Quality of orthodontic care-A multicenter cohort study in a German convenience sample : Part 2: Cross-sectional patient-reported outcomes after orthodontic treatment.

OBJECTIVES: In light of the growing interest in orthodontic care and its effectiveness in Germany, part 2 of this multicenter cohort study evaluated patient-reported outcomes such as oral health-related quality of life (OHRQoL), oral hygiene habits, oral health beliefs, and potential influencing factors. METHODS: Of 586 patients screened from seven German study centers, data from 343 patients were analyzed for this part of the study. At the end of their orthodontic treatment, study participants filled out a questionnaire of either the German long version of the Oral Health Impact Profile (OHIP-G 49) or the German short version of the Child Oral Health Impact Profile (COHIP-19), depending on their age, as well as questions about their oral hygiene behavior and beliefs. Patient-, treatment- and occlusion-related factors were analyzed to account for potential influencing factors with regard to patients' OHRQoL after orthodontic treatment. RESULTS: In all, 222 study participants filled out the OHIP-based and 121 the COHIP-based questionnaire. The mean OHIP-G 49 score was 12.68 and the mean OHIP-G 14 score was 3.09; the mean COHIP-19 score was 6.52 (inverted score 69.48). For OHIP-G 49 scores, a nonsignificant trend towards a higher score for male patients (14.45 vs 11.54; p = 0.061) was detected, while this trend was inverse for the COHIP-19 scores, i.e., female patients reported more impairment (total score 6.99 vs. 5.84; p = 0.099). Analyses suggested a trend towards better OHRQoL for patients who classified for the Peer Assessment Rating (PAR) Index improvement rate group 'greatly improved' as well as for nonsmokers. Oral hygiene habits and beliefs after orthodontic treatment were estimated to be good. CONCLUSION: In this German cohort, OHRQoL proved to be good and was rather unimpaired after orthodontic treatment. Furthermore, self-reported oral hygiene behavior and oral health beliefs represented good health awareness.

Two-year follow-up after a six-week high-intensity training intervention study with breast cancer patients: physiological, psychological and immunological differences.

PURPOSE: Previously we demonstrated the feasibility of a six-week-long combination of high-intensity interval endurance and strength training (HIT/HIRT) for women with nonmetastatic breast cancer leading to improvements in psychological well-being and performance. Now we report results of a 24-month follow-up. METHODS: Previous intervention (IG, n = 10; 58.7 ± 8.4yrs) and control group (CG, n = 9; 58.8 ± 6.6yrs) were asked for follow-up examinations 12 (T12) and 24 months (T24) after cessation of the supervised training (POST). Medical history, mental well-being, performance and immunological variables were analyzed with respect to intervention start (PRE). RESULTS: IG maximum oxygen consumption (⩒O2peak) 12%-improved POST (p = 0.05) and declined to baseline values T24, while CG ⩒O2peak increased 12% T24 (p = 0.01). IG strength (1RM) increased 31% POST (p < 0.001) and remained above baseline level T24 (p = 0.003), whereas CG 1RM slightly improved T24 (+19%, p = 0.034). IG Anxiety and Depression decreased POST and did not change until T24. IG C-reactive protein decreased POST and increased to pre-exercise levels T24. CG immunological/inflammatory/life quality markers did not change. CONCLUSIONS: Six weeks of HIT/HIRT by breast cancer patients can induce similar beneficial effects like two years of convalescence, but outcomes were unstable and showed a fast backslide in aerobic capacity, activity level and in pro-inflammatory state within 12 months.IMPLICATIONS FOR REHABILITATIONHigh-intensity interval endurance and strength training (HIT/HIRT) for female breast cancer patients was shown to improve psychological well-being and performance, but long-term effects/adherence are unknown.Significant backslides in aerobic capacity, activity level as well as in the pro-inflammatory response after one and two years are observed and should be monitored.Continuous supervision and/or support of breast cancer patients before, during, and after medical care due to poor training adherence when voluntarily executed is recommended.

Do skeletal muscle composition and gene expression as well as acute exercise-induced serum adaptations in older adults depend on fitness status?

BACKGROUND: Inactive physical behavior among the elderly is one risk factor for cardiovascular disease, immobility and increased all-cause mortality. We aimed to answer the question whether or not circulating and skeletal muscle biomarkers are differentially expressed depending on fitness status in a group of elderly individuals. METHODS: Twenty-eight elderly individuals (73.36 ± 5.46 years) participated in this exploratory study after participating as part of the multinational SITLESS-clinical trial (implementation of self-management and exercise programs over 16 weeks). A cardiopulmonary exercise test (CPX) and resting skeletal muscle biopsy were performed to determine individual physiological performance capacity. Participants were categorized into a high physical fitness group (HPF) and a low physical fitness group (LPF) depending on peak oxygen uptake (VO2peak). Serum blood samples were taken before (pre) and after (post) CPX and were examined regarding serum BDNF, HSP70, Kynurenine, Irisin and Il-6 concentrations. Skeletal muscle tissue was analyzed by silver staining to determine the myosin heavy chain (MyHC) composition and selected genes by qRT-PCR. RESULTS: HPF showed lower body weight and body fat, while skeletal muscle mass and oxygen uptake at the first ventilatory threshold (VO2T1) did not differ between groups. There were positive associations between VO2peak and VO2VT1 in HPF and LPF. MyHC isoform quantification revealed no differences between groups. qRT-PCR showed higher expression of BDNF and BRCA1 in LPF skeletal muscle while there were no differences in other examined genes regarding energy metabolism. Basal serum concentrations of Irisin were higher in HPF compared to LPF with a trend towards higher values in BDNF and HSP70 in HPF. Increases in Il-6 in both groups were observed post. CONCLUSIONS: Although no association between muscle composition/VO2peak with fitness status in older people was detected, higher basal Irisin serum levels in HPF revealed slightly beneficial molecular serum and muscle adaptations. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02629666 . Registered 19 November 2015.

Is estimated cardiorespiratory fitness an effective predictor for cardiovascular and all-cause mortality? A meta-analysis.

BACKGROUND AND AIMS: Estimated cardiorespiratory fitness (eCRF) derived from algorithm correlates well with exercise testing-measured CRF, yet its clinical use for mortality risk stratification has not been systematically evaluated. This meta-analysis with dose-response analysis was conducted to quantify its association with risk of cardiovascular and all-cause mortality. METHODS: Electronic databases were searched for prospective cohort studies that investigated the association of eCRF with risk of cardiovascular and all-cause mortality. Study-specific multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) per 1-metabolic equivalent (MET) higher of eCRF were pooled using a random-effects model. RESULTS: Twenty-five datasets from 8 cohort studies that enrolled more than 170,000 participants were included. The summary HR per 1-MET higher of eCRF was 0.83 (95% CI 0.80 to 0.86) for cardiovascular mortality (11 datasets) and 0.83 (95% CI 0.78 to 0.88) for all-cause mortality (14 datasets) in the general population. These associations showed no sex-difference and were all linearly shaped (all pnonlinearity ≥ 0.27). The performance of eCRF (assessed by the area under the curve) in discriminating future risk of cardiovascular and all-cause mortality was higher than all its components (such as physical activity, resting heart rate, and body mass index, all p < 0.05), but slightly lower than exercise testing-measured CRF. CONCLUSIONS: Higher eCRF was independently associated with lower risk of cardiovascular and all-cause mortality in the general population, indicating that eCRF might hold the potential as an effective and practical risk prediction tool in epidemiological or population research.

Does objectively measured light-intensity physical activity reduce the risk of cardiovascular mortality? A meta-analysis.

AIMS: Current physical activity guidelines emphasize little on light-intensity physical activity (LPA) in terms of reducing the risk of cardiovascular mortality. This meta-analysis aimed to bridge this gap by assessing their association using objectively measured LPA data. METHODS AND RESULTS: Databases of PubMed and Scopus were searched to April 2020 for prospective cohort studies that reported the association of LPA assessed by activity monitors with the risk of cardiovascular mortality in the general population. Multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Dose-response and subgroup analyses were also performed. Six cohort studies with seven datasets enrolling 13 960 participants were included. LPA was all measured by accelerometers. The HR of LPA per 30 min/day for cardiovascular mortality was pooled to be 0.80 (95% CI 0.67-0.96). This association was non-linearly shaped (Pnonlinearity < 0.01) and unaffected by sex difference. Moreover, substituting LPA for sedentary time of 30 min/day lowered the risk of cardiovascular mortality by 16% (95% CI 0.73-0.96). Results showed further that LPA was inferior to moderate-to-vigorous physical activity in reducing the risk of cardiovascular mortality when performed with an equal time-length set at 30 min/day (HR 0.83 vs. 0.54, Pcomparison = 0.046), but became comparable if at an equal activity-amount set at 150 metabolic equivalents-min/day (HR 0.67 vs. 0.54, Pcomparison = 0.41). CONCLUSION: LPA shows potential in reducing the risk of cardiovascular mortality, and interventions targeting at LPA improvement are worth being encouraged.

Differences in Immune Response During Competition and Preparation Phase in Elite Rowers.

Background: Metabolic stress is high during training and competition of Olympic rowers, but there is a lack of biomedical markers allowing to quantify training load on the molecular level. We aimed to identify such markers applying a complex approach involving inflammatory and immunologic variables. Methods: Eleven international elite male rowers (age 22.7 ± 2.4 yrs.; VO2max 71 ± 5 ml·min-1·kg-1) of the German National Rowing team were monitored at competition phase (COMP) vs. preparation phase (PREP), representing high vs. low load. Perceived stress and recovery were assessed by a Recovery Stress Questionnaire for Athletes (RESTQ-76 Sport). Immune cell activation (dendritic cell (DC)/macrophage/monocytes/T-cells) was evaluated via fluorescent activated cell sorting. Cytokines, High-Mobility Group Protein B1 (HMGB1), cell-free DNA (cfDNA), creatine kinase (CK), uric acid (UA), and kynurenine (KYN) were measured in venous blood. Results: Rowers experienced more general stress and less recovery during COMP, but sports-related stress and recovery did not differ from PREP. During COMP, DC/macrophage/monocyte and T-regulatory cells (Treg-cell) increased (p = 0.001 and 0.010). HMGB1 and cfDNA increased in most athletes during COMP (p = 0.001 and 0.048), while CK, UA, and KYN remained unaltered (p = 0.053, 0.304, and 0.211). Pro-inflammatory cytokines IL-1ß (p = 0.002), TNF-α (p < 0.001), and the chemokine IL-8 (p = 0.001) were elevated during COMP, while anti-inflammatory Il-10 was lower (p = 0.002). Conclusion: COMP resulted in an increase in biomarkers reflecting tissue damage, with plausible evidence of immune cell activation that appeared to be compensated by anti-inflammatory mechanisms, such as Treg-cell proliferation. We suggest an anti-inflammatory and immunological matrix approach to optimize training load quantification in elite athletes.

Autonomic function may not modulate irisin release in healthy adults: findings from a randomized cross-over study.

OBJECTIVE: Autonomic nervous system, especially the sympathetic nervous system, may stimulate the expression of peroxisome proliferator-activated receptor γ coactivator-1α, which regulates irisin. This study aimed to explore whether there was any association between autonomic function as assessed by heart rate related indices and irisin release following acute exercise. SUBJECTS AND METHODS: Seventeen healthy adults were asked to perform an incremental exhaustive cycling as well as an incremental exhaustive running separately on different days. Heart rate was monitored, and blood samples were collected before, immediately, 10-, and 60-minutes post-exercise. Serum irisin was measured using ELISA kit. RESULTS: Markers for autonomic function, such as heart rate at rest, peak, or recovery, heart rate reserve, heart rate recovery, and chronotropic index, were comparable between cycling and running (all P > 0.10). Irisin was increased immediately following both exercise. No significant association was observed between heart rate at rest, peak, or recovery and irisin level at the corresponding time-point, as well as between heart rate reserve, heart rate recovery, or chronotropic index and exercise induced irisin release, with or without controlling for age, body mass index, and glucose (all P > 0.10). CONCLUSIONS: Autonomic function might not be associated with irisin release in healthy adults. Arch Endocrinol Metab. 2020;64(3):201-4.

Beneficial Molecular Adaptations In BRCA-Mutation Carriers By Combined HIT/HIRT Intervention: Results From A Pilot Study.

: Based on growing evidence that breast cancer (BRCA) also plays a pivotal role in the regulation of skeletal muscle metabolism and the response to anti-oxidative stress, we examined the influence of regular exercise in human BRCA mutation carriers on their BRCA1 gene/protein expression and inflammatory/oxidative response. Sixteen BRCA-mutation carriers were assigned to an intervention (IG) or control group (CG). IG received a combination of high-intensity interval endurance (HIT) and strength training (HIRT) for six weeks, whereas CG received a low-intensity activity program. Before (T0) and at the end of the intervention (T1), muscle biopsy, physiological performance, blood withdrawal and anthropometry were obtained. Parameters included: Muscle BRCA1 gene/protein expression, inflammatory/oxidative stress, anti-oxidative capacity, peak oxygen capacity (VO2peak) and 1-repetition maximum (1-RM) at six different training machines. VO2peak and 1-RM of IG were increased at T1 compared to T0, whereas CG performance, physiological and molecular parameters remained unchanged. IG showed increased BRCA1 protein concentration as well as anti-oxidative capacity, whereas gene expression was unaltered. IG inflammatory and oxidative damage did not differ between time points. Combined HIT/HIRT increases aerobic and strength performance of BRCA-mutation carriers with up regulated BRCA1 protein expression and improved anti-oxidative status without showing an increased inflammatory response.

Autonomic function may not modulate irisin release in healthy adults: findings from a randomized cross-over study

ABSTRACT Objective Autonomic nervous system, especially the sympathetic nervous system, may stimulate the expression of peroxisome proliferator-activated receptor γ coactivator-1α, which regulates irisin. This study aimed to explore whether there was any association between autonomic function as assessed by heart rate related indices and irisin release following acute exercise. Subjects and methods Seventeen healthy adults were asked to perform an incremental exhaustive cycling as well as an incremental exhaustive running separately on different days. Heart rate was monitored, and blood samples were collected before, immediately, 10-, and 60-minutes post-exercise. Serum irisin was measured using ELISA kit. Results Markers for autonomic function, such as heart rate at rest, peak, or recovery, heart rate reserve, heart rate recovery, and chronotropic index, were comparable between cycling and running (all P > 0.10). Irisin was increased immediately following both exercise. No significant association was observed between heart rate at rest, peak, or recovery and irisin level at the corresponding time-point, as well as between heart rate reserve, heart rate recovery, or chronotropic index and exercise induced irisin release, with or without controlling for age, body mass index, and glucose (all P > 0.10). Conclusions Autonomic function might not be associated with irisin release in healthy adults. Arch Endocrinol Metab. 2020;64(3):201-4

Objectively-Measured Light-Intensity Physical Activity and Risk of Cancer Mortality: A Meta-analysis of Prospective Cohort Studies.

BACKGROUND: The impact of light-intensity physical activity (LPA) in preventing cancer mortality has been questioned. To address this concern, the present meta-analysis aimed to quantify the association between objectively-measured LPA and risk of cancer mortality. METHODS: We conducted a systematic literature search in PubMed and Scopus to January 2020. Prospective cohort studies reporting the association between objectively-measured LPA using activity monitors (e.g., accelerometers) and risk of cancer mortality in the general population were included. The summary hazard ratios (HR) per 30 min/day of LPA and 95% confidence intervals (CI) were obtained using a random-effects model. Dose-response analysis was used to plot their relationship. RESULTS: Five prospective cohort studies were included, in which the definition of LPA based on accelerometer readings was mainly set within 100 to 2,100 counts/min. The summary HR for cancer mortality per 30 min/day of LPA was 0.86 (95% CI, 0.79-0.95; I 2 < 1%), and the association between LPA and risk reduction in cancer mortality was linearly shaped (P nonlinearity = 0.72). LPA exhibited a comparable magnitude of risk reduction in cancer mortality of moderate-to-vigorous physical activity regardless of equal time-length (0.87 per 30 min/day vs. 0.94 per 30 min/day, P interaction = 0.46) or equal amount (0.74 vs. 0.94 per 150 metabolic equivalents-min/day, P interaction = 0.11). Furthermore, replacing sedentary time by LPA of 30 min/day decreased the risk of cancer mortality by 9%. CONCLUSIONS: Objectively-measured LPA conferred benefits in decreasing the risk of cancer mortality. IMPACT: LPA should be considered in physical activity guidelines to decrease the risk of cancer mortality.

The Effect of Potato Protease Inhibitor II on Gastrointestinal Hormones and Satiety in Humans During Weight Reduction.

CONTEXT: It is questioned whether the potato protein protease inhibitor II (PI2) reduces appetite and exerts effects on the satiety hormone cholecystokinin (CCK). OBJECTIVE: To investigate PI2 impact on gastrointestinal hormones and appetite measures during weight reduction. DESIGN: In a randomized, placebo-controlled trial over 20 weeks, fifty-two overweight/obese participants (BMI 25.2-38.0 kg/m2) received a protein-rich diet (30%) adjusted to 500 kcal below their individual daily needs. Subjects ingested a capsule containing either PI2 (150 mg) or placebo twice daily 1 hr before lunch and dinner. At week 0 and week 10 participants joined breakfast test meals to determine CCK, GLP-1, ghrelin, leptin, glucose and insulin concentrations in a time course experimental manner. Appetite sensations were measured on test meal days and in week 4, 9, 14 and 19 using visual analogue scales. RESULTS: Weight loss at week 10 and 20 in the PI2 group was 4.3±3.1 kg and 5.6±4.1 kg, in the control group: 4.7±4.0 kg and 6.8±3.7 kg. A significant effect of PI2 on circulating CCK levels was observed at week 10. The other hormones were unaffected by PI2. At week 10, PI2 group subjects showed higher satiety and decreased desire to eat compared to placebo. During study duration, PI2 showed a significant impact on appetite ratings prior to lunch, one hour before dinner and just before dinner. CONCLUSION: PI2 increased circulating CCK plasma levels during the diet intervention. Likewise, PI2 modulated appetite sensation from week 4 to 20. The study demonstrated that the PI2 can modulate a key satiety signal.

Association between circulating cell adhesion molecules and risk of type 2 diabetes: A meta-analysis.

BACKGROUND AND AIMS: Cell adhesion molecules (CAMs) are implicated in the initiation and progression of atherosclerosis, but their association with risk of type 2 diabetes remains inconsistent. This meta-analysis aimed to quantify this association with dose-response analysis in the general population without type 2 diabetes at baseline. METHODS: Prospective studies, investigating the association of circulating (plasma/serum) CAMs, such as intercellular adhesion molecule-1 (ICAM-1), E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and P-selectin, with risk of type 2 diabetes, were included. The overall relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Sixteen datasets from 15 studies were included. The overall RR was 1.88 (95% CI 1.59 to 2.23) per 1-ln µg/ml increase in ICAM-1, and 2.44 (95% CI 1.90 to 3.12) per 1-ln µg/ml increase in E-selectin. These associations were log-linearly shaped (both pnon-linearity >0.05) and independent of traditional cardiovascular risk factors (all p < 0.05). ICAM-1 had comparable predictive ability as E-selectin (2.22 versus 2.66, p = 0.40). However, no significant association was observed for VCAM-1 (RR 1.20, 95% CI 0.73 to 1.98) or P-selectin (RR 1.01, 95% CI 0.64 to 1.59), and the added predictive value of circulating CAMs assessed by Integrated Discrimination Improvement to the basic prediction models was small (0.01 for ICAM-1, 0.003 for E-selectin, and 0.007 for VCAM-1). CONCLUSIONS: Elevated circulating CAMs, especially ICAM-1 and E-selectin, led to increased risk of type 2 diabetes in a dose-dependent manner, supporting the assumption that endothelial dysfunction contributes to the development of diabetes.

Association Between Cardiorespiratory Fitness and Risk of Heart Failure: A Meta-Analysis.

BACKGROUND: Evidence emerges that cardiorespiratory fitness (CRF) might be implicated in the development of heart failure (HF). This meta-analysis aimed to quantify the association between CRF exposed at baseline and HF risk with dose-response analysis and to assess whether CRF changes over time are correlated with alterations in HF risk. METHODS AND RESULTS: Cohort studies that assessed the association between CRF and risk of HF in subjects without baseline HF were included. Study-specific multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Ten studies from 8 articles were included, enrolling 8987 incident HF cases from 154,598 participants. The RR of HF per 1-metabolic equivalent (MET) higher CRF at baseline was 0.82 (95% CI 0.80-0.84) in the overall population. The RRs were similar in men (0.82, 95% CI 0.80-0.85) and women (0.81, 95% CI 0.78-0.84), and remained minorly changed in patients with existing diabetes, hypertension, or cardiovascular disease at entry. No evidence of a nonlinear relationship between CRF at baseline and risk of HF was observed (Pnonlinearity = .18). The RR of HF per 1-MET increase in CRF over time was 0.79 (95% CI 0.67-0.93), and the measurement of CRF provided incremental value to the prediction of HF beyond conventional models. CONCLUSIONS: High or increased CRF resulted in reduced risk of HF in a dose-dependent manner, supporting the necessity to increase CRF to prevent HF in clinical practice.

Association Between Cardiorespiratory Fitness and Risk of Type 2 Diabetes: A Meta-Analysis.

OBJECTIVE: This meta-analysis aimed to (1) quantify the association of cardiorespiratory fitness (CRF) with type 2 diabetes risk in the general population and statin users and (2) investigate the joint effects of CRF and fatness with type 2 diabetes risk. METHODS: Databases were searched for cohort studies reporting the association between CRF and type 2 diabetes risk. Summary hazard ratios (HRs) were obtained using random-effects models. RESULTS: Fifteen studies were included. The HRs of type 2 diabetes for every 1-metabolic equivalent increase in CRF were 0.90 (95% CI: 0.86-0.94) for the general population and 0.92 (95% CI: 0.87-0.97) for statin users, and the HRs were linearly shaped (both Pnonlinearity > 0.40). Compared with the nonstatin cohort, there was an increased risk of type 2 diabetes in statin users with the lowest and moderate CRF categories, but this was not present in the highest CRF category. The HR of type 2 diabetes for overweight/obesity-fit category versus normal weight-fit category was larger than that of the normal weight-unfit category versus the normal weight-fit category (Pinteraction   = 0.004). CONCLUSIONS: There was an inverse and dose-dependent association between CRF and type 2 diabetes risk. High CRF may eliminate the diabetogenic effect from statins, yet decreased body weight index seems superior in preventing type 2 diabetes.

Increased Hepcidin Levels During a Period of High Training Load Do Not Alter Iron Status in Male Elite Junior Rowers.

The liver-derived hormone hepcidin plays a key role in iron metabolism by mediating the degradation of the iron export protein ferroportin 1 (FPN1). Circulating levels of hepcidin and the iron storage protein ferritin are elevated during the recovery period after acute endurance exercise, which can be interpreted as an acute phase reaction to intense exercise with far-reaching consequences for iron metabolism and homeostasis. Since absolute and functional iron deficiency (ID) potentially lead to a loss of performance and well-being, it is surprising that the cumulative effects of training stress on hepcidin levels and its interplay with cellular iron availability are not well described. Therefore, the aim of this study was to determine serum levels of hepcidin at six time points during a 4-week training camp of junior world elite rowers preparing for the world championships and to relate the alterations in training load to overall iron status determined by serum ferritin, transferrin, iron, and soluble transferrin receptor (sTfR). Serum hepcidin levels increased significantly (p = 0.02) during the initial increase in training load (23.24 ± 2.43 ng/ml) at day 7 compared to the start of training camp (11.47 ± 3.92 ng/ml) and turned back on day 13 (09.51 ± 3.59 ng/ml) already, meeting well the entrance level of hepcidin at day 0. Serum ferritin was significantly higher at day 7 compared to all other timepoints with exception of the subsequent time point at day 13 reflecting well the time course pattern of hepcidin. Non-significant changes between training phases were found for serum iron, transferrin, and sTfR levels as well as for transferrin saturation, and ferritin-index (sTfR/log ferritin). Our findings indicate that hepcidin as well as ferritin, both representing acute phase proteins, are sensitive to initial increases in training load. Erythropoiesis was unaffected by iron compartmentalization through hepcidin. We conclude that hepcidin is sensitive to rigorous changes in training load in junior world elite rowers without causing short-term alterations in functional iron homeostasis.

Using step counters to promote physical activity and exercise capacity in patients with chronic obstructive pulmonary disease: a meta-analysis.

BACKGROUND: Although step counters are popularly employed for physical rehabilitation in chronic obstructive pulmonary disease (COPD) patients, their effectiveness is inconsistent and even questioned. This meta-analysis aimed to investigate whether step counter use increases physical activity or improves exercise capacity in COPD patients. METHODS: Electronic databases were searched for randomized controlled trials that assessed the efficacy of step counter use in increasing physical activity or in improving exercise capacity. Data were aggregated using a random-effects model to get the overall effect sizes [standard mean difference (SMD) with 95% confidence interval (CI)], and subgroup analyses were performed. RESULTS: A total of 15 trials enrolling 1316 patients with moderate to severe COPD were included. Step counter use increased physical activity compared with controls (SMD = 0.57, 95% CI 0.31-0.84), which is equal to a magnitude of 1026 steps/day in daily steps. It also enhanced exercise capacity with an effect size of 0.30 (95% CI 0.16-0.45), approximating to a magnitude of 11.6 m in the 6-min walking distance. Step counter use could augment physical activity (SMD = 0.64, 95% CI 0.19-1.08) and exercise capacity (SMD = 0.32, 95% CI 0.01-0.62) for patients receiving pulmonary rehabilitation. Yet it cannot enhance physical activity or exercise capacity in patients with severe COPD or among studies with intervention durations ⩾6 months (both p > 0.50). CONCLUSIONS: Step counter use increases physical activity and improves exercise capacity in COPD patients, at least in the short term, which supports the notion of recommending step counter use in COPD management.

Acute exercise-induced irisin release in healthy adults: Associations with training status and exercise mode.

There is a growing interest in exploring irisin response to acute exercise; however, the associations of acute exercise-induced irisin release with training status and exercise mode are not fully understood. This study was primarily designed to evaluate these associations. Sixteen healthy adults (8 trained versus 8 untrained) underwent a bout of cycling at 80% of maximal oxygen uptake (VO2max) for 50 min, with blood drawn pre-, 10-, and 180-min post-exercise. Another 17 healthy adults performed 2 bouts of graded exercise (cycling and running) until exhaustion on separate days using a randomized cross-over design, with blood taken pre-, 0-, 10-, and 60-min post-exercise. Circulating irisin, creatine kinase (CK), aspartate aminotransferase (AST), and myoglobin (Mb) were measured, and their respective areas under the curves (AUCs) were calculated. Irisin increased 10-min after 50 min of cycling at 80% of VO2max, while its changes from baseline to post-exercise and the amount of exercise-induced irisin release (presented as AUC) were comparable between trained and untrained adults (all P > .05). Irisin remained elevated 10-min post-exhausting running but decreased towards baseline 10-min post-exhausting cycling. Exhausting running induced an increase in irisin release for the whole course of exercise and recovery periods, but cycling did not. Acute exercise-induced irisin changes seemed not related to changes of CK, aspartate AST, and Mb in general. In conclusion, acute exercise-induced irisin release is not associated with training status but might be affected by training mode. Future studies are required to investigate which exercise mode might be most efficient in altering irisin.

Exercise training and endothelial function in patients with type 2 diabetes: a meta-analysis.

BACKGROUND AND AIMS: Exercise training is considered a cornerstone in the management of type 2 diabetes, which is associated with impaired endothelial function. However, the association of exercise training with endothelial function in type 2 diabetes patients has not been fully understood. This meta-analysis aimed to investigate their associations with focus on exercise types. METHODS: Databases were searched up to January 2018 for studies evaluating the influences of exercise training with durations ≥ 8 weeks on endothelial function assessed by flow-mediated dilation (FMD) among type 2 diabetes patients or between type 2 diabetics and non-diabetics. Data were pooled using random-effects models to obtain the weighted mean differences (WMDs) and 95% confidence intervals (CIs). RESULTS: Sixteen databases were included. Exercise training resulted in an overall improvement in FMD by 1.77% (95% CI 0.94-2.59%) in type 2 diabetes patients. Specifically, both aerobic and combined aerobic and resistance exercise increased FMD by 1.21% (95% CI 0.23-2.19%) and 2.49% (95% CI 1.17-3.81%), respectively; but resistance exercise only showed a trend. High-intensity interval aerobic exercise did not significantly improve FMD over moderate-intensity continuous exercise. Notably, the improvement in FMD among type 2 diabetes patients was smaller compared with non-diabetics in response to exercise training (WMD - 0.72%, 95% CI - 1.36 to - 0.08%) or specifically to aerobic exercise (WMD - 0.65%, 95% CI - 1.31 to 0.01%). CONCLUSIONS: Exercise training, in particular aerobic and combined exercise, improves endothelial function in type 2 diabetes patients, but such an improvement appears to be weakened compared with non-diabetics. Trial registration PROSPERO CRD42018087376.

Feasibility and effects of a combined adjuvant high-intensity interval/strength training in breast cancer patients: a single-center pilot study.

PURPOSE: To evaluate feasibility of an exercise intervention consisting of high-intensity interval endurance and strength training in breast cancer patients. METHODS: Twenty-six women with nonmetastatic breast cancer were consecutively assigned to the exercise intervention- (n= 15, mean age 51.9 ± 9.8 years) and the control group (n = 11, mean age 56.9 ± 7.0 years). Cardiopulmonary exercise testing that included lactate sampling, one-repetition maximum tests and a HADS-D questionnaire were used to monitor patients both before and after a supervised six weeks period of either combined high-intensity interval endurance and strength training (intervention group, twice a week) or leisure training (control group). RESULTS: Contrarily to the control group, endurance (mean change of VO2, peak 12.0 ± 13.0%) and strength performance (mean change of cumulative load 25.9 ± 11.2%) and quality of life increased in the intervention group. No training-related adverse events were observed. CONCLUSIONS: Our guided exercise intervention could be used effectively for initiation and improvement of performance capacity and quality of life in breast cancer patients in a relatively short time. This might be especially attractive during medical treatment. Long-term effects have to be evaluated in randomized controlled studies also with a longer follow-up. Implications for Rehabilitation High-intensity interval training allows improvement of aerobic capacity within a comparable short time. Standard leisure training in breast cancer patients is rather suitable for the maintenance of performance capacity and quality of life. Guided high-intensity interval training combined with strength training can be used effectively for the improvement of endurance and strength capacity and also quality of life. After exclusion of contraindications, guided adjuvant high-intensity interval training combined with strength training can be safely used in breast cancer patients.