Efficacy of ultraviolet B radiation versus vitamin D3 on postural control and cognitive functions in relapsing-remitting multiple sclerosis: A randomized controlled study.

BACKGROUND: The relapsing-remitting multiple sclerosis (RRMS) is the most common type of MS with prevalence rate 20-60 patients/100.000 individuals in Egypt. Poor postural control and cognitive dysfunctions are well-established complications of RRMS without potent remedy yet. The latest evidence highlighted the potential and independent immune-modulating effects of vitamin D3 and ultraviolet radiation in the management of RRMS. OBJECTIVE: To investigate the efficacy of broadband ultraviolet B radiation (UVBR) versus moderate loading dose of vitamin D3 supplementation in improving postural control and cognitive functions. DESIGN: Pretest-posttest randomized controlled study. SETTING: Multiple sclerosis outpatient unit of Kasr Al-Ainy Hospital. PARTICIPANTS: Forty-seven patients with RRMS were recruited from both genders, yet only 40 completed the study. INTERVENTIONS: Patients were randomized into two groups: UVBR group involved 24 patients, received sessions for 4 weeks and vitamin D3 group involved 23 patients, took vitamin D3 supplementation (50 000 IU/week) for 12 weeks. MAIN OUTCOME MEASURES: Overall balance system index (OSI) and symbol digit modalities test (SDMT). RESULTS: Highly significant decrease (P < 0.001) of the OSI in both groups post-treatment, indicating improved postural control. Moreover, highly significant improvement in the SDMT scores was noted, indicating information processing speed enhancement. Nonetheless, no statistically significant (P ≥ 0.05) differences were evident between the two groups post-treatment in all tested measures. CONCLUSION: Both therapeutic programs were statistically equal in improving postural control and cognitive functions. However, clinically, UVBR therapy was more convenient owing to its shorter treatment time and higher percentage of change for all tested measures.

Effects of Exercise Mode on Improving Cardiovascular Function and Cardiorespiratory Fitness After Bariatric Surgery: A Narrative Review.

ABSTRACT: Obesity affects 600 million people globally and increases the risk of developing cardiovascular disease, stroke, diabetes, and cancer. Bariatric surgery is an increasingly popular therapeutic intervention for morbid obesity to induce rapid weight loss and reduce obesity-related comorbidities. However, some bariatric surgery patients, after what is considered a successful surgical procedure, continue to manifest obesity-related health issues, including weight gain, reduced physical function, persistent elevations in blood pressure, and reduced cardiorespiratory fitness. Cardiorespiratory fitness is a strong predictor of mortality and several health outcomes and could be improved by an appropriate exercise prescription after bariatric surgery. This review provides a broad overview of exercise training for patients after bariatric surgery and discusses cardiorespiratory fitness and other potential physiological adaptations in response to exercise training.

Anti-proliferative, Anti-angiogenic and Anti-inflammatory Effects of Moringa peregrina Leaf Extracts on Testosterone- Induced Benign Prostatic Hyperplasia in Rats.

AIM: To investigate the potential anti-inflammatory and biochemical effects of Moringa peregrina leaf extracts on testosterone-induced benign prostatic hyperplasia (BPH) in rats. METHODS: Six groups of rats (each group included 5 rats) were included in this study. The groups included: 1) the control group, 2) the testosterone-induced BPH group, 3) with 50 mg/kg bwt (bodyweight) oil-treated BPH, 4) with 100 mg/kg bwt. oil-treated BPH, 5) with 500mg/kg bwt. ethanol treated BPH and 6) with 1,000 mg/kg bwt. aqueous treated BPH group. Biochemical markers were measured to evaluate the effect of M. peregrina leaf extracts. RESULTS: Our results showed a significant improvement in the thickness of epithelial cells of the BPH glandular tissues when treated with different M. peregrina extracts (p < 0.05). In addition, M. peregrina extracts showed anti-inflammatory, anti-proliferative and anti-angiogenesis effects on the BPH tissues by reduction of IL-6, PCNA and VEGF-A, respectively. CONCLUSION: Our preclinical study concluded that M. peregrina leaf extracts showed a significant effect on BPH by reducing inflammation, proliferation, and angiogenic processes with no signs of toxicity.

More than a matter of the heart: the concept of intravascular multimorbidity in cardiac rehabilitation.

INTRODUCTION: Coronary artery disease (CAD) is the major cause of death of cardiovascular disease. It is initiated by atherosclerosis, which narrows the coronary arteries and limits blood flow and oxygen to the heart. Multiple pathophysiological conditions within the arteries, such as arterial wall thickening, endothelial dysfunction, and arterial stiffening, are associated with the development of atherosclerosis. AREAS COVERED: We introduce a new concept of 'intravascular multimorbidity,' the presence and integration of multiple pathophysiological conditions within the arteries. We also introduce some measurements of intravascular multimorbidity and discuss how these measurements can be utilized in cardiac rehabilitation (CR). EXPERT OPINION: We propose that the measures of intravascular multimorbidity in different arteries may provide information on disease severity and serve as unique prognostic 'barometers' to disease progression in patients with CAD. By measuring the underlying disease mechanisms within the arteries and understanding individual variability of disease progression/regression, these measures may also provide a unique prognostic window in CR. The window into intravascular multimorbidity can help guide clinical strategies, for example, assessing progress and appropriate titration of exercise. Intravascular multimorbidity may represent an important opportunity for more researchers and clinical professions to evaluate patients in CR.

The Effect of Low-Carbohydrate Diet on Macrovascular and Microvascular Endothelial Function is Not Affected by the Provision of Caloric Restriction in Women with Obesity: A Randomized Study.

Obesity impairs both macro- and microvascular endothelial function due to decreased bioavailability of nitric oxide. Current evidence on the effect of low-carbohydrate (LC) diet on endothelial function is conflicting and confounded by the provision of caloric restriction (CR). We tested the hypothesis that LC without CR diet, but not LC with CR diet, would improve macro- and microvascular endothelial function in women with obesity. Twenty-one healthy women with obesity (age: 33 ± 2 years, body mass index: 33.0 ± 0.6 kg/m2; mean ± SEM) were randomly assigned to receive either a LC diet (~10% carbohydrate calories) with CR (n = 12; 500 calorie/day deficit) or a LC diet without CR (n = 9) and completed the 6-week diet intervention. After the intervention, macrovascular endothelial function, measured as brachial artery flow-mediated dilation did not change (7.3 ± 0.9% to 8.0 ± 1.1%, p = 0.7). On the other hand, following the LC diet intervention, regardless of CR, blocking nitric oxide production decreased microvascular endothelial function, measured by arteriolar flow-induced dilation (p ≤ 0.02 for both diets) and the magnitude was more than baseline (p ≤ 0.04). These data suggest improved NO contributions following the intervention. In conclusion, a 6-week LC diet, regardless of CR, may improve microvascular, but not macrovascular endothelial function, via increasing bioavailability of nitric oxide in women with obesity.

Advances in Health Technology Use and Implementation in the Era of Healthy Living: Implications for Precision Medicine.

Much of the focus of precision medicine has been directed toward genomics, despite the fact that "lifestyle and behavioral factors" are included in the description of precision medicine. Numerous structured diet and PA interventions have demonstrated success in preventing and/or reducing chronic-disease risk. The use of personal health technologies has expanded exponentially in the health care arena; there are a number of consumer-based technologies yielding health information to individual users. The explosion in technology use provides an opportunity for broader dissemination of health care services and products. In addition, tracking cardiovascular disease risk and lifestyle and behavioral aspects of healthy living (HL) profiles in those products may be an important leveraging interface for precision medicine. This review will discuss and present an overview of current health technologies, their use in promotion of HL metrics and how this data may be integrated into venues that support HL and precision medicine.

Precision Measurements to Assess Baseline Status and Efficacy of Healthy Living Medicine.

Precision medicine recently has gained popularity, calling for more individualized approaches to prevent and/or reduce chronic-disease risk and to reduce non-communicable diseases such as cardiovascular disease (CVD). Encompassed under Precision medicine initiatives is the concept of healthy living medicine (HLM), which emphasizes the promotion of lifestyle and behavioral practices including physical activity and healthy dietary pattern. Precision measurements have the potential to improve the understanding of how risk factors influence disease trajectory, and further inform on how to precisely tailor clinical strategies to manage risk factors to prevent disease manifestation, and refine therapies according the patient's demographic, environment, and disease etiology. The purpose of this review is to summarize the application of established and emerging measurements that may be used in HLM to manage and optimize care in CVD prevention.

The Value of Detecting Asymptomatic Signs of Myocardial Ischemia in Patients With Coronary Artery Disease in Outpatient Cardiac Rehabilitation.

BACKGROUND: Electrocardiographic (ECG) monitored outpatient cardiac rehabilitation (OP-CR) is routinely performed following a variety of cardiovascular procedures and conditions. OBJECTIVE: The aim of this study is to determine if diagnostic-quality ECG monitoring in patients with coronary artery disease (CAD) during OP-CR is useful in identifying asymptomatic myocardial ischemia, resulting in change(s) in care or medical management. METHODS: A retrospective analysis of ECG monitoring was done on all OP-CR patients diagnosed with CAD (n = 1213) from January 2000 through June 2013. RESULTS: Nearly a quarter of the patients (24%; n = 288) displayed at least 1 mm of asymptomatic ST-segment depression at 80 milliseconds after the J-point during at least 1 session of OP-CR. Of these patients, 57% had medical management change(s) compared with 24% for those who did not show ECG changes suggesting ischemia (P < .0001). In patients with asymptomatic ischemia having medical management change(s), 84% resulted directly from OP-CR staff detection. Fewer patients diagnosed with myocardial infarction and coronary artery bypass graft surgery demonstrated ECG signs of ischemia, whereas more patients diagnosed with stable angina and percutaneous coronary interventions demonstrated ECG signs of ischemia. CONCLUSION: This study demonstrates that most patients with CAD showing asymptomatic ECG signs suggesting ischemia undergo medical management change(s) as a result of the finding. Diagnostic-quality ECG monitoring during OP-CR appears warranted in this population.

Exercise and Hypertension: Uncovering the Mechanisms of Vascular Control.

Hypertension (HTN) has recently been determined to be the number one overall risk factor of disease. With direct and indirect costs amounting to $46.4 billion in 2011 and projections of six-fold increases by 2030, the importance of low-cost nonpharmacological interventions can be appreciated. Vascular structural changes, endothelial dysfunction, and sympathetic overstimulation are major contributing factors to the pathophysiology of HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of nonpharmacological interventions for BP control. Different ET modalities (aerobic, resistance, and concurrent training) have contributed differently to BP reduction and control, driving scientific discourse regarding the optimum ET prescription (modality, volume, and intensity) for such effects; ET results in a multitude of physiological effects, with vascular and autonomic adaptations providing major contributions to BP control. Despite widespread acceptance of the role and importance of ET for BP reduction, only 15% of US adults have been found to meet ET/physical activity recommendations. The purpose of this review is to explore BP lowering effects of aerobic and resistance ET and the underlying physiological mechanisms that result in such effects. Further research is required to enhance our understanding of the proper ET prescription for BP control across different age groups and racial ethnicities. Furthermore, research into methods of improving awareness and adherence to ET recommendations proves to be equally important.

Text-messaging program improves outcomes in outpatient cardiovascular rehabilitation.

BACKGROUND: Outpatient cardiac rehabilitation (OP-CR) is a highly beneficial program but vastly under utilized. METHODS: The efficacy of a text-messaging program was analyzed to determine if implementation could improve number of OP-CR sessions completed. All patients enrolled in OP-CR from July 2011 through December 2012 were invited to join a text-messaging program on their first visit. The program required that the patient possesses a cell phone with texting capabilities. Participants received three to five text-messages per week offering heart-healthy tips and requests for body weight, minutes of exercise, blood pressure, and medication adherence. Patients enrolled (n = 52) in the texting program (Tx) were compared with those who were not (n = 185) (NTx) in several clinical indices and were compared using matched pairs (same subjects), comparison of means and frequencies, chi-square statistics, t-tests, and the Wilcoxon Rank Sum test. RESULTS: Significantly more patients in the Tx group completed the OP-CR program (61.5% versus 50%, p = 0.01). For those completing OP-CR, subjects in the Tx group completed significantly more sessions (31.4) than the NTx group (25.3) (p = 0.01). Additionally, significantly more in the Tx group were younger than those in the Ntx group. CONCLUSIONS: Patients enrolled in OP-CR who participated in a text-messaging program were younger, attended significantly more sessions and were significantly more likely to complete the program.

Use of virtual reality gaming systems for children who are critically ill.

Children who are critically ill are frequently viewed as "too sick" to tolerate physical activity. As a result, these children often fail to develop strength or cardiovascular endurance as compared to typically developing children. Previous reports have shown that early participation in physical activity in is safe and feasible for patients who are critically ill and may result in a shorter length of stay and improved functional outcomes. The use of the virtual reality gaming systems has become a popular form of therapy for children with disabilities and has been supported by a growing body of evidence substantiating its effectiveness with this population. The use of the virtual reality gaming systems in pediatric rehabilitation provides the children with opportunity to participate in an exercise program that is fun, enjoyable, playful, and at the same time beneficial. The integration of those systems in rehabilitation of children who are critically ill is appealing and has the potential to offer the possibility of enhancing physical activities. The lack of training studies involving children who are critically ill makes it difficult to set guidelines on the recommended physical activities and virtual reality gaming systems that is needed to confer health benefits. Several considerations should be taken into account before recommended virtual reality gaming systems as a training program for children who are critically ill. This article highlighted guidelines, limitations and challenges that need to be considered when designing exercise program using virtual reality gaming systems for critically ill children. This information is helpful given the popular use of virtual reality gaming systems in rehabilitation, particularly in children who are critically ill.

Effects of exercise and B vitamins on homocysteine and glutathione in Parkinson's disease: a randomized trial.

BACKGROUND: Individuals with Parkinson's disease (PD) have decreased glutathione levels and elevated homocysteine levels. These substances are considered markers of health, and an inverse relationship has been suggested through the transsulfuration pathway. This experiment tested the effects of exercise and B vitamin supplementation on homocysteine and glutathione levels, and if a relationship was present between these two markers in those with PD. Secondary aims included examining the impact of the interventions on aerobic efficiency and strength. METHODS: Thirty-six subjects were randomly assigned to 4 groups. The Vit group received vitamins B(6), B(12) and folic acid daily for 6 weeks. The Ex group received aerobic and strength training twice weekly for 6 weeks. The Vit + Ex group received both interventions. A control group received no intervention. Subjects were tested prior to and after intervention on the following measures: glutathione and homocysteine levels, strength measures and oxygen consumption. RESULTS: Subjects who received 6 weeks of B vitamin supplementation had lowered homocysteine levels. Subjects who received 6 weeks of exercise training had increased glutathione levels, strength and aerobic capacity. The combination of vitamin and exercise did not yield greater changes than the separate intervention. The control subjects did not change on any measures. CONCLUSION: Positive results were realized with each intervention; however, the expected relationship between glutathione and homocysteine was not found in this sample of subjects with PD. Homocysteine and glutathione levels can be improved independently in individuals with PD with exercise or vitamins B(6), B(12) and folic acid supplementation.

Effects of exercise induced oxidative stress on glutathione levels in Parkinson's disease on and off medication.

Resting plasma glutathione (GSH) levels are lower in individuals with Parkinson's disease (PD) than any other neurological condition. Medications used to treat PD have also been shown to further decrease this depletion. Acute exercise has been shown to be an effective tool to produce oxidative stress in other populations as reflected in lowering levels of GSH. The purpose of this study was to determine how PD responds to acute exercise stress and how medication affects these responses. Fourteen men with PD and 14 men without PD underwent an exercise stress test. Subjects with PD performed the test once off PD medication (PD-Off-med) for 12 h then again 1 week later on PD medication (PD-On-med). GSH and glutathione disulfide (GSSG), were collected via blood draws at rest and after peak exercise along with peak VO(2). At rest and at peak exercise GSH levels and the GSH:GSSG ratio were significantly lower in the PD-On-med and PD-Off-med as compared to controls. GSSG levels were significantly higher in both medication conditions at rest and peak exercise compared to controls. When comparing PD-On-med vs. PD-Off-med at rest and peak exercise, the PD-On-med had lower GSH levels, a lower GSH:GSSG ratio and higher GSSG levels. VO(2) correlated positively with GSH levels. Subjects with PD have lower plasma GSH levels than healthy controls at rest and at peak exercise.

Martial art training enhances the glutathione antioxidant system in middle-aged adults.

The purpose of this study was to compare the antioxidant capacity of physically active middle-aged martial artists to age-matched sedentary controls. Nine sedentary subjects (mean age 52.9 yr) and 9 martial artists (mean age 51.8 yr) who practice Soo Bahk Do, a Korean martial art and were age- and sex-matched performed a graded exercise test (GXT) using a modified Bruce protocol. Ages ranged from 41 to 58 years. A GXT has been shown to be an effective technique for inducing oxidative stress. Glutathione (GSH) is the body's most highly concentrated antioxidant, is the central component of the antioxidant system, and plays an essential role in protecting tissues against oxidative stress. Free radical oxidation leads to the transformation of GSH to glutathione disulfide (GSSG). Venous blood samples for GSH and GSSG were collected before and immediately after the GXT. Repeated measures analysis of variance were performed on the resting baseline values and immediate post-GXT values of GSH, GSSG, and GSH:GSSG to compare groups. The blood GSH, GSSG, and GSH:GSSG levels were significantly different (p < 0.001) between the 2 groups at rest and after the GXT. The Soo Bahk Do practitioners had higher resting levels of GSH and lower levels of GSSG and responded more effectively to acute oxidative stress than the age-matched sedentary controls. Soo Bahk Do appears to enhance the antioxidant defense system and may be an effective intervention for improving overall health by protecting against the adverse effects of oxidative stress that is associated with the free radical theory of aging. Health professionals should be aware of alternative methods of training, conditioning, and exercise that can improve the general adaptation response to oxidative stress.

Relationship of resting B-type natriuretic peptide level to cardiac work and total physical work capacity in heart failure patients.

PURPOSE: Plasma B-type natriuretic peptide (BNP) levels obtained at rest have been previously shown to be correlated with the global functional capacity measures of peak oxygen uptake (V(O(2peak))) and the minute ventilation/carbon dioxide (VE/V(O(2))) slope. The purpose of this study was to assess the relationship of the plasma BNP level to the rate-pressure product (RPP) as an indicator of central or cardiac work capacity. METHODS: Twenty-two subjects (12 men), mean age 57 +/- 12 years, diagnosed with heart failure (8 ischemic/14 nonischemic) were recruited. All subjects were stable on optimal medical therapy for at least 1 month. Blood samples for BNP level analysis were obtained at rest. Subjects underwent a symptom-limited treadmill exercise test using a ramping protocol while V(O(2)), heart rate (HR), and blood pressure (BP) were monitored. Correlation analyses were conducted to assess the relationship of BNP level to RPP level, V(O(2peak), VE/V(O(2)) slope, end-tidal CO(2) pressure (P(ET)CO(2)), and left ventricular ejection fraction (LVEF). RESULTS: Resting BNP levels were significantly correlated with RPP levels (r = -0.69). The BNP level and the RPP level were correlated with V(O(2peak)) (r = -0.63 and r = 0.66, respectively) and VE/V(O(2)) slope (r = 0.53 and r = -0.54, respectively). The RPP level but not the BNP level was correlated with P(ET)CO(2) (r = 0.57). Neither BNP nor RPP levels were well correlated with LVEF (r = -0.26 and r = 0.14, respectively). DISCUSSION: The results of this study suggest that resting plasma BNP level may be a useful clinical measure for evaluating both global functional capacity and myocardial specific work capacity in individuals with heart failure.

Norepinephrine and cardiovascular responses to maximal exercise in Parkinson's disease on and off medication.

The aim of this experiment is to understand how Parkinson's disease (PD) medication affects the autonomic responses of individuals during an acute exercise stress test. Fourteen people with PD and fifteen healthy individuals age-matched between 50 and 80 years performed a modified Bruce protocol. Subjects with PD performed the test once off medication (PD-off) and then 1 week later on medication (PD-on). Heart rate (HR), blood pressure (BP), VO(2), and norepinephrine (NE) levels were taken at rest and at peak exercise. At peak exercise HR, BP, and NE values for the PD-on and PD-off group were all significantly lower than healthy controls, regardless of whether subjects were on their medication. Autonomic abnormalities during exercise in this population appear to be disease manifested and not impacted by medications used to treat PD. We can assume, both on and off medication, this population will show markedly lower BP, HR, and NE responses.

Effects of exercise training on the glutathione antioxidant system.

PURPOSE: The glutathione (GSH) antioxidant system has been shown to play an important role in the maintenance of good health and disease prevention. Various approaches have been used to enhance GSH availability including diet, nutritional supplementation, and drug administration, with minor to moderate success. Exercise training has evolved as a new approach. The purpose of this study was to investigate the effects of aerobic exercise training (AET), circuit weight training (CWT), and combined training (AET+CWT) on general adaptations, and resistance to acutely induced oxidative stress, as assessed by changes in the GSH antioxidant system. METHODS: Eighty healthy sedentary volunteers participated in the study who were randomly assigned to four groups: control (no exercise); AET, CWT, and AET+CWT. Exercise training programs were designed to simulate outpatient cardiac rehabilitation (40 min x 3 days x 6 weeks). Venous blood sampling was taken at rest and post maximal graded exercise test (GXT). A new improved spectrophotometric venous assay analysis technique was used. A mixed model repeated measures analysis of variance design was used with t-tests for preplanned comparisons evaluated at Bonferroni-adjusted alpha levels. RESULTS: Effectiveness of the exercise training programs was demonstrated by significant between-group (exercise group versus control) comparisons. AET, CWT, and AET+CWT showed significant pretraining-posttraining increases in resting GSH and glutathione-glutathione disulfide ratio (GSH:GSSG), and significant decreases in GSSG levels (P<0.005). AET+CWT showed the most pronounced effect compared with AET or CWT alone (P<0.025). CONCLUSION: This study represents the first longitudinal investigation involving the effects of multiple modes of exercise training on the GSH antioxidant system with evidence, suggesting the GHS:GSSG ratio as the most sensitive change marker. The significant findings of this study have potential clinical implications to individuals involved in cardiac and pulmonary rehabilitation.

Effects of a maximal graded exercise test on glutathione as a marker of acute oxidative stress.

PURPOSE: Strenuous exercise in animal studies has been shown to cause acute oxidative stress due to the generation of oxygen-centered free radicals reflected in lower levels of glutathione (GSH), higher levels of glutathione disulfide (GSSG), and a drop in GSH:GSSG ratios, the maintenance of which is crucial for a variety of cell functions. Human studies on this topic are limited. The purpose of this study was to investigate the effects of a maximal graded exercise test GXTmax (modified Bruce protocol) on GSH as a marker of acute oxidative stress, and whether full recovery will occur at 60 minutes postexercise. METHODS: Eighty sedentary subjects were used as a sample of convenience. Venous blood samples for GSH and GSSG were collected directly before, immediately after, and 60 minutes post-GXTmax. Repeated-measures analysis of variance and Bonferroni adjusted t tests (post-GXTmax) versus resting, and 60 minutes recovery versus resting) were used for data analysis. RESULTS: As an acute response to maximal exercise, the GSH levels dropped significantly from a resting baseline value of 1025.75 microM to an immediate post-GXTmax value of 893.30 microM (pooled SE = 7.17 microM). The GSSG levels significantly increased from 2.24 microM to 3.15 microM (pooled SE = 0.03 microM). The GSH:GSSG ratio levels significantly dropped from baseline 462.12 to 276.40 postexercise (pooled SE = 5.98). The blood GSH, GSSG, and GSH:GSSG ratio levels showed no significant difference at 60 minutes post-GXTmax when compared with resting values, indicating full recovery. CONCLUSION: The current results indicated that in sedentary individuals, a maximal treadmill GXT is an effective technique for inducing acute oxidative stress as evidenced by GSH system responses, with full return to resting baseline levels within 60 minutes of recovery. The potential for using this model in assessing oxidative stress responses to cardiac and pulmonary rehabilitation is of clinical interest, with a need for further investigation.