Healthy Exercise

Persons at any age can substantially improve their fitness for work and play through appropriate exercise training. Considerable evidence indicates that physical activity is valuable for weight control, modifying lipids and improving carbohydrate tolerance. Less rigorous scientific data are available for associated long-term blood pressure and psychological changes with habitual exercise. Strenuous physical activity most likely reduces the incidence of coronary heart disease and the detrimental impact of certain chronic diseases on health. Adverse effects may result from a training program, but the major concern is the susceptibility to cardiovascular events during and immediately after exertion. To achieve optimal benefits with minimal risk, exercise must be carefully prescribed within the context of overall health and training objectives. Taken altogether, a distinct rationale exists for regular vigorous exercise as an integral part of a personal health maintenance program.     

Strength training and aerobic exercise: comparison and contrast

Most exercise programs for conditioning and rehabilitation are oriented to strength development, aerobic (cardiovascular) fitness, or a combination of the 2. Because the 2 types of exercise are located at the opposite extremes of a muscular power continuum, the design of a program must be highly specific with regard to the exercise to be undertaken, as well as the intensity, duration, and frequency, in order to attain optimal results. Strength exercise programs involve weight training or the use of high-resistance machines with exercise that is limited to a few repetitions (generally less than 20) before exhaustion. Aerobic exercise involves exercise performed for extended periods (e.g., 10-40 minutes) with large muscle activity involving hundreds of consecutive repetitions that challenge the delivery of oxygen to the active muscles. The chronic physiological adaptations and the variables in program design are highly specific to the type of exercise performed.     

The sense and nonsense of direct-to-consumer genetic testing for cardiovascular disease

Expectations are high that increasing knowledge of the genetic basis of cardiovascular disease will eventually lead to personalised medicine—to preventive and therapeutic interventions that are targeted to at-risk individuals on the basis of their genetic profiles. Most cardiovascular diseases are caused by a complex interplay of many genetic variants interacting with many non-genetic risk factors such as diet, exercise, smoking and alcohol consumption. Since several years, genetic susceptibility testing for cardiovascular diseases is being offered via the internet directly to consumers. We discuss five reasons why these tests are not useful, namely: (1) the predictive ability is still limited; (2) the risk models used by the companies are based on assumptions that have not been verified; (3) the predicted risks keep changing when new variants are discovered and added to the test; (4) the tests do not consider non-genetic factors in the prediction of cardiovascular disease risk; and (5) the test results will not change recommendations of preventive interventions. Predictive genetic testing for multifactorial forms of cardiovascular disease clearly lacks benefits for the public. Prevention of disease should therefore remain focused on family history and on non-genetic risk factors as diet and physical activity that can have the strongest impact on disease risk, regardless of genetic susceptibility.     

Physical fitness of an industrial fire department vs. a municipal fire department

Both industrial and municipal firefighters need to maintain high levels of physical fitness and minimize cardiovascular risk factors. The nature of firefighter responsibilities in industrial and municipal settings may vary, affecting the ability to sustain high levels of physical fitness. We compared the working conditions, physical fitness, and exercise training practices of an industrial fire department (n = 17) to those of a nearby municipal fire department (n = 55). After informed consent, aerobic capacity, muscular strength, muscular endurance, body composition, flexibility, blood lipid concentrations, and blood pressure levels were measured. Exercise training practices and related factors were assessed using a questionnaire. Despite programmatic differences, these departments demonstrated similar, relatively high degrees of physical fitness and similar blood lipid concentrations, blood pressure levels, and cardiac risk factors. It is recommended that fire departments involve appropriately trained staff, schedule on-duty times for exercise, offer well-equipped exercise facilities, and follow National Strength and Conditioning Association (NSCA) and American College of Sports Medicine (ACSM) guidelines for exercise conditioning in order to maintain a high degree of physical fitness.     

NADPH oxidase p22phox gene variants are associated with systemic oxidative stress biomarker responses to exercise training.

Systemic oxidative stress plays a role in many degenerative diseases. Although regular physical activity has been known as the most effective nonpharmacological intervention to alleviate the oxidative stress, the beneficial effect varies between individuals. We investigated whether NADPH oxidase p22phox gene C242T and A640G polymorphisms are associated with systemic oxidative stress level response to exercise training (ExTr). Fifty-nine sedentary middle-aged to older Caucasians with relatively high cardiovascular disease risk factors underwent a 6-mo standardized ExTr program. Body mass index, plasma lipoprotein-lipid profiles, cardiovascular fitness, and plasma thiobarbituric acid reactive substances (TBARS) were measured before and after ExTr. Demographic and initial levels of cardiovascular disease risk factors were similar among genotype groups for both polymorphisms. Overall, TBARS was decreased by 16% with ExTr in the entire group (P < 0.001). There was no significant difference in TBARS changes with ExTr among the C242T genotype groups. However, A allele carriers showed greater reduction in TBARS than noncarriers at the A640G locus (P = 0.05). There was a significant interaction (P = 0.05) between ExTr and A640G polymorphism in TBARS changes with ExTr. This interaction remained after accounting for age and baseline TBARS level. Furthermore, diplotype analysis showed that TBARS was decreased to a greater extent in the C242/A640 haplotype carriers compared with the noncarriers (P < 0.05). We found that p22phox polymorphisms, especially A640G, were associated with differential changes in systemic oxidative stress with aerobic exercise training.     

Physical activity, cardiorespiratory fitness and insulin resistance: a short update

PURPOSE OF REVIEW: High levels of cardiorespiratory fitness and/or habitual physical activity are associated with reduced risk of cardiovascular disease. The responsible mechanisms are multifarious, but effects on insulin sensitivity are likely to play an important role. The purpose of this review is to highlight some recent evidence on the interrelationships between physical activity, fitness, obesity, genotype and insulin resistance. RECENT FINDINGS: Effects on cardiorespiratory fitness and abdominal obesity are both likely to contribute to the insulin-sensitizing effects of regular physical activity. Recent data suggest that at least in older adults, the intensity of an exercise intervention may influence the magnitude of changes in insulin sensitivity, and emerging data suggest that individual changes in insulin sensitivity following an exercise programme may, in part, be influenced by genotype. SUMMARY: Increasing physical activity reduces insulin resistance. As both intensity of exercise and genetic factors may modulate the magnitude of this effect, current physical activity for health guidelines that emphasize engagement in moderate-intensity physical activity in a 'one-size-fits-all' approach may need revision in the future to optimize the potential benefits accrued from individuals becoming more active.     

Effects of exercise on endothelium and endothelium/smooth muscle cross talk: role of exercise-induced hemodynamics

Physical activity, exercise training, and fitness are associated with decreased cardiovascular risk. In the context that a risk factor "gap" exists in the explanation for the beneficial effects of exercise on cardiovascular disease, it has recently been proposed that exercise generates hemodynamic stimuli which exert direct effects on the vasculature that are antiatherogenic. In this review we briefly introduce some of the in vitro and in vivo evidence relating exercise hemodynamic modulation and vascular adaptation. In vitro data clearly demonstrate the importance of shear stress as a potential mechanism underlying vascular adaptations associated with exercise. Supporting this is in vivo human data demonstrating that exercise-mediated shear stress induces localized impacts on arterial function and diameter. Emerging evidence suggests that exercise-related changes in hemodynamic stimuli other than shear stress may also be associated with arterial remodeling. Taken together, in vitro and in vivo data strongly imply that hemodynamic influences combine to orchestrate a response to exercise and training that regulates wall stress and peripheral vascular resistance and contributes to the antiatherogenic impacts of physical activity, fitness, and training.     

Long-term effects of physical training programme on risk factors for coronary heart disease in otherwise sedentary men.

Three hundred and seventy sedentary men aged 20-65 years enrolled in a physical training programme after a medical and fitness examination that included measurements of "classical" risk factors for coronary heart disease. Five years later re-examination showed (a) that on average the subjects had not changed significantly in weight, blood pressure, serum lipid concentrations, smoking habits, and physical working capacity; (b) that men who had remained active and therefore had a higher degree of fitness did not differ in risk factors from men who had returned to sedentary habits; and (c) that men who had improved substantially in fitness did not differ in risk factors from men whose fitness had not changed or had declined. Five years after the initial programme one-third of the men were continuing with regular vigorous exercise. These results do not support the view that classical risk factors for coronary heart disease improve with increased physical activity and fitness.     

Some metabolical aspects of physical exercise under laboratory and field conditions

Parameters of exercise physiology were studied in nearly 300 subjects to resolve whether these indices were equally suitable under laboratory and field conditions to assess the level of physical fitness and optimum work load. Respiratory gas exchange, heart rate and exercise acidosis parameters were studied. The inference drawn on the basis of the obtained data has been that both the mode and the intensity of the imposed exercise exert significant influence on the variation of physiological parameters. During running either on the treadmill or in the field test, blood lactate levels were comparable, but performances related to these concentrations were not the same. When different modes of exercise were employed, also lactate levels differed between the laboratory and field studies. The performance of patients under or after exercise rehabilitation following acute myocardial infarction by using instrumental monitoring in the laboratory was found to excel that attained during rehabilitation exercise training. Any change in the level of physical fitness can only be reliably followed when physiological parameters are obtained with the same mode of exercise and intensity under the same environmental conditions. Modern training planning of sports and exercise should take into account the data derived from both the laboratory and the field studies concerning cardiorespiratory system and metabolism.     

Study protocol: EXERcise and Cognition in Sedentary adults with Early-ONset dementia (EXERCISE-ON)

ABSTRACT: BACKGROUND: Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia. METHODS: One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an aerobic exercise program in a rehabilitation centre or a flexibility and relaxation program in a rehabilitation centre. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a daily physical activity program set at home making use of pedometers. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures. DISCUSSION: The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life.Trial registrationThe present study is registered within The Netherlands National Trial Register (ref: NTR2124).     

Health-related fitness of sedentary elderly in the Netherlands

The assessment of fitness is a component of a national project aimed at the enhancement of physical avtivity among sedentary older adults, aged 55-65 year in the Netherlands. Deterioration in physical functioning may be improved through an exercise programme. Research showed that enhancement of physical activity results in improved fitness, increased functional ability and health-related quality of life. Scientific results of the association between exercise and physical fitness in older adults is not sufficiently evidence-based in the Netherlands. In order to support health policy interventions 5.584 fitness tests of sedentary older adults were analyzed. The fitness was assessed by the Groninger Fitnesstest for Elderly (GFE). The analysis of physical fitness in sedentary older adults showed a lower fitness status among the age group 55-65 of age and women. Health risk factors such as overweight and having a chronic disease explained 88% of the variance between a low fitness and a high fitness profile.     

Obesity negatively impacts aerobic capacity improvements both acutely and 1-year following cardiac rehabilitation

Cardiac rehabilitation (CR) produces a host of health benefits related to modifiable cardiovascular risk factors. The purpose of the present investigation was to determine the influence of body weight, assessed through BMI, on acute and long-term improvements in aerobic capacity following completion of CR. Three thousand nine hundred and ninety seven subjects with coronary artery disease (CAD) participated in a 12-week multidisciplinary CR program. Subjects underwent an exercise test to determine peak estimated metabolic equivalents (eMETs) and BMI assessment at baseline, immediately following CR completion and at 1-year follow-up. Normal weight subjects at 1-year follow-up demonstrated the greatest improvement in aerobic fitness and best retention of those gains (gain in peak METs: 0.95 ± 1.1, P < 0.001). Although the improvement was significant (P < 0.001), subjects who were initially classified as obese had the lowest aerobic capacity and poorest retention in CR fitness gains at 1-year follow-up (gain in peak eMETs: 0.69 ± 1.2). Subjects initially classified as overweight by BMI had a peak eMET improvement that was also significantly better (P < 0.05) than obese subjects at 1-year follow-up (gain in peak eMETs: 0.82 ± 1.1). Significant fitness gains, one of the primary beneficial outcomes of CR, can be obtained by all subjects irrespective of BMI classification. However, obese patients have poorer baseline fitness and are more likely to "give back" fitness gains in the long term. Obese CAD patients may therefore benefit from additional interventions to enhance the positive adaptations facilitated by CR.     

Effects of a comprehensive cardiac rehabilitation program on quality of life and exercise tolerance in women: A retrospective analysis

BACKGROUND: Currently, there are a lack of investigations that have examined the effect of participating in a comprehensive cardiac rehabilitation program on quality of life and physiological measures in women of different ages. The purpose of this investigation was to examine the effect of participating in a comprehensive cardiac rehabilitation program on quality of life, exercise tolerance, blood pressure and lipids in women between 33 and 82 years of age. METHODS: The 126 women participated in a 14-week cardiac rehabilitation program that consisted of 7 weeks of formal supervised exercise training and 7 weeks of unsupervised exercise and lifestyle modification. Physiologic and quality of life outcome measures obtained at the outset and after 14 weeks included: 1) exercise treadmill time; 2) resting and peak systolic and diastolic blood pressure; 3) total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and Triglycerides; 4) Cardiac Quality of Life Index questionnaire. RESULTS: Significant improvements were found in the following quality of life measures after participating in the cardiac rehabilitation program: physical well being, psychosocial, worry, nutrition and symptoms. No significant differences were seen for any QOL variable between the different age groups. Significant improvements were seen in exercise tolerance (+21%) and high density lipoprotein (+5%). CONCLUSION: Cardiac rehabilitation may play an important role in improving quality of life, exercise tolerance and high density lipoprotein cholesterol levels in younger and older women with underlying cardiovascular disease.     

Impact of exercise training on cardiovascular disease and risk

Epidemiological studies in large cohorts support the notion that physical fitness is associated with reduced cardiovascular mortality and hospitalization due to cardiovascular disease. During the last 20 years even the concept of resting inactive after a myocardial infarction has dramatically changed and nowadays patients are mobilized and included into exercise training programs very shortly after the insult. Unfortunately, these beneficial effects of exercise training are independent of the genetic background and are only observed in case the training program is not paused for a longer time. Therefore, to take advantage of the effects of exercise training in health care the challenge for the future is to increase exercise compliance by offering interesting and effective exercise training programs. At the physiological and molecular level, exercise training affects several organs like the vascular system and the skeletal muscle. Changes elicited by regular exercise training range in the vascular system from increasing vasodilation due to an elevation of bioavailable nitric oxide to a shift in the catabolic/anabolic balance in the peripheral skeletal muscle. In this review we discuss the healthy benefit of exercise training and the molecular changes triggered by exercise training in the setting of secondary prevention.     

Managing concomitant cardiac disease and erectile dysfunction

Early studies of peak heart rates and blood pressure during coitus led physicians to believe that sexual activity represents a significant risk to patients with cardiovascular disease. Subsequent studies indicated, however, that the heart rate during coitus was no higher than the rate during unaccustomed physical exercise or associated with anger. The absolute risk of myocardial infarction (MI) in a patient with a history of MI has been found to be 10 per million per hour, and the doubling of this risk in the 2 hours following coitus has a negligible impact on annual risk. Coronary artery disease (CAD) is a powerful indicator of the presence of erectile dysfunction (ED), and the risk factors for ED are similar to those for CAD. Studies of sildenafil citrate use in patients with a history of cardiovascular disease have found sildenafil to be safe and effective, except for an absolute contraindication in the concomitant use of nitrates. Physicians should become familiar with the clinical guidelines for classifying ED patients with a history of cardiovascular disease as high risk, intermediate or indeterminate risk, and low risk. The guidelines permit physicians MIlow risk while deferring the resumption of sexual activity among higher risk patients pending further evaluation.     

The prevalence of cardiovascular disease risk factors in patients from Croatian Zagorje County treated at Department of Medicine, Zabok General Hospital from 2000 to 2006

The aim of the study was to assess the prevalence of risk factors for cardiovascular disease in patients treated for coronary heart disease (CHD) at Department of Medicine, Zabok General Hospital during the 2000-2006 period. Cardiovascular diseases are a group of diseases that occur due to arterial. The risk factors that lead to the development and occurrence of cardiovascular disease are hypertension, cigarette smoking, hyperholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history. Additional factors favoring the occurrence of cardiovascular disease include overweight, inadequate physical activity, and emotional stress. Data on all patients hospitalized and diagnosed with CHD at Department of Medicine, Zabok General Hospital during the 2000-2006 period were analyzed for the prevalence of risk factors for CHD, i.e. hypertension, cigarette smoking, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history of cardiovascular disease. Hypercholesterolemia was defined by a cholesterol level higher than 5.1 mmol/L, hypertension from history data and blood pressure measurement on admission greater than 140/90 mmHg, diabetes mellitus from history data, and hypertriglyceridemia by a triglyceride level greater than 1.7 mmol/L. Information on heredity and cigarette smoking was collected from history and a questionnaire filled out on admission. All laboratory values were determined on patient admission to the hospital. Analysis of the risk factors for CHD recorded in patients from Zagorje County during the 2000-2006 period revealed hypertension to be the most common risk factor in our patients. According to sex, CHD was found to show a male preponderance. According to age at admission, CHD predominated in the > 70 age group, which accounted for one third of all patients, followed by a comparable proportion of the 50-60 and 60-70 age groups, i.e. still active population groups. As CHD is one of the leading health threats worldwide, estimated to remain so at least by 2020, it is fully justified to invest all efforts in the study of cardiovascular disease. New research projects should be focused on the prevention and early detection of the disease, improvement of diagnosis procedures, introduction of novel therapeutic options, use of new concepts, and due survey of the measures taken. CHD poses great socioeconomic burden upon every community in industrialized societies because of the ever younger age at onset. Actions should be taken to improve awareness of the CHD risks and morbidity in the population at large, stimulating favorable lifestyle and dietary modifications, and one's own health awareness, in order to upgrade the control of risk factors for and morbidity of cardiovascular disease.     

Physical fitness level is reflected by alterations in the human plasma metabolome

An excessive energy intake combined with a low level of physical activity induces detrimental processes involved in disease development, e.g. type 2 diabetes and cardiovascular disease. However the underlying mechanisms for regulation of metabolic capacity and fitness status remain unclear. Metabolomics involves global studies of the metabolic reactions in an organism or cell. Thus hypotheses regarding biochemical events can be generated to increase the understanding of disease development and thereby aid in the development of novel treatments or preventions. We present the first standardized intervention study focusing on characterizing the human metabolome in relation to moderate differences in cardiorespiratory fitness. Gas chromatography-time of flight/mass spectrometry (GC-TOF/MS) was used to characterize 460 plasma samples from 27 individuals divided into two groups based on physical fitness level (VO(2)max). Multi- and univariate between group comparisons based on 197 metabolites were carried out in samples collected at rest prior to any intervention, over time following a nutritional load or a standardized exercise scheme, with and without nutritional load. We detected decreased levels of gamma-tocopherol (GT), a vitamin E isomer, in response to a high fitness level, whereas the opposite was seen for the alpha isomer (AT). In addition, the high fitness level was associated with elevated ω3-PUFA (DHA, 22 : 6ω3) and a decrease in ω6-PUFA (18 : 2ω6) as well as in saturated (16 : 0, 18 : 0), monounsaturated (18 : 1) and trans (16 : 1) fatty acids. We thus hypothesize that high fitness status induces an increased cardiorespiratory inflammatory and antioxidant defense system, more prone to deal with the inflammatory response following exercise and nutrition intake.     

Exercise, oxidative stress and risk of cardiovascular disease in the elderly. Protective role of antioxidant functional foods

Free radicals and oxidative stress are involved in the pathogenic mechanisms of cardiovascular disease (CVD), diabetes and cancer. Exercise is a useful strategy for preventing CVD but in elderly persons it can enhance oxidative stress, which is why some studies recommend antioxidant supplementation for exercising elderly subjects. This intervention study was performed on 320 elderly subjects following a Geriatric Revitalization Program (GEREPRO) to maintain physical health and reduce CVD risk. GEREPRO was based on regular exercise concurrent with a nutritional antioxidant treatment based on daily intake of a functional antioxidant food, Biofrutas. Sustained exercise (10 months, 3 sessions/week) significantly increased cardiorespiratory fitness and plasma HDL-cholesterol; it reduced some predictors of cardiovascular risk (arterial pressure, LDL-cholesterol, total cholesterol/LDL-C, LDL-C/HDL-C), but significantly enhanced some biomarkers of oxidative stress. Concurrent antioxidant supplementation did not produce any ergogenic effects but, meaningfully, enhanced some positive effects of exercise on physical health and the CDV risk index, and it totally prevented the exercise-induced oxidative stress. Our results show that regular and moderate exercise improves cardiorespiratory function and reduces CVD risk in elderly people, while concurrent antioxidant supplementation modulates oxidative insult during exercise in the elderly and enhances the beneficial effects of exercise.