EX Group Research Articles

An Intervention to Improve Physical Function and Caregiver Perceptions in Family Caregivers of Persons With Heart Failure.

Objective: This randomized controlled trial was conducted to determine whether a 12-week home-based aerobic and resistance exercise program would improve physical function and caregiving perceptions among family caregivers (FCGs) of persons with heart failure. Method: Overall, 127 FCGs were randomized to one of three groups: usual care attention control (UCAC), psychoeducation only (PE), and psychoeducation plus exercise (PE + EX). Physical function measures (6-min walk test, handgrip, and upper and lower strength) and caregiving perceptions (Bakas Caregiving Outcomes Scale) were obtained at baseline and at 6 months. Results: FCGs in the PE + EX showed significant improvement in 6-min walk distance (p = .012), handgrip, and lower extremity strength compared with the PE and UCAC groups. The combined group had the greatest improvement in caregiver perceptions (p < .001). Conclusion: FCGs in the PE + EX group improved the most in physical function and caregiver perception outcomes. Directions for future research are provided.

Supervised, Individualized Exercise Programs Help Mitigate Costs during Cancer Treatment

Background: Cancer and its associated treatments often result in long-term physical and psychological side effects that negatively impact the cancer survivor's quality of life. In addition, the financial costs of cancer are substantial and are projected to reach $158 billion by the year 2020. Research indicates that endurance exercise training is helpful in attenuating the deleterious effects of cancer treatments by increasing survival, attenuating myocardial lesions and myocyte disarray, increasing levels of antioxidants, decreasing lipid peroxidation induced by oxidative stress and markers of apoptosis, and preserving cardiac function. However, nationally less than 5% of patients are ever referred to a cancer rehabilitation exercise program. Cost is a barrier to these programs, as they often are not reimbursable under most insurance plans. Purpose: Therefore, the purpose of this investigation was to determine if exercise training during cancer treatment helped to minimize side effects and reduce health care costs. Specifically, treatment tolerance, length of hospital stay, hospital readmits, ER visits, and treatment compliance were measured. Methods: This was a retrospective, two-group study which ascertained the protective effect of an exercisetraining program during cancer treatment. All oncology patients who received cancer treatment at Kettering Medical Center in Dayton, Ohio between January-December 2016 were identified by office staff. Their medical records were pulled and patients were placed in one of two groups: those who exercised during treatment, and those who remained sedentary. The medical records were reviewed to determine outcome data for length of hospital stays, hospital readmits, ER visits, treatment compliance, fatigue, and anxiety/depression related to oncology conditions. The age range of the patients was 21-93 years. Patients were excluded if they had pre-existing cardiac, liver, and bone marrow conditions prior to treatment. Individuals in the exercise group (EX, n=672) completed 12 weeks of prescribed, individualized exercise that included cardiovascular, strength training, and flexibility components. The intensity level for the cardiovascular exercise ranged from 30%-45% of the individual’s predicted VO2max. The strength training involved a full body workout, with emphasis on all major muscle groups. Individuals in the sedentary group (SED, n=728) did not participate in an exercise program during treatment. Results: Patients in the EX group had significantly lower reports of fatigue, pain, and cardiac problems (p<0.05), as well as fewer notes of depression and anxiety than their SED group counterparts. In addition, the EX group tolerated their treatment significantly better than the SED group (p<0.05). Finally, the EX group had a significantly lower number of ER visits (EX=2, SED=14, p<0.05), 30-day readmits (EX=2, SED=53, p<0.05) as well as a shorter length of stay (EX=0.75, SED=3 p<0.05). Conclusion: Results from this investigation point to a protective effect of moderate-intensity exercise that translated to reductions in ER visits, 30-day readmits, and length of hospital stay, which translated into cost savings for the payer, provider, and patients, alike.

The Differential Impact Of High-Intensity Swimming Exercise and Inflammatory Bowel Disease On IL-1b, TNF-a, and COX-2 Gene Expression in the Small Intestine and Colon in Mice

Background and Objective&#x0D; We aimed to examine the impact of high-intensity swimming exercise and inflammatory bowel disease (IBD) on IL-1β, TNF-α, and COX-2 gene expression in the small intestine and colon of mice.&#x0D; Material and Methods&#x0D; Forty male C57BL/6 mice were divided into 4 groups: the control group (CON), swimming exercise group (EX), 50% ethanol (EtoH) control group (50%EtoH CON), and 2,4,6-trinitrobenzene sulfonic acid group (TNBS). The EX group performed 4 weeks of exercise. Intrarectal TNBS injection induced IBD in the TNBS group; the 50%EtoH CON group received control injections. Reverse transcription and real-time polymerase chain reaction were used to examine IL-1β, TNF-α, and COX-2 mRNA expression in the small intestine and colon.&#x0D; Results&#x0D; IL-1β, TNF-α, and COX-2 mRNA expression was significantly increased in the EX group compared to that in the CON group (p’s&lt;0.05). IL-1β and COX-2 mRNA expression was significantly increased in the TNBS group compared to that in the 50%EtoH CON group (p’s&lt;0.05).&#x0D; Conclusion&#x0D; Thus, inflammatory cytokine IL-1β and COX-2 expression in the small intestine and colon was increased in both high-intensity swimming exercise and IBD models. However, TNF-α was increased only in the swimming exercise model. Further research is required to confirm these observations and establish swimming exercise regimes appropriate for patients with IBD.

EFFECT OF 12-WEEK LOW-INTENSITY EXERCISE ON INTERLEUKIN-2, INTERFERON-GAMMA AND INTERLEUKIN-4 CYTOKINE PRODUCTION IN RAT SPLEENS

Background and Objective&#x0D; High-intensity exercise has been linked to immunity; however, the relationship between low-intensity exercise and the immune system is unclear. In this study, the effects of exercise on cytokine production in T helper 1 (interleukin-2 [IL-2] and interferon-gamma [INF-g]) and T helper 2 cells (interleukin-4 [IL-4]) in spleens were investigated.&#x0D; Material and Methods&#x0D; Sprague–Dawley male rats were divided into a control group (CON, n = 10) and a low-intensity exercise group (EX, n = 10). EX rats were trained on a treadmill (8 m/min, 50 min/day, 5 times over 12 weeks). Spleen tissues were analyzed by hematoxylin-eosin staining and real-time PCR to quantify IL-4, INF-γ, and IL-2 expression.&#x0D; Results&#x0D; IL-4 expression was significantly higher in the EX group than in the CON group (p &lt; 0.05). However, IL-2 and INF-γ expression did not differ between groups (p &gt; 0.05).&#x0D; Conclusion&#x0D; These results suggest that exercise in rats enhances immune function by regulating cytokine production in T helper type 2 (IL-4) cells, but not in T helper type 1 (IL-2 and IFN-g) cells of the activated spleen.

Concurrent treatment with ursolic acid and low-intensity treadmill exercise improves muscle atrophy and related outcomes in rats.

The objective of this study was to analyze the concurrent treatment effects of ursolic acid (UA) and low-intensity treadmill exercise and to confirm the effectiveness of UA as an exercise mimetic to safely improve muscle atrophy-related diseases using Sprague-Dawley (SD) rats with skeletal muscle atrophy. Significant muscle atrophy was induced in male SD rats through hind limb immobilization using casting for 10 days. The muscle atrophy-induced SD rats were group into four: SED, sedentary; UA, daily intraperitoneal UA injection, 5 mg/kg; EX, low-intensity (10–12 m/min, 0° grade) treadmill exercise; and UEX, daily intraperitoneal UA injection, 5 mg/kg, and low-intensity (10–12 m/min, 0° grade) treadmill exercise. After 8 weeks of treatment, endurance capacity was analyzed using a treadmill, and tissues were extracted for analysis of visceral fat mass, body weight, muscle mass, expression of muscle atrophy- and hypertrophy-related genes, and endurance capacity. Although the effects of body weight gain control, muscle mass increase, and endurance capacity improvement were inadequate in the UA group, significant results were confirmed in the UEX group. The UEX group had significantly reduced body weight and visceral fat, significantly improved mass of tibialis anterior and gastrocnemius muscles, and significantly decreased atrophy-related gene expression of MuRF1 and atrogin-1, but did not have significant change in hypertrophy-related gene expression of Akt and mTOR. The endurance capacity was significantly improved in the EX and UEX groups. These data suggest that concurrent treatment with low-intensity exercise and UA is effective for atrophy-related physical dysfunctions.

Bone metabolism in response to oat bran consumption and jogging exercise in young males

Adopting a physically active lifestyle along with consumption of nutritional supplementation is a strategy for improving health-related quality of life. We aimed to investigate the combined effects of oat bran consumption and jogging exercise compared to oat bran consumption alone and jogging exercise alone on bone metabolism in young males. Forty-seven sedentary male university students with mean age 20.9 ± 1.7 years were recruited. They were randomly assigned into sedentary control (C), oat bran supplementation alone (OB), exercise alone (EX) and combined oat bran and exercise (OBEX) groups. The participants in OB and OBEX group consumed 18 g of oat bran powder with 3.6 g of β-glucan daily for 8 weeks. The participants in Ex and OBEx group performed jogging exercise with moderate intensity, i.e. 55–70% of their age-predicted HRmax, 30 min per day, 3 days per week for 8 weeks. Participants’ anthropometric parameters and bone metabolism markers were measured at pre- and post-intervention. Repeated measures ANOVA was performed for statistical analysis. In OB group, no significant changes in bone metabolism markers were observed. In EX group, there was a significant increase (p < 0.05) in carboxyterminal telopeptide of type 1 collagen (CTX-1). However, there were no significant changes in bone metabolism markers in OBEX group. Eight weeks of jogging exercise alone elicited significant effects on bone turnover marker in young sedentary males. Nevertheless, future studies with longer exercise duration and higher dosage of oat bran are warranted to investigate the combined effects of jogging exercise and oat bran consumption on bone metabolism markers in this population.

Short-term outcomes after EX-PRESS implantation versus trabeculectomy alone in patients with neovascular glaucoma.

BackgroundThe purpose of this study was to investigate postoperative clinical outcomes in patients with neovascular glaucoma (NVG) who underwent trabeculectomy or EX-PRESS implantation and to identify predictors of successful EX-PRESS implantation.MethodsThe study designed as a retrospective observational analysis and was set in a single tertiary center. Eighty-nine patients (89 eyes) with NVG, were treated using trabeculectomy alone (Trab group; n=39) or EX-PRESS implantation (EX group; n=50). All patients with a history of glaucoma surgery were excluded. The main outcome measures were postoperative intraocular pressure (IOP), visual acuity (VA), number of medications, complications, additional therapy, and success rate.ResultsThe mean follow-up duration was 4.6 months in the Trab group and 4.2 months in the EX group. There was no significant difference in IOP between the groups except at 1-month follow-up (P=0.045). The number of patients with early postoperative hypotony, a shallow anterior chamber, hyphema, or anterior chamber irrigation was significantly lower in the EX group than in the Trab group (P=0.016, 0.008, 0.019, and 0.014, respectively). The other outcomes, ie, VA, number of medications, and success rate, were similar between the two groups. In the EX group, the success rate was significantly lower in 15 patients with a history of vitrectomy compared to that in 35 patients without a history of vitrectomy (P=0.047).ConclusionImplantation of an EX-PRESS device may be more effective and safer than trabeculectomy alone in patients with NVG. However, a history of vitrectomy may affect the surgical success rate when using EX-PRESS.

L’activité physique, un facteur protecteur cardiovasculaire et métabolique chez les patients porteurs d’une insuffisance rénale terminale

ObjectiveThe aim of the study was to test the effectiveness of Physical Activity (PA) during haemodialysis as a protective treatment against cardiovascular (CV) diseases. MethodsEighty volunteer patients were included in this multicentric prospective study and followed for two years: 40 patients in the Exercise group (EX), 40 patients in the Control group (Ctrl). CV risk factors: Total Cholesterol, HDL Cholesterol (HDL-c), LDL cholesterol (LDL-c), Triglycerides (TG) and Hemoglobin (Hb), and Prealbumin, Albumin, Parathormon, 25-OH Vitamin D, were checked at Month 0 (M0) and Month 24 (M24). The number of antihypertensive treatments and the Erythropoietin Stimulating Agent (ESA) required doses were collected. We noted for each group during the follow-up the number of hospitalizations for CV reasons. After two years, we compared 31 patients in EX and 35 in Ctrl. ResultsWe observed a significant decrease of total cholesterol EX group: 1.86±0.49g/L at M0 versus 1.64±0.38g/L at M24 (P<0.05). HDLc and but LDL-c remained stable in both groups. TG decreased significantly in EX: 1.76±0.89g/L vs 1.44±0.69g/L (P<0.05). The number of antihypertensive drugs per patient decreased significantly (P<0.05) in the EX group between M0 and M24 (1.61±1.28 at M0 and 0.74±0.85 at M24). The EX patients were three times less frequently hospitalized for cardiovascular reasons. There were five hospital stays versus 14 for the Ctrl group. ConclusionOur study demonstrates that an intradialytic aerobic cycling training program promotes beneficial effects on cardiovascular protection. Physical activity reduced the number of CV events in our population during two years follow-up.

Effects of voluntary exercise on blood pressure, angiotensin II, aldosterone, and renal function in two-kidney, one-clip hypertensive rats.

Spontaneous dynamic exercise promotes sympathoinhibition and decreases arterial pressure in two-kidney, one-clip (2K-1C) hypertensive rats. Renal sympathetic nerves stimulate renin secretion and increase renal tubular sodium reabsorption. We hypothesized that daily voluntary wheel running exercise by 2K-1C rats will decrease mean arterial pressure (MAP), plasma angiotensin II (Ang II), and aldosterone as well as normalize urinary sodium and potassium excretion independent of changes in glomerular filtration rate (GFR). Five-week-old male Sprague Dawley rats underwent sham clipping (Sham) or right renal artery clipping (2K-1C). Rats were randomized to standard caging (SED) or cages with running wheels (EX). After 12 weeks, rats were assigned to either collection of aortic blood for measurement of Ang II and aldosterone or assessment of inulin clearances and excretory function. Running distances were comparable in both EX groups. MAP was lower in 2K-1C EX vs 2K-1C SED rats (P<0.05). Plasma Ang II and aldosterone were significantly higher in 2K-1C SED rats and decreased in 2K-1C EX rats to levels similar to Sham SED or Sham EX rats. Clipped kidney weights were significantly lower in both 2K-1C groups, but GFR and urine flow rates were no different from right and left kidneys among the four groups. Total and fractional sodium excretion rates from the unclipped kidney of 2K-1C SED rats were higher vs either Sham group (P<0.05). Values in 2K-1C EX rats were similar to the Sham groups. Potassium excretion paralleled sodium excretion. These studies show that voluntary dynamic exercise in 2K-1C rats decreases plasma Ang II and aldosterone, which contribute to the lower arterial pressure without deleterious effects on GFR. The effects on sodium excretion underscore the impact of pressure natriuresis despite elevated plasma Ang II and aldosterone in sedentary 2K-1C rats. In contrast, potassium excretion is primarily regulated by circulating aldosterone and distal sodium delivery.

Monitoring of peripheral blood cluster of differentiation 4+ adenosine triphosphate activity and CYP3A5 genotype to determine the pharmacokinetics, clinical effects and complications of tacrolimus in patients with autoimmune diseases.

A total of 25 patients with autoimmune diseases receiving tacrolimus were screened using a peripheral blood cluster of differentiation 4+ adenosine triphosphate (ATP) activity assay (IMK assay) between October 2013 and July 2014. The autoimmune diseases of patients were as follows: Rheumatoid arthritis (n=15), lupus nephritis (n=6), ulcerative colitis (n=2) and myasthenia gravis (n=2). Patients were divided into two groups based on CYP3A5 genotype [expression of *1 allele: Expressor (EX; n=6) and non-expressor (NEX; n=19)]. The tacrolimus concentration and concentration/dose ratio was significantly lower in the EX group compared with the NEX group (P=0.0108 and 0.0056, respectively). In addition, all enrolled patients that presented with adverse effects belonged to the NEX group. No significant associations were observed between IMK ATP levels and the concentration or dose of tacrolimus (P=0.1092 and 0.6999, respectively). However, the IMK ATP high-level group exhibited a significantly higher occurrence rate of insufficient effect when compared with the normal and low-level groups (P=0.0014). In conclusion, the clearance of tacrolimus in patients with autoimmune diseases was affected by the CYP3A5 genotype, as previously reported in organ transplant patients. The IMK ATP level may indicate the clinical response irrespective of tacrolimus concentration.

Effects of exercise training on excitation-contraction coupling, calcium dynamics and protein expression in the heart of the Neotropical fish Brycon amazonicus

Matrinxã (Brycon amazonicus) is a great swimming performance teleost fish from the Amazon basin. However, the possible cardiac adaptations of this ability are still unknown. Therefore, the aim of the present work was to investigate the effects of prolonged exercise (EX group - 60days under 0.4BL·s−1) on ventricular contractility by (i) in-vitro analysis of contractility comparing the relative roles of sodium/calcium exchanger (NCX) and sarcoplasmic reticulum (SR) in the excitation-contraction (E-C) coupling and (ii) molecular analysis of NCX, sarcoplasmic reticulum Ca2+ ATPase (SERCA2) and phospholamban (PLB) expression and quantification. The exercise training significantly improved twitch tension, cardiac pumping capacity and the contraction rate when compared to controls (CT). Inhibition of the NCX function, replacing Na+ by Li+ in the physiological solutions, diminished cardiac contractility in the EX group, reduced all analyzed parameters under both high and low stimulation frequencies. The SR blockage, using 10μM ryanodine, caused ~50% tension reduction in CT at most analyzed frequencies while in EX, reductions (34–54%) were only found at higher frequencies. SR inhibition also decreased contraction and relaxation rates in both groups. Additionally, higher post-rest contraction values were recorded for EX, indicating an increase in SR Ca2+ loading. Higher NCX and PLB expression rates and lower SERCA2 rates were found in EX. Our data indicate that matrinxã presents a modulation in E-C coupling after exercise-training, enhancing the SR function under higher frequencies. This was the first study to functionally analyze the effects of swimming-induced exercise on fish cardiac E-C coupling.

Responses of inflammatory cytokines following moderate intensity walking exercise in overweight or obese individuals.

This study investigated the effects of a 4-week moderate intensity walking exercise on the levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and adiponectin in overweight or obese individuals. Twenty-seven (13 men and 14 women) physically inactive, over-weight or obese (body mass index>25.0 kg/m2) individuals participated in the study. Each participant was randomly assigned to either exercise (EX; n=15) or control (CON; n=12) group. The EX group performed moderate intensity walking exercise on a treadmill for 60 min at 70% of maximal heart rate for 4 weeks (3 days/wk). Overnight fasting blood samples were collected before and after the study period (Pre and Post) to analyze the levels of pro-/anti-inflammatory cytokines such as CRP, TNF-α, and adiponectin. CRP and adiponectin as well as body weight and body composition were not significantly altered following the 4-week exercise intervention. However, there was a significant group×time interaction for TNF-α. The post hoc test revealed that the level of TNF-α significantly decreased only in EX (EX: mean±standard deviation, Pre 55.18±6.57 pg/mL, Post 50.31±6.22, P=0.018 vs. CON: Pre 55.5±5.88, Post 58.19±6.48, P=0.25). EX Post was also significantly lower as compared to CON Post (P=0.0074). Although there was no change in body weight or fat mass, the 4-week aerobic exercise training was long enough to decrease the level of TNF-α, indicating physical activity may improve level of inflammation independently from the change in fat mass. The current study also confirmed previous research suggesting that longer period of exercise training accompanied by weight loss may be required to induce significant changes in CRP and adiponectin.

Feasibility and Effects of a Physical Activity Program Using Gerontechnology in Assisted Living Communities for Older Adults

BackgroundThe number of older adults residing in assisted living communities is increasing. Despite the benefits of physical activity (PA) on physical and cognitive capacities, and the opportunities for being active offered in these living environments, this population is highly sedentary and more at risk of physical decline. This study aimed to assess the feasibility, the acceptability, and the effects of PA intervention using gerontechnology in assisted living communities. MethodsForty-two older adults in 4 assisted living communities were recruited and randomly assigned to an exercise intervention group (EX) or a control group (CON) using a 2:1 ratio. The EX group followed a 12-week PA program (2 sessions per week) using gerontechnology. Body composition, health status, quality of life, and functional capacities were evaluated at baseline, 12 weeks, and 24 weeks after baseline. ResultsDifferences between groups were observed in the number of reported comorbidities (EX: 3.1 ± 1.6 vs CON: 5.0 ± 1.8; P = .007), SF-36 total score (EX: 80% ± 10% vs CON: 66% ± 15%; P = .004), and Short Physical Performance Battery (SPPB) total score (EX: 9.1 ± 1.8 vs CON: 7.5 ± 1.4; P = .006) at baseline. The EX group completed 89% ± 17% of the 24 prescribed sessions and realized 67% ± 13% of them in autonomy, reaching a quality level of 87% ± 6%. Of the EX participants, 93.8% enjoyed the exercises a lot or well, and 92.8% of them rated the exercises as being either easy or a little difficult. Changes between baseline and follow-up were statistically different between groups for walking speed (EX: +0.10 ± 0.20 vs CON: −0.04 ± 0.16 m/s; P = .04) and the SPPB score (EX: +1.1 ± 2.0 vs CON: −0.4 ± 1.6; P = .03). ConclusionWe found that PA intervention using gerontechnology in assisted living communities for older adults was feasible and acceptable, but more importantly induced improvement in functional capacities and walking speed, which is the main predictor of mortality in the elderly population.

Combined exercise training reduces blood pressure, arterial stiffness, and insulin resistance in obese prehypertensive adolescent girls

ABSTRACTChildhood obesity is strongly linked to pathological processes for cardiovascular diseases in later adulthood. Obese adolescent girls with high blood pressure (BP) are reported to have increased arterial stiffness, which is associated with the development of hypertension and atherosclerosis. The present study sought to examine the impact of combined resistance and aerobic exercise (CRAE) training on BP, brachial-ankle pulse wave velocity (baPWV), insulin resistance (IR), and body composition in obese prehypertensive girls. Forty girls (age, 15 ± 1 years; systolic BP, 132 ± 2 mmHg, diastolic BP, 80 ± 5 mmHg) were randomly assigned to either a combined exercise (EX, n = 20) or no exercise group (CON, n = 20). The EX group performed CRAE for 12 weeks, 3 times per week. BP, baPWV, blood nitrite/nitrate, endothelin-1 (ET-1), homeostasis model assessment for insulin resistance (HOMA-IR), and body composition were measured before and after the exercise intervention. BP (∆-7.3 ± 2.67 mmHg), baPWV (∆-1.23 ± 0.49 m/s), ET-1 (∆-14.35 ± 1.76 μmol/mL), nitrite/nitrate (∆0.5 ± 0.09 μM), HOMA-IR (∆-1.4 ± 0.07), percent body fat (∆-1.35 ± 0.9%), and waist circumference were significantly improved (P < 0.05) in the EX group after 12 weeks of training versus the CON group. These findings indicate that 12 weeks of CRAE improves BP, HOMA-IR, and arterial stiffness and reduces central adiposity in obese adolescent girls with prehypertension. Thus, this study provides evidence that CRAE can be a useful therapeutic treatment for high BP, IR, and central adiposity, thereby reducing the likelihood of pathological development for cardiovascular diseases in later adulthood.

Serum metabolomic response to exercise training in spontaneously hypertensive rats

Chronic aerobic exercise training exhibits blood pressure protective effects, but the mechanism in metabolic level remains largely unclear. This study aims to investigate the effect of exercise training from serum metabolic profiles on the development of hypertension in spontaneously hypertensive rats (SHRs). Exercise training was performed, and the serum metabolites were measured by integrating gas chromatography–mass spectrometer and correlation-based network analysis. After a period of 6 weeks of chronic aerobic exercise training, systolic blood pressure was significant lower in the exercise training group (SHR + EX) rats than the control group (SHR). Principal component analysis indicated a clearly separation of metabolomic profiles between SHR + EX and SHR. Nineteen of 63 metabolites in serum were identified (P < .05, variable importance in projections > 1, false discovery rate < 0.1), including fatty acids, amino acids, and others. Lower levels of six fatty acids were observed in SHR + EX. Besides, pathway analysis indicated a significant alteration of fatty acid metabolism. The correlation-based (Pearson correlation coefficient > 0.83) network of serum metabolites revealed a decreased correlation linkage of SHR + EX than SHR rats. Higher activities of hexokinase, citrate synthase, aspartate aminotransferase, and alanine aminotransferase were detected in liver, left ventricle, and skeletal muscle of SHR + EX groups. In summary, these findings provided essential biochemistry information about the metabolic alteration to exercise training in SHR, which may in part explain the protective effect of exercise in hypertensive individuals.

The Effects of Exercise Training on Cardiorespiratory Fitness in Obese Sedentary Pregnant Women

PURPOSE: Maternal obesity has profound detrimental effects on the offspring’s risk of obesity and cardiometabolic health. Although pre-conception interventions are preferable, exercise during pregnancy can potentially mitigate the effects of maternal obesity on metabolic health in both the mothers and the offspring. The Expecting study is an ongoing RCT in obese sedentary women aiming to determine if combined resistance and aerobic exercise during pregnancy improves maternal health and decreases the risk of obesity in the offspring. The purpose of the current analysis was to assess the effects of 11 weeks of exercise training on markers of cardiorespiratory health in women participating in the study for whom data are available at gestation week (GW) 12 and 24. METHODS: Women (n=40) were recruited at GW 12. Body composition and submaximal aerobic capacity were assessed at GWs 12 and 24 using air displacement plethysmography and an incremental treadmill test, respectively. Twenty-one women were randomized to receive standard of care (SOC) and 19 received a combined exercise intervention (EX) 3 times/week. Oxygen consumption (VO2, ml·kg-1·fat-free-mass-1) and oxygen pulse [OP, ml/beat, (VO2/heart rate)] are reported for the work load corresponding to a rate of perceived exertion of 15 on Borg’s scale (RPE-15). The intervention effect was assessed using analysis of covariance where baseline measurements and incline were used as covariates. Data are presented as mean ±SE. RESULTS: at GW 12, groups were comparable in terms of age (EX=30±4 vs. SOC=29±4 years, NS), BMI (37.4±5.2 vs. 37.8±6.6, NS), body fat mass (48.8±5.4 vs. 47.8±5.2%, NS), and body fat free mass (51.1±5.9 vs. 51.4±7.5 kg, NS). Mean attendance to EX sessions was 80±9% (2.4±0.3 visits/wk.) After 11 weeks of training, the EX group had higher VO2 (34.0±0.8 vs. 30.3±0.7, p=0.002) than the SOC group. Oxygen pulse was also higher in the EX group compared to the SOC group (11.6±0.3 vs. 10.6±0.3). CONCLUSION: A structured exercise intervention during pregnancy in obese sedentary women is not only well-received and easy to adhere to, but also results in improved aerobic fitness. Supported by USDA-ARS # 6026-51000-010-05S, ACRI, and Arkansas Biosciences Institute, the major research component of the Arkansas Tobacco Settlement Proceeds Act of 2000.

Influence of Experience and Attentional Focus in a Single Arm Isokinetic Elbow Flexion

Previous research has shown that adopting an external focus (i.e., movement of the handle), rather than an internal focus (i.e., muscle contraction) increases force output and decreases muscle activation during an elbow flexion movement in men and women with strength training experience. However, little is known about the influence of attentional focus in novice populations. PURPOSE: To determine the influence of attentional focuses on muscle activation and force output among experienced and inexperienced males performing a unilateral isokinetic elbow flexion. METHODS: Fourteen male participants with >3 years of strength-training experience (EX group mean age 20.6 ± 0.9) and 9 novice participants with <6 months of resistance training experience (NOV group mean age 19.5 ± 1.0) performed 10 repetitions of a unilateral elbow flexion using a Biodex System 4 dynamometer. Repetitions were performed under 3 conditions (a control followed by randomly assigned internal and external focuses) at a speed of 60°(s-1). Peak torque (N·m) was measured by the Biodex, and peak muscle activation (mV) of the biceps brachii was measured using surface EMG. RESULTS: Within-group differences were analyzed using a repeated measures MANOVA. In the EX group, an external focus showed significantly higher peak torque (65.3 ± 3.2 N·m) than both the control (60.0 ± 3.2 N·m) and internal (50.1 ± 4.2 N·m) focus (all p<0.05). For the NOV group, there were no significant differences in peak torque production between any conditions. Further, there were no within-group significant differences in peak muscle activation for either group. CONCLUSION: Supporting previous research, our results show that adopting an external focus yields greater force output than an internal focus for experienced populations. However, no difference in force output is observed in novices with an external or internal focus. Thus, instructing experienced individuals to adopt an external focus may be beneficial for exercises where maximum force output is the goal, but additional research is needed to better understand the influence of attentional focus for similar exercises among novices. Supported by University of St. Thomas Collaborative Inquiry Grant.

Postinjury Exercise and Platelet-Rich Plasma Therapies Improve Skeletal Muscle Healing in Rats But Are Not Synergistic When Combined

Background: Skeletal muscle injuries are the most common sports-related injury and a major concern in sports medicine. The effect of platelet-rich plasma (PRP) injections on muscle healing is still poorly understood, and current data are inconclusive. Purpose: To evaluate the effects of an ultrasound-guided intramuscular PRP injection, administered 24 hours after injury, and/or posttraumatic daily exercise training for 2 weeks on skeletal muscle healing in a recently established rat model of skeletal muscle injury that highly mimics the muscle trauma seen in human athletes. Study Design: Controlled laboratory study. Methods: A total of 40 rats were assigned to 5 groups. Injured rats (medial gastrocnemius injury) received a single PRP injection (PRP group), daily exercise training (Exer group), or a combination of a single PRP injection and daily exercise training (PRP-Exer group). Untreated and intramuscular saline–injected animals were used as controls. Muscle force was determined 2 weeks after muscle injury, and muscles were harvested and evaluated by means of histological assessment and immunofluorescence microscopy. Results: Both PRP (exhibiting 4.8-fold higher platelet concentration than whole blood) and exercise training improved muscle strength (maximum tetanus force, TetF) in approximately 18%, 20%, and 30% of rats in the PRP, PRP-Exer, and Exer groups, respectively. Specific markers of muscle regeneration (developmental myosin heavy chain, dMHC) and scar formation (collagen I) demonstrated the beneficial effect of the tested therapies in accelerating the muscle healing process in rats. PRP and exercise treatments stimulated the growth of newly formed regenerating muscle fibers (1.5-, 2-, and 2.5-fold increase in myofiber cross-sectional area in PRP, PRP-Exer, and Exer groups, respectively) and reduced scar formation in injured skeletal muscle (20%, 34%, and 41% of reduction in PRP, PRP-Exer, and Exer groups, respectively). Exercise-treated muscles (PRP-Exer and Exer groups) had significantly reduced percentage of dMHC-positive regenerating fibers (35% and 47% decrease in dMHC expression, respectively), indicating that exercise therapies accelerated the muscle healing process witnessed by the more rapid replacement of the embryonic-developmental myosin isoform by mature muscle myosin isoforms. Conclusion: Intramuscular PRP injection and, especially, treadmill exercise improve histological outcome and force recovery of the injured skeletal muscle in a rat injury model that imitates sports-related muscle injuries in athletes. However, there was not a synergistic effect when both treatments were combined, suggesting that PRP does not add any beneficial effect to exercise-based therapy in the treatment of injured skeletal muscle. Clinical Relevance: This study demonstrates the efficacy of an early active rehabilitation protocol or single intramuscular PRP injection on muscle recovery. The data also reveal that the outcome of the early active rehabilitation is adversely affected by the PRP injection when the two therapies are combined, and this could explain why PRP therapies have failed in randomized clinical trials where the athletes have adhered to postinjection rehabilitation protocols based on the principle of early, active mobilization.

Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect

ObjectiveThe aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). MethodsA total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). ResultsIntensity of pain was significantly decreased in both groups with the treatment (p < 0.05). The WII Group had significantly better results for all Neer test, SRT and SAT than the EX Group (p < 0.05). ConclusionVirtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level of EvidenceLevel I, Therapeutic study.

Voluntary Exercise Enhances Cardiac Growth in Response to Chronic β‐Adrenergic Receptor Stimulation

Exercise has been demonstrated to protect the heart against the adverse effects of cardiovascular disease. Given the prevalence of cardiovascular disease (CVD), the role that exercise plays in protecting the heart prior to CVD is an important area of research given its clinical implications. Therefore, this study aims to examine how voluntary exercise can impact the progression of heart failure. To do this, a mouse model with nine‐week‐old female and male CB6F1 hybrid mice was used to test the impact of voluntary wheel running on heart failure resulting from chronic β‐adrenergic receptor stimulation. Mice either exercised for five weeks on a voluntary wheel (EX) or remained sedentary during the duration of the study (SED). After three weeks, both SED and EX mice were administered either vehicle (VEH) or isoproterenol (ISO, 30mg/kg/day) via an osmotic pump for two weeks. In the EX group, mice were further divided into two groups: one that continued exercising while receiving ISO (EX+ISOe) and one that became sedentary (EX+ISOs). At the end of the treatment, morphometric data was collected including heart weight‐to‐tibia length (HW/TL). Significant cardiac growth was observed in the both males and females in the mice that exercised for the entire five weeks (EX+VEH) as compared to their sedentary counterparts (SED+VEH). Additionally, male and female mice that were sedentary for 21 days and received ISO (SED+ISO) had increased heart size in comparison to the control group (SED+VEH). In male and female EX+ISOs mice, both sexes had similar cardiac growth to the SED+ISO group. Finally, cardiac growth in both EX+ISOe males and female was greater than any of the other groups of mice. Our results suggest that there is an additive effect of both exercise and ISO causing this significant increase in size. This data is in contrast to previous studies that demonstrated forced exercise reduced cardiac hypertrophy in response to chronic β‐adrenergic receptor stimulation. To better understand these differences in our study, we are currently performing quantitative PCR on left ventricular tissue to identify changes in a number of hypertrophic gene markers. These investigations will allow us to better understand the cardioprotective effects of exercise on the progression of heart failure.Support or Funding InformationMurdock Faculty Start‐up Funding (SL)