Part Of Lifestyle Intervention Research Articles

Association Between Physical Activity and Depression in Middle Aged Premenopausal and Postmenopausal Women in Malaysia

Objective: The objective of this study was to investigate the relationship between physical activity levels and depression among middle-aged premenopausal women in Malaysia. Methods: A cross-sectional study was conducted in a community centre, workplace, and healthcare institution. The Beck Depression Inventory-II questionnaire was used to assess the severity of depression symptoms. Multiple logistic regression analysis was conducted to determine the association between the amount of physical activity and depression. Results: Compared to those with low activity levels, participants with moderate activity levels had 25% lower odds of experiencing depression (adjusted OR = 0.75, 95% CI [0.60, 0.92], p 0.05). Participants with high activity levels also had 35% lower odds. Conclusions: This study highlights the significant inverse relationship between the level of physical exercise and depression in Malaysian women. Encouraging regular physical activity as a part of lifestyle interventions may serve as an effective strategy for preventing and managing depressive symptoms in this population. Further research is needed to explore the underlying mechanisms and to inform targeted interventions for promoting physical activity, thus promoting positive mental health outcomes.

Treatment strategies in diabetic nephropathy - Update 2022

A new classification of patients with diabetes mellitus into so-called clusters can be used to assess the risk of developing diabetic nephropathy. Up to date treatment of patients with diabetic nephropathy includes not only glycemic control, but focuses on a holistic approach with prevention of (progression of) secondary diabetic complications and reduction of the patient's cardiovascular mortality. To achieve this treatment goals, it requires comprehensive management of the patient to implement lifestyle interventions (regarding diet, physical activity, weight loss, smoking cessation) and selection of the medication with the greatest individual benefit. Part of lifestyle intervention is adherence to a dietary regimen that has again been shown in recent studies to be relevant in inhibiting progression of chronic kidney disease and reducing cardiovascular risk. In particular, this includes protein restriction with preference for plant sources of protein, and salt restriction. Adjustment of drug therapy is no longer based on antihyperglycemic effects alone, but takes into account inhibition of progression of nephropathy and cardiac risk, as well as support of body weight control. For this purpose, in addition to RAAS inhibitors from the field of antihypertensives, the antidiabetic classes of SGLT2 inhibitors and GLP-1 receptor agonists as well as the non-steroidal aldosterone antagonist finerenone are now available.

An integrated approach for obesity management: the effectiveness of glucagon-like peptide 1 agonist and life-style interventions for obesity management

Background. The obesity is found in 24.8% (approximately 10 million people) and overweight in 34.3% of the population of Ukraine, mainly in females. Obesity is associated with hereditary factors, overeating as well as a sedentary lifestyle. An integrated approach is applied to treat obesity such as combination of adequate eating behavior, high physical activity and administration of pharmacological correction, including glucagon-like peptide 1 agonist (GLP-1). Currently, the little is known about utility and effectiveness of GLP-1 in combination with adequate physical activity for obesity management among Ukrainian patients. The purpose of this study was to determine and evaluate the role of GLP-1 in combination with high physical activity for weight loss in obese patients and to compare with obese patients receiving treatment with metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Materials and methods. A prospective study included 155 obese patients, and follow-up data were available of 49 patients. The study group GLP-1 consisted of 30 patients receiving combination therapy GLP-1 liraglutide in daily doses of 1.2 to 3 mg per day. The control group consisted of 19 patients receiving complex therapy with metformin in daily doses from 500 to 2000 mg, and SGLT2i in daily doses from 10 to 12.5mg. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and WC/HC ratio were evaluated. Number of daily steps was determined using pedometers built into smartphones or smartwatches. Evaluation of the obtained data was performed using non-parametric statistical methods. Results. In study group GLP-1 the mean weight before the treatment was 104.6kg, after treatment 96.36 kg (p=0.000007), the mean weight lost was 7.8% (range 1–23.71%) of initial body weight. Mean BMI before treatment was 37.1 kg/m2, after treatment 34.11kg/m2 (p=0.000006). In the control group, the mean weight before the treatment was 99.4 kg, after treatment 91.74 kg (p=0.000196), the mean weight lost was 7.73% (range 0–16.9%) of initial body weight. Mean BMI before treatment was 35.6kg/m2, after treatment 34.11 kg/m2 (p=0.000196). Analyses of the entrie chorot showed that before treatment, the daily number of steps >5000/day was determined in 25 (51%) patients, after treatment in 48 (98%); the daily number of steps >10,000/day before treatment was determined in 6 (11%) patients, after treatment it was 5 times more frequent in 31 (63%) patients. These results indicate a significant intensification of physical activity, and high motivation for weight loss in both study groups. Conclusions. Our findings suggest that weight loss in obese people is effective in case of administration of GLP-1, metformin, SGLT2i in combination with high physical activities of daily steps >5000, which is part of life style intervention.

553-P: Differential Effects of High-Intensity Interval Training on Somatosensory and Autonomic Nerve Function in Patients with Type 2 Diabetes

It remains unclear, whether exercise training as part of lifestyle intervention has favorable effects on the development or progression of diabetic neuropathy in patients with type 2 diabetes (T2D). Therefore, we assessed peripheral and autonomic nerve fiber function and morphology in patients with T2D as well as in individuals with normal glucose tolerance (CON) before and after a high intensity interval training (HIIT) intervention program over 12 weeks. The T2D group included 20 male individuals ([median (1st; 3rd quartile)] age: 56 (53; 63) years; diabetes duration: 5 (2; 9) years; BMI: 31.2 (28.6; 32.8) kg/m²; HbA1c: 6.9 (6.4; 8.0)%). The CON group was matched for age, sex, and BMI (n=23; age: 57 (53; 60) years; BMI: 30.3 (28.4; 32.2) kg/m²; HbA1c: 5.4 (5.2; 5.7)). Somatosensory and autonomic nerve tests included nerve conduction velocity, quantitative sensory testing, skin biopsy, corneal confocal microscopy, cardiovascular autonomic function tests (CAFT), and spontaneous baroreflex sensitivity (BRS). After 12 weeks of HIIT, no improvement in somatosensory nerve tests was detected in T2D or CON. In both groups, resting heart rate decreased ([mean±SEM] baseline vs. follow-up: T2D: 68.8±2.3 vs. 63.4±1.8 bpm; CON: 65.1±1.8 vs. 60.2±1.9 bpm; both P<0.05). The change in systolic blood pressure after standing up (-13.9±2.6 vs. -9.4±2.2 mmHg) and three BRS sequence analysis indices (e.g., BRS-slope: 7.9±1.9 vs. 12.6±5.1 ms/mmHg) improved in T2D (P<0.05), while the standard deviation of normal RR intervals (SDNN; 36.1±2.6 vs. 55.3±8.8 ms; P<0.05) and coefficient of variation (CV; 3.8±0.3 vs. 5.2±0.7%; P<0.05) improved in CON. In conclusion, while cardiovascular autonomic function improved moderately after 12 weeks of HIIT in male T2D patients, a longer training period may be required to achieve favorable effects on somatosensory nerve function or morphology. Disclosure G.J. Bönhof: None. A. Strom: None. M. Apostolopoulou: None. D. Pesta: None. M. Roden: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Poxel SA, Servier. Board Member; Self; Eli Lilly and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi. Speaker's Bureau; Self; Novo Nordisk Inc. D. Ziegler: Advisory Panel; Self; Allergan, TrigoCare. Consultant; Self; Mitsubishi Tanabe Pharma Corporation, Mylan, Novartis Pharmaceuticals Corporation, Wörwag. Speaker's Bureau; Self; Berlin-Chemie AG. Funding German Ministry of Culture and Science of the State of North Rhine-Westphalia; German Federal Ministry of Health; German Federal Ministry of Education and Research

Study of evaluation of hemodynamic response during isometric handgrip exercise in young adult males

Background: Isometric exercise is less extensively studied and compared to isotonic exercises, variable circulatory responses were observed by previous researchers to isometric exercise. Aims and Objectives: The present study aimed to analyze the changes in cardiocirculatory parameters during and after isometric exercise in young adult males. Materials and Methods: A total of 31 normotensive young healthy males (Mean age: 19.065 ± 0.92 years) were randomly selected in a cross-sectional study. Isometric handgrip (IHG) exercise at 30% of maximum voluntary contraction (MVC) was maintained by participants for 3 min or till fatigue. Hemodynamic factors such as blood pressure, heart rate, and peripheral oxygen saturation were recorded noninvasively at rest, 1st min of exercise, at 3rd min or till failure, and 2 min after completion of exercise. Mean arterial pressure, pulse pressure, and rate pressure product were calculated subsequently. Anthropometric variables were correlated with MVC. Repeated measure analysis of variance (ANOVA) was used to test level of significance for P < 0.05 at 95% confidence interval. Results: Exercise hemodynamic factors (at 1st min of exercise and at 3rd min or till failure) were significantly greater (P < 0.05) than values at rest. All the parameters return to resting level during the recovery period. Conclusion: IHG exercise can be a simple test to evaluate the left ventricular reserve and may be of value as a part of lifestyle intervention for the prevention of cardiovascular events.

PL-018 Effects and safety of exercise combined with medication and diet in treatment of diabetes and comorbidity

PL-018 Effects and safety of exercise combined with medication and diet in treatment of diabetes and comorbidity

A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes

Background: Despite recommendations, many patients with type 2 diabetes receive dietary advice from nurses or doctors instead of individualized nutrition therapy (INT) that is provided by a dietitian.Objective: We performed a meta-analysis to compare the effect of INT that is provided by a registered dietitian with the effect of dietary advice that is provided by other healthcare professionals.Design: A systematic review was conducted of Cochrane library databases, EMBASE, CINAHL, and MEDLINE in the period 2004-2017 for guidelines, reviews, and randomized controlled trials (RCTs) that assessed the outcomes glycated hemoglobin (HbA1c), weight, body mass index (BMI; in kg/m2), and LDL cholesterol. Risk of bias and the quality of evidence were assessed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines.Results: We identified 5 RCTs comprising 912 participants in total. In the first year of intervention (at 6 or 12 mo), nutrition therapy compared with dietary advice was followed by a 0.45% (95% CI: 0.36%, 0.53%) lower mean difference in HbA1c, a 0.55 (95% CI: 0.02, 1.1) lower BMI, a 2.1-kg (95% CI: 1.2-, 2.9-kg) lower weight, and a 0.17-mmol/L (95% CI: 0.11-, 0.23-mmol/L) lower LDL cholesterol. No longer-term data were available. Some of the included studies had a potential bias, and therefore, the quality of the evidence was low or moderate. In addition, it was necessary to pool primary and secondary outcomes.Conclusions: INT that is provided by a dietitian compared with dietary advice that is provided by other health professionals leads to a greater effect on HbA1c, weight, and LDL cholesterol. Because of the potential bias, we recommend considering nutrition therapy that is provided by a dietitian as part of lifestyle intervention in type 2 diabetes, but further randomized studies are warranted.

Influence of depression on cardiometabolic responses to a lifestyle intervention in at-risk individuals

BackgroundCardiometabolic diseases and depression are public health problems that are often related. The benefits of behavioral interventions on lifestyle are well documented. However, the influence of depression in these interventions is unclear. ObjectiveTo evaluate whether depression affects the impact of a lifestyle intervention on cardiometabolic response in an at-risk sample. Methods129 individuals identified by the public health system to be at risk for cardiometabolic disease were allocated to 18-month interventions on diet and physical activity. Socio-demographic and clinical data were obtained. Depressive symptoms were assessed by the Beck Depression Inventory. Changes by at least 10% in each of 6 cardiometabolic risk factors were used to define responses to intervention. Logistic regression models were employed for each gender. ResultsApproximately 42% of individuals had depressive symptoms. They had higher adiposity, cholesterol, and blood pressure levels and lower quality of life and physical activity levels than non-depressed individuals. In adjusted models, only women with depression at baseline had lower chance of improving plasma glucose (OR: 0.32) and lower chance of improving mean blood pressure (OR: 0.29) after the follow-up, compared with non-depressed women. LimitationsThe small sample size may have diminished the power of the results and the instrument used to measure depression does not provide clinical diagnosis according to DSM criteria. ConclusionDepression at baseline of lifestyle interventions predicted a lower chance of improving long-term cardiometabolic risk, particularly in women, suggesting that screening and management of depression as part of lifestyle interventions can potentially improve cardiometabolic risk profile.