Stretching Control Group Research Articles

Impact of Yoga on Global Cardiovascular Risk as an Add-On to a Regular Exercise Regimen in Patients With Hypertension

We aimed to determine whether the addition of yoga to a regular exercise training regimen improves cardiometabolic risk profile. Sixty individuals with diagnosed hypertension (≥ 140/90 mm Hg for 3 measurements on different days) were recruited in an exercise training program. In addition to aerobic exercise training, participants were randomised into either a yoga or a stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercise training 5 times weekly. Blood pressure, anthropometry, high-sensitivity C-reactive protein (hs-CRP), glucose, and lipid levels as well as the Framingham and Reynolds Risk Scores were measured. At baseline, there was no difference in age, sex, smoking status, body mass index, blood pressure, heart rate, lipid and glucose levels, and Framingham Risk Score between groups. After the 3-month intervention period, the decrement in systolic and diastolic blood pressures (before vs after stretching: 126 ± 11/76 ± 7 vs 122 ± 11/73 ± 8 mm Hg; before vs after yoga: 130 ± 13/77 ± 10 vs 119 ± 11/69 ± 8 mm Hg) and heart rate was greater (P < 0.001) in the yoga group, with similar decreases in lipid, glucose, and hs-CRP levels and Framingham Risk Score in both groups. Reynolds Risk Score decrement was higher in the yoga vs the control group (absolute reduction-1.2 ± 1.2 vs-0.6 ± 0.8; relative reduction 13.2 ± 11.8% vs 9.3 ± 6.5%; P < 0.05). In patients with hypertension, the practice of yoga incorporated in a 3-month exercise training program was associated with greater improvement in resting blood pressure and heart rate and Reynolds Risk Score compared with stretching.

A randomized, controlled trial of group exercise training for fall prevention and functional improvements during and after treatment for prostate cancer.

TPS193 Background: Many prostate cancer survivors are treated with androgen deprivation therapy (ADT), but these therapies may increase frailty, worsen physical functioning, and increase fall risk. While exercise may counter functional declines associated with ADT, no studies have tested whether and which type of exercise may reduce falls and frailty. The purpose of this trial is to compare the relative efficacy of strength training versus tai ji quan training against each other and to a stretching control group on falls, frailty and physical functioning in men expose to ADT for prostate cancer. Methods: Prostate cancer survivors treated with ADT (n = 360) will be recruited to participate in this single-blind, parallel group, randomized trial. To be eligible men must meet the following criteria: 1) histologically confirmed prostate cancer, 2) received at least 6 months of ADT within the past 10 years, 3) report &gt;1 fall in the past year OR have a score on one of two physical performance tests that is associated with increased fall risk (i.e. ≥ 12.0 seconds to complete the 3 meter timed up and go (TUG), or ≥ 10.0 seconds to complete 5 chair stands), 4) completed any other treatment at least 6 weeks prior to enrollment and not be on any concurrent prostate cancer therapy besides ADT, 5) not currently participating in moderate-vigorous intensity lower-body strength training or tai ji quan training ≥ 2 times/week for ≥ 30 minutes per session, 6) no cognitive difficulties that limit ability to answer survey questions or participate in exercise classes and performance tests, 7) no medical condition, disorder, or take medication that contraindicates participation in moderate intensity exercise, and 8) are able to communicate in English. Participants will be randomized to one of three supervised, group training programs: i) strength training, ii) tai ji quan training, or iii) stretching (control), that train 3x/week for 6 months. Outcomes are assessed at baseline, 3 (mid-intervention), 6 (immediately post-intervention) and 12 (follow-up) months. The primary outcome is falls assessed by monthly self-report. Secondary outcomes include the following: Frailty (low lean body mass (by bioelectrical impedance analysis), exhaustion (by SF-36 vitality scale), low activity (by CHAMPS physical activity survey), slowness (by 4m usual walk speed), and weakness (by chair stand time)); Objective and subjective measures of physical function will also be collected. Negative binomial regression models will be used to assess differences in falls between groups, while mixed-effects modeling will be used to compare the relative efficacy of training group on secondary outcomes. Registered November 18, 2018. Clinical trial information: NCT03741335.

Protocol for GET FIT Prostate: a randomized, controlled trial of group exercise training for fall prevention and functional improvements during and after treatment for prostate cancer

BackgroundMany prostate cancer survivors are treated with androgen deprivation therapy (ADT), but these therapies may increase frailty, worsen physical functioning, and increase fall risk. While exercise may counter functional declines associated with ADT, no studies have tested whether and which type of exercise may reduce falls and frailty. The purpose of this trial is to compare the relative efficacy of strength training versus tai ji quan training against each other and to a stretching control group on falls, frailty, and physical functioning in men expose to ADT for prostate cancer.MethodsProstate cancer survivors treated with ADT (N = 360) who have fallen in the past year or are at risk of a fall based on validated risk factors will be recruited to participate in this single-blind, parallel group, randomized trial. Participants will be randomized to one of three supervised, group training programs: (i) strength training, (ii) tai ji quan training, or (iii) stretching (control), that train 3×/week for 6 months. Outcomes are assessed at baseline, 3 (mid-intervention), 6 (immediately post-intervention), and 12 (follow-up) months. The primary outcome is falls assessed by monthly self-report. Secondary outcomes include the following: frailty (low lean body mass (by bioelectrical impedance analysis), exhaustion (by SF-36 vitality scale), low activity (by CHAMPS physical activity survey), slowness (by 4 m usual walk speed), and weakness (by chair stand time)); objective and subjective measures of physical function will also be collected. Negative binomial regression models will be used to assess differences in falls between groups, while mixed effects modeling will be used to compare the relative efficacy of training group on secondary outcomes.DiscussionExercise represents a non-pharmacologic approach to mitigate the problem of falls experienced among men treated with ADT. By engaging in appropriate exercise, men may be able to avoid or delay falls, frailty, and disability associated with their cancer treatment. Findings of the trial are expected to inform clinical practice about how exercise could be prescribed as part of cancer care for prostate cancer survivors prescribed ADT.Trial registrationClinicalTrials.gov NCT03741335. Registered on November 18, 2018.

Effects of a 12-week combined aerobic and strength training program in ambulatory patients with amyotrophic lateral sclerosis: a randomized controlled trial.

To compare the effectiveness of a combined aerobic, strength, and flexibility training program with flexibility alone on disease-specific and health-related symptoms in ambulatory amyotrophic lateral sclerosis (ALS) patients. Thirty-two ambulatory patients with ALS were equally randomized into a combined aerobic-strength intervention group or a stretching control group. The intervention period for both groups was identical, 12 consecutive weeks, two sessions per week. The combined intervention program consisted of aerobic training by recumbent cycling, flexibility achieved by stretching and passive exercises, and strength training via functional exercises. Patients in the control group performed basic stretching exercises of the upper and lower limb at home. Outcome measures included the ALS Functional Rating Scale-Revised (ALSFRS-R), respiratory function, mobility, fatigue, and quality of life and were collected 1-week prior to the intervention, after 6-weeks of training, and at the completion of the intervention. Twenty-eight participants (17 males, 11 females); mean age (S.D.) = 58.5 (13.2) years; mean disease duration (S.D.) = 7.3 (12.0) years, completed the study. According to the group X time analysis, significant differences were found in respiratory function, mobility, and the ALSFRS-R in favor of the aerobic-strength group. These patients maintained their abilities, whereas, a significant decrease was observed in the flexibility training group. Scores of the SF-36 categories "physical functioning", "energy fatigue" and "wellbeing" were higher following the intervention in the aerobic-strength group compared with the stretching control group. A 12-week combined aerobic and strength training program is far superior to flexibility alone in improving respiratory function, mobility, and wellbeing in ambulatory ALS patients.

Quasi-cluster randomized trial of a six-month low-intensity group-based resistance exercise for hemodialysis patients on depression and cognitive function: a 12-month follow-up

ABSTRACT Objective This study aimed to examine the effects of a six-month group-based low-intensity resistance exercise program on depression and the cognitive function of hemodialysis patients. Method We conducted a quasi-cluster randomized, open-label controlled study from October 2017 to December 2018. Forty-two patients undergoing hemodialysis completed the trial over six months; half participated in the resistance exercise group (n = 21, mean = 74.90 years of age, SD = 2.23, 66.67% female) and the other half were in a stretching control group (n = 21, mean = 72.57 years of age, SD = 2.26, 28.57% female). Depressive symptoms and cognitive function were the primary outcome measures. Behavioral and psychological problems associated with cognitive decline (NPI-Q), subjective insomnia, and exercise self-efficacy were secondary outcomes. Outcomes were measured at baseline, three-month (mid-intervention), six-month (end of intervention), and 12-month (six months after intervention) follow-ups. Linear mixed model analyses were used to determine short-term (immediately after intervention) and long-term (six months after intervention) effects. Results In depression, cognitive function, and the NPI-Q, there were no significant effects. In subjective insomnia, a short-term group-by-time interaction in the intervention group compared to the control group was found (ES = .43). However, the effect had disappeared by the 12-month follow-up. In exercise self-efficacy, short- and long-term group-by-time interactions were found. A significant short-term increase in the resistance exercise and a significant decrease in the stretching control was observed (ES = -.83). However, the effect was weakened in the long term (ES = -.38). Conclusion The results showed that low-intensity group resistance exercise would reduce subjective insomnia and improve exercise self-efficacy, but the effect was not maintained by six months after the program. Trial registration: This study was registered on the University Hospital Medical Information Network Clinical Trials Registry (UMIN000029372). Trial registration: UMIN Japan identifier: UMIN000029372.

Feasibility of an 8-week Yoga Intervention among Middle-aged and Older Adults

Feasibility studies play a critical role in determining whether the target population is likely to engage with larger scale efficacy and effectiveness trials. Feasibility data for yoga interventions designed and conducted with older adults is limited. In this paper we present feasibility and acceptability data from an 8-week randomized controlled trial (RCT) conducted with middle aged and older adults. Participants n=118 (Mean age: 62.0 years) were randomized to either a Hatha yoga or Stretching Control group with hour long group exercise classes held 3x/week for 8 weeks. Herein we report feasibility and acceptability, including enrollment rates, attendance, attrition and adverse events, participant feedback and satisfaction data. Of the 265 adults screened, 118 were eligible and randomized. Session attendance was high for both groups (80.82 to 81.29 %) and only 10 people were lost to follow-up. Program satisfaction for both groups was high (4.8 and 4.86 out of 5) and no adverse events were reported. Participants’ feedback regarding most and least helpful aspects of the program as well as suggestions for future yoga interventions are summarized. Overall, the yoga intervention was highly feasible and acceptable. The feasibility parameters from this trial can aid researchers in estimating desired sample sizes to successfully recruit, randomize and retain older adults in short- and long-term yoga based RCTs.

P635The addition of yoga to aerobic exercise programs reduces global cardiovascular risk

Abstract Introduction Regular physical activity may modulate the inflammatory process and be cardio-protective. Yoga is a form of exercise that may have cardiovascular benefits. The effects of yoga on global cardiovascular risk have not been adequately described. The purpose of this study is to determine whether the addition of yoga to a regular exercise regimen reduces global cardiovascular risk. Methods Sixty consecutive individuals with essential hypertension were recruited in a lifestyle intervention program. All individuals with known hypertensive end organ damage, known cardiovascular diseases, as well as those taking medications/supplements that affected blood pressure, blood sugar, cholesterol or vascular inflammation were excluded. Participants were randomized to either a yoga group or similar duration stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercises thrice weekly. Blood pressure, cholesterol levels and hs-CRP were measured, and Reynold's Global Cardiovascular Risk Score was calculated at baseline and at the end of the 3-month intervention program. Results At screening, there were no statistically significant differences between the groups in any measured parameters or the 10-year risk of a cardiovascular event as measured by the Reynolds Risk Score. (8.2 vs. 9.0%; yoga vs. control group) After the 3-month intervention period, there was a statistically significantly greater decrease in the Reynold's Risk Score in the yoga vs. the control group. (7.0 vs. 8.4%, p=0.003, relative reduction 13.2 vs. 6.5%, p&lt;0.0001) Baseline and 3 Month Outcomes Conclusions In patients with essential hypertension on no medications and with no known end organ damage, the practice of yoga incorporated into a 3-month exercise intervention program was associated with significant greater improvement in the Reynold's Risk of a 10-year cardiovascular event, when compared to the control stretching group. If these results are validated in more diverse populations over a longer duration of follow up, yoga may represent an important addition to traditional cardiovascular disease prevention programs.

Effects of resistance plus aerobic training on body composition and metabolic markers in older breast cancer survivors undergoing aromatase inhibitor therapy.

To evaluate the effects of combined aerobic + resistance training on body composition and metabolic markers in older breast cancer survivors undergoing aromatase inhibitor therapy. Older breast cancer survivors were randomized to an exercise [resistance + aerobic training]: n = 18, or placebo control group: n = 18. Body composition (measured by DXA) and blood markers of lipid and glucose were measured at baseline, and at 12, 24, and 36 weeks. The exercise group performed 40 min of resistance exercises on machines followed by 30 min of aerobic training on a treadmill, three times per week. Separate 2 (group) × 4 (time) repeated-measure ANOVAs were used to compare groups over time. Significant group × time interactions were found for total and trunk fat mass (p < 0.001 and p = 0.001) and % body fat (p < 0.001), where women in the exercise group lost fat compared to slight gains among women in the stretching control group. There were no significant differences between groups for lean mass, hip or spine BMD, metabolic markers, or CRP. Our aerobic + resistance exercise program prevented fat gain, but may not have been sufficient to improve metabolic or bone health markers in older breast cancer survivors undergoing aromatase inhibitor therapy.

Effects of acute aerobic exercise or meditation on emotional regulation

Effective emotional regulation is critical for overall psychological well-being; as such, it is important to investigate potential methods to optimize emotion regulation abilities. The purpose of this study was to examine the effects of an acute bout of aerobic exercise and meditation on emotional regulation among young adults. Participants (N=63, mean age=21.3yrs) were randomly assigned to stretch (control group, n=21), walk (n=21), or meditate (n=21) for 10-min, after which they were exposed to a film clip (3min) intended to elicit a negative emotional state (e.g., sadness, anger). Participants then viewed 12 International Affective Picture System images validated to elicit a negative valence. Participants' affect (valence and arousal) states were monitored before, during, and after the stretching, walking, and meditation bouts using the Feeling Scale (FS) and Felt Arousal Scale (FAS). Distinct affect was assessed utilizing an affective circumplex measure before and after the stretch/walk/meditation bout, as well as following the film clip and image viewing. A significant group×time interaction effect was present when evaluating circumplex excited: P=0.001 (η2=0.21). Additionally, an interaction effect of meditation and emotional regulation was observed (P=0.009) among those with varying degrees of meditation experience. A 10-min bout of brisk walking and meditation, prior to exposure to a negative emotion cue, did not differentially effect the ability to regulate sadness, anger, or anxiousness when compared to an active stretching control group. Future replicative work addressing this paradigm, which is in support of positive psychology theory, is warranted.

A Randomized Control Intervention Investigating the Effects of Acute Exercise on Emotional Regulation

PURPOSE: To examine the effects of an acute bout of aerobic exercise on emotional regulation among young adults. METHODS: Participants (N= 27, mean age = 24.2 years) were randomly assigned to stretch (control group, n= 10), walk (n= 9), or jog (n= 8) for 15-minutes (exercise 1), after which they were exposed to a film clip (3 min) intended to elicit a negative emotional response (e.g., sadness, anger, anxiousness). Participants then completed the same stretching, walking, or jogging protocol (exercise 2) for a second time. Notably, walking and jogging occurred at a self-selected intensity on a treadmill. Participants’ emotions were monitored before and during both exercise bouts, as well as after the film clip using the Exercise Induced Feelings Inventory (EFI) and an affective circumplex scale. RESULTS: A group x time split-plot (baseline vs. post- film clip) ANOVA interaction effect was significant for anger (P=.046) and anxiousness (P=.038). Follow-up analyses (paired t-tests) showed that only the stretching group (P=.048) had a significantly increased anger score from baseline to post- film clip, suggesting a protective emotional effect from walking and jogging. For anxiousness, the P-values for the stretching, walking, and jogging groups were .21, .21, and .06, respectively, suggesting that anxiousness was more significantly different between baseline and post- film clip in the jogging group (vs. walking or stretching). CONCLUSIONS: Fifteen minutes of aerobic exercise (via walking or jogging) was more effective in regulating anger and anxiousness after a stressful event (i.e., there was an attenuated negative emotional response) when compared to a stretching control group. These findings provide evidence supporting the potential utility of exercise in regulating emotions, after exposure to an environmental stressor.

Yoga practice improves executive function by attenuating stress levels

BackgroundProlonged activation of the hypothalamus–pituitary–adrenal system is thought to have deleterious effects on brain function. Neuroendocrine studies suggest that brain exposure to higher cortisol concentrations contribute to cognitive deficits as we age. Mind-body techniques such as yoga have shown to improve stress levels by restoring the body’s sympathetic-parasympathetic balance. The objective of this study was to determine whether yoga practice moderated the stress response resulting in improved executive function. MethodsSedentary community dwelling older adults (N=118, Mean age=62.02) were randomized to an 8-week yoga intervention or a stretching control group. At baseline and following 8 weeks, all participants completed measures of executive function, self-reported stress and anxiety and provided saliva samples before and after cognitive testing to assess cortisol. ResultsYoga participants showed improved accuracy on executive function measures and an attenuated cortisol response compared to their stretching counterparts who showed increased cortisol levels and poor cognitive performance at follow up. The change in cortisol levels as well as self-reported stress and anxiety levels predicted performance on the running span task, n-back working memory and task switching paradigm (β’s=0.27–0.38, p’s≤0.05 for yoga and β’s=−0.37–0.47, p’s≤0.01 for stretching control). ConclusionEight weeks of regular yoga practice resulted in improved working memory performance that was mediated by an attenuated response to stress as measured by self-report stress and objective salivary cortisol measurements. This trial offers evidence for non-traditional physical activity interventions such as yoga that may be helpful in restoring HPA balance in older adults, thereby preventing cognitive decline.

A randomized controlled trial of exercise in spinal and bulbar muscular atrophy.

ObjectiveTo determine the safety and efficacy of a home-based functional exercise program in spinal and bulbar muscular atrophy (SBMA).MethodsSubjects were randomly assigned to participate in 12 weeks of either functional exercises (intervention) or a stretching program (control) at the National Institutes of Health in Bethesda, MD. A total of 54 subjects enrolled, and 50 completed the study with 24 in the functional exercise group and 26 in the stretching control group. The primary outcome measure was the Adult Myopathy Assessment Tool (AMAT) total score, and secondary measures included total activity by accelerometry, muscle strength, balance, timed up and go, sit-to-stand test, health-related quality of life, creatine kinase, and insulin-like growth factor-1.ResultsFunctional exercise was well tolerated but did not lead to significant group differences in the primary outcome measure or any of the secondary measures. The functional exercise did not produce significantly more adverse events than stretching, and was not perceived to be difficult. To determine whether a subset of the subjects may have benefited, we divided them into high and low functioning based on baseline AMAT scores and performed a post hoc subgroup analysis. Low-functioning individuals receiving the intervention increased AMAT functional subscale scores compared to the control group.InterpretationAlthough these trial results indicate that functional exercise had no significant effect on total AMAT scores or on mobility, strength, balance, and quality of life, post hoc findings indicate that low-functioning men with SBMA may respond better to functional exercises, and this warrants further investigation with appropriate exercise intensity.

OA10.02. Yoga for women with breast cancer undergoing radiotherapy (XRT): a randomized clinical trial with an active stretching control group

Methods Patients with stage 0-III disease were recruited prior to XRT (baseline) and randomized to one of three groups: Yoga (YG-n=53) or Stretching program (STR-n=56) 3 times a week for 6 weeks during XRT or Waitlist Control (WLC-n=54). Self-report measures of fatigue (BFI), depression (CESD), QOL (SF-36), benefit finding (BF), and spirituality (FACT-SP) were completed and saliva collected at baseline, end of treatment, and 1, 3, and 6 months later. We examined change from baseline for questionnaires and slope analyses for cortisol.

An examination of serotonin and psychological variables in the relationship between exercise and mental health

Research has revealed that exercise is effective for reducing symptoms of depression and anxiety. The mechanisms by which these reductions occur, however, have not been widely studied. To examine several potential theories, a prospective, randomized, 7-week exercise intervention was conducted. Untrained participants were randomly assigned to an aerobic exercise group or to a stretching-control group. Participants completed several questionnaires to assess psychological variables, including measures of depression and anxiety, and blood was drawn at pre- and post-test to measure serum serotonin levels. A mixed-design ANOVA revealed that the exercise group had lower levels of depression than the stretching-control group after the intervention. The exercise group also showed a larger percentage decrease in serotonin than the stretching-control group. This reduction in blood serotonin after exercise is similar to the effects of selective serotonin reuptake inhibitors. Additionally, percent change in serotonin was found to partially mediate the relationship between exercise and depression.

Failure to demonstrate that memory improvement is due either to aerobic exercise or increased hippocampal volume

We read with interest the article in PNAS, “Exercise training increases size of hippocampus and improves memory” by Erickson et al. (1). It is a noteworthy finding that over a 1-y period anterior hippocampal volume increased by 2% in the aerobic exercise group, whereas it decreased by 1.4% in the stretching control group. However, contrary to both the title and abstract, there is virtually no evidence in this article that exercise improved memory. After 1 y there were no differences between the exercise and control groups. “Both groups showed improvements in memory, as demonstrated by significant increases in accuracy between the first and last testing sessions for the aerobic exercise [t(2,51) = 2.08; P 0.05). Furthermore, changes in BDNF were not associated with improvements in memory function for either group (r 0.20).” The authors then “reasoned that increased hippocampal volume after the exercise intervention should translate to improved memory function.” To support this hypothesis they correlated aerobic exercise group hippocampal volume increase and memory improvement and found statistically significant correlations, which are small. For left hippocampus r = 0.23 (P < 0.05), accounting for 5% variance, and for right hippocampus r = 0.29 (P < 0.02), accounting for 8% variance. They concluded that “this indicates that increases in hippocampal volume after 1 y of exercise augments memory function in late adulthood.” However, association cannot be assumed to indicate causality. Furthermore, it is clear that although the aerobic exercise group improved on the memory task, so did the stretching control group in whom hippocampal volume decreased, further undermining any assumed link between hippocampal volume and improved memory. However, just such a link was explicitly drawn in the abstract, which states “here we show, in a randomized controlled trial with 120 older adults, that aerobic exercise training increases the size of the anterior hippocampus, leading to improvements in spatial memory.” Unfortunately both the title and abstract are misleading and a major overstatement of the findings. A similar lack of precision in reporting is evident elsewhere in the research literature, making it difficult to evaluate what the real evidence is in relation to cognitive enhancement interventions and aging. This clouds the picture for the scientific community and is misleading for the general public. It behooves us all to ensure rigor in our scientific reporting.

Effect of Exercise on Oxidative Stress

This study examined the effect of a yearlong exercise intervention on F2-isoprostane, a specific marker of lipid peroxidation and a general marker of oxidative stress. In a randomized, controlled trial, 173 overweight or obese, postmenopausal, sedentary women were randomized either to an aerobic exercise intervention (60%-75% observed maximal HR) for > or =45 min.d-1, 5 d.wk-1 (n = 87), or to a stretching control group (n = 86), on an intent-to-treat basis. Baseline and 12-month measures included urinary F2-isoprostane, maximal O2 uptake, body weight, body fat percentage, waist circumference, and intra-abdominal fat surface area. Urine samples were available from 172 and 168 women at baseline and 12 months, respectively. During the 12-month study, controls minimally changed maximal O2 uptake (+0.2%) and body weight (+0.1 kg), whereas exercisers increased maximal O2 uptake (+13.6%; P < 0.0001 vs controls) and decreased body weight (-1.3 kg; P = 0.007 vs controls). F2-isoprostane increased slightly among controls (+3.3%) and decreased in exercisers (-6.2%), although the effect was not statistically significant (P = 0.26). In planned subgroup analyses, F2-isoprostane decreased linearly with gain in maximal O2 uptake (Ptrend = 0.005) relative to controls; exercisers who increased maximal O2 uptake by >15% decreased F2-isoprostane by 14.1% (P = 0.005 vs controls). A borderline statistically significant trend was observed between decreased waist circumference and F2-isoprostane (P = 0.06). Similar subgroup analyses by 12-month changes in body fat percentage, weight, and intra-abdominal fat were not statistically significant. These findings suggest that aerobic exercise, when accompanied by relatively marked gains in aerobic fitness, decreases oxidative stress among previously sedentary older women and that these effects occur with minimal change in mass or body composition.

Effects of Aerobic Exercise on Mild Cognitive Impairment

To examine the effects of aerobic exercise on cognition and other biomarkers associated with Alzheimer disease pathology for older adults with mild cognitive impairment, and assess the role of sex as a predictor of response. Six-month, randomized, controlled, clinical trial. Veterans Affairs Puget Sound Health Care System clinical research unit. Thirty-three adults (17 women) with amnestic mild cognitive impairment ranging in age from 55 to 85 years (mean age, 70 years). Intervention Participants were randomized either to a high-intensity aerobic exercise or stretching control group. The aerobic group exercised under the supervision of a fitness trainer at 75% to 85% of heart rate reserve for 45 to 60 min/d, 4 d/wk for 6 months. The control group carried out supervised stretching activities according to the same schedule but maintained their heart rate at or below 50% of their heart rate reserve. Before and after the study, glucometabolic and treadmill tests were performed and fat distribution was assessed using dual-energy x-ray absorptiometry. At baseline, month 3, and month 6, blood was collected for assay and cognitive tests were administered. Performance measures on Symbol-Digit Modalities, Verbal Fluency, Stroop, Trails B, Task Switching, Story Recall, and List Learning. Fasting plasma levels of insulin, cortisol, brain-derived neurotrophic factor, insulinlike growth factor-I, and beta-amyloids 40 and 42. Six months of high-intensity aerobic exercise had sex-specific effects on cognition, glucose metabolism, and hypothalamic-pituitary-adrenal axis and trophic activity despite comparable gains in cardiorespiratory fitness and body fat reduction. For women, aerobic exercise improved performance on multiple tests of executive function, increased glucose disposal during the metabolic clamp, and reduced fasting plasma levels of insulin, cortisol, and brain-derived neurotrophic factor. For men, aerobic exercise increased plasma levels of insulinlike growth factor I and had a favorable effect only on Trails B performance. This study provides support, using rigorous controlled methodology, for a potent nonpharmacologic intervention that improves executive control processes for older women at high risk of cognitive decline. Moreover, our results suggest that a sex bias in cognitive response may relate to sex-based differences in glucometabolic and hypothalamic-pituitary-adrenal axis responses to aerobic exercise.

Effect of exercise intensity on depressive symptoms in women

Exercise has been shown to relieve depressive symptoms, yet optimal exercise intensity for treating depression has not been established. The mechanisms that explain the antidepressant effect of exercise also require investigation. The purpose of this study was to test (a) the effect of two different exercise intensities prescribed for aerobic training on depressive symptoms, and (b) a previously proposed psychological mechanism for this effect: self-efficacy. Sedentary women scoring ≥14 on the Beck Depression Inventory-II (BDI-II) were randomized to one of two aerobic training groups that differed on exercise intensity (high [65–75% MaxVO 2 reserve] or low [40–55% MaxVO 2 reserve]), or to a stretching control group for 10 weeks. Main outcome variables included depressive symptoms (BDI-II) and self-efficacy (exercise self-efficacy [ESE] and depression coping self-efficacy [DCSE]), which were measured at study entry, 5 and 10 weeks later. Participants in all groups (high, n = 18; low, n = 18; stretching, n = 18) had significant reductions in depressive symptoms at Week 5 ( p < .001) and Week 10 ( p < .001). The BDI-II change scores did not differ significantly among the groups ( p = .066). Follow-up analyses controlling for baseline BDI-II scores showed that the high intensity group had significantly fewer depressive symptoms than the low intensity and stretching control groups at weeks 5 and 10 ( p < .05). There was no significant association between changes in aerobic capacity and changes in depressive symptoms ( r = −.099, p = .491). At 10 weeks, both ESE ( p = .013) and DCSE ( p < .001) increased significantly for the whole sample, with no significant group difference ( p = .613 for ESE, p = .277 for DCSE). Controlling for baseline scores, the increase remained significant for ESE ( p = .005) but not for DCSE ( p = .629). Partial correlations showed significant negative relationships between both types of self-efficacy and depressive symptoms at Week 5 and Week 10 ( p < .02). We concluded that both high and low intensity aerobic exercise, as well as stretching exercise were associated with reductions in mild to moderate depressive symptoms in initially sedentary women. Changes in depression were associated with changes in ESE and DCSE.

Effect of a 12-Month Randomized Clinical Trial of Exercise on Serum Prolactin Concentrations in Postmenopausal Women

Prolactin is associated with an increased risk of postmenopausal breast cancer; however, few modifiable factors are known to reduce prolactin concentrations. Therefore, we examined the effect of a 12-month moderate-intensity exercise intervention on serum prolactin concentrations as a secondary end point (primary end points were estrogens and androgens). We randomly assigned 173 postmenopausal women who were sedentary, overweight (body mass index >24 kg/m(2), body fat >33%), ages 50 to 75 years, and not using hormone therapy to an exercise intervention or stretching control group. The intervention was facility- and home-based (45 min, 5 days/wk moderate-intensity sports/recreational exercise). One hundred and seventy (98%) women completed the study. Prolactin concentrations were similar at baseline (P = 0.25, geometric mean exercisers = 6.9 and controls = 7.5 ng/mL). Overall, the intervention was not associated with changes in prolactin concentrations between exercisers and controls at 3 months (P = 0.46) or 12 months (P = 0.29). The intervention effect did not vary by baseline age, body mass index, parity, or change in percent body fat during the intervention. Among exercisers, there was a significant difference in prolactin concentrations by change in fitness (VO(2)max) between baseline and 12 months. Exercisers whose VO(2)max changed by <5% had a 5% increase in prolactin concentrations, whereas those who increased their VO(2)max by 5% to 15% and >15% had a 11% (P = 0.03) and 7% (P = 0.01) decrease in prolactin concentrations, respectively. Although the exercise intervention had little effect on prolactin concentrations overall, increasing physical fitness was associated with reduced prolactin concentrations among postmenopausal women.

Effects of an exercise intervention on other health behaviors in overweight/obese post-menopausal women

Background Little is known about whether initiating physical activity induces change in other health-related behaviors. If other behaviors do change with increasing physical activity, this would complicate interpretation of differences in study outcomes in exercise intervention trials. Design Randomized controlled trial. Setting/participants 173 sedentary, overweight (body mass index between 24.0 and 25.0 kg/m 2 with body fat > 33% or BMI ≥ 25.0 kg/m 2), postmenopausal women, ages 50 to 75 years, not using hormone therapy, and living in the Seattle, WA area. Intervention Participants were randomly assigned to an exercise intervention ( n = 87) or a stretching-control group ( n = 86). The exercise intervention included facility and home-based moderate-intensity exercise. Main outcome measures Changes in dietary intake, alcohol consumption, and medication and supplement use were compared from baseline to 3- and 12-month follow-up between exercise and control groups, and by tertiles of exercise adherence. Data were collected between January 1998 and July 2001. Results In general, changes in dietary intake between the exercise and control group were not statistically different. The exercise group had a greater increase in the proportion of participants who used multivitamins (+ 5%) compared to the control group (− 10%) at 3 months ( p-interaction = 0.04), but not at 12 months ( p-interaction = 0.58). Furthermore, there were few differences when comparing changes in health behaviors across exercise adherence tertiles. Conclusions Our results suggest that participation in a year-long exercise intervention trial among post-menopausal women has little effect on other health behaviors. These findings suggest that additional behavior changes in exercise trials are minimal and unlikely to bias primary study results.