Rethinking Prenatal and Postpartum Exercise

Physical Activity and Diabetes.

A Comparison of Aerobic Exercise and Resistance Training in Patients With and Without Chronic Kidney Disease

Pilon, R, Matos-Santos, L, Matlez, MP, Rodrigues, G, Amorim, F, Lattari, E, Farinatti, P, and Monteiro, W. Effects of isocaloric resistance, aerobic, and concurrent exercise on excess postexercise oxygen consumption in older adults. J Strength Cond Res 38(4): 755-761, 2024-Excess postexercise oxygen consumption (EPOC) is a major determinant of exercise-related caloric expenditure and metabolic adaptations. Exercise modality may influence the EPOC, but this issue has not been investigated in older adults. This study compared the EPOC after isocaloric bouts of continuous aerobic exercise (AE), resistance exercise (RE), and concurrent exercise (CE) in older individuals. Ten subjects (5 men; 73 ± 6 years) had their cardiorespiratory data assessed during AE, RE, and CE and along 30-minute postexercise recovery. Total energy expenditure (EE) during exercise was similar (p > 0.05) in AE (126.0 ± 30.7 kcal), RE (123.9 ± 30.6 kcal), and CE (130.8 ± 32.6 kcal), with different times to achieve the targeted EE (RE: 61.4 ± 1.9 minutes > CE: 43.3 ± 5.6 minutes > AE: 26.6 ± 5.7 minutes; p < 0.001). Consistently, the relative intensity during exercise was superior (p < 0.05) in AE (74 ± 15% oxygen uptake reserve [VO2R]) vs. CE (43 ± 13% VO2R) vs. RE (24 ± 9% VO2R). Despite the isocaloric conditions, average EPOC and EE were approximately 45% greater (p < 0.001) in AE (8.0 ± 2.3 L; 40.1 ± 11.7 kcal) vs. RE (5.6 ± 1.2 L; 28.1 ± 5.8 kcal) and CE (5.4 ± 2.3 L; 26.9 ± 11.5 kcal). In conclusion, the EPOC was greater after isocaloric AE vs. RE and CE performed by older adults. Exercise intensity seemed to be a more important determinant of EPOC than volume reflected by EE during exercise bouts. Moderate-intensity continuous AE was more time-efficient than RE and CE to achieve a target EE. In older individuals, AE should be preferred over RE or CE when the purpose is to increase the daily caloric expenditure.

Clawson LL, Cudkowicz M, Krivickas L, Brooks BR, Sanjak M, Allred P, Atassi N, Swartz A, Steinhorn G, Uchil A, Riley KM, Yu H, Shoenfeld DA, Maragakis NJ. A randomized controlled trial of resistance and endurance exercise in amyotrophic lateral sclerosis. Amyotrophic Lateral Scler Frontotemporal Degene. 2018;19(3–4):250–8.Amyotrophic lateral sclerosis (ALS) is classified as a neurodegenerative disease that results in destruction of motor neurons in the brain and spinal cord (1). The cause of this disease is unknown, with 90% of all cases being nonfamilial (1). As ALS progresses, it results in cachexia, loss of muscle mass and movement coordination, paralysis, and eventual death (1). It is estimated that 30,000 people in the US (1) and 1,400 people in Australia (2) are living with ALS.According to the American Academy of Neurology the current standard of care for persons with ALS includes static stretching and passive range of motion to offset muscle and joint stiffness caused by neurologic decline (3). Low powered studies and conflicting research results of the effect of resistance (weights lifting) and/or aerobic exercise on ALS have led to difficulty determining recommendations for these modes of exercise (3). Some researchers indicate that vigorous aerobic or intense resistance training may increase the risk of (4) or exacerbate the progression (3) of ALS. Because of this, some clinicians instruct patients to avoid these forms of exercise. On the contrary, authors of several studies in mice (5) and humans (6) suggest resistance and aerobic exercise have multiple benefits for ALS, including delayed onset of symptoms, slowed progression, and improved quality of life, without being a major risk factor (7). The aim of this study was to determine the tolerance and compliance of exercise when comparing resistance, aerobic, and stretching or passive range of motion exercises in persons with ALS.This 24-week, randomized controlled trial included persons with ALS who met these inclusion criteria: (a) classified as having lab-supported probable or definite ALS, confirmed by a neurologist and (b) willingness to participate in this study. Exclusion criteria were not mentioned. Due to difficulty with the recruitment of persons with ALS who were willing to perform exercises, this study began in April 2012, with the last participant enrolled in September 2015.Fifty-nine participants were randomly assigned to resistance training (n = 21), aerobic exercise (n = 18), or static stretching or passive range of motion [S-ROM] (n = 20). Tolerability was defined as each participant completing ≥50% of total repetitions assigned for resistance training and S-ROM and ≥50% of aerobic exercise duration programmed at a specific heart rate and perceived exertions scale (Borg 6–20) rating. Compliance was defined as each participant attempting ≥50% of all exercise sessions for the 24-week period. Broad compliance measures were implemented with anticipation of rapid progression of ALS and inability to perform higher intensity or longer duration exercise. As a result, broad compliance measures afforded participants greater consistency with exercise completion at each session. To improve retention and avoid travel to treatment center, home-based exercise was programmed for all participants. The participants' “home exercise partner” was initially trained by a physical therapist, and appropriate exercise form was evaluated at follow-up visits throughout the course of the intervention. Outcome measures included exercise compliance and tolerance with secondary measures, including ALS Functional Rating Scale-Revised, ALS Scale for Quality of Life-Revised (3), Fatigue Severity Scale, Ash-worth Spasticity Scale (6), and Visual Analog Scale. Follow-up measures were taken at weeks 12 and 24. Training logs and teleconferences were used to track at-home exercise compliance and tolerance.All groups performed 3 exercise sessions per week. Resistance training included 2 sets of 8 repetitions with use of ankle or wrist weights. Initial intensity was 40% 1 repetition maximum (1RM) and was increased to 50% 1RM at week 4 and 70% 1RM at week 6. 1RM testing was conducted at baseline. Aerobic exercise included the use of a minicycle with 10 min of upper and lower body cycling, respectively, at 50%–70% heart rate reserve and 13–15 on the Borg scale. S-ROM exercise included 4 sets of 30-second static stretches for each exercise. For a list of exercises, see the Supplemental Material (https://www.tandfonline.com/doi/suppl/10.1080/21678421.2017.1404108).Analysis of all primary and secondary outcomes was conducted at 12 and 24 weeks. Over the course of the study, there were 4 serious adverse events resulting in withdrawal from the study, none of which were deemed a direct result of the exercise intervention or resulted in death. In addition, another 11 participants were lost to follow up (n = 4), co-enrollment in another study (n = 1), difficulty with travel (n = 1), or complication associated with disease progression (n = 2). Minor adverse events that are frequently seen in persons with ALS included musculoskeletal injury, fatigue, and falling, which did not differ between the groups.When assessing the proportion of participants that were able to tolerate exercise, the S-ROM, resistance, and aerobic groups were 77%, 65%, and 51% compliant. These results indicated all 3 modes of exercise are well tolerated by persons with ALS and safe to perform, with greatest compliance occurring in the S-ROM and resistance groups. There were no differences at 12 or 24 weeks regarding any of the secondary measures, which suggests that resistance and aerobic training did not exacerbate or cause accelerated progression of disease, reduce quality of life, or increase fatigue in this sample of participants.This is one of the first studies to demonstrate that resistance and aerobic exercise is safe and well tolerated for persons with ALS, and compliance with resistance training is comparable with standard care (S-ROM). The findings of this study are supported by previous researchers (6,8) that demonstrate short-term improvement in disability associated with supervised resistance and aerobic training. It is possible that differences in exercise adherence can be attributed to the intensity parameters being too low for resistance training or too high for aerobic training, resulting in lower compliance rates associated with the S-ROM, respectively. Future researchers will need to focus on specific frequency, intensity, type, and volume of exercise programming for the management of ALS. Although the clinical exercise physiologist should interpret the results of this study with caution, the use of resistance and aerobic training should be considered as a management technique for patients diagnosed with ALS.Quinn L, Hamana K, Kelson M, Dawes H, Collett J, Townsen J, Raymund R, van der Plas AA, Reilmann R, Frich JC, Rickards H, Rosser A, Busse M. A randomized, controlled trial of a multi-modal exercise intervention in Huntington's disease. Parkinsonism Relat Disord. 2016;31:4–52.Huntington's disease (HD) is a genetically linked neurodegenerative disease that is progressive and results in neuronal damage to the substantia nigra and cerebral cortex of the brain (1). HD is associated with nonmotor symptoms such as cognitive impairment, dementia, memory loss, and disorientation, as well as motor symptoms including chorea (irregular or rapid) and athetosis (slow or writhing involuntary) movements of the hands, feet, face, and trunk (1). Currently, there are approximately 30,000 people in the US (1) and 1,500 people in Australia (2) who are living with HD.The effectiveness of exercise as a management technique for HD is a relatively new research focus with limited studies. It is suggested that multimodal rehabilitation programs can improve physical function, quality of life (3), and possibly cognition (4) in persons with HD. Many challenges exist with determining the effectiveness of exercise-based interventions on HD, including level of supervision, appropriately programmed intensity, variability of cognitive impairment, exercise preference or tolerance, and comfort with exercise settings (5,6). These factors can lead to reduced initiation and adherence to exercise for persons with HD. Therefore, the aim of this study is to determine the effectiveness of a multimodal exercise program on persons with mild to moderate HD to determine safety, feasibility regarding retention and adherence, and improvement of physical fitness, motor control, physical function, and cognition.This was a randomized, controlled, multicenter trial, that assigned 32 of 312 screened participants to an exercise (n = 17) or control (n = 15) group for a 12-week intervention and 26-week follow up. Inclusion criteria were (a) genetically confirmed cases of HD, (b) ≥18 years of age, and (c) stable medication regime of antichoreic drugs for 4 weeks. Participants were excluded if they were (a) unable to use an exercise bike, (b) had psychological or physical limitation precluding exercise testing, and (c) currently in an exercise program. All participants who met inclusion criteria were screened for cardiovascular risk factors and underwent electrocardiogram testing to ensure safety with initiation of exercise.The control (CT) group was instructed to carry on with normal activity for the full duration of the intervention. Participants in the exercise (EX) group participated in three 50-min exercise sessions per week for a total of 12 weeks. Follow-up assessment occurred at week 13 and was compared with the baseline. Exercise included 25 min of cycling at 55%–85% age-predicted maximum heart rate (APMHR), 10–15 min of resistance training (2 sets of 15 repetitions), and 5 min of static stretching. For full details on the exercise program, see the Supplemental Material (https://www.prd-journal.com/article/S1353-8020(16)30243-7/fulltext#supplementaryMaterial). Participants could choose between their home or a medical fitness center to perform the exercise. An exercise professional provided gym-based supervision and at-home exercise for all 3 sessions during weeks 1–2, which was then tapered to 2 sessions for weeks 3–6, and 1 session for the final 6 weeks.Primary outcome measures included retention (completion of intervention) and adherence (completion of sessions), which was predetermined as &gt;75% of supervised and unsupervised sessions and maintaining APMHR intensities for &gt;75% (19/25 min) of the cycling duration. A series of secondary measures were also collected at baseline and follow-up assessment to determine improvement in motor control, quality of life, and physical and cognitive function (7–10).Three participants from the EX group dropped out before the 13-week assessment due to concomitant conditions, and 10 (n = 5 EX and n = 5 CT) were unable to be contacted at the 26-week period. Two serious adverse events occurred in the CT group, both attempted suicides, with 1 possibly being related to the week 13 assessment. A total of 97% of the EX group completed the intervention. Ninety-three percent of the EX group were able to complete the required sessions of the intervention, with only 75% achieving APMHR at each exercise session. Blunted heart rate response can be attributed to autonomic dysfunction commonly associated with HD, resulting in the inability to reach a predetermined percentage for APMHR (1). The EX and CT groups showed no differences in fall occurrence, suggesting that supervised exercise does not incur a greater fall risk in this population.The EX group improved aerobic fitness (VO2 MAX), motor function, and reduced body weight compared with the CT group. A reduced body weight may not be considered a positive finding because HD can lead to rapid weight loss in some people, resulting in cachexia and negative health outcomes (11). Follow-up assessment at 26 weeks indicated that all EX participants returned to low levels of physical activity after the intervention was terminated, and there were no differences in measured health outcome between groups.This is the first study to demonstrate that a multimodal exercise program is safe and that persons with mild to moderate HD can adhere to exercise with and without supervision and in different settings. The authors of this study showed improvement in aerobic fitness and motor control, but no improvement in strength, physical function, or cognition, which can all reduce quality of life in persons with HD (3). The exclusion of those with cognitive deficit and mental health disease, which is commonly associate with HD, may have resulted in reduced applicability of this study. The resistance training protocol may have used an intensity and/ or volume that was too low for improvement in strength. Future researchers might investigate the effects of resistance versus aerobic training and allow for a more robust sample of participants with and without HD-related cognitive impairment. The clinical exercise physiologist should encourage persons with HD to remain physically active using a multimodal program when safe and appropriate for an individual.The current Research Highlights editor would like to thank the JCEP Editorial Board for the opportunity to contribute this journal by authoring the Research Highlights for the past several years. We welcome Dr. Elizabeth O'Neill, DPE (Springfield College, Springfield, MA) as the new Research Highlights editor.

Importance:Little evidence exists on which exercise modality is optimal for obese adolescents. Objective: To determine the effects of aerobic training, resistance training, and combined training on percentage body fat in overweight and obese adolescents.Design, Setting, and Participants:Randomized, parallel-group clinical trial at community-based exercise facilities in Ottawa (Ontario) and Gatineau (Quebec), Canada, among previously inactive postpubertal adolescents aged 14-18 years (Tanner stage IV or V) with body mass index at or above the 95th percentile for age and sex or at or above the 85th percentile plus an additional diabetes mellitus or cardiovascular risk factor. Interventions: After a 4-week run-in period, 304 participants were randomized to the following 4 groups for 22 weeks: aerobic training (n = 75), resistance training (n = 78), combined aerobic and resistance training (n = 75), or nonexercising control (n = 76). All participants received dietary counseling, with a daily energy deficit of 250 kcal.Main Outcomes and Measures:The primary outcome was percentage body fat measured by magnetic resonance imaging at baseline and 6 months. We hypothesized that aerobic training and resistance training would each yield greater decreases than the control and that combined training would cause greater decreases than aerobic or resistance training alone.Results:Decreases in percentage body fat were −0.3 (95% CI, −0.9 to 0.3) in the control group, −1.1 (95% CI, −1.7 to −0.5) in the aerobic training group (p = .06 vs. controls), and −1.6 (95% CI, −2.2 to −1.0) in the resistance training group (p = .002 vs controls). The −1.4 (95% CI, −2.0 to −0.8) decrease in the combined training group did not differ significantly from that in the aerobic or resistance training group. Waist circumference changes were −0.2 (95% CI, −1.7 to 1.2) cm in the control group, −3.0 (95% CI, −4.4 to −1.6) cm in the aerobic group (p = .006 vs controls), −2.2 (95% CI −3.7 to −0.8) cm in the resistance training group (p = .048 vs controls), and −4.1 (95% CI, −5.5 to −2.7) cm in the combined training group. In per-protocol analyses (&gt; 70% adherence), the combined training group had greater changes in percentage body fat (-2.4, 95% CI, −3.2 to −1.6) vs the aerobic group (-1.2; 95% CI, −2.0 to −0.5; p = .04 vs the combined group) but not the resistance group (-1.6; 95% CI, −2.5 to −0.8).Conclusions and Relevance:Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.

The Diabetes Aerobic and Resistance Exercise trial found that aerobic training and resistance training alone each reduced hemoglobin A1c (HbA1c) compared with nonexercising controls, and combined aerobic and resistance training caused greater HbA1c reduction than either training type alone. Our objective was to determine whether a dose-response relationship existed between frequency of exercise training and HbA1c change, and whether this varied by exercise modality or participant characteristics. Post hoc analysis of data from 185 Diabetes Aerobic and Resistance Exercise trial participants with type 2 diabetes randomized to aerobic, resistance or combined training thrice weekly. Dose-response relationships between adherence (percent of prescribed training sessions completed) and HbA1c change were assessed with linear regression. Median overall adherence was 84.9% (interquartile range, 74.4%-93.6%). Higher exercise adherence was associated with greater HbA1c reduction; a 20% increase in adherence (e.g., an additional two sessions per month) was associated with a 0.15% (2 mmol·mol) decrease in HbA1c (β = -0.0076, R = -0.170, P = 0.021). Significant dose-response relationships were identified for aerobic (β = -0.0142, R = -0.313, P = 0.016) and combined training (β = -0.0109, R = -0.259, P = 0.041), but not resistance training (β = 0.0068, R = 0.153, P = 0.233). Dose-response relationships in all training groups combined were significant in subgroups younger than 55 yr (β = -0.0113, R = -0.286, P = 0.005), males (β = -0.0123, R = -0.234, P = 0.010), and baseline HbA1c ≥7.5% (58 mmol·mol) (β = -0.013, R = -0.263, P = 0.011). There was a dose-response relationship between adherence to prescribed exercise and HbA1c reduction suggesting that glycemic control is improved more in individuals with type 2 diabetes with a higher training volume. Dose-response relationships existed for aerobic and combined training but not resistance training. These findings support aerobic and combined exercise prescriptions outlined in clinical practice guidelines.

Background: Physical inactivity is highly prevalent in patients with hemodialysis, and a large body of evidence reported the positive effect of different exercise modalities on their health outcomes. However, the effective dosage of exercise for hemodialysis patients still requires verification.Objective: We aimed to determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for hemodialysis patients.Design: Systematic review with network meta-analysis of randomized trials.Data sources: Five electronic databases (PubMed, EMBASE, Web of Science, Cochrane CENTRAL, and Scopus) were searched for randomized controlled trials. Data extraction and quality appraisal were conducted by two authors independently. Data were analyzed by the R (version.3.6.2) and the Stata (version.15.0).Result: We included 1893 patients involving four exercise modalities and six exercise intensities. Combined training (aerobic exercise plus resistance exercise) has been the top-ranking exercise modality for improving the 6-min walk test (6MWT) (surface under the cumulative ranking curve analysis (SUCRA) score, 90.63), systolic blood pressure control (SUCRA score, 77.35), and diastolic pressure control (SUCRA score, 90.56). Moreover, the top-ranking exercise intensity was moderate–vigorous for 6MWT (SUCRA score, 82.36), systolic blood pressure (SUCRA score, 77.43), and diastolic blood pressure (SUCRA score, 83.75). Regarding dialysis adequacy and health-related quality of life, we found no exercise modality or intensity superior to the placebo.Conclusion: This network meta-analysis indicated that combined training and moderate–vigorous intensity might be the most effective interventions to improve 6MWT and blood pressure control. This finding helps further guide clinical exercise prescriptions for hemodialysis patients.Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021268535].

The Clinical Utility of Neuromotor Exercise as Antihypertensive Lifestyle Therapy.

Exercise has been shown to be a beneficiary in pts with systolic heart failure. Yet little data regarding heart failure with preserved ejection fraction (HFPEF) are available. We compare the influence of two exercise modalities on cardiac parameters and functional status in pts with HFPEF. Methods: 139 pts with HFPEF NYHA IV, 65±12 years (43 female) were randomized to three groups in order to receive resistance (RT, n=47) or aerobic (AT, n=47) training for 4 weeks or passive group (PG, n=45). Medications (ACEI, β-blockers, Ca2+ channel lockers, diuretics) were evenly distributed in groups. The study started after one week pre-training adaptation. Aerobic training (AT) was performed on treadmill four times per week with 30 min duration (excluding 5 min warm up and cooling down) and 70% maximum oxygen uptake. Resistance training (RT) was implemented as a weight lifting of 10 predetermined exercises of the upper and the lower body (2 set of 10 repetitions) for the same duration and frequency with the intensity of 50% of the one repetition maximum. EchoCG parameters as EF, indexes of LV EDV, ESV, maximal LA volume (LAVI), E/Em septal, LV diastolic wall strain (DWS) as (PWs – PWd)/PWs, as well as NTproBNP levels were obtained at the onset and the end of the study. Baseline parameters were comparable between groups. Results: Both exercises interventions significantly improve E/Em and NTproBNP levels compare to baseline and PG end-study parameters which remained unchanged (E/Em: AT 13.9±2.2 vs 11.6±1.3, p<0.05; RT: 13.7±2.1 vs 9.4±1.2, p<0.03; NTproBNP: AT 1592±193 vs 923±62 pg/ml, p<0.05; RT 1587±191 vs 531±37 pg/ml, p<0.02) without changes in EF, EDVI and ESVI. The RT group reduced E/EM, NTproBNP in greater degree compared with AT group (E/Em 11.6±1.3 vs 9.4±1.2, p<0.05; NTproBNP 923±62 vs 531±37 pg/ml, p<0.05). Also in RT group LAVI reduced in a greater degree compare with AT (29±4 vs 34±6, p<0.05) whereas in PG remained unchanged. DWS significantly improved in both AT and RT to a greater degree in RT (0.37±0.3 vs 0.31±0.2, p<0.05) without changes in PG. 37 pts (78%) in RT and 38 pts (80%) in AT improved their functional status compare with baseline as assessed on 9 min self-powered treadmill test peak VO2 consumption (AT: 13.7±1.4 to 18.3±1.6 ml/kg/min, p<0.05; RT: 13.6±1.4 to 18.6±1.7 ml/kg/min, p<0.05). Conclusion: Both exercise modalities are beneficial in hypertensive pts with HFPEF. RT appears to be a better choice probably because of better improvement of LV diastolic function and alteration of LA remodeling.

We compared the effects of aerobic exercise, resistance exercise, and combined aerobic and resistance exercise on total, regional subcutaneous adipose tissue (SAT) and visceral AT (VAT), skeletal muscle (SM), and biomarkers of cardiovascular disease in adolescents. Adolescents with overweight/obesity (N = 118; body mass index ≥ 85th percentile; age, 12-17 years) were randomized to 1 of the following groups for 6 months (3 days/week, 180 min/week): aerobic exercise (n = 38), resistance exercise (n = 40), or combined aerobic and resistance exercise (n = 40). After accounting for age, sex, and baseline value, there was a greater (P < 0.05) reduction in body weight in the aerobic exercise group compared with the resistance exercise group and the combined groups. There were reductions (P < 0.05) in total and regional SAT within the aerobic exercise group only, and the reductions in lower-body SAT were greater (P = 0.02) than the combined group. All groups had reductions (P < 0.01) in VAT, with no group differences. There were significant increases in total and regional SM mass in the resistance exercise and combined group, and not in the aerobic exercise group. Although all exercise modalities are effective in reducing VAT, aerobic exercise is superior at reducing total and regional SAT, but inferior for increasing SM in adolescents with obesity. Despite reductions in VAT, carotid-femoral pulse wave velocity and carotid intima-media thickness did not improve with either exercise. Clinicaltrials.gov identifier: NCT01938950. Novelty Regular exercise (180 min/week) is associated with reductions in visceral fat independent of exercise modality. Resistance exercise alone and combined resistance and aerobic exercise are similarly effective in increasing SM mass.

To the Editor: The meta-analysis of exercise interventions in type 2 diabetes by Mr Umpierre and colleagues concluded that “aerobic, resistance, and combined training are each associated with HbA1c decreases.” However, we are not convinced that “the magnitude of this reduction is similar across the 3 exercise modalities.” Key factors likely to influence the magnitude of hemoglobin A1c (HbA1c) reduction achieved by a glucoselowering intervention include baseline HbA1c and use of an intention-to-treat analysis. When baseline HbA1c is higher, greater reductions are likely to be achieved. Six of the 20 aerobic exercise trials had baseline HbA1c greater than 8.5% vs none of the trials evaluating combined aerobic and resistance training. Six of the 20 aerobic exercise trials included more than 3 weekly exercise sessions vs none of the resistance exercise studies and only 1 combined exercise study. When intention-to-treat analyses are performed, smaller HbA1c reductions are likely to be observed than in analyses that exclude subjects who drop out. Among the aerobic exercise studies, only 2 of 20 trials used intention-to-treat analyses; these 2 trials included 132 of 490 subjects (27%) performing only aerobic exercise. Among trials evaluating combined exercise, 2 of 7 trials used intention-to-treat analyses; these included 140 of 261 participants (54%) performing combined exercise. Therefore, bias introduced by aerobic exercise–only studies having higher baseline HbA1c levels, greater exercise frequency, and proportionally fewer intention-to-treat analyses may have resulted in relative overestimation of the effect of aerobic exercise alone. The trials by Church et al and Sigal et al were the largest in the meta-analysis and were among the highest in methodological quality. Both used intention-to-treat analyses. Unlike most of the other studies, these trials included direct comparisons of combined aerobic and resistance training vs aerobic training alone. In both studies, combined training produced the strongest results. The Church et al study found that combined training, but not aerobic training, reduced HbA1c compared with controls, and combined training also resulted in greater decreases in body fat and increases in strength. The Sigal et al trial found that combined exercise resulted in a significantly greater decrease in HbA1c than aerobic training or resistance training alone (−0.97%, −0.51%, and −0.38% vs control, respectively). We think that the best evidence supports combined aerobic and resistance training as the most effective exercise regimen for improving glycemic control in people with type 2 diabetes.

Strategies for Increasing Physical Activity and Healthy Lifestyles for the Individual With Human Immunodeficiency Virus

Regular exercise training is recognized as a powerful tool to improve work capacity, endothelial function and the cardiovascular risk profile in obesity, but it is unknown which of high-intensity aerobic exercise, moderate-intensity aerobic exercise or strength training is the optimal mode of exercise. In the present study, a total of 40 subjects were randomized to high-intensity interval aerobic training, continuous moderate-intensity aerobic training or maximal strength training programmes for 12 weeks, three times/week. The high-intensity group performed aerobic interval walking/running at 85-95% of maximal heart rate, whereas the moderate-intensity group exercised continuously at 60-70% of maximal heart rate; protocols were isocaloric. The strength training group performed 'high-intensity' leg press, abdominal and back strength training. Maximal oxygen uptake and endothelial function improved in all groups; the greatest improvement was observed after high-intensity training, and an equal improvement was observed after moderate-intensity aerobic training and strength training. High-intensity aerobic training and strength training were associated with increased PGC-1alpha (peroxisome-proliferator-activated receptor gamma co-activator 1alpha) levels and improved Ca(2+) transport in the skeletal muscle, whereas only strength training improved antioxidant status. Both strength training and moderate-intensity aerobic training decreased oxidized LDL (low-density lipoprotein) levels. Only aerobic training decreased body weight and diastolic blood pressure. In conclusion, high-intensity aerobic interval training was better than moderate-intensity aerobic training in improving aerobic work capacity and endothelial function. An important contribution towards improved aerobic work capacity, endothelial function and cardiovascular health originates from strength training, which may serve as a substitute when whole-body aerobic exercise is contra-indicated or difficult to perform.

OBJECTIVE: To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. DESIGN: Network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: Seven electronic databases were systematically searched from inception to January 2022. STUDY SELECTION CRITERIA: Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. DATA SYNTHESIS: An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. RESULTS: Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. CONCLUSION: Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251.

BackgroundWith the increase in life expectancy, age-related cognitive decline has become a prevalent concern. Physical activity (PA) is increasingly being recognized as a vital non-pharmacological strategy to counteract this decline. This review aimed to (i) critically evaluate and synthesize the impact of different PA and exercise modalities (aerobic, resistance, and concurrent training) on cognitive health and overall well-being in older adults, (ii) discuss the influence of exercise intensity on cognitive functions, and (iii) elucidate the potential mechanisms through which PA and exercise may enhance or mitigate cognitive performance among older adults.Main BodyAn exhaustive analysis of peer-reviewed studies pertaining to PA/exercise and cognitive health in older adults from January 1970 to February 2025 was conducted using PubMed, Scopus, Web of Science, PsycINFO, and MEDLINE. There is compelling evidence that aerobic and resistance training (RT) improve cognitive function and mental health in older adults, with benefits influenced by the type and intensity of exercise. Specifically, moderate-intensity aerobic exercise appears to bolster memory, executive functions, and mood regulation, potentially through increased cerebral blood flow, neurogenesis, and production of brain-derived neurotrophic factors in the hippocampus. Moderate-to-high-intensity RT acutely enhances visuospatial processing and executive functions, with chronic training promoting neurogenesis, possibly by stimulating insulin-like growth factor-1 and augmenting blood flow to the prefrontal cortex. Findings related to the effects of concurrent training on cognitive function and mental health are heterogeneous, with some studies reporting no significant impact and others revealing substantial improvements. However, emerging evidence indicates that the combination of concurrent training and cognitive tasks (i.e., dual tasks) is particularly effective, often outperforming aerobic exercise alone.ConclusionsRegular aerobic and RT performance is beneficial for older adults to mitigate cognitive decline and enhance their overall well-being. Specifically, engaging in moderate-intensity aerobic exercises and moderate-to-high-intensity RT is safe and effective in improving cognitive function and mental health in this demographic. These exercises, which can be conveniently incorporated into daily routines, effectively enhance mental agility, memory, executive function, and mood. The findings related to concurrent training are mixed, with emerging evidence indicating the effectiveness of combined concurrent and cognitive tasks on cognitive health and well-being in older adults.Key Points- Moderate-intensity aerobic exercise is associated with significant improvements in cognitive function, mood regulation, and overall well-being in older adults. These benefits are linked to structural and functional changes in the brain such as increased hippocampal volume and elevated levels of brain-derived neurotrophic factor.- Moderate-to-high-intensity resistance training, both in acute and chronic forms, enhances cognitive performance in older adults, particularly in executive functions and visuospatial processing. Cognitive benefits, including improvements in information-processing speed, attention, and memory, can be sustained through regular training.- The effects of concurrent resistance and aerobic training on cognitive function in older adults are mixed. However, combining concurrent training with cognitive tasks (i.e., dual-task training) is particularly effective and often outperforms aerobic exercise alone.- Cognitive and well-being improvements from aerobic and resistance training are mediated by mechanisms such as increased cerebral blood flow and oxygen delivery, enhanced neurogenesis, reduced oxidative stress and inflammation, and positive hormonal changes.- While the optimal exercise dosage for promoting cognitive health in older adults remains undetermined, empirical evidence indicates a positive correlation between increased exercise dosage and cognitive health improvements.