Combined Exercise Research Articles

Efficacy of combined exercise training during different menstrual phases in young students with primary dysmenorrhoea

AbstractObjectivesThe objective of the study was to compare the effectiveness of combined exercise training during different menstrual phases on pain, quality of life and menstrual symptoms.MethodsA total of 72 participants for the study were randomly assigned into three groups: Group 1 (N = 24), Group 2 (N = 24) and Group 3 (N = 24) which had undergone combined exercise training during the follicular, luteal and bleeding phases of their menstrual cycle, respectively. The treatment programme included combined exercise training involving deep breathing exercises, Kegel exercises, core strengthening exercises and stretching exercises. Exercises were repeated 5 times with hold duration of 15 s with total of 30–40 min session with 5–10 min of warm‐up and cooldown sessions. Demographic data and outcome measures (Visual Analogue Scale [VAS], Menstrual Symptom Questionnaire [MSQ], and Working ability, Location, Intensity, Days, Duration [WaLIDD]) were assessed at baseline and assessed again during the first menstrual cycle after the completion of the treatment programme. One‐way ANOVA was used for between‐group comparisons of the normally distributed data.ResultsWithin‐group comparison of the outcome variables except VAS in group 3 showed a statistically significant difference in all groups. Comparison of post‐intervention results of the outcome measures of all the groups revealed a statistically significant difference for the VAS, while there was no statistically significant difference for in between the comparison of the WaLIDD and MSQ scoring.ConclusionCombined exercise training is effective in reducing pain only when performed during follicular and luteal phases and significantly improve quality of life and menstrual symptoms in all phases of the menstrual cycle.

Effects of Ball Combination Exercise Combined with cTBS Intervention on Sleep Problems in Children with Autism.

Sleep problems significantly affect the quality of life of autism spectrum disorder (ASD) children. This study aimed to evaluate the effects of a 12-week ball combination exercise, continuous theta burst stimulation (cTBS) stimulation, and combined intervention on sleep problems in children with ASD. Forty-five ASD children were divided into three intervention groups (ball combination exercise(n = 12), cTBS stimulation(n = 10), combined (n = 12) and a control group (n = 11). The intervention groups underwent intervention, while the control group maintained daily activities. The effects were assessed using the Children's Sleep Habits Questionnaire (CSHQ) scale. The results revealed that after 12 weeks of intervention, three programs reduced sleep problems in children with ASD. The post-test scores of the cTBS group (p = 0.002) and the combined group (p < 0.001) were significantly lower than the baseline scores on the CSHQ scale. The exercise group (p = 0.002) and the combined group (p < 0.001) showed significant improvement in sleep anxiety, while there was no statistically significant difference in the effectiveness of the three interventions for sleep-onset delay. The combined group outperformed the single intervention groups in the CSHQ score and sleep anxiety sub-dimensions. The combined intervention group showed slightly superior performance in sleep onset latency, however, there was no significant difference. Three interventions alleviated sleep issues in ASD children, with the combined method proving more effective. This study validates non-pharmacologic and combined approaches for ASD sleep problems. Future research should delve deeper into the mechanisms of these interventions in ASD children's sleep improvement.

Effectiveness of bracing combined with exercise-based treatment of adolescent idiopathic scoliosis: Assessing the synergistic benefits: A systematic review

The purpose of this study was to evaluate evidence on the effectiveness of combined bracing and exercise on adolescent idiopathic scoliosis (AIS). From inception to April 28, 2022, PubMed and Web of Science searched for randomized clinical and nonrandomized prospective studies reporting Cobb angle (CA), angle of trunk rotation (ATR), quality of life (QoL), and pulmonary function (PF) in AIS patients treated with exercise and braces (10 years-skeletal maturity). Two authors analyzed and extracted data for this review. The PEDro scale was used to assess the risk of bias (RoB). Therapy protocols and basic data have been collected. Each CA, ATR, QoL, and PF study’s evidence and strength were also included. A total of 12 studies with 714 patients with AIS were included. Five studies used a control group with exercises and 7 with braces. The results showed that exercise-brace can decrease CA and ATR and increase QoL and PF with AIS; however, the strength of conclusion for all outcomes was moderate. In this review, 4 studies were categorized as low RoB, 3 as moderate RoB, and 5 as high RoB. Level of evidence analysis revealed that 12 studies were classified as level of evidence B. The current studies do not sufficiently support the effects of exercise and brace therapy on CA, ATR, QoL, and PF in patients with AIS.

Circulating CD31+ Angiogenic T cells are reduced in prediabetes and increase with exercise training

AimsTo investigate circulating angiogenic cells in adults with prediabetes and the effect of a structured exercise program. MethodsA cohort of adults with overweight/obesity and either normal glucose (NG) or prediabetes were randomised to receive exercise (Exercise) (as twice weekly supervised combined high intensity aerobic exercise and progressive resistance training, and once weekly home-based aerobic exercise) or an unsupervised stretching intervention (Control) for 12 weeks. Circulating angiogenic T cells, muscle strength, and cardiovascular disease risk factors, including blood lipids, arterial stiffness, central haemodynamic responses, and cardiorespiratory fitness (VO2peak) in those with prediabetes (n = 35, 16 Control, 19 Exercise) and NG (n = 37, 17 Control, 20 Exercise) were analysed at baseline and after the 12-week intervention. ResultsAt baseline, compared with NG those with prediabetes demonstrated reduced VO2peak, angiogenic CD31+CD8+ T cells and VEGFR2+CD4+ T cells, and increased systolic blood pressure. CD31+ T cells were negatively correlated with cardiovascular disease (CVD) risk. Compared with Control, exercise training increased muscle strength, VO2peak, and CD31+CD4+ and CD31+CD8+ T cells in NG and prediabetes. ConclusionsCirculating angiogenic CD31+ T cells are decreased in people with prediabetes and are enhanced with exercise training. Exercise increases CD31+ T cells, and through this mechanism it is proposed that it may reduce CVD risk. Trial registrationAustralian New Zealand Clinical Trials Registry number: ACTRN12617000552381.

Effect of Combined Exercise and Nutrition Interventions During Inpatient Chemotherapy in Acute Leukemia and Malignant Lymphoma Patients: A Randomized Controlled Trial

The aim of the present study was to determine the effectiveness of combined exercise and nutrition interventions on physical function and quality of life (QOL) in patients with acute leukemia or malignant lymphoma (ML) during inpatient chemotherapy. The study was a randomized controlled trial where patients with acute leukemia or ML who were receiving inpatient chemotherapy and exercise therapy were divided into an intervention group (IG) and a control group (CG). Both groups underwent resistance training and aerobic exercise. The patients in the IG were instructed to take nutritional supplements twice a day. Assessment items were muscle strength (handgrip strength and knee extension strength), 6-min walking test, skeletal muscle mass, QOL, nutritional status, and fatigue. Two-way analysis of variance showed a significant interaction for bilateral handgrip strength and knee extension strength. No significant interactions were found for the other items. The results of the present study showed improved muscle strength in the IG compared to the CG, indicating the effectiveness of combined exercise and nutrition interventions during inpatient chemotherapy in patients with acute leukemia or ML.

The effect of four-weeks combined exercise improves cognitive functions in obese women

This study investigated the effects of a four-week combined exercise program on brain-derived neurotrophic factor (BDNF) levels in obese women. Obesity has been associated with reduced BDNF levels, which can negatively impact cognitive function. Although previous research has shown that obesity affects BDNF levels in both men and women, this study focused on female participants to examine gender-specific responses. Twenty obese females (mean age: 21.85±1.43 years, body mass index [BMI]: 31.61±2.87 kg/m²) participated in the program, which involved moderate-intensity exercises performed three times per week. Blood samples were collected before and after the intervention to measure brain-derived neurotrophic factor (BDNF) levels using Enzyme-linked Immunosorbent Assay (ELISA) kits. Paired sample t-tests were conducted with a significance level of 5%. Results indicated that BDNF levels in the control group (COG) increased from 614.49±34.86 to 626.74±34.13 pg/mL (p=0.399), while the treatment group (TRG) showed a significant increase from 619.14±69.96 to 716.41±21.92 pg/mL (p=0.001). These findings suggest that a four-week combined exercise program effectively increases BDNF levels and may be a physical therapy option for improving cognitive function in obese individuals. Keywords: BDNF, Cognitive function, combined exercise, obesity, women

Effects of aerobic, resistance, and combined exercise training on body fat and glucolipid metabolism in inactive middle-aged adults with overweight or obesity: a randomized trial

MethodTwenty inactive males (BMI 27.67 ± 0.88 kg/m2, age 49.15 ± 2.58 years) participated in an eight-week were randomly assigned to one of three intervention groups (combined (CT), resistance (RT), and aerobic (AT)) exercise modalities to assess within-subject and between group changes in glycolipid profile. Data were analyzed using repeated measures ANCOVA.ResultPre-post mean values of body fat percentage (%BF), area under the curve (AUC), low density lipoprotein (LDL), high density lipoprotein (HDL) and total cholesterol (TC) decreased in all three groups. The main effect of exercise modality on the AUC (F (2, 26) = 10.577, P = 0.001, η2 = 0.569) was significant. Post-hoc analyses revealed that the RT group (-30.653 ± 6.766, p = 0.001) with 11.53% and the CT group (M = -0.896, SE = 3.347, P = 0.015) with 3.79% exhibited significantly greater reductions in AUC compared to the AT group. LDL levels showed significant different between groups (F (2, 26) = 6.33, p = 0.009, η2 = 0.442), specially significantly 3.7% lowered in AT (MD = 4.783, SE = 1.563, P = 0.002) and 3.79% lower in CT (MD = 4.57, SE = 1.284, P = 0.008) groups compared to the RT group. AT significantly reduced TC by 17.716 ± 5.705 mg/dL (p = 0.02) compared to RT, representing a 7.97% decrease.ConclusionExercise type significantly influences lipid profiles and glycemic control. Notably, both aerobic and combined training demonstrated a superior ability to modulate the lipid profile, and resistance training and combined training were more effective in reducing the AUC.Trial registrationMay, 31st 2024. Registration no: PACTR202405463745521 “Retrospectively registered”.

Improved heart rate variability in postmenopausal women following short-term combined exercise training

Imbalances in cardiac autonomic nervous systems are associated with cardiovascular risk factors and poor cardiac outcomes. Heart rate variability (HRV) is a practical and reproducible measure of cardiac autonomic nervous system function. Exercise training promotes positive adjustments in HRV. However, previous studies have reported mixed results. Therefore, this study aimed to investigate the effects of short-term combined exercise training on heart rate variability in post-menopausal women. Thirty-four women aged 50-80 years, at least 12 months post-menopause, were divided into a control (CON) group and an exercise (EX) training group. The participants in the exercise group underwent a 2-week of combined exercise program consisting of aerobic, strength, flexibility, and balance exercises. HRV was recorded using an Actiheart device, before and after the final exercise intervention in a sitting position. The significant main effects of time and group were found in the parameter of SDNN (p time = 0.039; p group = 0.026). Post-hoc analysis showed a borderline increase in SDNN in the EX group (POST: 48.79 ± 17.88 VS 44.54 ± 17.39, p = 0.055). No significant change was observed in the CON group (POST: 35.55 ± 13.51 VS 33.17 ± 8.74, p = 0.288). Statistical analysis of other HRV components revealed no significant results (all P &gt; 0.05). In conclusion, a 2-week of combined exercise training program, including aerobic, resistance, balance, and flexibility exercises improves global cardiac autonomic function in post-menopausal women. Keywords: combined exercise training, heart rate variability, blood pressure, menopause, and women

The Effectiveness of Exercise in Reducing Cardiovascular Risk Factors Among Adults: A Systematic Review and Meta-Analysis.

Cardiovascular disease (CVD) remains one of the major causes of sickness and death in the world. However, lifestyle modifications, such as exercise, can significantly reduce the risk of this disease. This study aimed to assess the effectiveness of various forms of physical activity in reducing CVD risk factors among adults. A comprehensive search of the databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Excerpta Medica Database (EMBASE) databases was conducted between January 1, 2014, and May 31, 2024, as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs), cohort studies, and observational studies on the impact of aerobic, resistance, or combined training on cardiovascular risk factors in adults (≥18 years) were considered for inclusion. Data relating to primary outcomes, including stroke and myocardial infarction rates, BP, cholesterol levels, and BMIwere collected. The Cochrane risk-of-bias tool and the Methodological Index for Non-Randomized Studies (MINORS) checklist were used for quality and bias assessment. Meta-analyses were performed using the RevMan software, with heterogeneity evaluated by I² statistics; 17 studies, including 11 RCTs and six cohort studies, met the inclusion criteria. There was a significant reduction in the mean systolic BP (SBP) by 3.32 mmHg [95% confidence interval (CI): 0.85-5.78 mmHg; p<0.0001] and mean diastolic BP (DBP) by 2.99 mmHg (95% CI: 2.34-3.64 mmHg; p < 0.00001) after exercise interventions. Moreover, cholesterol levels and BMI values improved with exercise. Those who exercised had a lower risk of stroke or heart attack compared with the controls [odds ratio (OR): 0.57; 95% CI: 0.28-1.14; p >0.0001], although there was substantial heterogeneity in effect size across the studies (I² = 98%). Different types of physical activity (i.e., aerobic, resistance, or combined exercise) can effectively reduce key cardiovascular risk factors, including BP, cholesterol levels, and BMI values. Regular physical activity is still regarded as the most effective preventive measure against CVD, despite inconsistencies in research findings. Future studies should aim to identify optimal exercise programs and their long-term effects on diverse populations.

The Impact of Exercise-Based Rehabilitation on ACL Patients: A Comprehensive Review in the Context of China’s Healthcare System

This journal review investigates the effectiveness of exercise-based rehabilitation in assisting ACL patients to return activity level. The main objective of this review is to analyze how exercise-based rehabilitation influences recovery for ACL clients within a Chinese healthcare system. The specific exercise-based rehabilitation that were investigated as part of the study included Nordic, hamstring exercises, aquatic workouts; suspension training and lastly eccentric isokinetic. The outcome factors for ACL healing were improved muscle strength and proprioception, remarkable functional stability levels, regain of full range of motion as well free of pain and reduced risk to re-injury. The retrieval of relevant scholarly sources were gathered from extensive use online databases and publications. The results of the research showed that exercise rehabilitation programs contributed to successful treatment of ACL injuries in Chinese patients. The literature has indicated that aquatic exercises and Nordic hamstring have proved to be successful in enhancing the muscle strength, proprioception among Chinese ACL patients. In addition, suspension training led to the improvement of functional stability and return-to play. Secondly, the study results indicated that rehabilitation training was appropriate for relieving pain and enhancing ROM in people with ACL injuries. Lastly, eccentric kinetic exercise was proven effective in decreasing the chances of re-injury and as a physical activity post injury. Recommendations in the study include targeted exercise-based rehabilitation therapies, and as required instituting combined exercise treatment among patients with ACL.

The Combination of Exercise and Konjac Glucomannan More Effectively Prevents Antibiotics-Induced Dysbiosis in Mice Compared with Singular Intervention.

Our previous studies have demonstrated that konjac glucomannan (KGM) can prevent dysbiosis induced by antibiotics. While exercise may also impact the gut microbiome, there are limited studies reporting its protective effect on antibiotic-induced dysbiosis. Therefore, this study investigated the preventive and regulatory effects of a combination of 6-week exercise and KGM intervention on antibiotic-induced dysbiosis in C57BL/6J mice compared with a single intervention. The results showed that combined exercise and KGM intervention could restore the changes in the relative abundance of Bacteroides (3.73% with CTL versus 14.23% with ATBX versus 4.46% with EK) and Prevotellaceae_Prevotella (0.33% with CTL versus 0.00% with ATBX versus 0.30% with EK) induced by antibiotics (p < 0.05), and minimized the Bray-Curtis distance induced by antibiotics (0.55 with CTL versus 0.81 with ATBX versus 0.80 with EXC versus 0.83 with KGM versus 0.75 with EK). Compared with the combined intervention, exercise intervention also produced a certain level of recovery effects; the relative abundance of Rikenellaceae (1.96% with CTL versus 0.09% with ATBX versus 0.49% with EXC) was restored, while KGM supplementation showed the best preventive effect. In addition, the combination of exercise and KGM significantly enriched microbial purine metabolic pathways (p < 0.05). These findings indicate that combining exercise with KGM could be a promising approach to reducing the side effects of antibiotics on the gut microbiome.

The Relationship Between Exercise Frequency and Cognitive Flexibility in Anxiety Disorder Patients Undergoing Combined Exercise and Cognitive Behavioral Therapy

This study investigates the relationship between exercise frequency and cognitive flexibility in patients with anxiety disorders undergoing combined Cognitive Behavioral Therapy (CBT) and exercise interventions. A longitudinal follow-up design was employed, with 80 participants randomized into four groups: low-frequency exercise, moderate-frequency exercise, high-frequency exercise, and a control group receiving CBT without exercise. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST), and anxiety levels were measured by the Hamilton Anxiety Rating Scale (HAM-A) at baseline, post-intervention, and during 3-month and 6-month follow-ups. Results demonstrated a significant dose-response relationship, with higher exercise frequencies leading to greater improvements in cognitive flexibility and reductions in anxiety symptoms. The high-frequency exercise group exhibited the most substantial and sustained cognitive and emotional benefits, suggesting the importance of frequent exercise in enhancing and maintaining therapeutic outcomes in anxiety disorder treatment. These findings have critical implications for optimizing treatment strategies that integrate physical exercise with CBT to improve cognitive and emotional health in anxiety disorder patients.

Effect of an exercise intervention or combined exercise and diet intervention on health-related quality of life-physical functioning after kidney transplantation: the Active Care after Transplantation (ACT) multicentre randomised controlled trial

Robust evidence for interventions to improve health-related quality of life (HRQoL) in people who receive a kidney transplant is scarce. We aimed to assess the effects of a lifestyle intervention in this context. We conducted a multicentre, open-label, parallel-group, randomised controlled trial among people who have received a kidney transplant. Participants from six hospitals across the Netherlands were randomly assigned 1:1:1 by an independent company into: usual care, exercise, and exercise plus diet. The exercise intervention encompassed two phases, a 3-month supervised exercise programme (twice weekly) followed by 12months of lifestyle coaching, with 15months of additional dietary counselling (12 sessions) for the exercise plus diet group. The primary outcome was HRQoL-domain physical functioning, assessed using the 36-item Short Form Survey at 15months. From Oct 12, 2010to Nov 18, 2016, 221participants who had received a kidney transplant (138 [62%] male and 83 [38%] female, with a mean age of 52·5 [SD 13·5] years, who were a median of 5·5 [IQR 3·6-8·4] months post-transplant) were included and randomly assigned to usual care (n=74), exercise intervention (n=77), and exercise plus diet intervention (n=70). In the intention-to-treat analyses, at 15months post-baseline, no significant differences inHRQoL-domain physical functioning were found for the exercise group (5·3arbitrary units, 95% CI -4·2to 14·9; p=0·27), and the exercise plus diet group (5·9arbitrary units, -4·1to 16·0; p=0·25) compared with control. Safety outcomes showed no safety concerns. After 3months of supervised exercise intervention, HRQoL-domain physical functioning improved in the exercise group (7·3arbitrary units, 95% CI 1·2to 13·3; p=0·018) but not in the exercise plus diet group (5·8arbitrary units, -0·5to 12·1; p=0·072). A lifestyle intervention is safe and feasible in people who have received kidney transplants, paving the way for lifestyle intervention studies in other multimorbid populations with polypharmacy. However, improving HRQoL for people who have received a kidney transplant is challenging. The lifestyle interventions in the current study did not show significant improvements in HRQoL at the end of the study at the total group level. Dutch Kidney Foundation, Innovation Fund of the Dutch Medical Insurance Companies, and University Medical Center Groningen.

The Impact of Exercise on C-reactive Protein Levels in Hypertensive Patients: A Systematic Review.

Hypertension, defined as persistently elevated blood pressure, is a prevalent chronic condition and a significant global health issue, closely linked to cardiovascular complications, with inflammation being one of the underlying mechanisms. In hypertensive patients, C-reactive protein (CRP), an inflammatory marker, is often elevated and associated with increased cardiovascular risk. Alongside pharmacotherapy, exercise is recommended as a non-pharmacological approach to managing hypertension, with evidence suggesting that exercise can also reduce inflammation. This study examines the impact of exercise on CRP levels in hypertensive patients. Fourteen studies focusing on exercise interventions and physical fitness related to CRP in individuals with high blood pressure were identified through an extensive search of PubMed, PubMed Central, ScienceDirect, Cochrane Library, and Google Scholar. The findings indicated that most studies involving aerobic exercise consistently demonstrated reductions in CRP levels among hypertensive patients, with significant effects observed under supervised conditions, and additional benefits seen when combined with dietary control. Resistance training showed mixed results, with significant reductions in CRP observed primarily in longer-term interventions. Combined exercise training, incorporating both aerobic and resistance elements, effectively reduced CRP levels and improved cardiovascular health markers. Physical fitness assessments, such as a bicycle exercise test to exhaustion, revealed a relationship between physical fitness and decreased CRP levels. Therefore, regular, consistent aerobic and combined training, as well as prolonged resistance exercise, significantly reduce CRP levels in hypertensive patients, highlighting exercise's role as a non-pharmacological strategy for managing hypertension through the reduction of inflammation. Further research is essential to validate these findings and investigate the underlying mechanisms and differential effects of various exercise modalities.

Effectiveness of Exercise on Fatigue for Patients With Heart Failure: A Systematic Review and Meta-Analysis.

Exercise is the standard treatment for fatigue in heart failure (HF) patients. However, no study has investigated the effect of exercise on improving fatigue and HR-QoL in HF patients. Our study adhered to the Cochrane Handbook for Systematic Reviews of Interventions and followed the PRISMA statement. The date of the last search was October 31, 2021. We included randomized controlled trials (RCTs) using exercise to improve fatigue and HR-QoL. The combined exercise training studies showed improvement in fatigue (SMD = -.51, 95% CI = -.89 to -.12, p = .001, I2 = 48%). The IMT studies showed significantly improved fatigue (MD = -11.36, 95%CI = -15.30 to -7.41, p < .00001, I2 = 54%). However, three studies, with moderate heterogeneity (p = .10, I2 = 56%), showed non-significant changes in HR-QoL (SMD = -0.04, 95% CI = -.45 to .37, p = .83).

Effects of different exercise regimens on prognosis of patients with chronic obstructive pulmonary disease: a systematic reviews and meta-analysis

Introduction Skeletal muscle dysfunction is a significant factor contributing to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Although exercise training is often recommended to enhance patient outcomes, there continues to be ongoing debate regarding its exact effects. Objective The aim of this study is to evaluate the effectiveness of endurance exercise, strength training and combined exercise on cardiorespiratory fitness (including maximal oxygen uptake, maximal minute ventilation, and the 6-minute walk test), strength of lower limbs (measured by leg press), and quality of life (using the COPD Assessment Test) in patients with COPD. By conducting a systematic review and meta-analysis of randomized controlled trials (RCTs), our objective is to provide tailored training methods and intensity recommendations for patients with COPD in order to improve their quality of life. Methods The meta-analysis included 10 randomized controlled trials (RCTs) of exercise rehabilitation programs involving 180 patients with COPD that were retrieved from electronic databases (PubMed, Cochrane Library, and Embase). Two reviewers independently assessed the topical relevance, trial quality, and extracted data for the meta-analysis. Results Meta-analysis showed that primary outcomes representing exercise endurance were elevated under different exercise interventions compared to pre-test, such as maximal oxygen uptake (VO2max (ml/kg/min)) [SMD = 0.40, 95% CI (0.15, 0.64)] and the 6-min walk test (6MWT) [MD = 33.90, 95% CI (25.25, 42.55)], and primary outcomes representing strength also increased, such as leg press (1RM) [MD = 24.59, 95% CI (16.08, 33.11)], while secondary outcomes such as assessments of life such as the COPD Assessment Test (CAT) recovered [MD = 2.51, 95% CI (2.01, 3.00)], with all differences being statistically significant (p < 0.05). However, Maximum minute ventilation (VEmax (L)) [MD = 0.91, 95%CI (3.61, 5.43)] was not statistically significant (p > 0.05) when compared with the post-test data. The sensitivity test data were stable, and the results were reliable. We subgrouped the data from different types of exercise interventions and found that different types of exercise affected the experimental results. Conclusion Exercise interventions have a positive effect on the treatment of patients with COPD, significantly improving functional capacity, aerobic capacity, and exercise tolerance, but they should be individualized and developed according to the patient’s condition to achieve the best therapeutic effect.

Serum proteomic profiling of physical activity reveals CD300LG as a novel exerkine with a potential causal link to glucose homeostasis

Background:Physical activity has been associated with preventing the development of type 2 diabetes and atherosclerotic cardiovascular disease. However, our understanding of the precise molecular mechanisms underlying these effects remains incomplete and good biomarkers to objectively assess physical activity are lacking.Methods:We analyzed 3072 serum proteins in 26 men, normal weight or overweight, undergoing 12 weeks of a combined strength and endurance exercise intervention. We estimated insulin sensitivity with hyperinsulinemic euglycemic clamp, maximum oxygen uptake, muscle strength, and used MRI/MRS to evaluate body composition and organ fat depots. Muscle and subcutaneous adipose tissue biopsies were used for mRNA sequencing. Additional association analyses were performed in samples from up to 47,747 individuals in the UK Biobank, as well as using two-sample Mendelian randomization and mice models.Results:Following 12 weeks of exercise intervention, we observed significant changes in 283 serum proteins. Notably, 66 of these proteins were elevated in overweight men and positively associated with liver fat before the exercise regimen, but were normalized after exercise. Furthermore, for 19.7 and 12.1% of the exercise-responsive proteins, corresponding changes in mRNA expression levels in muscle and fat, respectively, were shown. The protein CD300LG displayed consistent alterations in blood, muscle, and fat. Serum CD300LG exhibited positive associations with insulin sensitivity, and to angiogenesis-related gene expression in both muscle and fat. Furthermore, serum CD300LG was positively associated with physical activity and negatively associated with glucose levels in the UK Biobank. In this sample, the association between serum CD300LG and physical activity was significantly stronger in men than in women. Mendelian randomization analysis suggested potential causal relationships between levels of serum CD300LG and fasting glucose, 2 hr glucose after an oral glucose tolerance test, and HbA1c. Additionally, Cd300lg responded to exercise in a mouse model, and we observed signs of impaired glucose tolerance in male, but not female, Cd300lg knockout mice.Conclusions:Our study identified several novel proteins in serum whose levels change in response to prolonged exercise and were significantly associated with body composition, liver fat, and glucose homeostasis. Serum CD300LG increased with physical activity and is a potential causal link to improved glucose levels. CD300LG may be a promising exercise biomarker and a therapeutic target in type 2 diabetes.Funding:South-Eastern Norway Regional Health Authority, Simon Fougners Fund, Diabetesforbundet, Johan Selmer Kvanes’ legat til forskning og bekjempelse av sukkersyke. The UK Biobank resource reference 53641. Australian National Health and Medical Research Council Investigator Grant (APP2017942). Australian Research Council Discovery Early Career Award (DE220101226). Research Council of Norway (Project grant: 325640 and Mobility grant: 287198). The Medical Student Research Program at the University of Oslo. Novo Nordisk Fonden Excellence Emerging Grant in Endocrinology and Metabolism 2023 (NNF23OC0082123).Clinical trial number:clinicaltrials.gov: NCT01803568.

The effects of a 12-week combined motor control exercise and isolated lumbar extension intervention on lumbar multifidus muscle stiffness in individuals with chronic low back pain.

Exercise therapy is the primary endorsed form of conservative treatment for chronic low back pain (LBP). However, there is still conflicting evidence on which exercise intervention is best. While motor control exercise can lead to morphological and functional improvements of lumbar multifidus muscle in individuals with chronic LBP, the effects of exercise prescription on multifidus stiffness assessed via shear wave elastography are still unknown. The primary aim of this study is to determine the effects of a combined motor control and isolated lumbar extension (MC + ILEX) intervention on lumbar multifidus muscle stiffness. A total of 25 participants aged 18 to 65 were recruited from local orthopedic clinics and the university community with moderate to severe non-specific chronic LBP. Participants performed a 12-week MC + ILEX intervention program. Stiffness of the lumbar multifidus muscle (primary outcome) at L4 and L5 was obtained at baseline, 6-week, and 12-week using shear wave elastography. Changes in stiffness ratio (e.g., ratio of lumbar multifidus muscle stiffness from rest to contracted) were also assessed at both time points. Pre to post-intervention changes in lumbar multifidus muscle stiffness were assessed using a one-way repeated measure ANOVA. Following the 12-week intervention, there were no statistically significant changes in lumbar multifidus muscle stiffness at rest on the right side at L4 (p = 0.628) and the left side at L4 and L5 (p = 0.093, p = 0.203), but a statistically significant decrease was observed on the right side at L5 (p = 0.036). There was no change in lumbar multifidus muscle stiffness ratio. This study provides preliminary evidence to suggest that a 12-week MC + ILEX intervention had minimal effect on lumbar multifidus muscle stiffness in individuals with chronic LBP. Further investigations are needed to confirm our findings and clarify the relationship between muscle stiffness and functional outcomes.

The Effects of Exercise Interventions on Ectopic and Subcutaneous Fat in Patients with Type 2 Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Meta-Regression.

Background/Objectives: The aim of the present study was to determine the effects of exercise training on ectopic and subcutaneous fat in patients with type 2 diabetes mellitus (T2DM). Methods: Web of Science, PubMed, and Scopus were searched for original articles published through November 2023 that included exercise versus control interventions on body mass (BM), liver fat percentage, visceral fat area (VFA), subcutaneous fat area (SFA), and intramuscular fat volume or mass (IMF) in patients with T2DM. Weighted mean differences (WMDs) for liver fat and BM, standardized mean differences (SMDs) for VFA, SFA, and IMF, and 95% confidence intervals (95% CIs) were determined using random-effects models. Results: Thirty-six studies comprising 2110 patients with T2DM were included in the present meta-analysis. Exercise training effectively reduced BM [WMD = -2.502 kg, p = 0.001], liver fat% [WMD = -1.559%, p = 0.030], VFA [SMD = -0.510, p = 0.001], and SFA [SMD = -0.413, p = 0.001] in comparison to the control. The IMF [SMD = 0.222, p = 0.118] remained unchanged compared to the controls. Subgroup analyses showed that the type of exercise, duration, and body mass index (BMI) of participants were sources of heterogeneity. Conclusions: The current meta-analysis provides strong evidence that exercise training, particularly aerobic and combined (aerobic and resistance) exercise programs, is effective for reducing BM, VFA, and SFA in patients with T2DM. However, aerobic exercise was more effective for reducing liver fat than combined exercise. The beneficial effects of exercise on VFA and SFA reduction, but not liver fat, are associated with weight loss. These findings highlight the importance of including consistent exercise as a key management component for T2DM and associated ectopic fat deposition, with potential long-term benefits for metabolic health.

Can we “prehabilitate” pancreatic cancer patients prior to surgery? A critical appraisal of the literature

BackgroundEnhancing a patient’s functional capacity to withstand the surgical stress by means of multimodal (combined exercise, nutrition and psychological interventions) prehabilitation may potentially lead to improved outcomes in pancreatic cancer surgery. MethodologyA systematic review was undertaken searching PubMed, Google Scholar and Cochrane Library databases, exploring the impact of prehabilitation in pancreatic surgery. Outcomes of interest were adherence to the prehabilitation, functional capacity, overall complications and post-operative length of stay. Pooled analysis was performed using a random-effects model. ResultsTwelve studies comprising of 1497 patients were included in the review. Most of the studies seem to lack a multimodal approach. Less than 50 % of the studies reported adherence, which ranged between 27 to 100 %. Functional capacity, in terms of 6-minute walk test, showed improvement with prehabilitation. Among the post-operative outcomes, prehabilitation was associated with significant improvement in pulmonary complications (2.4 % versus 6.7 %, RR 0.36, CI 0.17-0.74, p= 0.01, I2= 28%). Prehabilitation was not effective in terms of length of stay or readmission rates. ConclusionsLarger studies with multimodal prehabilitation approaches may demonstrate more consistent and clinically meaningful benefits, which would lead to a firm appreciation of its role the management of pancreatic cancer patients undergoing surgery.