Isometric Exercise Research Articles

Maximum Isokinetic Eccentric Elbow Flexor Muscle Force Can Be Estimated Using Maximum Isometric Contraction Force.

Purpose It is difficult to measure maximal isokinetic eccentric (ECC) muscle strength in the sports field. This study aimed to investigate whether elbow isometric (ISO) flexion muscle strength or muscle thickness (MT) can be used to estimate elbow ECC flexion muscle strength. Material and methods Maximal muscle strength and muscle thickness (MT) were measured in the elbow flexor muscle group of 147 healthy adults (age: 21.3±0.8 years, height: 167.3±8.6 cm, body mass: 61.4±10.6 kg: 99 males and 48 females). Both isometric contraction (ISO) and eccentric contraction (ECC) of elbow flexion muscle strength were measured using an isokinetic dynamometer. The ultrasound measured MT at 50% of the distance from the upper arm to the lateral epicondyle. We performed the multiple regression analysis with elbow ECC flexion muscle strength as the dependent variable and gender, age, height, body mass, elbow ISO flexion muscle strength, and MT as the independent variables. Results Multiple regression analysis revealed a coefficient of determination R2 value of 0.89 and an adjusted R2 value of 0.89 (p<0.01). In addition, the independent variables elbow ISO flexor strength (p<0.01, standardized coefficient β=0.94; p<0.01, standardized coefficient β=0.89) and muscle thickness (p<0.05, standardized coefficient β=0.07) were identified as significantly associated factors. Conclusions The results suggest that it is possible to estimate elbow ECC flexion muscle strength using only elbow ISO flexion muscle strength and that ECC flexion muscle strength can be estimated more accurately by adding muscle thickness of the elbow flexor muscle group.

Investigating The Mechanistic Role Of Muscle Growth On Strength In Response To Isometric Handgrip Training

Investigating The Mechanistic Role Of Muscle Growth On Strength In Response To Isometric Handgrip Training

Different Blood Pressure Response To Isometric Exercise And Its Effect On Cognitive Function.

Different Blood Pressure Response To Isometric Exercise And Its Effect On Cognitive Function.

The Effect of Arm Muscle Strength and Leg Muscle Explosiveness on Ball Shooting Results Basketball

The problem in this study is the lack of students in basketball shooting results so that the players often experience failures. The formulation of the problem in this study is whether there is an effect of arm muscle training and leg muscle explosive training on shooting results in extracurricular students of SMP Negeri 2 Bangka Barat. The purpose of this study is to find out whether there is an effect of arm muscle training and leg muscle explosiveness training on shooting results in extracurricular students of SMP Negeri 2 Bangka Barat. The method used in this study is the one group experiment method. The sample in this study is the total of the existing population, namely 26 students who participate in extracurricular activities at SMP Negeri 2 Bangka Barat. Based on the results of the research and the results of statistical calculations on the test of improving the results of arm muscle strength exercises to influence arm muscle strength and leg muscle explosiveness on basketball shooting results in extracurricular students of SMP Negeri 2 Bangka Barat, the author can conclude that: isometric exercises have an effect on basketball shooting in extracurricular basketball games of SMP Negeri 2 Bangka Barat. The magnitude of the influence is shown significantly at the real level of 0.05 with t calculated &gt; t 0.95 (50) = 6.84 &gt; 1.70.

Efficacy of Rapid Inspiratory Bouts Followed by Sustained Expiration on Maximal Force Generation During Isometric Exercise

Efficacy of Rapid Inspiratory Bouts Followed by Sustained Expiration on Maximal Force Generation During Isometric Exercise

Diastolic Blood Pressure Response During Non-isometric Exercise and Its Relationship with Family History of Hypertension

The purpose of this study was to find an association (if any) between isolated diastolic blood pressure response to non - isometric exercise and family history of hypertension. Diastolic blood pressure response (DBPR) of 32 apparently healthy young adults (aged 18 - 30 years) were noted during 10 minutes of cycling on a bicycle ergometer and during their recovery after exercise and their family history of hypertension were recorded by a separate observer.4 sets of data were rejected due to faulty technique and rest 28 sets of data were checked for association by a 2 by 2 contingency table and by performing Chi - Square test.17 subjects showed normal DBPR, 11 of them did not have any family history of hypertension, which should be a normal occurrence. And out of 11 subjects with abnormal/exaggerated DBPR, 6 had positive family history of hypertension, which was inconclusive. The test result gave us a more than 25% chance of randomness of association between abnormal/exaggerated DBPR and family history of hypertension, which refuted the association, meaning abnormal/exaggerated DBPR to non - isometric exercise and family history of hypertension can both be predictors of future hypertension but there is no association between them.

Exploring the efficacy of isometric strength exercises in knee rehabilitation among football players

Exploring the efficacy of isometric strength exercises in knee rehabilitation among football players

Efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for knee osteoarthritis: a systematic review and network meta-analysis.

While strengthening exercises are recommended for knee osteoarthritis (KOA) treatment, the optimal type of muscle contraction remains unclear, with current research showing conflicting results. This network meta-analysis (NMA) aims to evaluate the efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for KOA patients and provide clinical references. We conducted the NMA following the PRISMA-NMA. A comprehensive search of five databases (PubMed, Web of Science, CENTRAL, Embase, and SPORTDiscus) up to August 2024 identified randomized controlled trials (RCTs) investigating lower limb strengthening exercises in KOA patients. Control groups included receiving usual care, only providing health education, or no intervention at all. Outcomes analyzed included pain, physical function, quality of life, and muscle strength. Forty-one studies (2,251 participants) were included. Twenty-eight studies used rigorous randomization; eighteen reported allocation concealment. All had high performance bias risk due to exercise interventions. Regarding efficacy, isokinetic exercise ranked highest in pain relief (SMD = 0.70, 95% CI: 0.50-0.91, SUCRA = 82.6%), function improvement (SMD = 0.75, 95% CI: 0.57-0.92, SUCRA = 96.1%), and enhancement in muscle strength (SMD = 0.56, 95% CI: 0.34-0.78, SUCRA = 90.1%). Isometric exercise ranked highest in improving quality of life (SMD = 0.80, 95% CI: 0.28-1.31, SUCRA = 90.5%). Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions (≥5 times/week) showed superior pain relief compared with low-frequency (≤3 times/week) for isotonic, isometric, and isokinetic exercise. This NMA suggests isokinetic exercise may be most effective for pain, function, and muscle strength in KOA patients, while isometric exercise benefits quality of life most. Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions appear more effective than low-frequency ones. These findings support personalized KOA treatment, considering efficacy, accessibility, and patient-specific factors. Study biases, heterogeneity, and other limitations may affect result reliability. Future research should focus on high-quality studies with standardized protocols and analyze dose-response relationships to refine KOA treatment strategies. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024582525, identifier: CRD42024582525.

Sinding-Larsen-Johansson disease. Clinical features, imaging findings, conservative treatments and research perspectives: a scoping review.

This review aims to consolidate existing research on the pathogenesis, clinical diagnosis, imaging outcomes, and conservative treatments of Sinding-Larsen-Johansson disease (SLJD), identifying literature gaps. Scoping Review. A comprehensive literature search was conducted across databases including PubMed, Scopus, Medline OVID, Embase, Web of Science, and Grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) checklist. The body of evidence on SLJD, primarily derived from case studies, reveals limited and often conflicting data. Key findings include: (1) SLJD commonly presents as localized knee pain in physically active adolescents, particularly males, (2) ultrasound and MRI are the most effective diagnostic tools, (3) conservative treatment, which mainly focuses on activity limitation, yields positive outcomes within two to eight months. Our review shows that SLJD mainly affects physically active adolescents aged 9-17 years. The authors recommend conservative treatment, rest and/or cryotherapy, passive mobilization, muscle restraint, isometric exercise, and NSAIDs. Further cohort studies are necessary to refine the management and application of the SLJD treatment database.

Comparative effects of isometric and isotonic global neck muscles strengthening exercise programme on pain, range of motion, strength, function and quality of life in patients with chronic mechanical neck pain.

The randomised clinical current study was planned to determine the comparative effects of isometric and isotonic global neck muscles strengthening exercises on pain, range of motion, strength, function and quality of life in patients with chronic mechanical neck pain. The study comprised 22 patients with chronic mechanical neck pain. The subjects were randomly divided into two interventional groups, with group A receiving isometric exercises and group B receiving isotonic exercises. Numeric Pain Rating Scale, Neck Disability Index, goniometer, dynamometer and Short Form-36 questionnaire were used for data collection. Isometric and isotonic exercise groups showed significant improvement (p<0.05) in terms of decreasing pain and functional disability, and increasing range of motion and strength. Intergroup comparison showed no significant differences (p>0.05), indicating similar efficacy of isometric and isotonic global neck muscles strengthening exercises. This study was registered at ClinicalTrials.gov ID: NCT05865951.

Comparison of Isometric and Dynamic Bridging Exercises on Low Back Muscle Oxygenation.

Bridging exercises are commonly performed by people with low back pain (LBP). However, the effect of the contraction mode in a bridging exercise on the hemodynamics of the low back muscle has not been investigated in people with and without LBP. The objective of this study was to assess the effect of the mode of bridging exercise on oxygenation of the low back muscle. A near-infrared spectroscopy was used to measure hemodynamic responses of the erector spinae between isometric and dynamic bridging exercises in 16 healthy participants. The results demonstrated that during exercise, the isometric bridging exercise significantly decreased oxyhemoglobin and deoxy-hemoglobin compared to the dynamic bridging exercise (oxyhemoglobin, t=- 3.109, p=0.007, Cohen's d=0.68 and deoxy-hemoglobin, t=- 2.193, P=0.046, Cohen's d=0.60). The results also demonstrated that after exercise, the dynamic bridging exercise induced a significantly higher oxygenation response (oxygenation, t=- 2.178, P=0.048, Cohen's d=0.43). This study indicates that the dynamic bridging exercise is more effective in improving oxygenation of low back muscles.

Exercise for patients with low back pain

Background: Low back pain (LBP) is a common symptom that imposes a significant socioeconomic burden. Appropriate exercises that enhance the recovery of anatomical structures using biomechanical methods and improve lumbar stability are recommended for patients with LBP. Therefore, clinicians should prescribe appropriate exercises to alleviate LBP, improve function, and prevent recurrence.Current Concepts: Individualized and structured multimodal exercises (strengthening, aerobic, core stability exercises, and stretching) under the supervision of healthcare professionals are recommended for patients with LBP. It is preferable to focus on isometric trunk muscle exercises for strengthening, and strengthening the large muscles (back and gluteal muscles) attached to the thoracolumbar fascia is recommended rather than exercises that involve repeated extension and flexion of the trunk muscles. Individualized aerobic and core stability exercises are recommended, and stretching exercises focusing on extension movements are preferred. It is also important to educate patients regarding the etiology of LBP, harmful postures for LBP, and methods to maintain lumbar lordosis in daily life.Discussion and Conclusion: An appropriate exercise prescription can contribute to better clinical outcomes in patients with LBP. Although exercise is important for recovery and prevention of recurrence, inappropriate exercise can potentially exacerbate LBP; therefore, careful consideration is required.

Exercise for patients with arthritis

Background: Osteoarthritis and rheumatoid arthritis are major causes of pain and disability globally, and exercise is known to be effective at alleviating symptoms and improving physical function.Current Concepts: Knee osteoarthritis is a common degenerative disease, and comprehensive clinical practice guidelines have been established. Most studies strongly recommend appropriate weight management combined with exercise therapy. Aerobic, strength, resistance, isometric, neuromuscular, and balance training have been used. However, the current evidence is insufficient to recommend specific prescriptions regarding the exercise type and dose. Many guidelines group knee and hip osteoarthritis together for exercise recommendations. Evidence supporting the use of exercise for hand osteoarthritis is relatively scarce, and reports on its adverse effects are rare. Weight loss is not recommended for hand osteoarthritis, because its effectiveness has not yet been established. For patients with polyarticular osteoarthritis, exercise is recommended as a core treatment, with systematic land-based exercises being particularly advised. For rheumatoid arthritis, both general exercises and hydrotherapy are recommended to improve joint flexibility, muscle strength, and functional outcomes.Discussion and Conclusion: Exercise is a powerful treatment tool for various types of arthritis. However, further research is required to develop more specific exercise intervention protocols.

Smaller Left Ventricular Size But Preserved Function in Adolescents and Adults Born Preterm.

Prematurely born adults have increased risk for cardiovascular disease. There are limited cardiac data on US-born preterm individuals. We aimed to determine whether adolescents and adults born prematurely have altered left ventricular (LV) structure and function, and to interrogate diastolic function using isometric handgrip exercise. Adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or <1500 g birth weight) were recruited from the Parkland Health Neonatal Intensive Care Unit Registry. Full-term participants were recruited from the local area. Study procedures included anthropometrics and vitals, handgrip testing, and echocardiography performed at rest and during isometric handgrip exercise. Data were reported as mean±SD. The study enrolled 107 preterm and 48 term participants. Preterm participants (gestational age: 29.5±2.5 weeks) were shorter with higher body mass index (P<0.001) compared with term participants. Preterm participants exhibited smaller LV end-diastolic volume index (50.8±10.1 versus 56.9±10.0 mL/m2, P<0.001), LV stroke volume index (29.6±6.0 versus 34.1±6.5 mL/m2, P<0.001), and LV mass index (67.2±13.1 versus 73.3±14.2 g/m2, P=0.002) compared with term individuals. Preterm participants also had subclinical reductions in LV peak systolic tissue velocity and peak early diastolic tissue velocity lateral at rest. Isometric handgrip exercise promoted a reduction in diastolic function and an increase in hemodynamic measures, but changes during isometric handgrip exercise were similar between groups. Adolescents and adults born preterm exhibit overall normal cardiac function despite smaller cardiac volumes and mass compared with individuals born full term. Effects are most pronounced at the lowest gestational ages.

Penerapan Isometric Handgrip Exercise untuk Menurunkan Tekanan Darah pada Penderita Hipertensi di Wilayah Puskesmas Pucangsawit

Background: Hypertension that occurs in the world of the entire world population is 22% (WHO, 2021). Based on data obtained from the Pucangsawit Community Health Center, in 2023 there were 1,623 cases of Primary Hypertension. Isometric handgrip exercise therapy is a non-pharmacological therapy to help lower blood pressure. Objective: determine changes in blood pressure values in two respondents with hypertension before and after being given isometric handgrip therapy. Method: This research is a case study research using descriptive methods, namely by observing and interviewing two respondents with hypertension who are at risk of developing kidney disease and other diseases with a decrease in blood pressure results that become normal. Results: There was a decrease in blood pressure values in Mrs. S from 143/90 mmHg to 135/85 mmHg, while in Mr. N decreased from 160/98 to 150/90 mmHg. Conclusion: after applying isometric handgrip therapy to Mrs. S and Mr. N there is a decrease in blood pressure values ​​in hypertensive sufferers. This shows that the isometric handgrip can reduce blood pressure to normal.

Evaluation of the Suture Pull-Out Technique in Anterior Cruciate Ligament Avulsion Fractures at Different Weeks Post-fracture.

Background Anterior cruciate ligament (ACL) avulsion fractures often necessitate surgical intervention, with various fixation techniques available. Among these, the arthroscopic suture pull-out technique has gained attention as a promising approach. However, the influence of surgical timing on patient outcomes remains insufficiently studied. This study aims to evaluate the efficacy of the arthroscopic suture pull-out technique for ACL tibial avulsion fractures and assess how the timing of surgical intervention affects functional outcomes. Methodology This study was conducted at our hospital from November 2020 to October 2022. A total of 17 patients aged 21 to 41 years with isolated ACL avulsion fractures and no additional injuries or osteoarthritis were included. Participants were divided into three groups based on the interval from injury to surgery (one, two, or three weeks). The surgical procedure involved the suture pull-out technique. Postoperative management included immobilization, isometric exercises, and gradual weight-bearing. Functional outcomes were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lachman test at 6, 10, and 14 months, along with radiological evaluations. Results Significant functional improvements were observed in all groups, with postoperative Lysholm, IKDC, and Tegner scores showing notable enhancements compared to preoperative values. No significant differences were found among the groups regarding the timing of surgery, indicating that delays within the first three weeks did not adversely impact outcomes. Most patients achieved a full range of motion. Two minor postoperative complications were reported, namely, one case of arthrofibrosis and one case of persistent laxity. Conclusions The arthroscopic suture pull-out technique is effective and reliable for ACL tibial avulsion fixation. The timing of surgery within the first three weeks does not significantly affect functional outcomes. Future research with larger sample sizes and longer follow-ups is recommended to further validate these findings and optimize surgical strategies.

Arterial blood pressure regulation during prolonged isometric exercise in artistic gymnastic athletes compared to controls.

The aim of this cross-sectional study was to examine the baroreflex sensitivity alterations in regulating arterial blood pressure during prolonged isometric exercise at different intensities in elite artistic gymnastic athletes compared to non-athletes. Fourteen young males participated in the study; 7 international level artistic gymnastics athletes and 7 physically active students inexperienced to isometric or resistance training. On two occasions, both groups performed 3 minutes of isometric handgrip exercise either at 30% or 50% of maximum voluntary contraction (MVC), in a randomized order. Force production, arterial blood pressure and baroreflex sensitivity through finger plethysmograph were continuously recorded. At rest, arterial blood pressure was normal in both groups (systolic blood pressure [SBP], athletes [A]: 128±9.0 mmHg, non-athletes [NA]: 130±7.2 mmHg, P=0.62; DIA, A: 75.6±5.2, NA: 78.5±4.6, P=0.31) but baroreflex sensitivity (BRS) was higher in athletes than in non-athletes (A: 16.6±7.4, NA: 12.0±7.9, P=0.02). During prolonged isometric exercise at 30% MVC, blood pressure was similar between groups (SBP, A: 176.9±16 mmHg vs. NA: 189.5±15.1 mmHg P=0.9, diastolic blood pressure [DBP], A: 108±11 mmHg vs. NA: 118±11 mmHg, P=0.6) and BRS was still higher in athletes (A: 13.28±5.75 ms/mmHg vs. NA: 6.72±3.83, P=0.04), whereas at 50% MVC, blood pressure was lower in the athletes compared to the control group (SBP, A: 182.5±15 mmHg vs. NA: 222.1±19.3 mmHg, P=0.001; DBP A: 115±14 mmHg vs. NA: 141±20 mmHg, P=0.02,without statistically significant difference in BRS between groups (A: 7.39±5.34 ms/mmHg vs. NA: 3.9±1.73 ms/mmHg, P=0.44). The results of our cross-sectional study revealed that after years of exposure in high amounts of training loads, baroreflex sensitivity is increased in healthy athletes probably in order to prevent excessive increases in blood pressure during exercise.

Quantifying Active and Passive Stiffness in Plantar Flexor Muscles Following Intermittent Maximal Isometric Contractions Using Shear Wave Elastography

ObjectiveThis study aimed: (i) to investigate the impact of fatigue, triggered by maximal isometric contraction exercises, on the active and passive stiffness of plantar flexors (PF), and (ii) to examine the relationship between changes in mechanical parameters and neuromuscular alterations after fatigue. MethodsA healthy cohort (n = 12; age = 27.3 ± 5.5 y; BMI = 24.4 ± 2.35 kg/m²) was instructed to perform 60 isometric contractions, each lasting 4 s with a 1-s rest interval, using an ergometer. Several measures were taken before and after the fatigue protocol. First, the stiffness of the PF-tendon complex (PFC) was quantified during passive ankle mobilization both during and after the fatigue protocol using the ergometer. Additionally, from shear wave elastography, the active and passive stiffness of the gastrocnemius medialis (GM) were measured during passive ankle mobilization and isometric maximal voluntary contraction (MVC), respectively. Finally, the peak torque and the rate of torque development (RFD) of PF were assessed during the MVC using the ergometer. Ankle muscle activities (surface electromyograph [SEMG]) were recorded during all evaluations using electromyography. ResultsAfter the fatigue protocol, the results revealed a decline in active stiffness, peak torque of PF, RFD and SEMG activity of the GM (p < 0.001). Furthermore, significant correlation was identified between the decrease of the peak torque of PF and the active stiffness of the GM (r = 0.6; p < 0.05). A decrease in the PFC stiffness (p < 0.001) and a decrease in the shear modulus of the GM at 20° (p < 0.001) were also observed. ConclusionIsometric fatiguing exercises modify the mechanical properties of both the contractile and elastic components. Notably, decreases in both passive and active stiffness may be critical for athletes, as these changes could potentially increase the risk of injury.

Isometric Fatigue Resistance of Lumbar Extensors and Cardiovascular Strain in Lower Back Pain Patients Are Associated with Angiotensin-Converting Enzyme and Tenascin-C Gene Polymorphisms

Background: We tested whether gene polymorphisms for angiotensin-converting enzyme (ACE, rs1799752) and tenascin-C (TNC, rs2104772) are associated with variability in fatigue resistance and metabolic strain during static lumbar exercise through interactions with chronic nonspecific lower back pain and habitual physical exercise levels (PA). Methods: Forty-eight patients and matched controls performed an isometric endurance test for lumbar extensors. Metabolic strain to longissimus muscle (oxygen saturation, lactate) and cardiovascular system (muscle hemoglobin, blood pressure) and holding time were monitored. Subjects were genotyped for rs1799752 (II, ID, DD) and rs2104772 (AA, AT, TT). Associations of variance with group, genotype, and PA were analyzed under a 5% false discovery rate. Results: The holding time was lower in patients than in controls (150.9 vs. 188.6 s). This difference was associated with both genotypes, as patients with DD-rs1799752-genotype (p = 0.007) and TT-rs2104772-genotype (p = 0.041) showed lower fatigue resistance. Muscle deoxygenation during exercise varied in positive association with the rs2104772-genotype and PA (p = 0.010, η2 = 0.236). Mean arterial blood pressure (p = 0.028, η2 = 0.108) and recovery of hemoglobin concentration (p = 0.003, η2 = 0.907) demonstrated complex group x rs2104772 interactions. Conclusions: Polymorphisms rs1799752 and rs2104772 influence back pain-related variability in lumbar fatigue resistance. rs2104772 was linked to cardiovascular strain during isometric exercise and recovery via muscle perfusion.

Endothelial Dysfunction in Youth-Onset Type 2 Diabetes: A Clinical Translational Study.

Youth-onset type 2 diabetes (Y-T2D) is associated with increased risk for coronary atherosclerotic disease, but the timing of the earliest pathological features and evidence of cardiac endothelial dysfunction have not been evaluated in this population. Endothelial function magnetic resonance imaging may detect early and direct endothelial dysfunction in the absence of classical risk factors (severe hyperglycemia, hypertension, and hyperlipidemia). Using endothelial function magnetic resonance imaging, we evaluated peripheral and coronary artery structure and endothelial function in young adults with Y-T2D diagnosed ≤5 years compared with age-matched healthy peers. We isolated and characterized plasma-derived small extracellular vesicles and evaluated their effects on inflammatory and signaling biomarkers in healthy human coronary artery endothelial cells to validate the imaging findings. Right coronary wall thickness, coronary artery flow-mediated dilation, and brachial artery flow-mediated dilation were measured at baseline and during isometric handgrip exercise using a 3.0T magnetic resonance imaging. Human coronary artery endothelial cells were treated with Y-T2D plasma-derived small extracellular vesicles. Protein expression was measured by Western blot analysis, oxidative stress was measured using the redox-sensitive probe dihydroethidium, and nitric oxide levels were measured by 4-amino-5-methylamino-2',7'-difluororescein diacetate. Y-T2D (n=20) had higher hemoglobin A1c and high-sensitivity C-reactive protein, but similar total and LDL (low-density lipoprotein)-cholesterol compared with healthy peers (n=16). Y-T2D had greater coronary wall thickness (1.33±0.13 versus 1.22±0.13 mm; P=0.04) and impaired endothelial function: lower coronary artery flow-mediated dilation (-3.1±15.5 versus 15.9±17.3%; P<0.01) and brachial artery flow-mediated dilation (6.7±14.7 versus 26.4±15.2%; P=0.001). Y-T2D plasma-derived small extracellular vesicles reduced phosphorylated endothelial nitric oxide synthase expression and nitric oxide levels, increased reactive oxygen species production, and elevated ICAM (intercellular adhesion molecule)-mediated inflammatory pathways in human coronary artery endothelial cells. Coronary and brachial endothelial dysfunction was evident in Y-T2D who were within 5 years of diagnosis and did not have severe hyperglycemia or dyslipidemia. Plasma-derived small extracellular vesicles induced markers of endothelial dysfunction, which corroborated accelerated subclinical coronary atherosclerosis as an early feature in Y-T2D. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02830308 and NCT01399385.