Aerobic, resistance and combined training and detraining on body composition, muscle strength, lipid profile and inflammation in coronary artery disease patients.

Fifty-six elderly individuals diagnosed with coronary artery disease participated in the study and were divided into four groups: an aerobic exercise group, a resistance exercise group, a combined (aerobic + resistance) exercise group and a control group. The three exercise groups participated in 8 months of exercise training. Before, at 4 and at 8 months of the training period as well as at 1, 2 and 3 months after training cessation, muscle strength was measured and blood samples were collected. The resistance exercise caused significant increases mainly in muscle strength whereas aerobic exercise caused favourable effects mostly on lipid and apolipoprotein profiles. On the other hand, combined exercise caused significant favourable effects on both physiological (i.e. muscle strength) and biochemical (i.e. lipid and apolipoprotein profile and inflammation status) parameters, while the return to baseline values during the detraining period was slower compared to the other exercise modalities.

Muscular strength as a strong predictor of mortality: A narrative review.

Muscular strength, an important component of physical fitness, has an independent role in the prevention of chronic diseases whereas muscular weakness is strongly related to functional limitations and physical disability. Our purpose was to investigate the role of muscular strength as a predictor of mortality in health and disease. We conducted a systematic search in EMBASE and MEDLINE (1980-2014) looking for the association between muscular strength and mortality risk (all-cause and cause-specific mortality). Selected publications included 23 papers (15 epidemiological and 8 clinical studies). Muscular strength was inversely and independently associated with all-cause mortality even after adjusting for several confounders including the levels of physical activity or even cardiorespiratory fitness. The same pattern was observed for cardiovascular mortality; however more research is needed due to the few available data. The existed studies failed to show that low muscular strength is predictive of cancer mortality. Furthermore, a strong and inverse association of muscular strength with all-cause mortality has also been confirmed in several clinical populations such as cardiovascular disease, peripheral artery disease, cancer, renal failure, chronic obstructive pulmonary disease, rheumatoid arthritis and patients with critical illness. However, future studies are needed to further establish the current evidence and to explore the exact independent mechanisms of muscular strength in relation to mortality. Muscular strength as a modifiable risk factor would be of great interest from a public health perspective.

Acute pro- and anti-inflammatory responses to resistance exercise in patients with coronary artery disease: a pilot study.

Little is known about the inflammatory effects of resistance exercise in healthy and even less in diseased individuals such as cardiac patients. The purpose of this study was to examine the acute pro- and anti-inflammatory responses during resistance exercise (RE) in patients with coronary artery disease. Eight low risk patients completed two acute RE protocols at low (50% of 1 RM; 2x18 rps) and moderate intensity (75% of 1 RM; 3x8 rps) in random order. Both protocols included six exercises and had the same total load volume. Blood samples were obtained before, immediately after and 60 minutes after each protocol for the determination of lactate, TNFα, INF-γ, IL-6, IL-10, TGF-ß1, and hsCRP concentrations. IL-6 and IL-10 levels increased (p < 0.05) immediately after both RE protocols with no differences between protocols. INF-γ was significantly lower (p < 0.05) 60 min after the low intensity protocol, whereas TGF-ß1 increased (p < 0.05) immediately after the low intensity protocol. There were no differences in TNF-& and hs-CRP after both RE protocols or between protocols. The above data indicate that acute resistance exercise performed at low to moderate intensity in low risk, trained CAD patients is safe and does not exacerbate the inflammation associated with their disease. Key pointsAcute resistance exercise is safe without exacerbating inflammation in patients with CAD.Both exercise intensities (50 and 75% of 1 RM) elicit desirable pro-and anti-inflammatory responses.With both exercise intensities (50 and 75% of 1 RM) acceptable clinical hemodynamic alterations were observed.

Community-Based Training-Detraining Intervention in Older Women: A Five-Year Follow-Up Study.

This five-year follow-up nonrandomized controlled study evaluated community-based training and detraining on body composition and functional ability in older women. Forty-two volunteers (64.3 ± 5.1 years) were divided into four groups: aerobic training, strength training, combined aerobic and strength, and control. Body composition and physical fitness were measured at baseline, after nine months of training and after three months of detraining every year. After five years of training, body fat decreased, and fat free mass, strength, and chair test performance increased (p < .05) in all training groups. Training-induced favorable adaptations were reversed during detraining but, eventually, training groups presented better values than the control group even after detraining. Thus, nine months of annual training, during a five-year period, induced favorable adaptations on body composition, muscular strength, and functional ability in older women. Three months of detraining, however, changed the favorable adaptations and underlined the need for uninterrupted exercise throughout life.

Exercise in the prevention and rehabilitation of breast cancer.

Breast cancer is the most common type of cancer among women worldwide. Several epidemiological studies have shown an inverse relationship between the risk of breast cancer and physical activity levels, whereas exercise training has been recognized as a significant means in the rehabilitation process of breast cancer survivors. The relative risk reduction of breast cancer for women who engaged in moderate to vigorous physical activity for 3-5 days peek week ranged between 20-40 %. Furthermore, several studies demonstrated a 24-67 % reduction in the risk of total deaths and 50-53 % reduction in the risk of breast cancer deaths in women who are physically active after breast cancer diagnosis compared with sedentary women. Breast cancer survivors should be encouraged to participate in rehabilitation programs in order to obtain numerous physiological and psychological benefits. These include reductions in fatigue and improvements in immune function, physical functioning, body composition, and quality of life. Based on recent scientific evidence, a complete rehabilitation program for patients with breast cancer should combine both strength and aerobic exercise in order to maximize the expected benefits.

Acute and chronic effects of exercise on circulating endothelial progenitor cells in healthy and diseased patients.

Exercise is known to improve endothelial function in healthy subjects as well as patients with cardiovascular disease and this might be partially related to a regeneration of diseased endothelium by circulating progenitor cells (EPCs). EPCs are a subgroup of peripheral blood monocytes that contribute to re-endothelialization of injured endothelium as well as neovascularization of ischemic lesions. Cross-sectional studies have indicated that chronic, regular physical activity has a positive effect on the levels of circulating EPCs. This is associated with an improvement of endothelial dysfunction that is induced by apoptosis due to the underlying aging process or accelerated by cardiovascular risk factors. Furthermore, it is well established that chronic exercise training has the potency to mobilize EPCs from the bone marrow. For patients with cardiac disease this is of clinical importance since EPCs have been implicated in vascular repair and revascularization. Studies are needed to refine the best mode of exercise training that will upregulate circulating EPCs as well as to clarify the kinetics of EPCs after the termination of different exercise sessions in different diseases and medication. Whether there is a direct link between enhanced mobilization of EPCs via exercise and improvement of disease and prognosis remains a hypothesis which needs to be further evaluated.

Combined strength and aerobic training increases transforming growth factor-ß1 in patients with type 2 diabetes.

OBJECTIVE: The aim of the present study was to examine the effects of a combined strength and aerobic training program on pro- and anti-inflammatory cytokines and transforming growth factor-ß1 in patients with type 2 diabetes. DESIGN: Ten patients with type 2 diabetes, aged 55.5 (5) years [median (IQR)] participated in a supervised systematic exercise training program which included aerobic exercise and strength training, undertaken four days per week for eight weeks. RESULTS: The training program increased transforming growth factor-ß1 concentration (+50.4%) and reduced high sensitivity C reactive protein levels (-24.1%) without altering the levels of interleukin-6, interleukin-10, interferon-γ and tumor necrosis factor-α. Additional improvements were also achieved in anthropometric characteristics, glycated hemoglobin (HbA1c: -11.8%), homeostasis model assessment of insulin resistance index (HOMA-IR: -15%) and physical fitness parameters (stress test: +26.6%, upper muscle strength: +32.4% and lower muscle strength: +48.9%). CONCLUSION: A combined strength and aerobic exercise program has a potential anti-atherogenic and anti-inflammatory impact which most likely reduces the risk of cardiovascular disease and improves the health status in patients with type 2 diabetes.

Lipoprotein profile, glycemic control and physical fitness after strength and aerobic training in post-menopausal women with type 2 diabetes.

We studied the effects on blood lipids and physical fitness after a training program that combined strength and aerobic exercise in postmenopausal women with type 2 diabetes. Ten patients (55.0 +/- 5.2 years) followed four exercise sessions per week, two strength and two aerobic, and ten (59.4 +/- 3.2 years) served as a control group. Lipid profile, glycated hemoglobin (HbA(1c)), HOMA2 index, exercise stress and muscular testing were assessed at the beginning and after 16 weeks of training program. Exercise training increased significantly HDL-C (17.2%; P < 0.001) and decreased triglycerides (18.9%), HbA(1c) (15.0%), fasting plasma glucose (5.4%), insulin resistance (HOMA2 25.2%) and resting blood pressure (P < 0.01). After 16 weeks of training, exercise time (17.8%) and muscular strength increased significantly (P < 0.001). The results indicated that a combined strength and aerobic training program could induce positive adaptations on lipid profile, glycemic control, insulin resistance, cardiovascular function, and physical fitness in post-menopausal women with type 2 diabetes.

Training, detraining and retraining effects after a water-based exercise program in patients with coronary artery disease.

OBJECTIVE: The aim of this study was to investigate the adaptations of a water-based training program as well as the detraining and retraining effects on physiological parameters in patients with coronary artery disease (CAD). METHODS: Twenty-one patients were separated in an exercise group (n = 11) and a control group (n = 10). The exercise group followed three periods: training, detraining and retraining. Each period lasted 4 months. During the training and the retraining periods, the patients performed four sessions of water exercise (not swimming) per week. RESULTS: The water-based program was well-accepted and no adverse effects were observed. The exercise group improved (p < 0.05) their stress-test time (+11.8%), VO(2 peak) (+8.4%) and total body strength (+12.2%) after the training period; detraining tended to reverse these positive adaptations. Resumption of training increased the beneficial effects obtained after the initial training period (exercise stress: +4.5%; VO(2 peak): +6.6%; total strength: +7.0%). The patients in the control group did not show any significant alterations throughout the study. CONCLUSION: Water-based exercise is safe and induces positive physiological and muscular adaptations in low-risk patients with CAD. These could be reversed, however, after the cessation of exercise. This is why uninterrupted exercise throughout life is a must.

Land versus water exercise in patients with coronary artery disease: effects on body composition, blood lipids, and physical fitness.

BACKGROUND: We examined the effects of combined resistance and aerobic training on land versus combined resistance and aerobic training in water in patients with coronary artery disease. METHODS: Thirty-four patients were randomly assigned to land exercise (LE, n = 12), water exercise (WE, n = 12), and control (n = 10) groups. The LE group trained 4 times per week, twice with aerobic exercise and twice with resistance training. The WE program included aquatic aerobic activities 2 times per week and resistance exercise at the same frequency carried out in water. The duration of the training programs was 4 months. Body composition measurements, blood lipids, exercise stress testing, and muscular strength were obtained at the beginning and at the end of the training period. RESULTS: After 4 months of training, analysis of covariance revealed that body weight and sum of skinfolds were lower for WE and LE groups than for the control group. Patients who trained in water improved exercise time (+11.7% vs +8.1%) and maximum strength (+12.8% vs +12.9%) in a similar manner compared to the patients who trained on land. Total cholesterol (WE -4.4%, LE -3.3%) and triglycerides (WE -10.2%, LE -11.8%) decreased significantly for both exercise groups but not for the control group. CONCLUSIONS: Exercise programs that combine resistance and aerobic exercise performed either on land or in water can both improve exercise tolerance and muscular strength in patients with coronary artery disease. Furthermore, both programs induce similar favorable adaptations on total cholesterol, triglycerides, and body composition.

Physiological alterations to detraining following prolonged combined strength and aerobic training in cardiac patients.

BACKGROUND: The purpose of the present study was to assess the training and detraining effects on physiological parameters resulting from a combined strength and aerobic exercise programme in patients with coronary artery disease. DESIGN AND METHODS: Thirty male coronary artery disease patients were randomly assigned to an exercise (n = 16) and control group (n = 14). Patients in the exercise group participated in a supervised exercise programme for 8 months and were followed for 3 months after training cessation. The programme consisted of two sessions of circuit weight training and two sessions of aerobic training. Cardiopulmonary testing and muscular strength were assessed at baseline and after 4 and 8 months of training as well as after 3 months of detraining. RESULTS: The exercise training programme resulted in significant improvement in cardiorespiratory fitness (VO2peak 15.4% and exercise time 14%) after 8 months. Muscular strength also increased significantly in all exercises by an average of 28% (upper body 25.5% and lower body 35.4%). Three months of detraining, however, resulted in a 10% regression in VO2peak, 6.7% in exercise time, 12% in upper body strength and 15.7% in lower body strength. CONCLUSIONS: The above results indicate that a significant part of the favourable adaptations obtained after prolonged training is practically lost within 3 months of detraining. Therefore, patients with coronary artery disease should follow a systematic exercise programme throughout life in order to improve cardiovascular function, muscular strength and ameliorate their health status.

Resistance exercise training in patients with heart failure.

The utility, safety and physiological adaptations of resistance exercise training in patients with chronic heart failure (CHF) are reviewed and recommendations based on current research are presented. Patients with CHF have a poor clinical status and impaired exercise capacity due to both cardiac limitations and peripheral maladaptations of the skeletal musculature. Because muscle atrophy has been demonstrated to be a hallmark of CHF, the main principle of exercise programmes in such patients is to train the peripheral muscles effectively without producing great cardiovascular stress. For this reason, new modes of training as well as new training methods have been applied. Dynamic resistance training, based on the principles of interval training, has recently been established as a safe and effective mode of exercise in patients with CHF. Patients perform dynamic strength exercises slowly, on specific machines at an intensity usually in the range of 50-60% of one repetition maximum; work phases are of short duration (< or =60 seconds) and should be followed by an adequate recovery period (work/recovery ratio >1 : 2). Patients with a low cardiac reserve can use small free weights (0.5, 1 or 3 kg), elastic bands with 8-10 repetitions, or they can perform resistance exercises in a segmental fashion. Based on recent scientific evidence, the application of specific resistance exercise programmes is safe and induces significant histochemical, metabolic and functional adaptations in skeletal muscles, contributing to the treatment of muscle weakness and specific myopathy occurring in the majority of CHF patients. Increased exercise tolerance and peak oxygen consumption (V-dotO(2peak)), changes in muscle composition, increases in muscle mass, alterations in skeletal muscle metabolism, improvement in muscular strength and endurance have also been reported in the literature after resistance exercise alone or in combination with aerobic exercise. According to new scientific evidence, appropriate dynamic resistance exercise should be recommended as a safe and effective alternative training mode (supplementary to conventional aerobic exercise) in order to counteract peripheral maladaptation and improve muscle strength, which is necessary for recreational and daily living activities, and thus quality of life, of patients with stable, CHF.

The effects of a combined strength and aerobic exercise program on glucose control and insulin action in women with type 2 diabetes.

The purpose of the present study was to investigate the short- and long-term effects of a combined strength and aerobic training program on glycemic control, insulin action, exercise capacity and muscular strength in postmenopausal women with type 2 diabetes. Nine postmenopausal women, aged 55.2 (6.7) years, with type 2 diabetes participated in a supervised training program for 4 months consisting of two strength training sessions (3 sets of 12 repetitions at 60% one-repetition maximum strength) and two aerobic training sessions (60-70% of maximum heart rate at the beginning, and 70-80% of maximum heart rate after 2 months). Anthropometrical measurements, percentage glycated hemoglobin, a 2-h oral glucose tolerance test, exercise stress testing and maximum strength were measured at the beginning, and after 4 and 16 weeks of the exercise program. Significant reductions were observed in both the glucose (8.1% P<0.01) and insulin areas under the curve (20.7%, P<0.05) after 4 weeks of training. These adaptations were further improved after 16 weeks (glucose 12.5%, insulin 38%, P<0.001). Glycated hemoglobin was significantly decreased after 4 weeks [7.7 (1.7) vs 7.1 (1.3)%, P<0.05] and after 16 weeks [7.7 (1.7) vs 6.9 (1.0)%, P<0.01] of exercise training. Furthermore, exercise time and muscular strength were significantly improved after 4 weeks (P<0.01) as well as after 16 weeks (P<0.001) of training. Body mass and body-mass index, however, were not significantly altered throughout the study. The results indicated that a combined training program of strength and aerobic exercise could induce positive adaptations on glucose control, insulin action, muscular strength and exercise tolerance in women with type 2 diabetes.

Training and detraining effects of a combined-strength and aerobic exercise program on blood lipids in patients with coronary artery disease.

PURPOSE: The aim of this study was to investigate training and detraining effects on blood lipids and apolipoproteins induced by a specific program that combined strength and aerobic exercise in patients with coronary artery disease (CAD). METHODS: For this study, 14 patients participated in a supervised 8-month training program composed of two strength sessions (60% of 1 repetition maximum) and two aerobic training sessions (60%-85% of maximum heart rate), and 13 patients served as a control group. Blood samples for total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoproteins A1 (apo-A1) and B (apo-B), and lipoprotein (a) (Lp[a]) were obtained along with muscular strength at the beginning of the study, after 4 and 8 months of training and after 3 months of detraining. RESULTS: The patients in the intervention group showed favorable alterations after 8 months of training (TC, -9.4; TG, -18.6; HDL-C, 5.2; apo-A1, 11.2%; P <.05), but these were reversed after 3 months of detraining (TC, +3.7; TG, 16.1; HDL-C, -3.6; apo-A1, -5.5%). In addition, body strength also improved after training (27.8%) but reversed (-12.9%) after detraining (P <.05). The patients in the control group did not experience any significant alterations. CONCLUSIONS: The results indicate that an 8-month training program combining strength and aerobic exercise induces favorable muscular and biochemical adaptations, on TC, TG, HDL-C, and apo-A1 levels, protecting patients with CAD. After 3 months of detraining, however, the favorable adaptations were reversed, underscoring the need of uninterrupted exercise throughout life.