Higher Levels Of Exercise Research Articles

Exercise Dose Associated With Military Service: Implications for the Clinical Management of Inherited Risk for Arrhythmogenic Right Ventricular Cardiomyopathy.

High levels of aerobic exercise in individuals who have a gene mutation associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) are associated with clinical disease progression. Guidelines consequently restrict patients from competitive athletics. However, there is minimal literature to guide the safe dosing of physical activity outside of the setting of competitive athletics. Patients may be physically active pursuant to a variety of careers, including military service. This study aimed to define a therapeutic window for exercise for ARVC gene-positive individuals that are compatible with continuing military service and general health while maintaining a level of exercise below that which risks disease progression. Using standard metabolic equations, we calculated the minimum VO2 max (amount of oxygen utilized at peak exercise capacity) required to pass the physical fitness tests for each branch. We then developed a sample exercise prescription to maintain this level of fitness. We compared the prescribed exercise load with the physical activity levels associated with non-inferior clinical outcomes in ARVC gene-positive individuals. Additionally, we determined the physical activity exposure sustained by service members based on self-report data and compared these values with the upper limit of safe exercise exposure. Based on a review of the currently available literature, aerobic exercise exposure less than 700 to 1,100 MET-hours/year (metabolic equivalent-hours per year) is not associated with inferior clinical outcomes for gene-positive individuals. A military service member needs 600 to 700 MET-hours/year to minimally pass the physical fitness test. However, many military members are exercising in excess of this minimum, with typical exposures between 900 and 2,400 MET-hours/year. A therapeutic window of aerobic exercise may exist for ARVC gene-positive individuals which would allow continuation of military service while maintaining levels of exercise restriction associated with non-inferior clinical outcomes.

Association of Exercise with Inhibitory Control and Prefrontal Brain Activity Under Acute Psychosocial Stress.

Psychosocial stress has negative effects on cognition in adolescents. The aim of this study was to investigate whether physical exercise can buffer such effects on inhibitory control and associated cortical brain areas. Forty-two male high school students aged 16–20 years and with either low or high exercise levels performed a Stroop task under stress-free conditions and after the Trier Social Stress Test (TSST). Oxygenation of the dorsolateral prefrontal cortex (DLPFC) was measured with functional near-infrared spectroscopy. For inhibitory control, there was no significant primary effect of condition (F(1,40) = 1.09, p = 303., ηp² = 0.027) and no significant condition × group interaction (F(1,40) = 2.40, p = 0.129, ηp² = 0.057). For DLPFC oxygenation, a significant primary effect of condition was observed (F (1,38) = 6.10, p = 0.018, ηp² = 0.138). However, the condition × group interaction (F (1,38) = 0.05, p = 0.823, ηp² = 0.001) remained not significant. Adolescents’ exercise level was not associated with inhibitory control before and after stress. An impact of stress on a neurocognitive level was observed.

P1306EFFECT OF A SUPERVISED PERI- DIALYTIC EXERCISE PROGRAM ON SERUM ASYMMETRIC DIMETHYLARGININE IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract Background and Aims End-stage renal disease (ESRD) patients treated with maintenance hemodialysis (MHD) have high cardiovascular disease morbidity and mortality. Accumulation of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, has been strongly implicated in endothelial dysfunction, premature atherosclerosis, vascular events and mortality. Regular physical exercise effectively decreased serum ADMA in several studies. This potential should be explored among MHD patients. Method Forty four middle-aged ESRD patients treated with thrice-weekly MHD for >6 months completed a 6 months regimen of peri-dialytic lower limb exercise comprising pre-dialytic 10-12 stretching cycles and 20-30 minutes of intra-dialytic pedalling cycles. Plasma ADMA, CRP, other laboratory parameters and overall physical activity level were assessed initially and at the end of the study. Results S.ADMA increased from a median of 2375 to 3000 ng/mL (P=0.016). 31 patients sustained an increase in S.ADMA (ADMA_Inc), whereas 13 patients had a declining or stable S.ADMA (ADMA_Dec). Compared with ADMA_Inc, ADMA_Dec patients had significantly higher Kt/V (P=0.02), significantly higher grade of basal general physical activity level (P=0.017) and significantly less intra-dialytic hypotension episodes (IDHs) (P=0.019). The increase in S.ADMA and the post- study S.ADMA level had statistically significant positive correlations with number of IDHs (r=0.401,P=0.007 and r=0.305,P=0.044, respectively). Conclusion A 6 months program of combined aerobic and resistance peri-dialytic exercise failed to reduce S.ADMA in most MHD patients studied. A modest S.ADMA decline, however, occurred in patients with higher basal exercise level, higher Kt/V, and less IDHs. A potential benefit of peri-dialytic exercise in decreasing S.ADMA may be promoted by a multidisciplinary approach targeting increased physical activity, improved dialysis efficiency and prevention of IDHs.

45-LB: Introduction of the Diabetes Exercise Perception (DEEP-1) Questionnaire for Assessing Perceived Attitudes and Challenges in Athletes with Type 1 Diabetes

Background and Aims: Little is known about individual perspectives and challenges faced by elite-level athletes living with type 1 diabetes and where they turn to for advice. Currently, there is no validated tool to assess this. We aimed to generate and pilot test the Diabetes ExErcise Perception (DEEP-1) questionnaire in a group of professional endurance athletes with type 1 diabetes to investigate perceived attitudes and challenges. Methods: The online questionnaire consists of a range of open and closed questions, focusing on 4 key areas related to diabetes management and exercise: 1) Technology; 2) Sleep and Recovery; 3) Glucose Management; and 4) Nutrition. Sixteen professional cyclists with type 1 diabetes (age 27 ± 4 years; HbA1c 6.8 ± 0.5%) were asked to anonymously complete the questionnaire using SurveyMonkey.com. Data were then analyzed descriptively. Results: Fifteen participants responded. In this cohort, 90% showed an interest in using technology for improved exercise performance and 89% for glucose management, although 28% felt unaware of newer technologies. Glucose was perceived as being generally well regulated; however, according to the responses, more attention needs to be focused overnight and pre/during exercise. Sleep quality was rated as an important factor affecting exercise performance by 80% of respondents. 93% of participants identified nutrition as an area for improved performance, with 25% reporting a lack of education in this area. Conclusions: This pilot study highlights the importance of an individualized approach to diabetes management and high-level exercise performance. Future work should validate the DEEP-1 questionnaire in a larger sample size using individuals with a range of physical activity levels. Such a tool may provide a useful and time-efficient means for health care professionals to gain deeper insight into their patients’ attitudes and challenges regarding exercise. Disclosure S.N. Scott: None. F.Y. Fontana: None. C.A. Hayes: Other Relationship; Self; Novo Nordisk A/S. P.H. Lagrou: None. T. Zueger: None. P. Southerland: None. C. Stettler: None.

A Possible Antioxidant Role for Vitamin D in Soccer Players: A Retrospective Analysis of Psychophysical Stress Markers in a Professional Team.

The health benefits of physical activity are recognized, however, high levels of exercise may lead to metabolic pathway imbalances that could evolve into pathological conditions like the increased risk of neurological disease observed in professional athletes. We analyzed the plasma/serum levels of 29 athletes from a professional soccer team playing in the Italian first league and tested the levels of psychophysical stress markers (vitamin D, creatine kinase, reactive oxygen species (ROS) and testosterone/cortisol ratio) during a period of 13 months. The testosterone/cortisol ratio was consistent with an appropriate training program. However, most of the athletes showed high levels of creatine kinase and ROS. Despite the large outdoor activity, vitamin D values were often below the sufficiency level and, during the “vitamin D winter”, comparable with those of the general population. Interestingly, high vitamin D values seemed to be associated to low levels of ROS. Based on the results of our study we proposed a vitamin D supplementation as a general practice for people who perform high levels of physical exercise. Beside the known effect on calcium and phosphate homeostasis, vitamin D supplementation should mitigate the high reactivity of ROS which might be correlated to higher risk of neurodegenerative diseases observed in professional athletes.

Findings of a Pilot Study Investigating the Effects of Mediterranean Diet and Aerobic Exercise on Cognition in Cognitively Healthy Older People Living Independently within Aged-Care Facilities: The Lifestyle Intervention in Independent Living Aged Care (LIILAC) Study.

ABSTRACTBackgroundCognitive decline and Alzheimer disease are more prevalent in our aging population. Modifiable risk factors, such as diet and sedentary lifestyle, have been proposed as key to potentially ameliorating cognitive decline. Both exercise and Mediterranean diet (MedDiet) have been linked to reduced levels of cardiovascular disease and other comorbidities. Higher levels of exercise and MedDiet adherence may prove to be cognitively protective, both individually and synergistically.ObjectivesThe aim was to investigate the effect of a 6-mo program of MedDiet, exercise, and a combination of both, on cognition, mood, and general health in older persons living independently in aged-care communities.MethodsThe Lifestyle Intervention in Independent Living Aged Care (LIILAC) Study (ACTRN12614001133628) involved 102 participants, aged 60–90 y, who were randomly assigned to 1 of 4 intervention groups. Change in overall memory performance was assessed as the primary outcome. Additionally, changes in cognitive task performance, as well as mood, wellness, cardiovascular function, and blood biomarkers, were investigated.ResultsWhile there was no significant change in overall memory performance, there was a significant improvement in spatial working memory performance in the combined exercise and diet group, relative to controls. This combined intervention group also showed an overall improvement in their emotional state, as assessed by the Depression Anxiety Stress Scale, as did the exercise-only group.ConclusionsThis research indicates that diet and exercise programs have the potential to improve aspects of cognition and mood in an aging population. However, given the lower than optimal sample size and lack of resources to reinforce the interventions during the trial, further larger randomized controlled trials are required to substantiate whether the introduction of diet and exercise programs into independent-living facilities is a viable method to preserve cognitive health in older people. This trial was registered at www.ANZCTR.org.au ACTRN 12614001133628 (LIILAC Study)

Fast Return to Sports and High Level of Activity after Cementless Oxford Unicompartmental Knee Arthroplasty.

Physical activity is essential for overall health. For patients undergoing knee arthroplasty, questions about the implant's suitability for sports arise. The general recommendations for physical activity with knee replacements are often based upon experts' opinions, with a lack of scientific data. This study was performed at an independent high-volume center and aimed to investigate what level of activity patients can achieve and how they perform with a well-functioning cementless unicompartmental knee replacement (UKR). Possible differences in outcome in regards to patients' body mass index (BMI) were also examined. A total of 228 knees treated with cementless Oxford UKR (OUKR) were followed up after a mean of 37.1 months. Tegner's and UCLA (University of California, Los Angeles) scores were obtained to assess the level of physical activity. The Schulthess Clinical Activity Questionnaire was assessed for detailed information on practiced sports, and the SF-36 questionnaire was evaluated to analyze patients' quality of life. The return to activity rate was 92.9%. In total, 64% of the physically active patients had already taken up sports within 3 months after surgery. Mean Tegner's score was at 3.5, and mean UCLA score was at 6.3. High impact sports were not performed very often after surgery. Higher BMI showed a negative correlation with the numbers of sports (rsp = -0.289) as well as Tegner's (rsp = -0.222) and UCLA (rsp = -0.383) scores. The SF-36 scores were comparably good to those in an age-equivalent standard reference group. In conclusion, cementless OUKR allows a fast return to activity with a high level of physical exercise. Patients with increased BMI tend to practice less types of sports with decreased activity scores.

Impacts of Concurrent Cognitive Challenge on Aerobic Performance During Graded Exercise

IntroductionBoth sport and tactical performance relies on one’s ability to complete high levels of physical exercise simultaneously engaging in complex cognitive tasks (e.g. executive function). Several studies have found that combined cognitive tasks and muscle contractions can induce an earlier onset of fatigue and impair performance. However, it remains unclear if cognitive stress attenuates whole body dynamic exercise performance.PurposeTo determine if the addition of a cognitive task would limit maximal whole‐body exercise performance.Methods16 healthy Reserve Officer Training Corp cadets (19.6 ± 2 yrs, 5 Female) completed 3 graded exercise tests (GxT) separated by ≥ 24 hrs. The first GxT began at 3.5 mph, 0% grade increasing 2% every 2‐min until 16%, where speed increased by 0.5 mph every 2‐min until volitional fatigue. The next two GxTs (EFET, executive function exercise test) were identical to the first GxT while simultaneously completing an executive function test (Cedar Operator Workload Assessment Tool) on an iPad fixed to the treadmill. Heart rate (HR), respiration rate (RR), arterial blood saturation (SpO2) (Equivital Life monitoring system) and cerebral oxygenation (calculated tissue saturation index, TSI) using Near infrared spectroscopy was recorded throughout each test. Performance was determined by the number of stages completed. All data during the two EFET tests were averaged to form a singular response.ResultsData are mean ± SD, effect size calculated as Ω2. Concurrent executive function test and exercise did not significantly affect the number of stages completed when compared to the GxT (Stages completed, GxT= 8.6 ± 1.3, EFET= 8.5± 1.2, p= 0.2). However, 5 of 16 subjects completed fewer stages during EFET compared to GxT (Stages completed, GxT= 9.2± 1.3, EFET= 8.5± 1.1, p<0.01) were labelled Non‐Resilient (NR). The other 11 subjects who completed the same or more stages during the EFET were labeled Resilient (R) (Stages completed, GxT= 8.4± 1.3, EFET= 8.5± 1.2, p= 0.10). The R group had similar TSI responses between trials (p= 0.3, Ω2 = 0.01) while the NR group had a greater decay in TSI at the highest intensities during EFET compared to GxT (p<0.01, Ω2 = 0.11). Post hoc was unable to identify disparities at specific intensities (90% 61.9± 1.7 vs 63.7± 1.3 d=1.2 p>0.05, 100% 59.9± 1.7 vs 62.1± 1.3 d= 1.4 p>0.05, EFET vs. GxT, respectively). No difference in HR during EFET trials compared to GxT for NR (p=0.9, Ω2= 0.02) or R (p=0.5, Ω2 = 0.06) groups. No other variables differed between trials and groups.ConclusionConcurrent cognitive task does not impact graded exercise performance. However, our data suggests inter‐individual responses exist, where that some individuals maintain performance, while others cannot. The large effect size indicates NR were unable to sustain TSI during EFET. Therefore, maintenance of exercise performance with cognitive task seems to be related to one’s ability to preserve brain oxygenation during high intensity exercise.

Cardiovascular Care of Masters Athletes.

Masters athletes (MA), men and woman older than 35years who participate in competitive athletics, is a rapidly growing population that is increasingly encountered in clinical cardiovascular practice. Although the high levels of exercise typically performed by MA confer numerous health advantages, no amount of exercise confers complete immunity from cardiovascular disease. The review was written to cover the clinical management of MA with cardiovascular disease. Focus is dedicated to four of the most common clinical scenarios including atrial fibrillation, myocardial fibrosis, coronary artery disease, and dilation of the ascending aorta.

Exercise and arrhythmic risk in TMEM43 p.S358L arrhythmogenic right ventricular cardiomyopathy

High-level exercise has been associated with a malignant phenotype in desmosomal and genotype-negative forms of arrhythmogenic right ventricular cardiomyopathy (ARVC). This is the first study to examine this issue with ARVC secondary to the TMEM43 p.S358L mutation. The purpose of this study was to evaluate the impact of exercise on arrhythmic risk and cardiac death in TMEM43 p.S358L ARVC. Individuals with the TMEM43 p.S358L mutation enrolled in a prospective registry who had received a primary prevention implantable cardioverter-defibrillator (ICD) were invited to complete the modified Paffenbarger Physical Activity Questionnaire to assess their physical activity in the year before their ICD implantation. Time-to-event analyses using unadjusted and adjusted Cox proportional hazards models evaluated associations between physical activity and first appropriate ICD discharge secondary to malignant ventricular arrhythmia or cardiac death. In 80 subjects with the TMEM43 p.S358L mutation, exercise ≥9.0 metabolic equivalent of task (MET)-hours/day (high level) in the year before ICD implantation was associated with an adjusted 9.1-fold increased hazard of first appropriate ICD discharge (there were no deaths) relative to physical activity <9.0 MET-hours/day (moderate level) (95% confidence interval [CI] 3.3-24.6 MET-hours/day; P < .001). The median age from birth to first appropriate ICD discharge was 58.5 years (95% CI 56.5-60.5 years) vs 35.8 years (95% CI 28.2-43.4 years) (P < .001) in subjects in moderate- and high-level exercise groups, respectively. Exercise ≥9.0 MET-hours/day is associated with an increased risk of malignant ventricular arrhythmias in the TMEM43 p.S358L subtype of ARVC. Extrapolating these data, we suggest molecular testing be offered in early childhood to inform exercise choices reflective of the genotype.

Exploring Natural Clusters of Chronic Migraine Phenotypes: A Cross-Sectional Clinical Study

Heterogeneity in chronic migraine (CM) presents significant challenge for diagnosis, management, and clinical trials. To explore naturally occurring clusters of CM, we utilized data reduction methods on migraine-related clinical dataset. Hierarchical agglomerative clustering and principal component analyses (PCA) were conducted to identify natural clusters in 100 CM patients using 14 migraine-related clinical variables. Three major clusters were identified. Cluster I (29 patients) – the severely impacted patient featured highest levels of depression and migraine-related disability. Cluster II (28 patients) – the minimally impacted patient exhibited highest levels of self-efficacy and exercise. Cluster III (43 patients) – the moderately impacted patient showed features ranging between Cluster I and II. The first 5 principal components (PC) of the PCA explained 65% of variability. The first PC (eigenvalue 4.2) showed one major pattern of clinical features positively loaded by migraine-related disability, depression, poor sleep quality, somatic symptoms, post-traumatic stress disorder, being overweight and negatively loaded by pain self-efficacy and exercise levels. CM patients can be classified into three naturally-occurring clusters. Patients with high self-efficacy and exercise levels had lower migraine-related disability, depression, sleep quality, and somatic symptoms. These results may ultimately inform different management strategies.

Association of exercise with all-cause mortality in older Taipei residents.

Human life expectancy has increased rapidly in recent decades. Regular exercise can promote health, but the effect of exercise on mortality is not yet well understood. To investigate the association of exercise with mortality in the older people. We used data from annual health check-ups of the older citizens of Taipei in 2006. Participants were interviewed by trained nurses using a structured questionnaire to collect data on demographics and lifestyle behaviours. Overnight fasting blood was collected for measuring blood glucose, liver and renal function and lipid profiles. Exercise frequency was categorised into no exercise, 1-2 times in a week and more than 3-5 times in a week. All-cause mortality was ascertained from the National Registration of Death. All participants were followed up until death or December 312012, whichever came first. Kaplan-Meier curves and Cox proportional hazard analysis were used to investigate the association between exercise and all-cause mortality. In total, 42,047 older people were analysed; 22,838 (54.32%) were male and with a mean (SD) age of 74.58 (6.32) years. Kaplan-Meier curves of all-cause mortality stratified by exercise frequency demonstrated significant findings (Log-rank P < 0.01). Multivariate Cox regression analysis showed that older people with higher exercise levels had a significantly decreased risk of mortality (moderate exercise HR = 0.74, 95% CI: 0.68-0.81, high exercise HR = 0.65, 95% CI: 0.59-0.70) after adjusting for potential confounders, with a significant trend (P for trend<0.01). Older people with increased exercise levels had a significantly decreased risk of all-cause mortality.

Effect of Aerobic Physical Activity on Health-Related Quality of Life in Middle Aged Women with Osteoarthritis: Korea National Health and Nutrition Examination Survey (2016-2017).

Background: There have been few studies reporting the association between health-related quality of life (HRQoL) and osteoarthritis (OA) in female subjects performing aerobic exercise or not. The aim of this study is to compare HRQoL between OA patients and non-OA subjects in middle aged Korean women (40–59 years) with/without aerobic physical activity, and also to identify an association between EQ-5D instrument based HRQoL and OA controlling for aerobic exercise. Methods: This study used the cross-sectional data, the Korea National Health and Nutrition Examination Survey (KNANES) from 2016 to 2017. We only selected those who had completed the evaluations of aerobic physical activity and osteoarthritis diagnosis. In total, 2445 middle aged women were finally selected for this study. The European quality of life-5 dimensions (EQ-5D) was used for the evaluation of HRQoL as a dependent variable. In socio-demographic factors, age, sex, income level, education level, marital status, economic activity, type of insurance and private insurance and behaviour-related factors were included. One-way analysis of variance was conducted to compare the EQ-5D index and multiple linear regression analysis was employed to identify associated factors with the EQ-5D index. Results: In total, 2445 middle aged women were included in this study, in which 2209 participants were normal (90.0%) with aerobic physical activity (no: 55.0%, yes: 45.0%) and 246 participants were diagnosed with osteoarthritis (10.0%) with aerobic physical activity (no: 56.1%, yes: 43.9%). In group 2-2 (OA with aerobic), the moderate level of muscle exercise (less than 5 days per week) showed the highest HRQoL (p < 0.05) and high level exercise showed the lowest HRQoL (p < 0.05). In menopause status, the participants under menopause status showed lower HRQoL (p < 0.05) than those not under menopause status in group 2-2 (OA with aerobic) only. Conclusions: The HRQoL of OA patients was significantly lower than that of normal participants in middle aged Korean women (40–59 years). Especially, OA patients with maintained aerobic physical activity showed significantly higher HRQoL than those without that under controlling covariates such as age, income level, education level, marital status, economic activity, type of insurance, etc.

Lifelong Endurance Exercise as a Countermeasure Against Age-Related [Formula: see text] Decline: Physiological Overview andInsights from Masters Athletes.

Maximum oxygen consumption ([Formula: see text]) is not only an indicator of endurance performance, but also a strong predictor of cardiovascular disease and mortality. This physiological parameter is known to decrease with aging. In turn, physical exercise might attenuate the rate of aging-related decline in [Formula: see text], which in light of the global population aging is of major clinical relevance, especially at advanced ages. In this narrative review, we summarize the evidence available from masters athletes about the role of lifelong endurance exercise on aging-related [Formula: see text] decline, with examples of the highest [Formula: see text] values reported in the scientific literature for athletes across different ages (e.g., 35ml·kg-1·min-1 in a centenarian cyclist). These data suggest that a linear decrease in [Formula: see text] might be possible if physical exercise loads are kept consistently high through the entire life span, with [Formula: see text] values remaining higher than those of the general population across all ages. We also summarize the main physiological changes that occur with inactive aging at different system levels-pulmonary and cardiovascular function, blood O2 carrying capacity, skeletal muscle capillary density and oxidative capacity-and negatively influence [Formula: see text], and review how lifelong exercise can attenuate or even prevent most-but apparently not all (e.g., maximum heart rate decline)-of them. In summary, although aging seems to be invariably associated with a progressive decline in [Formula: see text], maintaining high levels of physical exercise along the life span slows the multi-systemic deterioration that is commonly observed in inactive individuals, thereby attenuating age-related [Formula: see text] decline.

Comparable Rates of Integrated Myofibrillar Protein Synthesis Between Endurance-Trained Master Athletes and Untrained Older Individuals.

BackgroundAn impaired muscle anabolic response to exercise and protein nutrition is thought to underpin age-related muscle loss, which may be exacerbated by aspects of biological aging that may not be present in older individuals who have undertaken long-term high-level exercise training, or master athletes (MA). The aim of this study was to compare rested-state and exercise-induced rates of integrated myofibrillar protein synthesis (iMyoPS) and intracellular signaling in endurance trained MA and healthy age-matched untrained individuals (Older Controls).MethodsIn a parallel study design, iMyoPS rates were determined over 48 h in the rested-state and following a bout of unaccustomed resistance exercise (RE) in OC (n = 8 males; 73.5 ± 3.3 years) and endurance-trained MA (n = 7 males; 68.9 ± 5.7 years). Intramuscular anabolic signaling was also determined. During the iMyoPS measurement period, physical activity was monitored via accelerometry and dietary intake was controlled.ResultsAnthropometrics, habitual activity, and dietary intake were similar between groups. There was no difference in rested-state rates of iMyoPS between OC (1.47 ± 0.06%⋅day–1) and MA (1.46 ± 0.08%⋅day–1). RE significantly increased iMyoPS above rest in both OC (1.60 ± 0.08%⋅day–1, P < 0.01) and MA (1.61 ± 0.08%⋅day–1, P < 0.01), with no difference between groups. AktThr308 phosphorylation increased at 1 h post-RE in OC (P < 0.05), but not MA. No other between-group differences in intramuscular signaling were apparent at any time-point.ConclusionWhile our sample size is limited, these data suggest that rested-state and RE-induced iMyoPS are indistinguishable between MA and OC. Importantly, the OC retain a capacity for RE-induced stimulation of skeletal muscle remodeling.

Pilot Program “Eating Healthy Living Healthy” in School Based Health Centers (SBHCs) - Combined Conventional and Integrative Approach

Background and Objectives: Adolescent obesity is widespread around the country. Among the behavioral factors responsible for high obesity rates are unhealthy eating patterns, high levels of stress, insufficient exercise, and poor sleep hygiene. “Eating Healthy Living Healthy” (EHLH) is a collaboration program between a health educator, a physical education teacher, and a nurse practitioner, developed as a pilot program in a School Based Health Center (SBHC) to address these factors. The motto “Small Steps to Big Change” reflects the main objective of this bilingual (Spanish/English), interdisciplinary program: helping teens transform …

Factors influencing prognosis for occupational hand eczema: new trends

Variables traditionally reported to influence the prognosis of occupational hand eczema (OHE) are atopic dermatitis (AD) and contact sensitization. However, recent studies indicate that lifestyle factors may be of major importance. To identify factors influencing the prognosis in a cohort of patients with recognized OHE. In this register-based cohort study, individuals with hand eczema recognized as occupational disease in the period January 2010-December 2011 were identified using files from Labor Market Insurance Denmark and included in the study. At baseline, information on sex, age, occupation, wet work, AD and contact sensitization was collected. In 2015 participants received a questionnaire with questions about lifestyle factors, current occupation and healing of OHE. In total, 2703 patients received the questionnaire; 1491 responded to the question about healing of OHE and were included in the study. Altogether, 19·3% of patients reported complete healing at follow-up. Current tobacco smoking and a high level of stress were factors inversely associated with healing of hand eczema (P < 0·001 and P = 0·030, respectively), while a high level of exercise was significantly related to healing of eczema (P = 0·011). Change of profession was a favourable prognostic factor, while age, sex, AD, contact sensitization and education did not significantly influence prognosis. Traditionally important risk factors such as AD and contact sensitization had no marked influence on prognosis, while lifestyle factors were of major importance. Our findings indicate that risk factors may vary over time, allowing for new perspectives on prevention. What's already known about this topic? Occupational hand eczema has a relapsing course and a poor overall prognosis. Atopic dermatitis and contact sensitization have previously been reported as risk factors for a poor prognosis. What does this study add? The results indicate that lifestyle factors are of importance for the prognosis of occupational hand eczema. Traditionally reported risk factors such as atopic dermatitis and contact sensitization do not currently influence prognosis.

Abstract 5056: Exercise and inflammation on the risk of cancer

Abstract Introduction: High systemic inflammation and low levels of exercise are associated with increased risk of cancer. We hypothesized that in the setting of inflammation, exercise mitigates cancer risk. Methods: To address this, we identified 6,388 participants, free of cancer and cardiovascular disease, enrolled in the Multi-Ethnic Study of Atherosclerosis. Regular moderate/vigorous intentional exercise was categorized as present or absent based on self-report from validated questions. A composite inflammatory score was created with a point given for C-reactive protein, IL-6, fibrinogen, and GlycA above normal, with composite scores &amp;gt; 2 points categorized as high. Cancer incidence was ascertained based on ICD codes abstracted from hospitalization or cancer registry data. Cox proportional hazard models were used to calculate subsequent risk of incident cancer. Models were adjusted for baseline age, gender, race, pack years smoking, education, income, health insurance status, body mass index, high-density lipoprotein levels, healthy diet adherence, statin and aspirin use. Results: The mean age was 62 years (±10.2 years), 53% female, 39% white, 26% black, 22% Hispanic, and 12% Chinese-American. Compared to the reference group (individuals reporting no exercise and with low levels of inflammation), in multi-variable adjusted models, individuals with high levels of inflammation and no exercise were at highest risk of cancer (hazard ratio = 1.17; 95% confidence interval 1.00 – 1.37), while those with low levels of inflammation who exercised were at the lowest risk of cancer (HR 0.80, 95% CI 0.68-0.95). Those who had high levels of inflammation, but regular exercise had no increased risk of cancer (HR 0.94, 95% CI 0.68-1.30). There was no significant interaction between exercise and inflammation. When considering individual inflammatory markers, there was a similar pattern (Table). Conclusion: Intentional moderate/vigorous exercise may lower the risk of cancer in individuals with high versus low levels of chronic inflammation. Cox proportional hazard models for incident cancer by exercise and measures of inflammation, adjusteno exerciseany exerciseHR95% CIHR95% CILow composite score (0 - 1)Ref0.800.680.95High composite score (&amp;gt;2)1.171.001.370.940.681.30P for interaction = 0.25Low CRP (&amp;lt;2 mg/L)Ref0.800.680.95High CRP (&amp;gt;2 mg/L)1.231.051.430.980.711.35P for interaction = 0.94Low IL-6 (&amp;lt; 1.8 pg/mL)Ref0.800.680.95High IL-6 (&amp;gt;1.8 pg/mL)1.070.911.260.860.621.19P for interaction = 0.18Low GlycA (&amp;lt;400 µmol/L)Ref0.800.680.95High GlycA (&amp;gt;400 µmol/L)1.191.021.390.960.691.32P for interaction = 0.73Low fibrinogen (&amp;lt;450 mg/dL)Ref0.800.680.95High fibrinogen (&amp;gt;450 mg/dL)0.970.751.250.770.511.18P for interaction = 1.00 Citation Format: Catherine Handy Marshall, Zeina Dardari, Miguel Cainzos-Achirica, Martin B. Mortensen, Khurram Nasir, Mouaz H. Al-Mallah, Michael D. Miedema, Ron Blankstein, Roger S. Blumenthal, Kala Visvanathan, Michael J. Blaha. Exercise and inflammation on the risk of cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5056.

The Spectrum of Change in the Elite Athlete's Heart

Extreme levels of both strength and aerobic training result in increased left ventricular (LV) and right ventricular (RV) volumes and LV mass, a key component of athletes' heart. The aim of this study was to document temporal changes in the hearts of elite professional athletes (Australian Football League players) over a 2- to 6-year period. Thirty-six Australian Football League players with 3.5±2.7years of professional training at enrollment prospectively underwent echocardiography in the preseasons of 2009, 2013, and 2015. At each time point, LV dimension and contractility and RV dimension, area, and contractility were measured using two-dimensional echocardiography. LV volumes, ejection fraction, and mass were measured using three-dimensional echocardiography. The mean age at baseline was 21.8±2.6years (range, 18-29years). Most players (n=20) had increasesin fitness between studies (mean maximal oxygen uptake, 62.3±3.6 vs 64.3±2.1mL/kg/min). In these players, there were increases in both LV and RV size and in LV mass. Players who were >25years of age at their baseline scans demonstrated a trend toward increases in RV size and a decline in RV global longitudinal strain.Fitness level and playing position also affected the degree of physiological athletic cardiac remodeling. Australian football is a sport that involves both strength and aerobic training. This study, unique in its length and detail, demonstrates that remodeling in the athlete's heart is a continuous spectrum of change. This remodeling occurs over time in response to high levels of exercise, with proportional increase in LV mass and LV dimensions.

Preoperative exercise as a predictor of weight loss in adolescents and young adults following sleeve gastrectomy: a cohort study

BackgroundPreoperative exercise is associated with weight loss following bariatric surgery in adults, but this relationship in adolescents and young adults (AYA) is not well studied. ObjectivesThe present study examined AYA-reported preoperative exercise and demographic factors and their prediction of percent excess body mass index (BMI) loss at 6 and 12 months following sleeve gastrectomy. SettingThe setting for recruitment and surgeries was in a children’s hospital in the United States. MethodsParticipants were 173 AYA aged 12–21 years (mean age, 16.5 [SD, 2.0] yr; mean preoperative BMI, 50 [SD, 8.5] kg/m2). Demographic characteristics including age, sex, ethnicity, and preoperative BMI were extracted from the medical record. Preoperatively, adolescents self-reported on exercise using 5 items from the Center for Disease Control’s Youth Risk Behavior Surveillance Survey. The study evaluated the association of self-reported preoperative exercise in total and obtained a threshold of higher exercise to weight loss at 6 and 12 months after surgery. ResultsMore preoperative exercise was associated with greater weight loss at 12 months. Grouping participants by those who reported exercising at high levels (≥5 hr/wk) compared with those who reported <5 hr/wk, high levels of exercise predicted greater weight loss at 6 and marginally at 12 months postoperatively. Lower preoperative BMI was a significant predictor of weight loss in all analyses. ConclusionsPreoperative exercise may predict and contribute to weight loss in AYA and could be a target for pre- and postoperative intervention to improve outcomes. The importance of lower preoperative BMI for maximizing postoperative weight loss was also supported.