Chronic Physical Activity Research Articles

Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries

BackgroundThere are no nationally representative population-based studies investigating the relationship between physical activity, chronic conditions and multimorbidity (i.e., two or more chronic conditions) in low- and middle-income countries (LMICs), and studies on a multi-national level are lacking. This is an important research gap, given the rapid increase in the prevalence of chronic diseases associated with lifestyle changes in these countries. This cross-sectional study aimed to assess the association between chronic conditions, multimorbidity and low physical activity (PA) among community-dwelling adults in 46 LMICs, and explore the mediators of these relationships.MethodsWorld Health Survey data included 228,024 adults aged ≥18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire (IPAQ). Nine chronic physical conditions (chronic back pain, angina, arthritis, asthma, diabetes, hearing problems, tuberculosis, visual impairment and edentulism) were assessed. Multivariable logistic regression and mediation analyses were used to assess the association between chronic conditions or multimorbidity and low PA.ResultsOverall, in the multivariable analysis, arthritis (OR = 1.12), asthma (1.19), diabetes (OR = 1.33), edentulism (OR = 1.46), hearing problems (OR = 1.90), tuberculosis (OR = 1.24), visual impairment (OR = 2.29), multimorbidity (OR = 1.31; 95% CI = 1.21–1.42) were significantly associated with low PA. More significant associations were observed in individuals aged ≥50 years. In older adults, depression mediated between 5.1% (visual impairment) to 23.5% (angina) of the association between a chronic condition and low PA. Mobility difficulties explained more than 25% of the association for seven of the eight chronic conditions. Pain was a strong mediator for angina (65.9%) and arthritis (64.9%), while sleep problems mediated up to 43.7% (angina) of the association.ConclusionsIn LMICs, those with chronic conditions and multimorbidity are significantly less physically active (especially older adults). Research on the efficacy and effectiveness of PA in the management of chronic diseases in LMICs is urgently needed. Targeted promotion of physical activity to populations in LMICs experiencing chronic conditions may ameliorate associated depression, mobility difficulties and pain that are themselves important barriers for initiating or adopting an active lifestyle.

Micro-longitudinal relation between chronic myalgia and daytime physical activity, sleepiness, and stress

Micro-longitudinal relation between chronic myalgia and daytime physical activity, sleepiness, and stress

Chronic Systemic Inflammation, Physical Activity and Skeletal Muscle in Elderly

PURPOSE: It t is hypothesized that chronic systemic inflammation is influenced by physical activity level and is involved in the age-related decline in muscle function. The impact of physical activ ...

Cross-sectional and prospective relationship between physical activity and chronic diseases in European older adults.

This study examined the relationship between physical activity (PA) and chronic diseases in European older adults, using a prospective analysis with data from 2011 and 2013. Participants were 37,524 older adults (16,204 men) who responded to the fourth (in 2011) and fifth (in 2013) wave of SHARE project, from 13 European countries. Participants' answers to interview questions about the presence of chronic conditions and PA. The cross-sectional and prospective association between PA and the number of chronic diseases was assessed using general linear models. Among men and women, moderate or vigorous physical activity (MVPA) in 2011 was associated with fewer reported chronic diseases in 2011 and 2013. In prospective analysis, MVPA in 2011 was inversely associated with the number of chronic diseases in 2013 in the unadjusted model. In the adjusted model MVPA more than once a week remained as a significant predictor of fewer chronic diseases. PA should be prescribed to older adults in order to prevent and reduce the number of chronic diseases, and, when possible, vigorous intensity PA should be recommended.

The Association between Physical Activity During the Day and Long-Term Memory Stability.

Despite positive associations between chronic physical activity and memory; we have little understanding of how best to incorporate physical activity during the day to facilitate the consolidation of information into memory, nor even how time spent physically active during the day relates to memory processes. The purpose of this investigation was to examine the relation between physical activity during the day and long-term memory. Ninety-two young adults learned a list of paired-associate items and were tested on the items after a 12-hour interval during which heart rate was recorded continuously. Although the percentage of time spent active during the day was unrelated to memory, two critical physical activity periods were identified as relating to the maintenance of long-term memory. Engaging in physical activity during the period 1 to 2-hours following the encoding of information was observed to be detrimental to the maintenance of information in long-term memory. In contrast, physical activity during the period 1-hour prior to memory retrieval was associated with superior memory performance, likely due to enhanced retrieval processing. These findings provide initial evidence to suggest that long-term memory may be enhanced by more carefully attending to the relative timing of physical activity incorporated during the day.

Abstract 13118: Urinary Sodium and Potassium Excretion are Associated With Blood Pressure among Adults in the United States

Introduction: One in three US adults has hypertension, a major risk factor for cardiovascular disease. We aimed to assess the associations between 24-h urinary excretion of sodium, potassium, and sodium-potassium ratio with blood pressure and hypertension status among US adults. Hypothesis: We hypothesized that urine sodium excretion and urine sodium-potassium ratio would be positively and urine potassium excretion would be inversely associated with blood pressure and hypertension. Methods: Cross-sectional data on up to two 24-h complete urine collections were analyzed from 765 non-institutionalized participants aged 20-69 y in the 2014 US National Health and Nutrition Examination Survey (NHANES). Urine collection started and stopped in the NHANES mobile examination center. Approximately half of participants had two complete collections; usual sodium and potassium excretion, and sodium-potassium ratio, were estimated using measurement error models accounting for day-to-day variability. Analyses adjusted for age, sex, race/ethnicity, body mass index, history of cardiovascular disease, diabetes, chronic kidney disease, smoking status, and physical activity, as well as the complex survey design. Results: In fully adjusted linear regression models, sodium excretion was positively associated with systolic (4.43 mmHg per 1000 mg/day, 95% CI 2.31,6.56) and diastolic (1.93 mmHg, 95% CI 0.34,3.51) blood pressure. Sodium-potassium ratio was also positively associated with systolic blood pressure (2.86 mmHg per .5 unit increase, 95% CI 1.15,4.56), and potassium excretion was inversely associated with systolic blood pressure (-3.39 mmHg per 1000mg/day increase, 95% CI -6.05,0.72). Adjusted odds ratios for hypertension, for excretion in the highest compared to the lowest quartiles, were 4.34 (95% CI 1.37,13.79) for sodium and 0.39 (95% CI 0.17,0.88) for potassium. Results were robust in sensitivity analyses restricted to persons not taking antihypertensive medications. Conclusions: Using a nationally-representative sample of US adults and a “gold-standard” urine biomarker, these data further support the strong relationship of higher sodium and lower potassium excretion with higher blood pressure and hypertension risk.

Using Physical Activity to Manage ADHD Symptoms:The State of the Evidence.

This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.

Does chronic physical activity level modify the airway inflammatory response to an acute bout of exercise in the postprandial period?

Recent studies have confirmed that a single high-fat meal (HFM) leads to increased airway inflammation. However, exercise is a natural anti-inflammatory and may modify postprandial airway inflammation. The postprandial airway inflammatory response is likely to be modified by chronic physical activity (PA) level. This study investigated whether chronic PA modifies the airway inflammatory response to an acute bout of exercise in the postprandial period in both insufficiently active and active subjects. Thirty-nine nonasthmatic subjects (20 active, 13 males/7 females) who exceeded PA guidelines (≥150 min moderate-vigorous PA/week) and 19 insufficiently active (6 males/13 females) underwent an incremental treadmill test to exhaustion to determine peak oxygen uptake. Subjects were then randomized to a condition (COND), either remaining sedentary (CON) or exercising (EX) post-HFM. Exercise was performed at the heart rate corresponding to 60% peak oxygen uptake on a treadmill for 1 h post-HFM (63% fat, 10 kcal/kg body weight). Blood lipids and exhaled nitric oxide (eNO: marker of airway inflammation) were measured at baseline and 2 h and 4 h post-HFM. Sputum differential cell counts were performed at baseline and 4 h post-HFM. The mean eNO response for all groups increased at 2 h post-HFM (∼6%) and returned to baseline by 4 h (p = 0.03). There was a time × COND interaction (p = 0.04), where EX had a greater eNO response at 4 h compared with CON. Sputum neutrophils increased at 4 h post-HFM (p < 0.05). These findings suggest that airway inflammation occurs after an HFM when exercise is performed in the postprandial period, regardless of habitual activity level.

Women's Health and Mindfulness (WHAM): A Randomized Intervention Among Older Lesbian/Bisexual Women.

Lesbian and bisexual (LB) women have higher body weight than heterosexual women. Interventions focused on health and well-being versus weight loss may be more likely to succeed among LB women. This article describes effects of Women's Health and Mindfulness, a 12-week pilot intervention addressing mindfulness, healthy eating, and physical activity, on outcomes associated with chronic disease risk among overweight and obese LB women older than 40 years. Eighty women were randomized, using a stepped-wedge design, to either an immediate- or a delayed-start intervention group; the delayed-start group served as the control. Eligible participants were aged 40 years or older, identified as LB, and had a body mass index of 27 or greater. We compared differences in biological markers of chronic disease, mindfulness, nutrition, and physical activity between immediate- and delayed-start intervention groups. We observed clinically significant improvements in low-density lipoprotein cholesterol but no change in hemoglobin A1c. We found evidence of intervention effects on improved mindfulness and mindful eating scores and on nutrition (improved vegetable intake). The Women's Health and Mindfulness pilot intervention appears to have initiated positive behavioral and physical health changes in this population. Refinements to the intervention model, such as extended intervention duration, and longer term follow-up are warranted to determine sustained effects.

Chronic intense physical activity changes the hormonal asset in female volleyball players

Background. Intense physical exercise influences the secretion of hormones involved in several metabolic processes. In particular, an acute cortisol (C) and growth hormone (GH) increase after an acute physical activity is widely demonstrated in literature. Moreover, the testosterone (T)/C ratio was recently proposed as a performance index in male athletes. On the contrary, little is known about hormonal changes in women under physical activity and only few studies evaluated the hormonal trend in an extended period of time.Aim. To evaluate the hormonal changes during an annual volleyball female regular season.Methodology. A longitudinal, retrospective, observational clinical trial was carried out. 28 female professional volleyball players belonging to the same team were enrolled. For each subject, blood samples were collected after 36 hours of rest in four visits. Visit 1 was performed at the beginning of the training phase, visit 2 and 3 were performed during and Visit 4 were performed at the end of the regular season. GH, insulin-like growth factor (IGF)-1, T and C were assessed by immunoenzimatic assays.Results. Both GH and IGF-1 were above the normal range at visit 1 (5.08 ± 5.22 ng/ml; 265.88 ± 105.85 ng/ml). In particular, five athletes had GH above the normal range (17.8%). No alterations of other hormones were found at Visit 1. C significantly changed during the regular season (p=0.009), with higher levels at Visit 2 (p=0.049), compared to visit 1 and the following visits. Similarly, T significantly changed during the season (p=0.013), even if a clear trend was not demonstrated. The post-hoc test showed two peaks of T at Visit 2 and Visit 4 (p=0.029 and p=0.024, respectively). Accordingly, the T/C ratio significantly changed during visits (p=0.009), decreasing of about 30% in the first phase of the regular season, suggesting an overreaching of subjects enrolled.Conclusion. Here we found that chronic intense physical activity influences hormonal levels in female volleyball players. In particular, C secretion is increased at the beginning of the regular season, whereas T serum levels shows a significant fluctuation during the regular season. Moreover, we suggest that T/C ratio could be useful in the evaluation of the training overload in female athletes.

More than one road leads to Rome: A narrative review and meta-analysis of physical activity intervention effects on cognition in youth

A growing body of research indicates that physical activity (PA) positively impacts cognitive function in youth. However, not all forms of PA benefit cognition equally. The purpose of this review was to determine the effect of different types of chronic PA interventions on cognition in children and adolescents. A systematic search of electronic databases and examination of the reference lists of relevant studies resulted in the identification of 28 studies. Seven categories of PA were identified, based on all possible combinations of three types of PA (aerobic, motor skill, cognitively engaging), and four comparison groups (no treatment, academic, traditional physical education (PE), aerobic). Effect sizes were calculated based on means and SDs at the post-test using Hedge’s g formula, which includes a correction for small sample bias. Each study was only entered once in each intervention-comparator category. Full data were provided from 21 studies (28 effect sizes; n = 2042 intervention; n = 2002 comparison group). Overall, chronic PA interventions had a significant small-to-moderate effect on cognition (0.46). Moderate significant positive effects were identified when PA interventions were compared to no treatment (0.86) or academic content (0.57). A non-significant effect was noted when PA interventions were compared to traditional PE (0.09) or aerobic group (0.80). However, high heterogeneity in pooled effect sizes suggests that important differences in the qualitative characteristics of the PA intervention and comparison interventions may exist. Effect sizes based on comparisons between different types of PA interventions and comparison groups are discussed in order to identify possible directions for future investigations. We conclude that chronic PA interventions have a positive impact on cognitive function in youth, but more systematic research is needed in this area.

Resilience does not explain the dissociation between chronic pain and physical activity in South Africans living with HIV.

Pain burden is high in people living with HIV (PLWH), but the effect of this pain on functionality is equivocal. Resilience, the ability to cope with adversity, may promote adaptation to pain, so we hypothesised that higher resilience would correlate with less pain-related impairment of activity. We recruited 197 black South African PLWH, 99 with chronic pain (CP) and 98 patients without. We measured pain intensity and interference using the Brief Pain Inventory, and resilience using the Resilience Scale. Participants were generally highly resilient. Greater resilience correlated with better health-related quality of life, but not with pain intensity or interference. We also measured physical activity objectively, by actigraphy, in a subset of patients (37 with chronic pain and 31 without chronic pain), who wore accelerometers for two weeks. There was no difference in duration or intensity of activity between those with and without pain, and activity was not associated with resilience. In this sample, pain was not associated with altered physical activity. Resilience did not explain differences in pain intensity or pain interference but was associated with improved quality of life. Financial stresses and the fear of HIV stigma may have driven patients to conceal pain and to suppress its expected impairment of activity.

Restoration of post-activation depression of the H-reflex by treadmill exercise in aged rats

The purpose of this study was to evaluate the effects of aging and chronic physical activity on the postactivation depression of the Hoffman reflex (H-reflex). The maximal amplitude H wave/maximal amplitude M wave ratio was measured, and the rate-sensitive depression of the H-reflex was assessed. Measurements were performed on sedentary rats aged of 3, 6, 12, and 20 months and on animals aged of 12 and 20 months performing an incremental treadmill exercise protocol during the last eight weeks preceding the recordings. At the end of the experiment, the muscle mass and/or body mass ratio was calculated. Results indicated that the H-reflex depression of the tibialis anterior and soleus muscles were present until age of 6 and 12 months, respectively. For the tibialis anterior muscle, results also pointed out a decrease in the relative muscle mass with age and that the exercise allowed to restore the rate-sensitive depression of the H-reflex and to increase the relative muscle mass in comparison with sedentary animals. These findings clearly demonstrate that neural alteration of the spinal cord is prevented by activity in aged rats.

Chronic Diseases, Exercise, and Physical Activity in Childhood: 2015 in Review.

The year of 2015 was a fruitful year in the field of chronic diseases, exercise, and physical activity in childhood. Many interesting papers came out on this topic. Exercise testing and prescription in children with chronic disease and disability is an increasingly studied area in which many disciplines are involved including pediatric physical therapy, medicine, nursing, physical education, and exercise physiology. This multidisciplinary aspect is reflected in the journals in which my highlighted publications (below) were published. Because no single discipline has the ownership of exercise testing and prescription and because different disciplines use different jargon, it is difficult to have the scientific knowledge translated to the clinic. A few years ago we initiated the Pediatric Exercise Medicine Network (PEMNet) to close this knowledge translation gap.

'Real-world' management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) General Pilot Registry.

Atrial fibrillation (AF) has different presentations (first detected, paroxysmal, persistent, permanent), with uncertain impact on outcome. The aim of this study was to investigate clinical presentation, management, and outcome of paroxysmal and non-paroxysmal AFs within the EURObservational Research Programme-Atrial Fibrillation General Pilot Registry. Overall 2589 patients with available 1-year follow-up data were evaluated according to AF type. Patients with paroxysmal AF (26.8%) were younger, had lower prevalence of heart disease (particularly valvular), and major co-morbidities, as well as lower CHADS2, CHA2DS2-VASc, and HAS-BLED scores. Patients with first-detected AF (29.9%) had characteristics similar to persistent AF patients (25.9%), but lower use of oral anticoagulants. Patients with permanent AF represented 17.4% of the cohort. At 1 year, the rate of stroke/transient ischaemic attack and thromboembolism was low (0.6-1.0%) and did not differ between paroxysmal and non-paroxysmal AFs. All-cause mortality was higher in non-paroxysmal vs. paroxysmal AF (log rank test, P = 0.0018). Using a multivariable Cox model, non-paroxysmal AF was not an independent predictor of death during follow-up. Independent predictors of death were age, chronic heart failure, chronic kidney disease, diabetes, restrictive cardiomyopathy, and physical activity. In this 'real-world' contemporary observational registry, patients with non-paroxysmal AF had a worse outcome, in terms of all-cause mortality, which was related to a more severe clinical profile. The risk of stroke at 1 year was relatively low, perhaps reflecting the high rates of anticoagulation use in this cohort.

Effects of Short-Term Physical Activity Interventions on Simple and Choice Response Times.

Objective. Response time (RT) is important for health and human performance and provides insight into cognitive processes. It deteriorates with age, is associated with chronic physical activity (PA), and improves with PA interventions. We investigated associations between the amount and type of PA undertaken and the rate of change in RT for low-active adults across the age range 18–63 yr. Methods. Insufficiently active adults were assigned to either a walking (n = 263) or higher-intensity (n = 380) exercise program conducted over 40 days. Active controls were also recruited (n = 135). Simple response time (SRT) and choice response time (CRT) were measured before and after the intervention and at 3-, 6-, and 12-month follow-up. Results. SRT and CRT slowed across the age range; however, habitually active participants at baseline had significantly faster CRT (p < 0.05). The interventions increased weekly PA with corresponding increases in physical fitness. These changes were mirrored in faster CRT across the study for both intervention groups (p < 0.05). No changes were found for SRT. Conclusions. Both PA interventions resulted in improvements in CRT among adults starting from a low activity base. These improvements were relatively rapid and occurred in both interventions despite large differences in exercise volume, type, and intensity. There were no effects on SRT in either intervention.

Disease Combinations Associated with Physical Activity Identified: The SMILE Cohort Study.

In the search of predictors of inadequate physical activity, an investigation was conducted into the association between multimorbidity and physical activity (PA). So far the sum of diseases used as a measure of multimorbidity reveals an inverse association. How specific combinations of chronic diseases are associated with PA remains unclear. The objective of this study is to identify clusters of multimorbidity that are associated with PA. Cross-sectional data of 3,386 patients from the 2003 wave of the Dutch cohort study SMILE were used. Ward's agglomerative hierarchical clustering was executed to establish multimorbidity clusters. Chi-square statistics were used to assess the association between clusters of chronic diseases and PA, measured in compliance with the Dutch PA guideline. The highest rate of PA guideline compliance was found in patients the majority of whom suffer from liver disease, back problems, rheumatoid arthritis, osteoarthritis, and inflammatory joint disease (62.4%). The lowest rate of PA guideline compliance was reported in patients with heart disease, respiratory disease, and diabetes mellitus (55.8%). Within the group of people with multimorbidity, those suffering from heart disease, respiratory disease, and/or diabetes mellitus may constitute a priority population as PA has proven to be effective in the prevention and cure of all three disorders.

Body Composition, Inflammation, Physical Exercises and Food Intake in Cystic Fibrosis: Cross-Sectional Study

Introduction: The body composition detects earlier impairment of the nutritional status and it may be altered by chronic inflammation, physical activity and energetic imbalance. Methods: It is a cross-sectional study with 46 patients from 8 to 18 years old with CF aged 11.9 ± 2.83 years. We evaluated the arm muscle area, ratio of the subscapular and triceps skinfolds, body fat percentage, 24 h dietary recall, physical activity, C-reactive protein, and cytokines. It was made descriptive statistics, univariate and multiple linear regressions. Findings: Among the patients studied, 52.2% were undernourished, 26.1% owned low body fat percentage and 55.6% increase in abdominal fat. The physical inactivity, inadequate intake, increased age and interleukin 8 contribute to the increase of body fat (p<0.05). The prevalence of malnutrition was 1.9 times higher in those with high C-reactive protein. The prevalence of malnutrition was 1.9 times higher in those with high C-reactive protein. There was a positive association of Interleucine-8 with body fat percentage and ratio of skinfolds. Conclusions: The C-reactive protein may be considered a prognostic indicator of malnutrition. The total energetic intake and level of physical activity are factors of preservation of lean body mass. The positive association of interleukins 8 with the percentage of body fat seems to be more associated with obesity.

Impact of psychoemotional stress and physical activity on endothelial function in hypertensive patients with obesity

Objective . To study the effect of chronic emotional stress and physical activity on endothelial function in patients with arterial hypertension (HTN) and obesity. Design and methods. We enrolled 76 male patients with HTN stage I and II. Group 1 consisted of 36 patients with HTN and obesity, group 2–40 hypertensive patients without obesity. Ultrasound of the brachial artery was performed to assess endothelial function after reactive hyperemia (flow-mediated dilation) and nitrate administration (nitrate-mediated dilation). Serum cortisol level was determined by enzyme-linked immunosorbent assay. PSM‑25 scale was used to access psycho-emotional stress. The level of reactive and personal anxiety was measured by the Spielberger and Khanin’s questionnaire. Brief international physical activity questionnaire was used (IPAQ) for physical activity evaluation. Results. In patients with HTN and obesity a more significant deterioration of the flow-mediated and nitrate-mediated dilation (FMD and NMD) was found compared to hypertensive patients without obesity, and to healthy individuals. In both groups physically inactive patients showed a significant decrease in endothelial function compared to physically active patients. In group 1, an inverse correlation between FMD with the level of reactive anxiety and trait anxiety (r = –0,54; r = –0,46, respectively; p < 0,05) and a direct correlation with the level of physical activity (r = 0,42; p = 0,01) was found. In group 2, FMD and NMD inversely correlated with psycho-emotional stress (r = –0,42; r = –0,33, respectively; p < 0,05) and directly correlated with the level of physical activity (r = 0,46; r = 0,33, respectively; p < 0,05). In both groups, there were direct correlations between cortisol levels with personal and reactive anxiety scores. Furthermore, there was an inverse association between FMD and cortisol levels in group 1 (r = –0,36; p = 0,05) and group 2 (r = –0,41; p = 0,02). Conclusions. Our findings suggest a strong connection between chronic emotional stress and physical inactivity with endothelial dysfunction in hypertensive patients.

Athlete's heart syndrome: A friend or foe?

Athlete's heart syndrome is a set of morphological and functional adaptive changes of the heart and consequently the cardiovascular system as a physiological response to chronic physical activity. It is believed that this syndrome is 'gray zone' between physiology and pathology and therefore subject to different interpretations. In the last few years, we have some sudden cardiac deaths of elite young athletes that have been speculated and associated with the athlete's heart syndrome. There is an increase in the scientific research in this field and the debate among the experts with one dilemma: if these physiological adaptive changes, athlete's heart syndrome, is the athletes friend or foe? In this Review, we describe various types of athlete's heart syndrome- their developmental, biology, differentiation, cell heterogeneity and functional characteristics.