[Laudation and measurement of cardiorespiratory fitness]. / A cardiorespiratoricus fittség dicsérete és mérése.

Life- and health-expectancies are very much dependent on the level of aerobic fitness. Measuring cardiorespiratory fitness, maximal oxygen uptake in spiroergometric labs is an expensive and time-consuming task. At least two dozens of illnesses could be avoided or at least postponed by this means, among them the most widespread cardiovascular pathologies, obesity, diabetes, some tumors, locomotor pathologies. Having a fit population is advantageous also from economical point of view for a country. A healthy way of life includes at least 3-5 hours a week with the recommended amount and type of exercise: endurance- (aerobic) and resistance- (muscle volume and force) tasks. There are relatively simple and reliable methods for estimating the aerobic capacity of population samples, to initiate and follow the rehabilitation of heart and lung patients, etc. Walking tests are discussed here. Orv Hetil. 2023; 164(26): 1020-1025.

Stroke and cardiorespiratory fitness / Stroke és a cardiorespiratoricus fittség.

Összefoglaló. A fizikai inaktivitás a cardiovascularis betegségek - így a stroke - jelentos kockázati tényezoje. A rendszeres testmozgás növeli az aerob kapacitást, a cardiorespiratoricus fittséget - ezzel csökkenti a cardiovascularis betegségek, köztük a stroke kockázatát. Az elmúlt évek azon vizsgálataiból idéz a közlemény, amelyek a fizikai aktivitás, a cardiorespiratoricus teljesítoképesség szerepét ismertetik a stroke elsodleges és másodlagos prevenciójában. Említésre kerülnek az aerob kapacitás mérésének módszerei. A nemzetközi tapasztalatok azt igazolják, hogy magas cardiorespiratoricus fittség esetén közel harmadával csökken a stroke elofordulása. A WHO ajánlása mindenkinek a heti legalább 150 percnyi mérsékelten-közepesen meglihegteto testi tevékenység - ez a leggyakoribb krónikus betegségek ellen bizonyos védelmet ad. Orv Hetil. 2021; 162(39): 1567-1572. Summary. Physical inactivity is a significant risk for cardiovascular diseases, even for stroke. Regular physical activity improves aerobic capacity, cardiorespiratory fitness, aerob endurance performance (synonyms), diminishing the risk of cardiovascular diseases as well as the risk of stroke. We refer to previous literature data from the past two decades demonstrating the beneficial role of the higher aerob fitness in the primary and secondary prevention of stroke. Relevant methods of measuring aerob performance have been described previously. In the case of optimal aerobic fitness, the occurrence of stroke is lower by a third according to international experience. WHO advices moderate-medium intensity physical activity of minimum 150 minutes per week, which carries significant protection against the majority of chronic cardio-metabolic diseases. Orv Hetil. 2021; 162(39): 1567-1572.

Therapy and prevention of obesity: nutrition, physical activity and medical treatment / Az elhízás kezelése és megelozése: táplálkozás, testmozgás, orvosi lehetoségek.

Összefoglaló. Az elhízás és következményes megbetegedései fontos népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek részérol nagy igény van egy viszonylag rövid, áttekintheto, naprakész gyakorlatias útmutatóra. A különbözo orvosszakmai társaságokban tevékenykedo, évtizedes szakmai tapasztalatokkal rendelkezo szerzok összefoglalják tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás kezelését lépcsozetesen célszeru megkezdeni, elotte felmérve a beteg motivációját, általános állapotát, lehetoségeit. A szerzok leírják az energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás megtervezésével kapcsolatos alapveto szempontokat. Felsorolják a hazánkban elérheto gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi támogatás igényét. Az elhízás megelozésében az élet elso 1000 napjának táplálkozása, a késobbiekben a szüloi minta a meghatározó. Sok kihasználatlan lehetosége van a háziorvosok, a lakóközösségek, az állami szervek koordinált együttmuködésének, helyi kezdeményezéseknek. Az elhízás betegségként való meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az elhízottak ellátására szakosodott multidiszciplináris centrumok számának és kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323-335. Summary. Obesity and related morbidities have a high public health impact in Hungary. The treatment is a challenge, but prevention seems more effective. General practitioners, other specialists and health care professionals who are treating obese persons require short, summarized, updated and practical guideline. Hungarian medical professionals of different scientific societies, having decennial practices, are summarizing their evidence-based knowledge. Obesity management requires step by step approach, evaluating previously the general health condition, motivation and options of the patients. The measurement of energy requirement, planning of diet and physical activities, available surgical methods and medications are described in detail with life style and mental support needed. The most important period in the prevention of obesity is the first 1000 days from conception. Other significant factors are the life style habits of the parents. Proper obesity prevention requires better coordination of primary health care, community and governmental activities. Obesity should be defined as morbidity, therefore stronger governmental support and more health-policy initiatives are needed, beside increasing number and developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323-335.

[Cardiac rehabilitation and its sporty face]. / A szívbetegek rehabilitációjának sportos arca.

The prognosis of cardiac and other diseases is highly determined by the level of cardiopulmonary fitness (aerobic capacity). The main purposes of rehabilitative activities include the restoration and increase of VO2max. The "classic" method is the continuous aerobic exercise (moderate-intensity continuous exercise). The higher increase of aerobic capacity in a shorter time can be developed by interval loads: shorter or longer active periods are interspersed by low-intensity rest periods. A recent form is the high-intensity interval training: 0.5-4 minutes on 70-90% of the aerobic capacity followed by a rest or low-intensity biking/walking/jogging/any activity. The sprint interval training uses a few ten seconds of maximal intensity bursts changed with longer low-intensity activities. The advantages of the interval methods are shorter training time, less monotony, higher efficiency with not more risks. Interval training methods are applied also in other pathologies without disadvantages. Orv Hetil. 2018; 159(33): 1346-1352.

[Preventive and curative value of yoga in cardiometabolic diseases]. / Kardiometabolikus betegségek megelozése és gyógyítása jógával.

Yoga and other body-mind techniques enjoy an increasing popularity in many fields of health maintaining practices, in prevention of some illnesses and in curative medicine in spite of our incomplete knowledge about its applicability and effects. There are large differences among the various yoga-schools and the heterogeneity of indications etc. In this article a bucket of recent information is offered for the inquirers on the potential advantages of yoga (diet, mind-exercises, asanas, pranayamas) for decreasing cardio-metabolic risk factors, stabilizing mental health, and its addictive use in curative medicine. Few adverse side-effects may occur only in the case of misapplication. Its advantages are low costs, availability for broad population, and very few contraindications. Disadvantages include differences in the ability of yoga instructors and in yoga practices.

[Physical activity diminishes aging-related decline of physical and cognitive performance]. / A fizikai aktivitás lassítja az öregedéssel járó teljesítoképesség-romlást.

Aging-related decline of muscle force, walking speed, locomotor coordination, aerobic capacity and endurance exert prognostic impact on life expectancy. Proper use of training may diminish the aging process and it may improve the quality of life of elderly persons. This paper provides a brief summary on the impact of training on aging-related decline of physical and cognitive functions.

[Atrial fibrillation and physical activity]. / Pitvarfibrilláció és a fizikai aktivitás.

Atrial fibrillation is the most frequent arrhythmia. Its "lone" form (when underlying pathology is not discovered) can be detected in a small percentage of endurance sports participants, and in growing numbers among veterans, probably as a result of some cardiac or other irregularities. Enhanced vagal tone and sudden sympathetic impulse, repetitive oxidative stress, inflammatory processes, enlarged atria, electric instabilization can explain the higher occurrence. Treatment of atrial fibrillation enables the affected persons to participate in regular medium-intensity exercise, 3-5 hours a week, which offers a protective role against cardiovascular, metabolic and mental illnesses.

[Measure of fitness and physical activity related to cardiovascular diseases and death]. / A cardiovascularis kockázat kapcsolata a fizikai aktivitással és a fittséggel.

The quality of fitness (aerobic capacity, maximal endurance performance or highly related physiological parameters) or physical activity improving fitness show a tight, reverse correlation to the all-cause and to the cardiovascular mortality within. The most fit one third of the population expect a 30-40 percent smaller chance for cardiovascular events, compared to the less fit third quarter. Low fitness (that can be changed) is just as a threatening risk factor as the traditional ones, its detection calls out for simple interventions to improve fitness: proper physical exercise.

[Physical activity and training against obesity]. / Testmozgással és edzéssel a túlsúly ellen.

A short review deals with the role of physical activity in the prevention and treatment of obesity, in order to avoid cardio-metabolic consequences of accumulation of the fat. Community-level interventions are necessary, based on estimations of the physical activity. Mechanisms and effects of the proper training on the body fat and muscle are summarized, and practical advices are presented for implementation of the regular physical activity.

[Costs of health. Costs-effectiveness in case of lifestyle changes]. / Az egészség ára. A gazdaságosság kérdései életmód-változtatás esetében.

Economical burden for the individuals and for the national budgets of chronic cardio-vasculo-metabolic diseases is high and is rapidly increasing. Costs of treatments and prevention are very different in countries of diverse culture, ethnicity, social-economical situations, but prevention with healthy foods and with adequate physical activity are cheaper than medicines anywhere in the world. A great couple of studies approved cost-effectiveness of interventions directed to the change of life style factors. Cheaper is to influence the whole, yet healthy population, but interventions on people with high risk are more target-specific and usually more expensive. Enhanced physical activity (minimum 30 minutes five times per week with low-medium intensity, plus resistance exercises for maintain the muscle mass and force, plus stretching and calisthenics to maintain joints motility) can be promoted by few hundred-few ten hundred euros or dollars. Price of gain in Quality/Disability-Adjusted Life Years expressed as Incremental Cost Effectiveness/Utility Ratio is known, estimated or modelled, and offers a good value of money.

[Master sportsmen. Health status and life expectancies of physically active elderly]. / Veterán sportolók. Az idôs, fizikailag aktív emberek egészsége és életkilátásaik.

People with higher fitness and higher aerobic capacity have longer life expectancies compared to inactive people. Longer and better life can result from some genetic factors, as well as from higher physical capacities acquired during younger years. However, there are several studies proving the definitive role of life-long physical activity, too, which can be engaged in at any age. Even at very old ages, regular physical activity results in a lot of benefits, in high quality of life, in independence and longevity.

[Heart rate variability analysis in sports]. / HRV-analízisrol a sportban és a klinikumban.

Differences in the duration of the cycles reflects the balance of the sympathetic and parasympathetic influence on the heart. Variance in the heart rate correlates to the breathing cycle, to baroreflex sensitivity, to day and night alternations and to changes in the vegetative tone evoked by physical exercises. Analysis of the time and/or frequency power domain of the heart rate variance is expected to have diagnostic value in physiological and pathological situations as adaptation to training, overtraining, heart disease etc. Both time- and frequency domains reflect the same physiological phenomenon but from different point of view. Vagus tonus is reflected in the high frequency part of the range of variance, while an increased sympathetic tone enriches the low frequency part of the variations of the duration of the consecutive heart cycles. This technically simple and relatively inexpensive method has inspired a couple of clinical and sports medical studies. Certain tendencies seem to be clear, but for individual diagnosis or for prognosis the data must be treated very carefully.

[Physical activity in prevention and treatment of diabetes]. / Fizikai edzés a cukorbetegség megelozésében és kezelésében.

Effects and mechanisms of a single bout of physical load and of the regular exercise (training) on the carbohydrate and fat metabolism are reviewed. During exercise and in the following couple of hours sugar utilization improves, "activity functions like insulin". Proper exercise contributes to using up the fat reserves, and slimmer body, fat reduction can be maintained by the combination of exercise and diet-control. Instructions in "exercise for everybody" and particularly for both type diabetics are detailed. In prevention of cardio-metabolic pathologies the most important measure were avoiding the overweight state by rational alimentation and regular physical activity.

[Rehabilitative training program for end-stage renal disease patients]. / A végstádiumú vesebetegek rehabilitációs edzésprogramja.

Muscle mass, force, cardiorespiratory (aerobic) endurance, cardiovascular risk status, quality of life and even the efficiency of hemodialysis improves by a weekly 2-3 times 30-60 minute training program at 45-60 percent intensity in end-stage renal disease patients. The exercise can also be performed during the hemodialysis. Respecting the contraindications and limiting factors, most of the renal patients could gain advantages by regular exercise programs.

Impact of repeated bouts of eccentric exercise on myogenic gene expression.

Evidence indicates that repeated-bouts of eccentric exercise (EE) do not exacerbate the extent of muscle damage indices, as compared to a single-bout. We hypothesized that molecular adaptations, under repeated-bouts of EE, would include suppression of muscle repair inhibitory factors such as myostatin and up-regulation of muscle repair positive regulatory factors such as myogenic regulatory factors (MRFs). Fifteen males were recruited for this study. The exercise group (n=9) successfully completed six sets of 15 reps of maximum voluntary eccentric contractions, for six consecutive days, using a dynamometer (Multicont-II). Blood and muscle biopsy samples were obtained from each subject 1 week prior to exercise, 2 days post the first training session, and 24 h after the last training session. Gene expression levels were determined using real-time RT-PCR. Blood samples were analyzed for creatine kinase (CK) and lactate-dehydrogenase (LDH) activity. Repeated-bouts of EE induced a large down-regulation of myostatin mRNA (-73%) which persisted throughout the study. The responses of MRFs were mild. At day 3 only myogenin increased significantly (1.9 fold) while MyoD decreased by 45%. Surprisingly, at day 7, despite the presence of muscle damage indices, all MRFs returned to the pre-exercise levels. The results of the present study showed that repeated-bouts of EE, for six consecutive days, dramatically decreased Myostatin mRNA expression but impaired the expression patterns of MRFs such that, with the exception of myogenin that showed a moderate non-sustained increase, MyoD and MYf5 response was minimal.

[Increase of muscle mass and strength with hormones and other drugs, combined with physical training]. / Izomero, izomtömeg növelése hormonokkal és egyéb szerekkel, edzéssel társítva.

Increasing muscle mass and strength is the aim of some body builders and sportsmen, and is a therapeutic target in hormonal deficiencies, as well as in many clinical situations, when muscle devastation is a life-limiting factor. Human growth hormone, insulin-like growth factor, anabolic-androgen steroids and regulating proteins influencing muscle development and differentiation are used also for delaying the aging processes. Some of the practices are hailed by several myths, mainly because doping cases in certain competitive sports. Physiology, and therapeutic experiences with these substances are reviewed with special reference to physical exercise and to some frail conditions.

[Physical exercise, oxidative stress and damage]. / Fizikai terhelés es oxidatív károsodás.

Physical activities (aerobic, anaerobic and resistance exercises) evoke an increased production of high oxidative substances, depending mainly on the intensity of the muscle actions. Antioxidants in the muscle and blood represent the first line of defense, but an oxidative stress activates the scavenger enzyme systems. If the stress is too high, structural modifications, "damage" of lipids, proteins and nucleic acids is a consequence. Markers of this oxidative damage can be recognized for a few days. Oxidative stress certainly have a role in the physiological adaptation to the physical activity. Moderate intensity (less than 50-60% of the aerobic capacity or of the maximal muscle tension) exercises exert low stress without oxidative damage impulse in the normally nourished subjects. Regular training and "normal" diet results a proper defense against excess oxidative stress. Monitoring of the oxidative stress or/and damage is not jet a tool in the training praxis in spite of the obvious advantages and of the existence of certain noninvasive methods. Data reinforce the necessity of regular exercise with moderate intensity in the primary prevention and in the rehabilitation of metabolic and cardiovascular diseases.

[Improving of muscle mass and force in rehabilitation of heart-lung patients. Aerobic interval training, resistance-exercises, excentric exercises, vibration]. / Izomzatfejlesztés a szív- és tüdobetegségben szenvedok rehabilitációjában. Szakaszos terhelés, rezisztenciaedzés, excentrikus edzés, vibráció.

Improvement of muscle mass and force which got depleted by inactivity or pathological processes is one of the aims and also a prerequisite of a rehabilitative intervention. Metabolically active larger and stronger muscles diminish the cardiovascular risk, permit the aerobic preventive and rehabilitative activities and enables a higher quality of life. Interval forms of aerobic exercise improves also the muscles. The resistance training plays an important part in rehabilitation. Beside the traditional dynamic strength training with weights, gym machines, body weight etc. the excentric type of muscle activity potentiates higher muscle load with lesser energy consumption, therefore it is suitable in the case of smaller performance ability. Vibration of the whole body or parts of it by machines improves the co-activity of the motor units and results in force development with small metabolic involvement.

[Vascular effects of physical activity]. / A fizikai aktivitás erhatásai.

Regular physical activity decelerates the aging processes of the arterial wall and of the endothelial functions, which is denoted with slackening of the propagation velocity of the pulse wave or by echo checking of the postischemic dilatation of the limb vessels. Of the factors evoking, organizing and executing the dilation and constriction of the arteries, the role of the endothelial nitrogen oxide, of the angiogenesis, and of the balance of the hemostasis seems to be the most important and best recognized. Even few months of training program improves the endothelial functions if the amount and the intensity suits to the recommended in cardiovascular diseases. Physical training is a very effective course for prevention and rehabilitation in various conditions incidental to endothelial dysfunction. Damaged endothelial function predisposes to local thrombotic events. Thrombogenic prevalence can be normalized by physical activity at many steps of the hemostasis: activated fibrinolysis, more favorable blood viscosity, lower plasminogen activator inhibitor (PAI-1) level, decreased platelet activity.

[Level of fitness or physical activity as a modifying factor of cardiovascular risk]. / A fizikai aktivitás és/vagy fittség mértéke a cardiovascularis kockázat besorolását módosító tényezo.

Epidemiological data congruently verify that low fitness/low physical activity predisposes a higher probability for all-cause and cardiovascular death, compared to the normal and high-fit/active population. Measure of fitness or physical activity is an independent risk factor with at least the same weight as smoking, hypertension, dyslipidemia etc. therefore it is reasonable to involve it into the calculation of the risk chart. A couple of simple and inexpensive methods are available for measuring the fitness/physical activity. Any information in this field would help toward a better lifestyle.