Exercise Program Research Articles

Physical Exercise and the Gut Microbiome: A Bidirectional Relationship Influencing Health and Performance

Background/Objectives: The human gut microbiome is a complex ecosystem of microorganisms that can influence our health and exercise habits. On the other hand, physical exercise can also impact our microbiome, affecting our health. Our narrative review examines the bidirectional relationship between physical activity and the gut microbiome, as well as the potential for targeted probiotic regimens to enhance sports performance. Methods: We conducted a comprehensive literature review to select articles published up till January 2024 on the topics of physical exercise, sports, probiotics, and gut microbiota from major scientific databases, incorporating over 100 studies. Results: We found that the impact of physical activity on the gut microbiome varies with the type and intensity of exercise. Moderate exercise promotes a healthy immune system, while high-intensity exercise for a long duration can cause a leaky gut and consequent systemic inflammation, which may disrupt the microbial balance. Combining aerobic and resistance training significantly affects bacterial diversity, linked to a lower prevalence of chronic metabolic disorders. Furthermore, exercise enhances gut microbiome diversity, increases SCFA production, improves nutrient utilization, and modulates neural and hormonal pathways, improving gut barrier integrity. Our findings also showed probiotic supplementation is associated with decreased inflammation, enhanced sports performance, and fewer gastrointestinal disturbances, suggesting that the relationship between the gut microbiome and physical activity is mutually influential. Conclusions: The bidirectional relationship between physical activity and the gut microbiome is exemplified by how exercise can promote beneficial bacteria while a healthy gut microbiome can potentially enhance exercise ability through various mechanisms. These findings underscore the importance of adding potential tailored exercise regimens and probiotic supplementation that consider individual microbiome profiles into exercise programs.

Regular supervised exercise training improves endothelial function, early atherosclerosis, arterial stiffness and endothelial progenitor cells in PCI patients

Abstract Backgrounds A disrupted balance between endothelial injury and repair induces endothelial dysfunction and endothelial progenitor cells (EPC) augment vascular repair. So, exercise improves endothelial function through increased numbers of EPC. We investigated the effect of training on vascular health by measuring the number of circulating EPC, and assessing flow-mediated dilation (FMD), brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) in patients with percutaneous coronary intervention (PCI). Methods Fifty-nine patients who were done PCI recently were randomized to full medical treatments or additional 3 months regular supervised exercise program (4 times a week, 1 hr a day). FMD, baPWV, carotid IMT, HOMA, hs-CRP and lipid profiles were measured and circulating CD34/KDR, CD34/CD117 and CD34/CD133 EPC were quantified by flow cytometry at baselines and after 3 months. Results Finally 23 patients joined exercise program(control, N=28). There was no significant difference of baseline characteristics and medication between 2 groups. After 3 months, FMD improved significantly in exercise group (6.62% to 11.48%) compared with control group (7.61% to 8.45%) (P<0.001) (fig 1). Carotid IMT reduced significantly in exercise group (0.759mm to 0.707mm) compared with control group (P=0.015) (fig 2). ba-PWV reduced significantly in exercise group (1529cmm/s to 1455 cmm/s) compared with control group (P=0.016) (fig 3). Numbers of CD34/KDR, CD34/CD117 and CD34/CD133 EPCs increased significantly after exercise compared with control group (P= 0.041, 0.011, 0.022, respectively) (fig 4). We also could see to reduce waist to hip ratio in exercise group compared with control group (P<0.001). Conclusions Three months regular supervised exercise improved FMD, ba-PWV, carotid IMT and waist to hip ratio in PCI patients. and it augmented numbers of circulating EPCs. Our results showed that exercise contributes to additional improvement of vascular health in PCI patients with optimal medical treatments.

Effects of Toe-Strengthening Exercises on Medial Longitudinal Arch Height, Muscle Stiffness, and Functional Movement

Background: Prolonged training in combat boots can place significant stress on the medial longitudinal arch, potentially leading to lower-extremity muscle stiffness and an increased risk of injury. This study assessed the impact of toe-strengthening exercises on improving the lower-extremity function and functional movement in cadets undergoing training. Methods: Forty junior cadets (mean age: 22.6 years) participated in this study. The measurements included the medial longitudinal arch height, lower-extremity muscle stiffness, functional movement, and leg length. Results: Cadets who performed the toe exercises demonstrated improved lower-extremity muscle stiffness and functional movement performance (hurdle step, p = 0.010; rotary stability, p = 0.001). A significant correlation was observed between the exercise group and time (tibialis right, p = 0.008; tibialis left, p = 0.028). Conclusions: This study highlighted the potential of toe-strengthening exercises to enhance the lower-extremity function and reduce the risk of injury among cadets. However, challenges in identifying the medical history, past injuries, and specific areas of pain for each cadet were noted. These findings support the implementation of targeted toe exercises in military training programs to prevent injuries.

Associations of Cardiac myosin binding protein C to Troponin I in patients with chronic heart failure during exercise. A substudy of the SMARTEX-HF trial

Abstract Aim Cardiac myosin binding protein C (cMyC) has shown promise being more sensitive than cardiac troponins, rising faster after myocardial infarction[i]. Its association to hs-cTnI in heart failure patients during physical activity is not known. The aim of this study was to assess the association between a novel biomarker: cMyC and the clinically used high sensitivity cardiac Troponin I (hs-cTnI) during a 12-week exercise training program in patients with chronic symptomatic heart failure with reduced ejection fraction (HFrEF). The changes of biomarkers in plasma levels in an intervention group, performing structured exercise programs, were compared to those in a control group, instructed to perform regular recommended exercise (RRE) according to current guidelines. Methods and results This was a post hoc analysis of the SMARTEX-HF trial in 215 patients with symptomatic heart failure (HF) with Left Ventricular Ejection Fraction (LVEF) <35% and NYHA II-III. The patients were randomly assigned to High Intensity Interval Training (HIIT, n=77), Moderate Continuous Training (MCT, n=65) or RRE, (n=73) for 12 weeks. Measurements and clinical data were acquired before and after the 12-week intervention. In 191 patients, plasma was available for hs-cTnI testing and in 189 patients plasma was available for cMyC testing. Due to the lack of a normal distribution, the values were log transformed. There was a significant association of change in log hs-cTnI and change in log cMyC (Pearson correlation R=0.52 (95% CI 0.37- 0.66) p<0.001) (Figure 1). For any 10% increase in cMyC level, the ratio of the hs-cTnI level increased with approximately 5% (Figure 2). There was no association between the levels of cMyC at baseline and change in hs-cTnI at 12 weeks. Conclusion Changes in levels of the novel biomarker cMyC was significantly associated with hs-cTnI plasma levels in patients with symptomatic chronic HFrEF during a structured 12 week exercise training program. Being more sensitive, it may indicate a role as a future marker of subclinical myocardial damage.Models with adjustmentsMarginal effect at the mean

The Impact of a 12-Week Workplace Physical Activity Program on the Quality of Life of Sedentary Workers: A Pilot Study

Office workers frequently display behavioral patterns marked by extended periods of sedentary and seated work. In this context, the implementation of a workplace exercise program has been shown to be effective in mitigating health-related risk factors. This study aimed to evaluate the impact of a 12-week workplace exercise program on the quality of life of employees whose primary occupational duties involve prolonged sitting. The final sample comprised 19 participants (6 females and 13 males), aged between 21 and 48 years (M = 32.26; SD = 9.03). Among these participants, 78.9% reported engaging in a hybrid work arrangement, 15.8% followed an on-site work regimen, and 5.3% worked remotely. Furthermore, 84.2% of participants reported sitting for 6 to 8 h per day, while 15.8% reported sitting for between 9 and 12 h daily. The quality of life of participants was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey. A paired samples t-test was employed to examine differences between dependent variables. The results revealed a statistically significant improvement in general health (p < 0.01), vitality (p < 0.01), social functioning (p < 0.05), and the mental health summary measure (p < 0.04). Promoting physical activity through workplace exercise programs offers substantial benefits for workers’ health and quality of life, contributing to the prevention of occupational diseases.

Evaluating Biomarkers of Bone Health After an 8-Week Walking Program in Non-Ambulatory Stroke Survivors: A Pilot Study

Background/Objectives: Stroke survivors have a significantly increased likelihood of developing osteoporosis, a condition characterized by weak and brittle bones as well as an elevated risk of bone fractures. However, previous studies on exercise intervention have mostly been on stroke survivors who are able to walk. The objective of this study was to examine the effect of walking exercise on bone health in non-ambulatory stroke survivors. Methods: This pre- and post-test study enrolled a group of chronic non-ambulatory stroke survivors. They were instructed to complete an 8-week aerobic walking exercise program, three sessions per week. Serum concentrations of osteocalcin (OC) and carboxy-terminal telopeptides of type I collagen (ICTP) were evaluated at baseline and after completing the walking exercise program. In addition, we assessed the ambulation capacity and balance control using the functional ambulation category (FAC) and Berg Balance Scale (BBS), respectively. Results: A total of 9 out of 10 non-ambulatory stroke survivors who were recruited completed the intervention. The serum concentration of OC significantly increased from 8.51 ± 2.28 ng/mL to 9.39 ± 2.97 ng/mL (p < 0.10). The serum concentration of ICTP significantly increased from 4.45 ± 2.58 ng/mL to 5.31 ± 2.92 ng/mL (p < 0.10). Both FAC and BBS scores significantly improved from 1.0 ± 0 to 1.33 ± 0.5 (p < 0.1) and from 7.22 ± 10.02 to 15.78 ± 14.81 (p < 0.01), respectively. Conclusions: The findings of this pilot study suggest that walking exercise may improve bone health by initiating a bone remodeling process in chronic non-ambulatory stroke survivors.

Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial.

Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference -0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference -0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients' physical functions and spinal flexibility.

Causes and predictors of long-term mortality in patients referred to a cardiac rehabilitation program

Abstract Introduction Cardiac rehabilitation (CR) programs have proven to reduce short-term mortality in patients with ischemic heart disease (IHD) and hospitalization rates in patients with heart failure (HF) (1-3). However, there is insufficient evidence about long-term mortality (>24-36 months) for patients receiving treatments based on recent clinical practice recommendations. Purpose To assess the long-term prognosis and predictors of mortality in a heterogenous group of patients referred to cardiac rehabilitation, and to obtain a detailed overview of death causes. Methods An inferential analysis of consecutive patients referred for exercise-based CR at a single site between January 2016 and January 2021 was performed. Included subjects were classified attending to four indications for referral: IHD, HF, valvular heart disease (VHD) and cancer therapy-related cardiovascular toxicity (CTR-CVT). Patients who did not initiate the CR program or were referred for other indications were excluded. The primary endpoint was all cause death. The secondary endpoint was cardiovascular (CV) death. A survival analysis was performed using Kaplan Meier estimates for each referral indication and a Cox proportional hazards model was fitted to investigate mortality predictors. The initiation of the exercise program was considered the inclusion date, and patients were followed until they met the primary endpoint or censored by January 2024. Results A total of 1180 patients were included in the analysis (81% male, mean age 61 ± 11 years), with a median follow-up of 5.3 years. Most of the patients had been referred due to IHD (87%), while the proportion for HF, VHD, and CTR-CVT was 9.9%, 1.8% and 1.4%, respectively. Seventy-eight patients (6.6%) died during follow-up, with a Kaplan-Meier estimated survival of 94.5% at 5 years (95% CI 93.2%-95.9%). Nineteen patients (24.4%) died due to a cardiovascular event, mostly sudden cardiac death (47%). The predominant non-CV causes of death were infectious disease (36%) and cancer (34%). A multivariate Cox model analysis (Table 1) showed an increased risk of all cause death for patients referred due to HF (HR 2.95, 95% CI 1.33 - 6.55), VHD (HR 5.55, 95% CI 1.19 - 25.9) and CTR-CVT (22.47, 95% IC 7.32 - 68.95) when compared to IHD (Figure 1). Other significant predictors of mortality were LVEF <40%, male sex, age, diabetes, peripheral vascular disease, and multivessel coronary disease. Only LVEF <40%, VHD, CTR-CVT and peripheral vascular disease were independent predictors of CV death. Conclusion Patients who initiated an exercise-based CR program had a low risk of all cause death at 5 years. Indications for CR other than IHD were associated with higher mortality rates after adjusting for confounder variables, likely due to a selection bias of patients in advanced stages of the disease.Table 1.Cox models for all-cause deathFigure 1.KM plot for all-cause death

The Effects of Physiotherapy Programmes, Aided by Virtual Reality Solutions, on Balance in Older Women: A Randomised Controlled Trial

Background: Modern technologies are being applied to maintain and improve the functional performance of older adults. Fully immersive virtual reality (VR) combined with a scope of dual-task (DT) activities may effectively complement conventional physiotherapy programmes for seniors. The study aimed to compare the effectiveness of a fully immersive virtual reality (VR) environment combined with a scope of dual-task activities regarding balance in older women. Methods: Eighty women were recruited to the study protocol and, following randomisation, allocated to two equally sized groups, one pursuing conventional OTAGO exercises, the other one the VR-solutions-aided exercise programme combined with a scope of DT activities. Physiotherapy sessions spanned 6 weeks, each one lasting 60 min, three times a week, in both groups. Results: Homogeneity analysis of both study groups indicated no statistically significant differences at the first measurement point. After the intervention, both study groups achieved significantly improved scores on all tests. The VR + DT group obtained better results in dual-task gait and single-leg standing, whereas the greatest difference was observed during SLS CL (1.52 s vs. 2.33 s—difference 0.81 s 53.2% change, p = 0.001). The OTAGO group performed better in the TUG single-task gait (11.35 s vs. 12.60 s, p < 0.001) and in the Berg balance scale. Conclusions: The VR + DT training is effective in improving individual balance as well as in reducing fall risks. VR-assisted physiotherapy should complement conventional physiotherapy programmes (e.g., OTAGO). The benefits of applying VR solutions indicate that older women might well use this form of activity regularly under the guidance of a therapist or a family member.

Exploring the effects of a real-time cardiac telerehabilitation using wearable devices in people with coronary artery disease following a recent myocardial infarction: a randomised controlled trial

Abstract Background Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary program for individuals after myocardial infarction (MI), that offers multiple health benefits. One of the greatest barriers to CR participation is the travelling distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of a remotely monitored CR in people with recent MI has yet to be examined. Purpose The aim of this randomised controlled trial was to assess the effects of a real-time cardiac telerehabilitation monitored by wearable devices in people with recent MI. Methods Thirty people (8 women, 22 men) with CAD following a recent (i.e., < 4 week) MI were randomly allocated into two groups (online home-based and gym-based groups). The groups underwent a 26-week CR, thrice per week. All patients performed the baseline and 24 weeks follow up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance and calories were assessed. Results The online group showed improved in mean daily steps (P<0.05) and mean daily distance (P<0.05) at 24 weeks compared to the gym-based group. The paired sample t-test showed that all the assessed variables were statistically (P<0.001) improved for both groups at 24 weeks. Pearson’s r demonstrated positive correlations between VO2peak and mean daily distance (r= .375), and negative correlations between VO2peak and muscle (r= -.523) and fat masses (r= -.460). There was no exercise-induced adverse events during the study. Conclusion Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the hemodynamic responses in CAD post MI patients is equally effective to a gym-based exercise programme.Individualized scanwatch report

Impact of telephone coaching supporting a physical maintenance exercise programme for older adults at risk of falls: a randomised controlled trial

BackgroundEncouraging compliance with recommended levels of exercise for older adults is a public health challenge. A minimal-resource solution is telephone coaching.ObjectivesPrimary aim: to compare timed up and go (TUG) performance 6 months after beginning a home exercise program between a group of older individuals who received additional telephone coaching, and a control group performing the home exercise program alone. Secondary aims: to compare functional and fall-related outcomes between groups at 6 and 12 months.MethodsMulticentre, assessor-blinded, randomised, controlled, open label, prospective study. Inclusion criteria included age ≥ 65 years, ≥ 1 fall in the past year, and discharged home from hospital rehabilitation or outpatient physiotherapy. All participants received a home exercise booklet and were asked to perform a set of exercises as often as possible (daily). The coaching group additionally received a monthly telephone call (total 5 calls) from their previous physiotherapist. Primary outcome was TUG performance at 6 months. Outcomes were measured at inclusion, and at 6 and 12 months. The primary outcome was analysed using a linear mixed model adjusted for the baseline value.ResultsIn total, 99 individuals were included (coaching group n = 50, control group, n = 49; mean [SD] age 83.1 [5.8] years and 77% women). TUG performance did not differ between groups at 6 months (adjusted difference 1.37, SE 1.32, 95% CI 1.26 to 4.01, p = 0.30). Secondary outcomes did not differ between groups at 6 or 12 months except compliance to the exercise program was higher in the coaching than the control group at 6 months (adjusted difference 1.0, SE 0.5, 95% CI 0.02 to 2.0, p = 0.05).ConclusionsThe lack of difference between the groups in the time taken to complete the TUG at 6 months suggests that the monthly telephone coaching sessions did not improve the effectiveness of a home exercise programme in elderly people who had suffered at least one fall. The trial was registered on ClinicalTrials.gov (NCT02828826; 11th of july 2016, last modification 16th of September 2024).

The Effect of a Multidisciplinary Lifestyle Intervention Program on Apelin-12, Vaspin and Resistin Concentrations in Children and Adolescents with Overweight and Obesity

Background: Obesity in childhood and adolescence has reached epidemic proportions in recent decades. Methods: In the present study, we determined the concentrations of apelin-12, vaspin and resistin in 106 children and adolescents with overweight or obesity before and after the implementation of a multidisciplinary, personalized lifestyle intervention program of diet, sleep and exercise for 1 year. All subjects attended our Center for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence. Results: Following the lifestyle intervention, there were significant decreases in BMI (p < 0.01), apelin-12 (p < 0.05) and resistin (p < 0.01) concentrations, and an increase in vaspin (p < 0.01) concentration. Glucose was the best positive predictor of apelin-12 (b = 0.236, p < 0.05), and osteopontin was the best negative predictor of changes in apelin-12 (b = −0.299, p < 0.05). Vaspin correlated positively with adiponectin (b = 0.29, p < 0.05), while vitamin D (b = 0.621, p < 0.05) was the best positive predictor of vaspin. BMI z score (b = −0.794, p < 0.05), HDL (b = −0.284, p < 0.05) and HbA1C (b = −0.262, p < 0.05) were the best negative predictors of changes in vaspin. BMI z score was the best positive predictor of resistin (b = 0.437, p < 0.05). Conclusions: These findings suggest that apelin-12, vaspin and resistin correlate with indices of obesity, glucose, lipids and bone metabolism, while interaction with other proteins, such as osteopontin and adiponectin, was also noted. Therefore, apelin-12, vaspin and resistin may be used as biomarkers in children and adolescents with overweight and obesity.

Postoperative early initiation of sequential exercise program in preventing persistent spinal pain syndrome type-2 after modified transforaminal lumbar interbody fusion: a prospective randomized controlled trial.

This prospective randomized controlled trial aimed to investigate the impact of early postoperative sequential motor control (starting first day post-operatively) and core stabilization training (starting fifth week post-operatively) compared to conventional exercise (starting fifth weeks post-operatively) on the risk of developing persistent spinal pain syndrome type-2 (PSPS-T2). 395 patients with lumbar degenerative diseases (LDDs) undergoing modified transforaminal lumbar interbody fusion and a 12-week postoperative exercise program (sequential vs. conventional exercise: 214 vs. 181) were evaluated for low back pain (LBP) intensity, Oswestry Disability Index (ODI), pressure pain threshold (PPT), temporal summation (TS), fatty infiltration of paraspinal muscles, transversus abdominis (TrA) activation capacity and Fear-Avoidance Beliefs Questionnaire (FABQ) pre-operatively, 3 months post-operatively, and 1 year post-operatively. At 3-month postoperative assessment, LBP in sequential exercise group were lower than those in conventional exercise group (P < 0.05), and sequential-exercise patients had greater local-area PPTs, lower TS, lower TrA activation capacities and less fatty infiltration of erector spinae than did the conventional-exercise patients (P < 0.05). At 1-year postoperative assessment, fewer sequential-exercise patients had PSPS-T2 compared with conventional-exercise patients (11/214 vs. 20/181; P < 0.05). LBP at rest and FABQ were lower in sequential-exercise patients than conventional-exercise patients (P < 0.05). Furthermore, both PPT and TS at 1-year postoperative assessment were associated with these measurements at 3-month postoperative assessment in patients with PSPS-T2 (P < 0.05). Postoperative sequential exercise has more positive effects to avoid PSPS-T2 than conventional exercise in patients with LDDs possibly because of its advantages in improving central and peripheral sensitization.

Plasma Lipidomic Profiles Improve upon Traditional Risk Factors for the Prediction of Arterial Stiffness Among Patients with Type 2 Diabetes Mellitum: A Randomized, Placebo-Controlled Trial

Background: Exercise or vitamin D intervention can reduce the risk of arterial stiffness; however, the underlying mechanisms of lipid metabolism remain unexplored. To examine the effects of a 12-week moderate and vigorous exercise program (65–80% maximal heart rate, 60 min/time, 2~3 times/week) with or without vitamin D supplementation (1000 IU/day) on the reduction in arterial stiffness and further explore whether the effects of interventions could be associated with the basal lipidome among patients with Type 2 diabetes mellitum (T2DM). Method: 61 patients with T2DM were randomly assigned to the following groups: control (CON, n = 15), exercise (EX, n = 14), vitamin D (VD, n = 16), and exercise + vitamin D (EX + VD, n = 16). Arterial stiffness risk factors (ankle–brachial index (ABI); brachial–ankle pulse wave velocity (baPWV), systolic blood pressure (SBP), and diastolic blood pressure (DBP)) were evaluated before and after the intervention. The plasma lipidome was determined using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Machine learning was applied to establish prediction models for the responsiveness to arterial stiffness. Result: Vitamin D supplementation could inhibit the decrease in the ankle–brachial index (mean ± SD: EX + VD and VD, −0.001 ± 0.058; EX + CON, −0.047 ± −0.089; p = 0.03). We observed high inter-individual variability in the arterial stiffness risk factors in response to the interventions. We also found that optimally selecting the lipid predictors at baseline, such as SM d44:6, LPE 18:2, and Hex2Cer 29:0, could enhance the predictive power by 100% for arm SBP changes in the exercise group. Basal levels of Cer (33:1) and GM3 (44:4) could enhance the predictive power by 100% for changes in baPWV in the vitamin D group. Conclusions: A 12-week vitamin D supplementation was beneficial in preventing arterial stiffness. Compared with traditional clinical risk factors, specific lipids at baseline could significantly improve the ability to predict intervention-induced changes in the reduction of arterial stiffness.

The effect of functional exercise program on physical functioning in older adults aged 60 years or more: A systematic review and meta-analysis of randomized controlled trials

ObjectiveIn this systematic review and meta-analysis, we assessed the impact of functional exercise training on physical functioning parameters in older adults 60 years and older. MethodDatabases including PubMed, MEDLINE, CINAHL, SPORTDiscus, and Cochrane Library were systematically searched. ResultsSixteen articles were included. Meta-analysis demonstrated that functional training significantly improved Barthel index (p = 0.01), gait speed (p = 0.002), gait cadence (p = 0.0002), Berg Balance Scale (p = 0.0003), Timed Up and Go test (TUG; p = 0.02), step length (p < 0.0001), Five Chair Stand (p < 0.0001) and physical activity questionnaire for the older adults score (p < 0.00001). However, hand grip strength remained unchanged. DiscussionThese findings underscore the significance of incorporating functional exercises in interventions for healthy aging and maintaining independence among older individuals. Further investigation is needed to explore long-term effects and optimal implementation strategies for functional exercise regimens in this populations.

Effects of Standard Tai Chi on Exercise Capacity and Mental Health in Exercise-Deprived Overweight/Obese Adults and Assessment of Participant Adherence.

To explore the effects of Tai Chi on body mass index (BMI), exercise capacity, and mental health of overweight/obese adults, and investigate factors influencing adherence to enhance adherence of Tai Chi as a sustainable exercise method. A randomized, controlled, exploratory clinical trial was conducted paired with a qualitative study of adherence management. A total of 20 overweight/obese participants were randomly assigned to a standard Tai Chi group (experimental) and a simplified Tai Chi group (control) for an 8-week intervention, 10 patients in each group, with a 12-month follow-up. BMI was calculated and exercise capacity including an isokinetic muscle strength and balance ability test were evaluated. Mental health was assessed using the General Well-Being Schedule (GWB), Pittsburgh Sleep Quality Index (PSQI), and Coping Self Efficacy Scale (CSES) at baseline, 4th week, and 8th week, respectively. The qualitative research included open-interviews with Tai Chi practitioners and semi-structured interviews with subjects. The intervention was conducted in Haidian Park, Beijing, China from October 6, 2022, to January 1, 2023, without dropouts. After an 8-week intervention, the participants in the experimental group exhibited a significant decrease in BMI (P<0.05). Both groups demonstrated significant improvements in exercise capacity (P<0.05). The experimental group exhibited a significant enhancement in the GWB, PSQI and CSES (P<0.05). Only GWB had significant difference in the control group (P<0.05). The experimental group surpassed the control group in GWB and CSES (P<0.05). The adherence rate was 87.5% in the experimental group and 57.9% in the control group after 8 weeks intervention. Analysis on adherence identified 15 themes, the top 3 themes mentioned were as follows: mind-body effects, online and on-site guidance, training schedule (for subjects); mind-body effects, difficulties in practicing, and understanding of Tai Chi (for practitioners). Both interventions were effective in improving exercise capacity. Tai Chi, integrating both physical and mental conditioning, reduced weight, improved exercise capacity and mental happiness, and increased adherence, providing a sustainable exercise program (ChiCTR2200063599).

Comparison of Differences in Kinetics of Elderly Women at Risk of Falling during Lumbar Stabilization Exercise per Obstacle Height

This study was performed to identify the kinetic and kinematic effects of the lumbar stabilization exercise on obstacle gait(5.2cm,15.2cm) among elderly women at risk of falls. The study subjects were 32 women aged 65 and over with a risk of falls identified by the Tinetti test. They were randomly allocated into 2 groups: the experimental group and the control group, and the lumbar stabilization exercise program was given to the experimental group for 12 weeks. The chi-square test and t-test were used to test homogeneity and compare baseline results of kinetic measurements on obstacle gait between the experimental and control groups. To identify the effects of the lumbar stabilization exercise program among study subjects, repeated measures of analysis of variance (ANOVA) were performed. Regarding kinetic variables, the knee joint angle of the propulsion foot significantly increased when overcoming a 5.2cm obstacle. When overcoming a 15.2cm obstacle, the obstacle overcoming speed and the knee joint angles of the support and propulsion feet significantly increased. However, the shortest vertical distance between the support and propulsion feet was reduced considerably. Our findings suggest that lumbar stabilization exercises could be a promising therapeutic exercise method for fall prevention and management in elderly women at risk of falling, providing reassurance about the effectiveness of our study's findings and the potential benefits for the elderly and other patients requiring trunk stability.

A functional exercise program improves pain and health related quality of life in patients with fibromyalgia: a randomized controlled trial

Background/objectiveFibromyalgia is a non-inflammatory syndrome characterized by generalized muscle pain, with other symptoms. Numerous forms of physical training for this population have been studied through high-quality randomized clinical trials involving strength, flexibility, aerobic conditioning and multicomponent exercise interventions. This research evaluated the effectiveness of a functional exercise program at reducing pain, improving functional capacity, increasing muscle strength as well as improving flexibility, balance and quality of life in individuals with fibromyalgia.MethodsEighty-two women with fibromyalgia were randomized into two groups. The functional exercise group performed functional exercises in 45-minute sessions twice per week for 14 weeks. The stretching exercise group performed flexibility exercises with the same duration and frequency. Outcome measures were: visual analog scale for widespread pain; Fibromyalgia Impact Questionnaire for health-related quality of life; Timed Up and Go test for functional performance; one-repetition maximum for muscle strength, Sit and Reach test on Wells bench for flexibility; Berg Balance Scale for balance; SF-36 for general quality of life.ResultsAfter the intervention, the functional exercise group had a statistically significant reduction in pain (interaction p = 0.002), and improvement in health-related quality of life measured by the Fibromyalgia Impact Questionnaire (interaction p < 0.001) and in general health state domain of SF-36 (interaction p = 0.043) compared to the stretching exercise group. No significant differences between groups were found regarding improvements in functional capacity, muscle strength, flexibility or balance.ConclusionFunctional exercise training was effective at reducing pain and improving quality of life in patients with fibromyalgia compared to stretching exercises.Trial registrationClinicalTrials.gov Identifier: NCT03682588 First prospectively registered in March 2018.

Examination of Exercise Physiological Traits According to Usage Grade of National Forest Trails

Forest trail difficulty levels must be investigated to promote their safe usage. However, exercise-based physiological changes are difficult to estimate in a forest environment. Hence, studies comparing indoor and outdoor environmental activities are required. We aimed to investigate the physiological traits associated with different usage grades of national forest trails in the Republic of Korea. We conducted both field and indoor experiments to measure different variables of 20 healthy participants aged 40–50 years to evaluate the exercise intensity and physiological effects of hiking on these trails. Significant variations in physiological responses were observed based on trail difficulty, with the highest heart rate and energy expenditure recorded during the most challenging uphill segments. Specifically, the heart rate increased from 115.4 ± 13.7 bpm in easy segments to 140.3 ± 15.6 bpm in difficult segments, whereas energy expenditure ranged from 404.1 ± 112.2 kcal/h to 518.1 ± 131.0 kcal/h. This study highlights the importance of considering both objective trail difficulty and users’ physiological reactions, including perceived exertion, to enhance user safety and optimize the health benefits of national forest trails. These findings provide essential data for developing comprehensive exercise programs and improving the national forest trail usage grade system.

The Effect of Reactive Neuromuscular Training versus General Warm-up on Proprioception and Balance in Female Handball Players with Rounded Shoulder: A Controlled Laboratory Study

Background: This study aimed to compare the immediate effects of a session of reactive neuromuscular training (RNT) with warming-up exercises on shoulder proprioception and dynamic balance in female handball players with shoulder impingement. Methods: In this controlled laboratory study, 18 female adolescent handball players from 14 to 18 years old were recruited from Samen City, Iran. The participants participated once in the warm-up routine program and once in the RNT program. Before and after each exercise program, shoulder proprioception was measured by photogrammetry and dynamic balance of the upper limb was measured using the Wye balance test. The paired t-tests, with a significance level of 0.05, were employed to compare pre-test and post-test data. Results: Both exercise protocols had no significant effects on shoulder repositioning error (P &gt; 0.05). However, participation in both exercise programs resulted in a significant improvement in the dynamic balance score of the upper limbs of the athletes (P &lt; 0.001). Moreover, no significant differences were observed between the effect of routine handball exercises and the effect of RNT exercises on shoulder repositioning and dynamic balance in female handball players (P &gt; 0.05). Conclusion: It seems that routine warm-up exercises and RNT could not improve proprioception in the shoulders of student- athletes with round shoulders. However, both training methods caused a significant improvement in the dynamic balance of the upper limb, although there was no significant difference between the effects of the two methods.