>50% MVIC) EMG activity in the BB. These exercises were ranked with an increasing level of activity in the BB. CONCLUSION: The continuum of exercises with moderate to high biceps activity may be applied in the more advanced phases of treatment for biceps disorders. In addition, biceps muscle activity may be targeted by (1) sagittal plane elevation; (2) elbow flexion with supination, without upper arm support; (3) biceps contraction from an elongated position; or (4) high-velocity, explosive exercises. CLINICAL RELEVANCE: These findings may assist clinicians to select appropriate exercises to be used in the more advanced phases of nonoperative or postoperative rehabilitation of overhead athletes with biceps-related injuries.

Efficacy of wearing compression garments during post-exercise period after two repeated bouts of strenuous exercise: a randomized crossover design in healthy, active males.

BACKGROUND: The efficacy of wearing [a] compression garment (CG) between repeated bouts of exercise within a same day has not been fully understood. The present study determined the effect of wearing a CG after strenuous exercise sessions (consisting of sprint exercise, resistance exercise, drop jump) twice a day on exercise performance, muscle damage, and inflammatory responses. METHODS: Eleven physically active males (age, 22.7 ± 0.9 years; height, 175.7 ± 6.7 cm; body mass, 73.6 ± 10.2 kg; BMI, 23.8 ± 2.7 kg/m2) performed two trials (a randomized crossover design), consisting of the trial with either wearing a whole-body CG during post-exercise period (CG trial) or the trial with wearing a normal garment without specific pressure (CON trial). Two exercise sessions were conducted in the morning (09:00-10:00, Ex1) and afternoon (14:00-15:00, Ex2). Immediately after completing 60 min of each exercise, the subjects in the CG trial changed into a whole-body CG. Time-course changes in exercise performance (bench press power, jump performances, repeated sprint ability), blood variables (lactate, glucose, myoglobin, creatine kinase, interleukin-6, leptin), and scores of subjective feeling (fatigue, muscle soreness) were compared between the CG and CON trials before Ex1 (8:40), immediately before Ex2 (14:00, 4 h after Ex1), 4 h after Ex2 (19:00), and 24 h after the onset of Ex1 (9:00). RESULTS: Two bouts of exercise significantly decreased performances of counter movement jump (main effect for time: P = 0.04, F = 3.75, partial η 2 = 0.27) and rebound jump (main effect for time: P = 0.00, F = 12.22, partial η 2 = 0.55), while no significant difference was observed between the two trials (interaction: P = 0.10, F = 1.96, partial η 2 = 0.16 for counter movement jump, P = 0.93, F = 0.01, partial η 2 = 0.001 for rebound jump). Repeated sprint ability (power output during 10 × 6 s maximal sprint, 30-s rest periods between sprints) did not differ significantly between the two trials at any time points. Power output during bench press exercise was not significantly different between the two trials (interaction: P = 0.46, F = 0.99, partial η 2 = 0.09 for Ex1, P = 0.74, F = 0.38, partial η 2 = 0.04 for Ex2, P = 0.22, F = 1.54, partial η 2 = 0.13 for 24 h after the onset of Ex1). Serum myoglobin, creatine kinase, leptin, and plasma interleukin-6 were not significantly different between the two trials (interaction: P = 0.16, F = 2.23, partial η 2 = 0.18 for myoglobin; P = 0.39, F = 0.81, partial η 2 = 0.08 for creatine kinase; P = 0.28, F = 1.30, partial η 2 = 0.13 for leptin; P = 0.34, F = 1.05, partial η 2 = 0.12 for interleukin-6). Muscle soreness at 24 h during post-exercise period was significantly lower in the CG trial than in the CON trial for pectoralis major muscle (P = 0.04), while the value was inversely lower in the CON trial for hamstring (P = 0.047). CONCLUSIONS: Wearing a whole-body CG during the post-exercise period after two bouts of strenuous exercise sessions separated with 4 h of rest did not promote recovery of muscle function for lower limb muscles nor did it attenuate exercise-induced muscle damage in physically active males.

Arthroscopic decompression not recommended in the treatment of rotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of ten years.

AIMS: Rotator cuff tendinopathy has a multifactorial origin. Rejecting the mechanistic theory has also led to abandoning operative treatment at initial presentation in the first line. Physiotherapy exercise programmes are the accepted first line treatment. The aim of this study was to assess the long-term additional benefits of subacromial decompression in the treatment of rotator cuff tendinopathy. PATIENTS AND METHODS: This randomised controlled trial of 140 patients (52 men, 88 women, mean age 47.1 years; 18 to 60) with rotator cuff tendinopathy extended previous work up to a maximum of 13 years. The patients were randomised into two treatment groups: arthroscopic acromioplasty and a supervised exercise treatment and a similar supervised exercise treatment alone. Self-reported pain on a visual analogue scale (VAS) was the primary outcome measure. Secondary measures were disability, working ability, pain at night, Shoulder Disability Questionnaire score and the number of painful days during the three months preceding the final assessment. RESULTS: A total of 90 patients (64%) returned questionnaires at a mean 12 years after randomisation. On an intention-to-treat basis, both treatment groups reached statistically significant improvement compared with the initial VAS for pain, but there was no significant difference between groups. The same was true in the secondary outcome measures. Due to group changes, the results were also analysed per protocol: operated or not. No significant differences between the groups were found. CONCLUSION: The natural history of rotator cuff tendinopathy probably plays a significant role in the results in the long-term. Even though the patients who underwent operative treatment had a stronger belief in recovery, which is likely to be surgical and the effect of placebo, the exercise group obtained similar results. In the future, an optimum exercise regime should be searched for, as the most clinically and cost-effective conservative treatment for rotator cuff tendinopathy. Cite this article: Bone Joint J 2017;99-B:799-805.

Calprotectin levels in patients with rheumatoid arthritis to assess and association with exercise treatment.

Rheumatoid arthritis (RA) is a chronic, inflammatory, and autoimmune disease that can cause permanent joint damage. In our study, we aim to analyze the change in calprotectin levels following the low-density exercise levels applied to the patients with RA. Twenty-eight patients with RA and 30 healthy controls were included in this study. To evaluate the activity of disease in RA, scores of disease activity that has increased (DAS-28) are figured. Calprotectin, nitric oxide (NO), white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) levels are tested as the laboratory evaluation. Calprotectin, NO, CRP, ESR, WBC, and RF levels were significantly higher in the patient group compared to the control group (p < 0.01, p < 0.001, p < 0.01, p < 0.01, p < 0.01, and p < 0.05, respectively). In correlation analysis applied to the patient group with RA, there has been determined a positive relation with calprotectin, and DAS-28, CRP, NO, RF, and WBC (p < 0.001, p < 0.05, p < 0.001, p < 0.05, and p < 0.05, respectively). In result of the low-density exercise treatment applied to patients with RA for 8 weeks, there has been determined a significant decrease in calprotectin, DAS-28, NO, CRP, ESR, and RF levels (p < 0.05, p < 0.001, p < 0.01, p < 0.05, p < 0.05, and p < 0.05, respectively). As a result, a significant relation is found between RA disease activity and calprotectin levels and other inflammatory parameters. At the same time, it shows that calprotectin which is a significant indicator of local inflammation can be used as a good identifier in following up exercise treatment.

Efficient management design for swimming exercise treatment.

Exercise-mediated physical treatment has attracted much recent interest. In particular, swimming is a representative exercise treatment method recommended for patients experiencing muscular and cardiovascular diseases. The present study sought to design a swimming-based exercise treatment management system. A survey questionnaire was completed by participants to assess the prevalence of muscular and cardiovascular diseases among adult males and females participating in swimming programs at sport centers in metropolitan regions of country. Using the Fuzzy Analytic Hierarchy Process (AHP) technique, weighted values of indices were determined, to maximize participant clarity. A patient management system model was devised using information technology. The favorable results are evidence of the validity of this approach. Additionally, the swimming-based exercise management system can be supplemented together with analyses of weighted values considering connectivity between established indices.