Interventions for reducing sedentary behaviour in people with stroke.

BACKGROUND: Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES: To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS: In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA: Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS: We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS: Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.

Cardiac Responses to Submaximal Isometric Contraction and Aerobic Exercise in Healthy Pregnancy.

PURPOSE: The increased physiological demand of pregnancy results in the profound adaptation of the maternal cardiovascular system, reflected by greater resting cardiac output and left ventricular (LV) deformation. Whether the increased resting demand alters acute cardiac responses to exercise in healthy pregnant women is not well understood. METHODS: Healthy nonpregnant (n = 18), pregnant (n = 14, 22-26 wk gestation), and postpartum women (n = 13, 12-16 wk postdelivery) underwent assessments of cardiac function and LV mechanics at rest, during a sustained isometric forearm contraction (30% maximum), and during low-intensity (LOW) and moderate-intensity (MOD) dynamic cycling exercise (25% and 50% peak power output). Significant differences (α = 0.05) were determined using ANCOVA and general linear model (resting value included as covariate). RESULTS: When accounting for higher resting cardiac output in pregnant women, pregnant women had greater cardiac output during isometric contraction (2.0 ± 0.3 L·min-1·m-1.83; nonpregnant, 1.3 ± 0.2 L·min-1·m-1.83; postpartum, 1.5 ± 0.5 L·min-1·m-1.83; P = 0.02) but similar values during dynamic cycling exercise (pregnant, LOW = 2.8 ± 0.4 L·min-1·m-1.83, MOD = 3.4 ± 0.7 L·min-1·m-1.83; nonpregnant, LOW = 2.4 ± 0.3 L·min-1·m-1.83, MOD = 3.0 ± 0.3 L·min-1·m-1.83; postpartum, LOW = 2.3 ± 0.4 L·min-1·m-1.83, MOD = 3.0 ± 0.5 L·min-1·m-1.83; P = 0.96). Basal circumferential strain was higher in pregnant women at rest, during the sustained isometric forearm contraction (-23.5% ± 1.2%; nonpregnant, -14.6% ± 1.4%; P = 0.001), and during dynamic cycling exercise (LOW = -27.0% ± 4.9%, MOD = -27.4% ± 4.6%; nonpregnant, LOW = -15.8% ± 4.5%, MOD = -15.2% ± 6.7%; P = 0.012); however, other parameters of LV mechanics were not different between groups. CONCLUSION: The results support that the maternal heart can appropriately respond to additional cardiac demand and altered loading experienced during acute isometric and dynamic exercise, although subtle differences in responses to these challenges were observed. In addition, the LV mechanics that underpin global cardiac function are greater in pregnant women during exercise, leading to the speculation that the hormonal milieu of pregnancy influences regional deformation.

A longitudinal study of muscle strength and function in patients with cancer cachexia.

PURPOSE: Patients with cancer frequently experience an involuntary loss of weight (in particular loss of muscle mass), defined as cachexia, with profound implications for independence and quality of life. The rate at which such patients' physical performance declines has not been well established. The aim of this study was to determine the change in muscle strength and function over 8 weeks in patients with already established cancer cachexia, to help inform the design and duration of physical activity interventions applicable to this patient group. METHODS: Patients with thoracic and gastrointestinal cancer and with unintentional weight loss of > 5% in 6 months or BMI < 20 plus 2% weight loss were included. Physical and functional assessments (baseline, 4 weeks, 8 weeks) included isometric quadriceps and hamstring strength, handgrip, standing balance, 10-m walk time and timed up and go. RESULTS: Fifty patients (32 male), mean ± SD age 65 ± 10 years and BMI 24.9 ± 4.3 kg/m2, were recruited. Thoracic cancer patients had lower muscle strength and function (p < 0.05). Despite notable attrition, in patients who completed all assessments (8 thoracic and 12 gastrointestinal), there was little change in performance over 8 weeks (p > 0.05). Baseline variables did not differentiate between completers and non-completers (p > 0.05). CONCLUSIONS: More than a third of patients with established cancer cachexia in our study were stable over 8 weeks, suggesting a subgroup who may benefit from targeted interventions of reasonable duration. Better understanding the physical performance parameters which characterise and differentiate these patients has important clinical implications for cancer multidisciplinary team practice.

Static and Dynamic Lung Volumes in Swimmers and Their Ventilatory Response to Maximal Exercise.

PURPOSE: While the static and dynamic lung volumes of active swimmers is often greater than the predicted volume of similarly active non-swimmers, little is known if their ventilatory response to exercise is also different. METHODS: Three groups of anthropometrically matched male adults were recruited, daily active swimmers (n = 15), daily active in fields sport (Rugby and Football) (n = 15), and recreationally active (n = 15). Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and maximal voluntary ventilation (MVV) was measured before and after exercise to volitional exhaustion. RESULTS: Swimmers had significantly larger FVC (6.2 ± 0.6 l, 109 ± 9% pred) than the other groups (5.6 ± 0.5 l, 106 ± 13% pred, 5.5 ± 0.8, 99% pred, the sportsmen and recreational groups, respectively). FEV1 and MVV were not different. While at peak exercise, all groups reached their ventilatory reserve (around 20%), the swimmers had a greater minute ventilation rate than the recreational group (146 ± 19 vs 120 ± 87 l/min), delivering this volume by breathing deeper and slower. CONCLUSIONS: The swimmers utilised their larger static volumes (FVC) differently during exercise by meeting their ventilation volume through long and deep breaths.

Patients with established cancer cachexia lack the motivation and self-efficacy to undertake regular structured exercise.

OBJECTIVES: Patients with advanced cancer frequently suffer a decline in activities associated with involuntary loss of weight and muscle mass (cachexia). This can profoundly affect function and quality of life. Although exercise participation can maintain physical and psychological function in patients with cancer, uptake is low in cachectic patients who are underrepresented in exercise studies. To understand how such patients' experiences are associated with exercise participation, we investigated exercise history, self-confidence, and exercise motivations in patients with established cancer cachexia, and relationships between relevant variables. METHODS: Lung and gastrointestinal cancer outpatients with established cancer cachexia (n = 196) completed a questionnaire exploring exercise history and key constructs of the Theory of Planned Behaviour relating to perceived control, psychological adjustment, and motivational attitudes. RESULTS: Patients reported low physical activity levels, and few undertook regular structured exercise. Exercise self-efficacy was very low with concerns it could worsen symptoms and cause harm. Patients showed poor perceived control and a strong need for approval but received little advice from health care professionals. Preferences were for low intensity activities, on their own, in the home setting. Regression analysis revealed no significant factors related to the independent variables. CONCLUSIONS: Frequently employed higher intensity, group exercise models do not address the motivational and behavioural concerns of cachectic cancer patients in this study. Developing exercise interventions which match perceived abilities and skills is required to address challenges of self-efficacy and perceived control identified. Greater engagement of health professionals with this group is required to explore potential benefits of exercise.

Cardiac dysfunction in cancer survivors unmasked during exercise.

BACKGROUND: The cardiac dysfunction associated with anthracycline-based chemotherapy cancer treatment can exist subclinically for decades before overt presentation. Stress echocardiography, the measurement of left ventricular (LV) deformation and arterial haemodynamic evaluation, has separately been used to identify subclinical cardiovascular (CV) dysfunction in several patient groups including those with hypertension and diabetes. The purpose of the present cross-sectional study was to determine whether the combination of these techniques could be used to improve the characterisation of subclinical CV dysfunction in long-term cancer survivors previously treated with anthracyclines. MATERIALS AND METHODS: Thirteen long-term cancer survivors (36 ± 10 years) with prior anthracycline exposure (11 ± 8 years posttreatment) and 13 age-matched controls were recruited. Left ventricular structure, function and deformation were assessed using echocardiography. Augmentation index was used to quantify arterial haemodynamic load and was measured using applanation tonometry. Measurements were taken at rest and during two stages of low-intensity incremental cycling. RESULTS: At rest, both groups had comparable global LV systolic, diastolic and arterial function (all P > 0·05); however, longitudinal deformation was significantly lower in cancer survivors (-18 ± 2 vs. -20 ± 2, P < 0·05). During exercise, this difference between groups persisted and further differences were uncovered with significantly lower apical circumferential deformation in the cancer survivors (-24 ± 5 vs. -29 ± 5, -29 ± 5 vs. 35 ± 8 for first and second stage of exercise respectively, both P < 0·05). CONCLUSION: In contrast to resting echocardiography, the measurement of LV deformation at rest and during exercise provides a more comprehensive characterisation of subclinical LV dysfunction. Larger studies are required to determine the clinical relevance of these preliminary findings.

High-intensity interval training versus moderate-intensity steady-state training in UK cardiac rehabilitation programmes (HIIT or MISS UK): study protocol for a multicentre randomised controlled trial and economic evaluation.

INTRODUCTION: Current international guidelines for cardiac rehabilitation (CR) advocate moderate-intensity exercise training (MISS, moderate-intensity steady state). This recommendation predates significant advances in medical therapy for coronary heart disease (CHD) and may not be the most appropriate strategy for the 'modern' patient with CHD. High-intensity interval training (HIIT) appears to be a safe and effective alternative, resulting in greater improvements in peak oxygen uptake (VO2 peak). To date, HIIT trials have predominantly been proof-of-concept studies in the laboratory setting and conducted outside the UK. The purpose of this multicentre randomised controlled trial is to compare the effects of HIIT and MISS training in patients with CHD attending UK CR programmes. METHODS AND ANALYSIS: This pragmatic study will randomly allocate 510 patients with CHD to 8 weeks of twice weekly HIIT or MISS training at 3 centres in the UK. HIIT will consist of 10 high-intensity (85-90% peak power output (PPO)) and 10 low-intensity (20-25% PPO) intervals, each lasting 1 min. MISS training will follow usual care recommendations, adhering to currently accepted UK guidelines (ie, >20 min continuous exercise at 40-70% heart rate reserve). Outcome measures will be assessed at baseline, 8 weeks and 12 months. The primary outcome for the trial will be change in VO2 peak as determined by maximal cardiopulmonary exercise testing. Secondary measures will assess physiological, psychosocial and economic outcomes. ETHICS AND DISSEMINATION: The study protocol V.1.0, dated 1 February 2016, was approved by the NHS Health Research Authority, East Midlands-Leicester South Research Ethics Committee (16/EM/0079). Recruitment will start in August 2016 and will be completed in June 2018. Results will be published in peer-reviewed journals, presented at national and international scientific meetings and are expected to inform future national guidelines for exercise training in UK CR. TRIAL REGISTRATION NUMBER: NCT02784873; pre-results.

Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses.

OBJECTIVE: Cardiac output, a fundamental parameter of cardiovascular function, has consistently been shown to increase across healthy pregnancy; however, the time course and magnitude of adaptation remains equivocal within published literature. The aim of the present meta-analyses was to comprehensively describe the pattern of change in cardiac output during healthy pregnancy. METHOD: A series of meta-analyses of previously published cardiac output data during healthy, singleton pregnancies was completed. PubMed and Scopus databases were searched for studies published between 1996 and 2014. Included studies reported absolute values during a predetermined gestational age (non-pregnant, late first trimester, early and late second trimester, early and late third trimester, early and late postpartum). Cardiac output was measured through echocardiography, impedance cardiography or inert gas rebreathing. Observational data were meta-analysed at each gestational age using a random-effects model. If reported, related haemodynamic variables were evaluated. RESULTS: In total, 39 studies were eligible for inclusion, with pooled sample sizes ranging from 259 to 748. Cardiac output increased during pregnancy reaching its peak in the early third trimester, 1.5 L/min (31%) above non-pregnant values. The observed results from this study indicated a non-linear rise to this point. In the early postpartum, cardiac output had returned to non-pregnant values. CONCLUSION: The present results suggest that cardiac output peaks in the early third trimester, following a non-linear pattern of adaptation; however, this must be confirmed using longitudinal studies. The findings provide new insight into the normal progression of cardiac output during pregnancy.

Exercise intensities of gardening tasks within older adult allotment gardeners in Wales.

Previous research has suggested that gardening activity could be an effective form of regular exercise for improving physical and psychological health in later life. However, there is a lack of data regarding the exercise intensities of various gardening tasks across different types of gardening and different populations. The purpose of this study was to examine the exercise intensity of gardening activity for older adult allotment gardeners in Wales, United Kingdom following a similar procedure used in previous studies conducted in the United States and South Korea by Park and colleagues (2008a; 2011). Oxygen consumption (VO2) and energy expenditure for six gardening tasks were measured via indirect calorimetery using the portable Oxycon mobile device. From these measures, estimated metabolic equivalent units (METs) were calculated. Consistent with Park et al. (2008a; 2011) the six gardening tasks were classified as low to moderate-high intensity physical activities based on their metabolic values (1.9-5.7 METs).

Relationship Between Break-Time Physical Activity, Age, and Sex in a Rural Primary Schools, Wales, UK.

The aim of this study was to examine the physical activity during the break-times of primary school children in rural areas, and its relationship with age and sex. 380 children (192 boys and 188 girls; age=9.5±1.1 years) participated in the study. Break-time physical activity in the morning and lunch breaks was measured by accelerometry. An ANOVA was used to determine differences by sex in each age group, together with the respective confidence intervals and effect sizes. The results showed that 8-year-olds performed more physical exercise than 11-year-olds during the two breaks (p=0.005). For the boys, the 8-year-olds did more physical activity than the 10-year-olds, while, for the girls, those aged 8 and 9 years did more PA than girls aged 11 years (p<0.001). The only difference between boys and girls was for the 10-year-olds (p=0.043), with the boys doing more physical activity. Teachers might find it useful to take these findings into account to design physical activity programmes aimed at increasing the playground physical activity of older children.

Playground designs to increase physical activity levels during school recess: a systematic review.

School recess provides a major opportunity to increase children's physical activity levels. Various studies have described strategies to increase levels of physical activity. The purpose of this systematic review is therefore to examine the interventions proposed as forms of increasing children's physical activity levels during recess. A systematic search of seven databases was made from the July 1 to July 5, 2012, leading to a final set of eight studies (a total of 2,383 subjects-599 "preschoolers" and 1,784 "schoolchildren") meeting the inclusion criteria. These studies were classified according to the intervention used: playground markings, game equipment, playground markings plus physical structures, and playground markings plus game equipment. The results of these studies indicate that the strategies analyzed do have the potential to increase physical activity levels during recess. The cumulative evidence was (a) that interventions based on playground markings, game equipment, or a combination of the two, do not seem to increase the physical activity of preschoolers and schoolchildren during recess and (ii) that interventions based on playground markings plus physical structures do increase the physical activity of schoolchildren during recess in the short to medium term.

A randomized feasibility study of a 12-week community-based exercise program for people with Huntington's disease.

BACKGROUND AND PURPOSE: The beneficial role of exercise as a treatment approach in Huntington's disease (HD) has support from both preclinical work and small-scale studies; however, there have been no controlled studies of gym-based exercise in people with HD. This phase 2 randomized trial (ISRCTN 59910670) assessed feasibility, safety, acceptability, and benefit of a structured exercise program. METHODS: Thirty-one participants (16 men; mean [SD] age = 50.4 [11.4] years) were randomly allocated to intervention (n = 16) or control group (usual care; n = 15). The intervention entailed a weekly supervised gym session of stationary cycling and resistance exercises, and a twice weekly independent home-based walking program. Retention and adherence rates and adverse events were recorded. Acceptability was determined from subjective reports of tolerability and physiological measures recorded during the gym sessions. Assessment of benefit included measures of physical abilities, disease severity, and quality of life (36-Item Short Form Health Survey). Analysis of covariance was used to test outcomes of interest. RESULTS: The retention rate was 81% (9 of the 11 individuals who started the intervention completed it) and of the 9 who completed the program, 7 attended more than 75% (9/12) of the gym sessions. There were no related adverse events and the intervention was well tolerated by most participants. The between-group effect estimate for the Mental Component Summary score of the 36-Item Short Form Health Survey (n = 9; intervention, n = 13; control) was 7 (95% CI: 0.4-13.7) Moderate effect sizes for cognitive outcomes and measures of walking were also observed. DISCUSSION AND CONCLUSIONS: Observed effect sizes for clinical outcomes suggest the structured exercise program has benefit for persons with HD; larger scale trials are warranted.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A60) for more insights from the authors.

Influence of fitness and physical activity on cardiovascular reactivity to musical performance.

OBJECTIVE: The current study examines the relationships between physical activity and fitness and reactivity to a musical performance stressor (MPS). Numerous studies suggest that being fitter and more physically active has a beneficial effect on individuals' cardiovascular responses to laboratory-based mental challenges. The results are equivocal regarding the transfer of such benefits to real world contexts such as musical performance. PARTICIPANTS: Forty six advanced music students completed this assessment. METHOD: All participants completed a 20-min pre-performance assessment of heart rate (HR), HR variability (HRV) and blood pressure. Participants also completed baseline measures and a sub-maximal fitness assessment on a separate day. RESULTS: A positive association between fitness and HR pre-MPS was found. Fitness was also positively associated with root mean square SD RR(interval) before the MPS. Higher fitness was related to lower state anxiety post-MPS. CONCLUSIONS: Implications of the findings are discussed in relation to classical musicians' day-to-day work and performance.

Relación entre actividad física diaria, actividad física en el patio escolar, edad y sexo en escolares de educación primaria / Relationship between daily physical activity, recess physical activity, age and sex in scholar of primary school, Spain

Fundamento. El sedentarismo tiene efectos negativos sobre la salud. El recreo escolar puede ser una oportunidad para realizar actividad física. El objetivo de este estudio fue describir la actividad física realizada diariamente y durante el recreo por escolares de Educación Primaria en función del sexo y la edad. Métodos. Participaron 738 escolares (379 niños y 359 niñas; 8,5±1,7 años; rango de 6 a 11 años). Se evaluó la actividad física diaria a través de cuestionario validado cubierto por los padres y la actividad física en el patio durante el recreo a través de acelerometría. Se realizó un ANOVA de una vía para conocer las diferencias entre niños y niñas en cada grupo edad, calculando, además, los intervalos de confianza y el tamaño del efecto. También se realizó un MANOVA para analizar los efectos de la edad y el sexo con post hoc de Sheffé. Resultados. Los niños mostraron mayores niveles de actividad física diaria que las niñas en todos los grupos de edad, siendo mayor esta diferencia a los siete años (47,6±6,5 vs 42,6±6,4 MET/día; p<0,001), a los ocho (48,5±8,6 vs 41,9±4,6 MET/día; p<0,001) y a los nueve (49,8±8,3 vs 44,1±5,9 MET/día; p<0,001). La actividad física en el patio fue mayor en niños que en niñas a los nueve (28,4±12,0 vs 23,7±11,8 motion counts; p<0,039), diez (28,5±10,8 vs 23,7±10,0 motion counts; p<0,014) y once años (24,6±12,2 vs 20,7±9,3 motion counts; p<0,047). Conclusión. En relación a la actividad física diaria, los niños son más activos que las niñas en todas las edades estudiadas (seis a once años). Por su parte, en la actividad física en el patio escolar sólo existen diferencias, a favor de los niños entre los nueve y once años(AU)

Background. Sedentary behavior has negative effects on health. School recess playgrounds provide important settings and opportunities for children to engage in physical activity. The aim of this study was to describe the daily physical activity (PA) and physical activity during recess of Primary School children and the relationship with sex and age. Method. 783 children (379 boys and 359 girls; age=8.5±1.7 years; range 6 to 11) participated in the study. Daily PAof each child was measured using a validated questionnaire that was completed by the parents of each child, whilst playground recess PA was measured using accelerometry. An ANOVA was used to determine differences by sex in each age group with confidence intervals and effect sizes. Also MANOVAwas used to analyse the main and interaction effects of age and sex on variables. The Scheffe post-hoc test was used for comparisons. Results. Boys reported higher daily PAlevels than girls across all age groups. The differences was bigger in seven (47,6±6,5 vs 42,6±6,4 MET/day; p<0,001), eight (48,5±8,6 vs 41,9±4,6MET/day; p<0,001) and nine years old (49,8±8,3 vs 44,1±5,9 MET/day; p<0,001). Measured recess PAwas higher for boys compared to girls at age nine (28,4±12,0 vs 23.7±11,8 motion counts; p<0,039), ten (28,5±10,8 vs 23,7±10,0 motion counts; p<0,014) and eleven years old (24,6±12,2 vs 20,7±9,3 motion counts; p<0,047). Conclusion. Daily PA is higher in boys compared to girls across all age groups (six to eleven years old). On the other hand, recess PAwas higher only in boys between nine and eleven years(AU)

The effect of a supported exercise programme in patients with newly diagnosed Type 2 diabetes: a pilot study.

The aim of this study was to examine the effectiveness of either a standard care programme (n = 9) or a 12-week supported exercise programme (n = 10) on glycaemic control, ß-cell responsiveness, insulin resistance, and lipid profiles in newly diagnosed Type 2 diabetes patients. The standard care programme consisted of advice to exercise at moderate to high intensity for 30 min five times a week; the supported exercise programme consisted of three 60-min supported plus two unsupported exercise sessions per week. Between-group analyses demonstrated a difference for changes in low-density lipoprotein cholesterol only (standard care programme 0.01 mmol · L(-1), supported exercise programme -0.6 mmol · L(-1); P = 0.04). Following the standard care programme, within-group analyses demonstrated a significant reduction in waist circumference, whereas following the supported exercise programme there were reductions in glycosylated haemoglobin (6.4 vs. 6.0%; P = 0.007), waist circumference (101.4 vs. 97.2 cm; P = 0.021), body mass (91.7 vs. 87.9 kg; P = 0.007), body mass index (30.0 vs. 28.7 kg · m(-2); P = 0.006), total cholesterol (5.3 vs. 4.6 mmol · L(-1); P = 0.046), low-density lipoprotein cholesterol (3.2 vs. 2.6 mmol · L(-1); P = 0.028), fasting ß-cell responsiveness (11.5 × 10(-9) vs. 7.0 × 10(-9) pmol · kg(-1) · min(-1); P = 0.009), and insulin resistance (3.0 vs. 2.1; P = 0.049). The supported exercise programme improved glycaemic control through enhanced ß-cell function associated with decreased insulin resistance and improved lipid profile. This research highlights the need for research into unsupported and supported exercise programmes to establish more comprehensive lifestyle advice for Type 2 diabetes patients.

Relationship between daily physical activity, recess physical activity, age and sex in scholar of primary school, Spain.

BACKGROUND: Sedentary behavior has negative effects on health. School recess playgrounds provide important settings and opportunities for children to engage in physical activity. The aim of this study was to describe the daily physical activity (PA) and physical activity during recess of Primary School children and the relationship with sex and age. METHOD: 783 children (379 boys and 359 girls; age=8.5±1.7 years; range 6 to 11) participated in the study. Daily PA of each child was measured using a validated questionnaire that was completed by the parents of each child, whilst playground recess PA was measured using accelerometry. An ANOVA was used to determine differences by sex in each age group with confidence intervals and effect sizes. Also MANOVA was used to analyse the main and interaction effects of age and sex on variables. The Scheffe post-hoc test was used for comparisons. RESULTS: Boys reported higher daily PA levels than girls across all age groups. The differences was bigger in seven (47,6±6,5 vs 42,6±6,4 MET/day; p<0,001), eight (48,5±8,6 vs 41,9±4,6MET/day; p<0,001) and nine years old (49,8±8,3 vs 44,1±5,9 MET/day; p<0,001). Measured recess PA was higher for boys compared to girls at age nine (28,4±12,0 vs 23.7±11,8 motion counts; p<0,039), ten (28,5±10,8 vs 23,7±10,0 motion counts; p<0,014) and eleven years old (24,6±12,2 vs 20,7±9,3 motion counts; p<0,047). CONCLUSION: Daily PA is higher in boys compared to girls across all age groups (six to eleven years old). On the other hand, recess PA was higher only in boys between nine and eleven years.

Low-intensity exercise exerts beneficial effects on plasma lipids via PPARgamma.

INTRODUCTION: An important mechanism by which physical activity reduces the risk of cardiovascular disease is through regulating plasma lipids. We investigated whether low-intensity exercise modulates lipid metabolism and the transcription factors peroxisome proliferator-activated receptor gamma (PPARgamma) and liver X receptor alpha (LXRalpha) responsible for controlling reverse cholesterol transport (RCT). METHODS: Thirty-four sedentary adults, mean age 45.6 +/- 11.1 yr, participated in an 8-wk low-intensity exercise program consisting of walking 10,000 steps, three times a week. Subjects were randomly allocated to either an exercise group or a sedentary control group, and serum lipid or lipoprotein concentrations were determined. RESULTS: Compared with controls, there was a significant decrease in total cholesterol (preexercise, 5.73 +/- 1.39 mmol x L; postexercise, 5.32 +/- 1.28 mmol x L) and a significant increase in HDL (preexercise, 1.46 +/- 0.47 mmol x L; postexercise, 1.56 +/- 0.50 mmol x L) after the exercise program. There was a significant increase in serum oxidized LDL (oxLDL) concentrations in the exercise group before and after exercise (0 wk, 554 +/- 107 ng x mL; 4 wk, 698 +/- 134 ng x mL; 8 wk, 588 +/- 145 ng x mL). A significant increase in leukocyte mRNA expression for PPARgamma (4 wk, 1.8 +/- 0.9-fold; 8 wk, 4.3 +/- 1.9-fold) was observed, which was reinforced by increased PPARgamma DNA-binding activity postexercise (preexercise, 0.22 +/- 0.09 OD units; postexercise, 1.13 +/- 0.29 OD units). A significant increase in gene expression was observed for the oxLDL scavenger receptor CD36 (4 wk, 3.8 +/- 0.6-fold; 8 wk, 2.7 +/- 0.5-fold) and LXRalpha (8 wk, 3.5 +/- 0.8-fold). Two LXRalpha-regulated genes involved in RCT, namely, ATP-binding cassette transporters A1 and GI (ABCA1 and ABCG1, respectively), were significantly up-regulated postexercise (8 wk: ABCA1, 3.46 +/- 0.56-fold; ABCG1, 3.06 +/- 0.47-fold). CONCLUSION: We propose that the net effect of these changes may be to increase oxLDL uptake, to stimulate RCT, and thus to promote clearance of proatherogenic lipids from the vasculature, ultimately contributing to the cardiovascular benefits of low-intensity aerobic exercise.

Effects of exercise on the absorption of insulin glargine in patients with type 1 diabetes.

OBJECTIVE: To study the effects of exercise on the absorption of the basal long-acting insulin analog insulin glargine (Lantus), administered subcutaneously in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 13 patients (12 men, 1 woman) with type 1 diabetes on a basal-bolus insulin regimen were studied. (125)I-labeled insulin glargine at the usual basal insulin dose was injected subcutaneously into the thigh on the evening (2100) before the study day on two occasions 1 week apart. Patients were randomly assigned to 30 min intense exercise (65% peak oxygen uptake [Vo(2peak)]) on one of these visits. The decay of radioactive insulin glargine was compared on the two occasions using a thallium-activated Nal gamma counter. Blood samples were collected at regular intervals on the study days to assess plasma glucose and insulin profiles. RESULTS: No significant difference was found in the (125)I-labeled insulin glargine decay rate on the two occasions (exercise vs. no exercise; repeated-measures ANOVA, P = 0.548). As expected, a significant fall in plasma glucose was observed over the exercise period (area under curve above fasting [DeltaAUC] glucose: -0.39 +/- 0.11 vs. -1.30 +/- 0.16 mmol . l(-1) . h(-1); nonexercise vs. exercise; P = 0.001), but insulin levels did not differ significantly on the two occasions (DeltaAUC insulin: -2.1 +/- 3.9 vs. 1.5 +/- 6.2 pmol . l(-1) . h(-1); nonexercise versus exercise; P = 0.507). CONCLUSIONS: An intense 30-min period of exercise does not increase the absorption rate of the subcutaneously injected basal long-acting insulin analog insulin glargine in patients with type 1 diabetes.

One hour cycling performance is not affected by ingested fluid volume.

This study investigated the effect of differing fluid volumes consumed during exercise, on cycle time-trial (TT) performance conducted under thermoneutral conditions (20 degrees C, 70% RH). Ten minutes after consuming a bolus of 6 ml x kg(-1) body mass (BM) of a 6.4% CHO solution and immediately following a warm-up, 8 male cyclists undertook a 1-h self-paced TT on 4 separate occasions. During a "familiarization" trial, subjects were given three 5-min periods (15-20 min, 30-35 min, and 45-50 min) to consume fluid ad libitum. Thereafter subjects undertook, in random order, trials consuming high (HF), moderate (MF), or low fluid (LF) volumes, where 300, 150, and 40 ml of fluid were consumed at 15, 30, and 45 min of each trial, respectively, and total CHO intake was maintained at 57.6 g. During exercise, power output and heart rate were monitored continuously, whilst stomach fullness was rated every 10 min. Additionally, BM loss and BM loss corrected for fluid intake was calculated during each trial. At 40, 50, and 60 min differences in ratings of stomach fullness were found between trials (LF vs. HF and MF vs. HF). There were however no differences in performance or physiological variables (heart rate or BM loss) between trials. These results indicate that when a pre-exercise CHO bolus is consumed, there is no effect of subsequent consumption of different fluid volumes when trained cyclists undertake a 1-h performance task in a thermoneutral environment.