Exercise ameliorates serum MMP-9 and TIMP-2 levels in patients with type 2 diabetes.

AIM: This study assessed the impact of regular exercise on inflammatory markers (high-sensitivity C-reactive protein [hsCRP], fibrinogen), and matrix metalloproteinases (MMPs) and their inhibitors (TIMPs), in patients with type 2 diabetes mellitus (T2DM). PATIENTS: Fifty overweight patients with T2DM were randomly assigned to two groups: (A) an exercise group (EXG, n=25), with self-controlled exercise for at least 150 min/week and one additional supervised exercise session/week; and (B) a control group (COG, n=25), with no exercise instructions. All participants were taking oral antidiabetic drugs, and none had diabetic complications. Clinical parameters, exercise capacity (VO(2 peak)), ventilatory threshold (VT), insulin resistance indices (fasting insulin, HOMA-IR, HOMA%S), hsCRP, fibrinogen, MMP-2, MMP-9, TIMP-1 and TIMP-2 were assessed at baseline and after 16 weeks. RESULTS: No significant changes were found in body mass index, waist/hip ratio, insulin-resistance indices, MMP-2 and TIMP-1 throughout the study in either group (P>0.05). Compared with controls, the EXG showed a significant decrease in systolic and mean blood pressure, total and LDL cholesterol, and HbA(1c) (P<0.05). Also, exercise significantly suppressed levels of fibrinogen (P=0.047), hsCRP (P=0.041) and MMP-9 (P=0.028), and the MMP-9-to-TIMP-1 ratio (P=0.038), whereas VO(2 peak) (P=0.011), VT (P=0.008) and plasma TIMP-2 levels (P=0.022) were considerably upregulated in the EXG vs. COG. Standard multiple-regression analyses revealed that MMP-9 changes were independently associated with fibrinogen and HbA(1c) changes, while fibrinogen changes independently predicted TIMP-2 alterations with exercise. CONCLUSION: Mostly self-controlled exercise of moderate intensity ameliorated serum levels of pro- and anti-atherogenic markers in patients with T2DM, with no effects on body weight. These data offer further insight into the cardioprotective mechanisms of exercise in patients with T2DM.

Beneficial effects of rosiglitazone on novel cardiovascular risk factors in patients with Type 2 diabetes mellitus.

AIM: Impaired exercise capacity, adiponectin, MMPs and TIMPs have all been implicated in the development of cardiovascular disease. The aim of our study was to determine the effects of rosiglitazone on these factors in diabetic patients. METHODS: Seventy individuals with Type 2 diabetes were assigned randomly to either a rosiglitazone group (8 mg/day, RG) or a control group (CG) for 6 months. All participants took gliclazide 160 mg plus metformin 1700 mg in stable dose. None of the individuals had diabetic complications or had previously participated in an exercise programme. Anthropometric parameters, VO2 peak, oxygen pulse, glycaemic indices, lipid profile, adiponectin, insulin resistance, blood pressure and serum MMP-9, TIMP-1, TIMP-2 levels were assessed at baseline and at the end of the study. After Bonferroni adjustment, a P-value < 0.017 was assumed to be statistically significant. RESULTS: Rosiglitazone treatment significantly increased VO2 peak (P < 0.0001), the duration of the exercise test (P < 0.0001), oxygen pulse (P = 0.010) and TIMP-2 levels (P = 0.008) in comparison with CG. Insulin resistance, hyperglycaemia, diastolic blood pressure and MMP-9 levels were also reduced (P < 0.017). Fat mass, lipid profile, TIMP-1 levels and MMP9 : TIMP-1 ratio were unaltered after rosiglitazone treatment. There were no significant changes in these parameters in control subjects. In univariate analysis, the rosiglitazone-induced increment of VO2 peak was associated with alterations in plasma adiponectin (r = 0.691), HOMA-IR (r = -0.782) and HbA(1c) (r = -0.676) (P < 0.017). These relationships retained significance after multiple regression analysis (P = 0.005). CONCLUSIONS: Rosiglitazone treatment increases cardiorespiratory fitness and modulates favourably serum adiponectin, MMP-9 and TIMP-2 levels. Whether these effects produce cardiovascular benefits in the long term requires further investigation.

Standardization of the motor scales of the Griffiths Test II on children aged 3 to 6 years in Greece.

AIMS: The present study aimed at the standardization of the motor scales (A-locomotor and D-eye-hand co-ordination) of the Griffiths Test II on Greek preschool-aged children. PARTICIPANTS: Nine hundred and thirty children living in Northern Greece were assessed (455 boys and 475 girls), aged from 37 to 72 months (3-6 years old). RESULTS: Percentile ranks were determined depending on the developmental quotient and the chronological age of the child. Through the present application of the Griffiths Test to the children in our country, we showed that the average developmental quotients of the two scales were higher than the relevant published quotients of the Griffiths Test II. DISCUSSION: Some of the factors that may have contributed to faster motor development are passage of time and the environmental and cultural differences between countries. The findings reinforce the need for standardization of a test before it is applied to the population of a country, and its re-standardization on the population of the country where it was first applied.

Gross and fine motor skills of left-handed preschool children.

From a population of 765 preschool children 4-6 years old, 31 children (4.1%) were identified as left-handers. Using the two motor subscales A (gross motor) and D (fine motor) of the Griffiths Test No. II, these children were compared with 31 right-handers, matched for age, sex, and preschool attended. Right-handed children received higher quotients than left-handed on both Griffiths' subscales, with a significant difference only on Scale D. However, the differences between right- and left-handed children arose from the poorer performance of left-handed boys on fine motor tasks (Scale D). These differences could be responsible for learning difficulties that left-handed children face later at school. Such difficulties should be identified as early as possible to facilitate psychoeducational intervention in preschool programs.

The response of muscle interstitial prostaglandin E(2)(PGE(2)), prostacyclin I(2)(PGI(2)) and thromboxane A(2)(TXA(2)) levels during incremental dynamic exercise in humans determined by in vivo microdialysis.

UNLABELLED: The microdialysis in vivo technique allows the isolation, purification and quantitative determination of bioactive molecules with low molecular weight (<20.000 Da) from interstitial fluid (IF) of the muscles. PGE(2)and PGI(2)are vasodilator local hormones, while the TXA(2)is a vasoconstrictor. PGI(2)and TXA(2)are unstable and convert to stable products 6-keto-PGF(1a)and TXB(2), respectively. The purpose of this study was to evaluate the response of PGE(2), PGI(2)and TXA(2)in the IF of human muscle (vastus lateralis) during dynamic exercise with a cycle ergometer. In this study two microdialysis probes were inserted with CMA-60 microdialysis catheters into the vastus lateralis muscle of the right leg of eight healthy volunteers aged 24.1+/-2.1 years, height 177.5+/-1.5 cm and body weight 78.1+/-2.4 kg. After insertion the microdialysis probes perfused at a rate of 3.0 microl/min with Ringer acetate solution. The dialysate fluid was collected a) during the 30' rest period, b) during the 30' exercise period at 100 watts, c) during the 30' exercise period at 150 watts and d) during the 30' rest period after exercise. Our measurements (by the RIA method) showed that the levels of PGE(2)and 6-keto-PGF(1a)in the I.F. of the vastus lateralis muscle increased significantly, while there was a significant decrease in TXB(2)during exercise. The changes in the above biomolecules were increased proportionately with the strain of the subject's muscle. CONCLUSION: Dynamic exercise of the muscles produces a local increase of the vasodilators PGE(2)and PGI(2)while the vasoconstrictor TXA(2)is reduced in the IF of the muscles. This is further evidence that exercise induces propitious biochemical changes. Furthermore, the muscle production of arachidonic acid metabolites during exercise depends on the intensity of the exercise.

Cardiorespiratory and metabolic responses during straight and bent knee cycling.

BACKGROUND: This study examined the influence of knee angle on the cardiorespiratory system loading during submaximal and maximal stationary cycle ergometry. METHODS: Experimental design and participants: eighteen untrained women (age: 21+/-1.88 years, weight: 57+/-5.75 kg, height: 165+/-5.03 cm, values are mean+/-SD) volunteered as subjects and underwent two-cycle ergometer incremental (Jaeger ER900) tests: 1) straight knee (180 degrees), 2) bent knee (140 degrees). MEASURES: oxygen uptake (VO2), ventilation (VE) and respiratory exchange ratio (RER) were measured continuously during each test using an open circuit spirometry and blood lactate concentration was determined by means of an enzymatic method. RESULTS: Comparing cycling with "straight knee" to cycling with "bent knee" at 50 W, heart rate (HR), V(E) and VO2 were significantly higher (10.6%, 12.5%, 17.8%). At 100 W, blood lactate was significantly lower (10.8%) while VO2 and RER was higher (5.5%, 7.1%). During maximal exercise, the total exercise time was significantly longer (11.2%) and VE, VO2 and HR were significantly higher during cycling with "straight knee" compared to cycling with "bent knee". No significant difference in peak lactate was evident between the two sitting positions. CONCLUSIONS: The results of this study indicate that cycling with bent knee requires lower oxygen uptake while pedaling with straight knee is the only way to reach VO2max during cycle testing, since the cardiorespiratory system is fully taxed.

Bone mineral density and muscle strength in young men with mental retardation (with and without Down syndrome).

The objective of this study was to compare the bone mineral density (BMD) of men with Down syndrome (DS) to otherwise mentally retarded (MR) men and to investigate whether leg muscle strength of these patients is related to BMD. Two groups with MR (with and without DS) participated in the study, having met the following criteria: similar age, moderate to mild mental retardation, Tanner stage V of sexual development, similar age of beginning to walk, and equal motor activities. The DS group consisted of 8 men 23.9 +/- 4.2 years, and the MR group without DS consisted of 8 men 23.5 +/- 3.6 years. The two groups were compared with 10 sedentary students of the same age range (25.9 +/- 2.9 years) attending our University. The BMD of the 2(nd) to 4(th) lumbar vertebrae was measured in the PA projection and the mean density was expressed as g/cm(2). The isokinetic muscle strength of the right quadriceps femoris and hamstrings muscles was measured on a Cybex II isokinetic dynamometer. The value measured was peak torque at angular velocities at 60, 120, and 300 degrees.sec(-1). The results showed that BMD in DS individuals versus young adults (reference group of the scanner) was lower at the 26% level (T-score - 2.66 +/- 0.29) and significantly lower (P = 0.002) than that of the MR group. Significantly different muscle strength was observed between the DS and non-DS MR group (in quadriceps at 300 degrees.s(-1): P < 0.01, at 120 and 60 degrees. s(-1): P < 0.05; in hamstrings at 300 degrees.s(-1): P < 0.05). Higher differences in muscle strength were found between MR and control men, but no significant difference existed in BMD between them. Bivariate correlation showed that quadriceps strength significantly predicted the BMD in the DS patients. Active lifestyle and increased physical exercise to improve muscular strength should be instituted to avoid the development of osteoporosis in DS patients.

Measurement of range of motion in individuals with mental retardation and with or without Down syndrome.

The purpose of this study was to assess differences in variability of three joints' range of motion in the lower extremity among individuals with Down syndrome, mentally retarded individuals without Down syndrome, and sedentary subjects without mental retardation (ns = 13, 25, and 30, respectively). Range of motion for hip and knee flexion was obtained using a Myrin goniometer. For hip abduction the range of motion was obtained using a double protractor goniometer (Brodin type). Three test repetitions were carried out, and the greatest value was recorded. As no significant differences were found between left and right sides for each motion, the average was used to represent the range of motion. The Down syndrome group had significantly higher mean range of motion in hip flexion than the mentally retarded group. No significant differences in mean range of motion were found between Down syndrome and sedentary groups, but a significant difference was observed between the control and mentally retarded groups. In hip abduction, the Down syndrome group showed significantly higher mean range of motion than the control and mentally retarded groups. The control group had significantly a higher mean range of motion than the mentally retarded group. No significant differences were found in knee flexion between the two mentally disabled groups, but significant differences in mean range of motion were found between each of the two groups of mentally retarded individuals and the control group. Because differences exist in mean range of motion between the two mentally disabled groups, individualized and differentiated training programs to improve flexibility must be designed based on the type of handicap.

Gonadal function in young women with Down syndrome.

OBJECTIVE: Investigations suggest an increased incidence of gonadal dysfunction in patients with Down syndrome. New features, Alzheimer disease and osteoporosis emerge in these individuals. Therefore, hormonal investigation in persons with Down syndrome is pursued. METHODS: Thirteen females with trisomy 21 (23.65 +/- 3.23 years old) participated in the study. Ultrasound studies were performed to explore the internal genitals. Blood samples were taken for the determination of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA-S), testosterone (T) and 17-hydroxyprogesterone (17-OHP). RESULTS: The patients were at stage V of sexual development. Ultrasonography demonstrated normal uterine and ovarian size and endometrial thickness as well. The ovaries of all patients contained follicles of normal distribution and various sizes. The mean concentrations of FSH, DHEA-S and E2 were normal. The level of PRL was significantly higher than that of the controls, but within the normal lab range. The levels of LH, T and 17-OHP were significantly elevated, compared to those of the control group (P < 0.05, P < 0.01, P < 0.001, respectively). CONCLUSIONS: Our data produce new information on the gonadal function of Down syndrome women. Specific studies on pituitary-gonadal and pituitary-adrenal axis function are needed.

Isokinetic knee muscle strength of individuals with mental retardation, a comparative study.

The purpose of this study was to assess differences in isokinetic muscle torque in the knee among mentally retarded individuals with Down syndrome, mentally retarded individuals without Down syndrome, and sedentary subjects without mental retardation (ns of 7, 8, and 12, respectively). Subjects performed strength tests to knee extension and flexion on a Cybex II isokinetic dynamometer. The measure was peak torque at angular velocities of 60, 120, and 300 degrees/sec. For the Mentally Retarded subjects with and without Down syndrome, the test was performed on two separate days 24 hr. apart. For Sedentary subjects, testing was performed on one day. Their scores indicated significantly higher values of torque than the two other groups. Also, subjects with Down syndrome had inferior muscle torque of lower extremities than peers in the Mentally Retarded Group.

Bone mineral density in adults with Down's syndrome.

The objective of the study was to elucidate if individuals with Down's syndrome (DS) are likely to experience an increased risk of osteoporosis with advancing age, in addition to precocious aging and their skeletal anomalies. Bone mineral density (BMD) was measured in 22 home-reared adults (9 males and 13 females; age 26.22 +/- 4.45 and 23.65 +/- 3.23 years, respectively) by dual energy X-ray absorptiometry (DXA). The BMD of the second to fourth lumbar vertebrae was measured in posteroanterior projection and the mean density expressed as grams per square centimetre. The BMD of DS individuals was compared with 27 control subjects (12 males and 15 females) of the same age (age 24.16 +/- 3.46 and 23.86 +/- 2.92 years, respectively). The results showed that the BMD of the lumbar spine in the males as well as in the females with DS was significantly lower than that in their control counter-parts (p < 0.001). Comparing the DS males with the females, the BMD was lower in the males at a level of 9%. Factors that contribute to this disorder may be mainly the muscular hypotonia, the sedentary life-style and the accompanying diseases which frequently observed in the syndrome. Future studies must be focused on the biochemistry of bone metabolism, the evaluation of gonadal, thyroid and parathyroid function, and the genes of the extra chromosome 21.

Knowledge of and attitudes towards children with special needs by selected groups.

To explore knowledge of and attitudes about children who have special needs, a questionnaire was submitted to 1145 persons (305 lyceum students, 94 teachers of secondary education, 247 medical students, 354 physical education students, and 145 persons having an exceptional child in their families). Questions concerned the knowledge of categories of children with special needs, acceptance of them in regular classrooms, and willingness to work with them. Analysis showed that most people including teachers had limited awareness of exceptional children, their problems, education, and integration. They showed partial acceptance of mainstreaming and desire to work with such children. Careful education for all, especially teachers, seems advisable.