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Biomedical subjects

P F Kokkinos

Publications and source records attributed to P F Kokkinos.

At least 19 recordsLinked to original sources
PubMed2002

The effect of the combination of Mediterranean diet and leisure time physical activity on the risk of developing acute coronary syndromes, in hypertensive subjects.

The World Health Organization reports that the number of hypertensives, worldwide, is estimated to be 600 million people. In addition a considerable proportion of hypertensive subjects remains untreated or uncontrolled. In this work we investigated the combined effect of physical activity and Mediterranean diet on coronary risk, in hypertensives. Thus we randomly selected, from all Greek regions, 848 hospitalised patients (695 males, 58 +/- 10 years old and 153 females, 65 +/- 9 years old) with a first event of coronary heart disease (CHD) and 1078 paired, by sex, age, region controls, without any suspicions for CHD. Physically active were those who reported non-occupational physical activity more than once per week. Subjects 'closer' to the Mediterranean diet were assessed through a special nutrient questionnaire. A total of 418 (49%) of the patients and 303 (28%) of the controls were hypertensive. Of these, 115 (27%) patients and 70 (23%) controls were untreated, 148 (35%)-111 (36%) were uncontrolled and 155 (38%)-122 (41%) were controlled (P-value <0.01). One hundred and sixty-two (19%) of the patients and 265 (25%) of the controls (P < 0.01) were 'closer' to the combination of Mediterranean type of diet and physical activity. The analysis showed that the previous combination is related to a 25% reduction of the coronary risk in controlled hypertensive subjects (OR = 0.75, P < 0.01), a 11% reduction in untreated (OR = 0.89, P < 0.05) and 17% reduction (OR = 0.83, P < 0.05) in uncontrolled, after adjusting for age, sex, educational and financial level and the conventional cardiovascular risk factors. Consequently, the adoption of Mediterranean diet by physically active subjects seems to reduce significantly the coronary risk and prevent, approximately, the one-third of acute CHD, in controlled hypertensive subjects.

Aged↗
PubMed2001

Exercise as hypertension therapy.

In conclusion, the findings of most recent studies show that moderate-intensity aerobic exercise training can lower BP in patients with stage 1 and 2 essential hypertension. The average reduction in BP is 10.5 mm Hg for systolic and 7.6 mm Hg for diastolic BP. The reductions do not appear to be gender- or age-specific. Significant reductions in BP and LVH regression in patients with stage 3 hypertension have also been reported following aerobic exercise training. Resistance training exercise has not consistently shown to significantly lower BP and is not recommended as the only form of exercise for hypertensive patients. The exercise training program for optimal benefits should consist of 3 to 5 times per week, 30 to 60 minutes per session, at 50% to 80% of PMHR. However, exercise programs should be individualized to meet the patient's needs and abilities. Exercise intensity and duration should be manipulated to promote a safe and effective antihypertensive program. Initially, the exercise intensity should be low and the duration short. Both intensity and duration should progressive increase over a period of weeks until the desired goal, is achieved. The rate of progression must be tailored to meet individual patient needs and abilities. The exercise program for overweight or obese hypertensive patients should aim to promote a caloric expenditure of 300 to 500 Kcal per day and 1000 to 2000 Kcal per week. Such an approach, combined with a prudent diet, is likely to reduce body weight. The mechanisms mediating exercise-induced BP reduction are poorly understood. BP reductions appear to be independent of changes in body weight or body composition. There are also no indications of age- or gender-related differences in BP response to exercise. The use of ambulatory blood pressure measuring devices in exercise studies is not extensive. The few studies available indicate a more moderate reduction in BP than that reported by casual observations.

Adult↗
PubMed2000

Exercise and hypertension.

Randomized, well-controlled exercise intervention studies have shown consistently that regularly performed aerobic exercise significantly lowers blood pressure in patients with essential hypertension. Mild to moderate intensity exercise may be more effective in lowering blood pressure than higher intensity exercises. Such exercise is also safe and effective in lowering blood pressure in treated patients with severe hypertension and left ventricular hypertrophy. A significant reduction in blood pressure and regression of left ventricular hypertrophy may be achieved in these patients even after substantial reductions in antihypertensive medication. Recent findings have also shown that exercise training attenuates exaggerated blood pressure response during physical exertion. The safety and efficacy of mild to moderate exercise has significant and positive clinical implications for all hypertensive patients. Exercise-induced reductions in resting blood pressure and prevention of abnormal increases in blood pressure during physical exertion can lead to fewer cardiovascular events. They may also reduce antihypertensive medication requirements, cost, and medication-related side-effects, and improve quality of life.

Blood Pressure Determination↗
PubMed1999

Physical activity and high density lipoprotein cholesterol levels: what is the relationship?

High density lipoprotein cholesterol (HDL-C) levels are strongly, inversely and independently associated with coronary heart disease (CHD). Increased physical activity is associated with reduced CHD mortality. This protection against CHD may partially be explained by the increase in HDL-C levels observed following aerobic exercise training. Many also agree that an exercise threshold needs to be met before such favourable changes in HDL-C metabolism can occur. Most likely, the exercise-induced changes in HDL-C are the result of the interaction amongst exercise intensity, frequency, duration of each exercise session and length of the exercise training period. Although a relative contribution of each exercise component (intensity, duration and frequency) is also likely, it has not been established. There is also substantial support for a dose-response relationship. Favourable changes in HDL-C appear to occur incrementally and reach statistical significance at approximately 7-10 miles per week or 1200 to 1600kcal. Exercise-induced changes in HDL-C may also be gender dependent. The volume of exercise required to increase HDL-C levels appears to be substantially more for women than men. This perhaps is due to higher HDL-C levels in women at baseline compared with men. However, the many other health benefits derived from increased physical activity should encourage women to participate in regular exercise regardless of the exercise effects on HDL-C levels. A practical approach in prescribing exercise for patients is to use moderate intensity exercises (70 to 80% of predicted maximal heart rate), 3 to 5 times per week, for a total of 7 to 14 miles per week. This is equivalent to approximately 1200 to 1600kcal per week. Moderate to low intensity exercise should be preferred because such exercise carries a lower risk for cardiac complications. In addition, patients are more likely to participate and sustain a lower than higher intensity exercise programme. It is also important to recognise that other modes of physical activity can also be encouraged for patients. Such activities should be associated with similar increases in HDL-C levels as long as they meet or exceed the caloric expenditure of 1200 to 1600kcal (7 to 14 miles per week of jogging).

Cholesterol, HDL↗
PubMed1998

Effects of moderate intensity exercise on serum lipids in African-American men with severe systemic hypertension.

The prevalence of systemic hypertension and its cardiovascular consequences is higher in African-Americans than in whites. Low to moderate intensity aerobic exercise lowers blood pressure (BP) in African-American patients with severe hypertension. It is not known whether such exercise can improve lipid metabolism in these patients. Thirty-six African-American men with established essential hypertension, aged 35 to 76 years, were randomly assigned to an exercise (n = 17) or no exercise (n = 19) group. The exercise group exercised for 16 weeks, 3 times/week, at 60% to 80% of maximum heart rate. After 16 weeks, peak oxygen uptake in the exercise group improved (21+/-4 vs 23+/-3 ml/kg/min; p <0.001). Body weight did not change. Exercise intensity correlated with high-density lipoprotein (HDL) cholesterol changes from baseline to 16 weeks (r = 0.65; p <0.01) and was the strongest predictor of these changes (R2 = 0.4; p = 0.009). Lipoprotein-lipid changes in the 2 randomized groups did not differ significantly. A 10% increase in HDL cholesterol--42+/-19 versus 46+/-19 mg/dl; p = 0.003--noted in 10 patients who exercised > or = 75% of maximal heart rate suggested the existence of an exercise intensity threshold. Thus low to moderate intensity aerobic exercise may not be adequate to modify lipid profiles favorably in patients with severe hypertension. However, substantial changes in HDL cholesterol were noted in patients exercising at intensities > or = 75% of age-predicted maximum heart rate, suggesting an exercise-intensity threshold.

Adult↗
PubMed1997

Effects of aerobic training on exaggerated blood pressure response to exercise in African-Americans with severe systemic hypertension treated with indapamide +/- verapamil +/- enalapril.

Hypertensive patients are likely to have an exaggerated blood pressure (BP) response during physical exertion. When moderate aerobic exercise was added to medical antihypertensive therapy in patients with severe hypertension, excessive elevations in BP during physical exertion were attenuated even with a modest reduction in BP at rest.

Adult↗
PubMed1996

The role of exercise in the control of hypertension and cardiovascular risk.

Exercise intervention studies have consistently shown that moderate intensity aerobic exercise lowers blood pressure in patients with mild-to-moderate hypertension. Recent findings also showed that exercise is safe and effective in further lowering blood pressure in treated patients with severe hypertension and left ventricular hypertrophy. A significant reduction in blood pressure of these patients was achieved even with substantial reduction in antihypertensive medication. In addition, exercise resulted in a significant regression of left ventricular hypertrophy. The safety and efficacy of moderate exercise has significant and positive clinical implications for all hypertensive patients. Reductions in blood pressure via regular exercise can theoretically reduce medication requirements, cost, and medication related side-effects.

Blood Pressure↗
PubMed1995

Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension.

BACKGROUND: The prevalence of hypertension and its cardiovascular complications is higher in African Americans than in whites. Interventions to control blood pressure in this population are particularly important. Regular exercise lowers blood pressure in patients with mild-to-moderate hypertension, but its effects in patients with severe hypertension have not been studied. We examined the effects of moderately intense exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. METHODS: We randomly assigned 46 men 35 to 76 years of age to exercise plus antihypertensive medication (23 men) or antihypertensive medication alone (23 men). A total of 18 men in the exercise group completed 16 weeks of exercise, and 14 completed 32 weeks of exercise, which was performed three times per week at 60 to 80 percent of the maximal heart rate. RESULTS: After 16 weeks, mean (+/- SD) diastolic blood pressure had decreased from 88 +/- 7 to 83 +/- 8 mm Hg in the patients who exercised, whereas it had increased slightly, from 88 +/- 6 to 90 +/- 7 mm Hg, in those who did not exercise (P = 0.002). Diastolic blood pressure remained significantly lower after 32 weeks of exercise, even with substantial reductions in the dose of antihypertensive medication. In addition, the thickness of the interventricular septum (P = 0.03), the left ventricular mass (P = 0.02), and the mass index (P = 0.04) had decreased significantly after 16 weeks in the patients who exercised, whereas there was no significant change in the nonexercisers. CONCLUSIONS: Regular exercise reduced blood pressure and left ventricular hypertrophy in African-American men with severe hypertension.

Adult↗
PubMed1995

Miles run per week and high-density lipoprotein cholesterol levels in healthy, middle-aged men. A dose-response relationship.

OBJECTIVE: To examine the association between miles run per week and high-density lipoprotein cholesterol levels in healthy middle-aged men. BACKGROUND: Regular exercise increases levels of high-density lipoprotein cholesterol. However, the exercise requirements for such increases are not well defined. METHODS: Healthy, nonsmoking men (n = 2906; age, 43 +/- 4 years) completed a questionnaire on health habits and physical activities and a symptom-limited exercise test. They were then stratified on the basis of the number of miles run per week. Six groups, with mileages of 0, 5, 9, 12, 17, and 31 per week, were established. RESULTS: A gradual increase in high-density lipoprotein cholesterol level was observed with increased miles (0.008-mmol/L [0.308-mg/dL] increase in high-density lipoprotein cholesterol level per mile). Most of the changes were associated with distances of 7 to 14 miles per week. Levels of low-density lipoprotein cholesterol, triglycerides, and the ratio of total cholesterol to high-density lipoprotein cholesterol also improved with weekly mileage. The high-density lipoprotein cholesterol level correlated significantly with all exercise components, anthropometric measures, and alcohol consumption. Group comparisons disclosed significant differences (P < .05) in exercise time to exhaustion, miles run per week, body fat, body weight, and body mass index. Age and alcohol consumption were similar across groups. CONCLUSIONS: These results indicate a dose-response relationship between miles run per week, high-density lipoprotein cholesterol level, and other lipoprotein-lipid levels. Most changes were noted in those who ran 7 to 14 miles per week at mild to moderate intensities. A mile-age threshold for changes in high-density lipoprotein cholesterol level was not observed. However, when compared with those of the nonexercising group, high-density lipoprotein cholesterol levels attained statistical significance at 7 or more miles per week.

Cholesterol, HDL↗
PubMed1995

Cardiorespiratory fitness and coronary heart disease risk factor association in women.

OBJECTIVES: The purpose of this study was to examine the association between cardiorespiratory fitness and coronary risk factors in healthy, nonsmoking adult women. BACKGROUND: A sedentary life-style is recognized as an independent risk factor for coronary heart disease, and increasing physical activity is strongly recommended to reduce this risk. However, studies examining the effects of increased physical activity on coronary heart disease risk factors in women are relatively few, and the findings have been equivocal. METHODS: Subjects provided written informed consent, completed a questionnaire on medical history and performed an exercise tolerance test. Blood chemistry and lipid levels were determined from fasting blood samples. Three fitness categories were established on the basis of treadmill time to exhaustion and were adjusted for age. RESULTS: The women in the lowest fitness category had less favorable lipid profiles, blood glucose levels, blood pressures and anthropometric indexes than those in the moderate and high fitness categories. CONCLUSIONS: Moderate fitness (equivalent to 10 metabolic equivalents [METs]) is required to improve the coronary risk profile in women.

Adult↗
PubMed1994

Effects of exercise training modality on glucose tolerance in men with abnormal glucose regulation.

To determine the effects of exercise training modality on glucose tolerance in men with untreated abnormal glucose regulation, 26 untrained men (age 54 +/- 9 years; mean +/- SD) with either non-insulin-dependent diabetes mellitus (N = 8), impaired glucose tolerance (IGT) (N = 12) or hyperinsulinemia with normal glucose tolerance (N = 6) were studied before and after 20 wk of either strength training (ST) (N = 8), aerobic (treadmill walk/jog) training (AT) (N = 8), or no exercise (control group; N = 10). Plasma concentrations of glucose and insulin were measured after a 12-14 hr fast and during a standard oral glucose tolerance test (OGTT) before and after training. The ST program significantly reduced total plasma glucose area (mmol.l-1.120 min-1) under the OGTT curve (1348 +/- 251 vs 1190 +/- 329, p < 0.05), and plasma glucose levels (mmol.l-1) at 60 min (p < 0.05), 90 min (P < 0.05), and 120 min (p < 0.05) after glucose ingestion. Strength training also lowered the total plasma insulin area (pmol.l-1.120 min-1) under the OGTT curve (60082 +/- 25467 vs 46727 +/- 11273, p < 0.05) as well as plasma insulin levels (pmol.l-1) at fasting (p < 0.05) and at 90 min (p < 0.01) and 120 min (p < 0.05) after glucose ingestion. All men with IGT (four in each training group) normalized their glucose tolerance following the training. There were no significant differences in OGTT results between ST and AT and no changes were observed in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1993

Aerobic versus strength training for risk factor intervention in middle-aged men at high risk for coronary heart disease.

To compare the effects of strength training (ST) to those of aerobic training (AT) for coronary heart disease (CHD) risk factor intervention, we studied 37 previously untrained males (aged 50 +/- 9 years, mean +/- SD) before and after 20 weeks of either ST (N = 14), AT (walk/jog, N = 13), or no exercise (inactive controls, N = 10). Lipoprotein and lipid profiles, blood pressure, and glucose and insulin responses to an oral glucose tolerance test (OGTT) were assessed before and after the training period in all three groups. The ST program produced significant reductions in plasma glucose levels at 60, 90, and 120 minutes (P < .05) after glucose ingestion, whereas the AT program resulted in significant reductions only at 90 and 120 minutes (P < .05). ST also decreased insulin levels during fasting (P < .05) and at 90 and 120 minutes (P < .01) after glucose ingestion. AT decreased insulin levels at 90 and 120 minutes (P < .01) after glucose ingestion. Both training programs reduced the total area under the glucose tolerance curve for glucose (both P < .05) and insulin (both P < .05), but there were no significant differences in these changes between the two groups. None of the glucose or insulin values were significantly altered in the control group. There were no significant changes in lipoprotein and lipid profiles or blood pressure in any of the three groups. These results suggest that ST and AT have comparable effects on risk factors for CHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Strength training does not improve lipoprotein-lipid profiles in men at risk for CHD.

Sixteen untrained males, age 46 +/- 11 yr (mean +/- SD), were studied to determine the effects of 20 wk of strength training on lipoprotein-lipid profiles and post-heparin lipase activities. All subjects had abnormal lipoprotein-lipid profiles and at least two other risk factors for coronary heart disease (CHD). To control for day-to-day variations in blood lipoprotein levels, baseline values were established by taking at least two blood samples on separate days from the training and control groups. The training program resulted in a 50% increase in upper body strength (P less than 0.001) and a 37% increase in lower body strength (P less than 0.001) as measured by the one repetition maximum test (1-RM). No changes in the 1-RM test were observed in the control group. There were no significant changes in VO2max (34.5 +/- 6.4 vs 36.2 +/- 7.4 ml.kg-1.min-1 or percent fat (25.4 +/- 4.2 vs 24.9 +/- 4.1%) with training. There were also no significant changes in plasma concentrations of triglyceride (193 +/- 96 vs 171 +/- 101 mg.dl-1), total cholesterol (231 +/- 22 vs 210 +/- 22 mg.dl-1), and HDL-C (35 +/- 6 vs 36 +/- 8 mg.dl-1), or LDL-C (139 +/- 16 vs 139 +/- 21 mg.dl-1). Furthermore, the activities of post-heparin lipoprotein lipase (9 +/- 4 vs 13 +/- 5 moles.ml-1.h-1) and hepatic lipase (35 +/- 10 vs 35 +/- 9 moles.ml-1.h-1) did not change with training.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Physical activity, smoking, alcohol consumption, body mass index, and plasma lipid profiles of military reserve officers.

We assessed the physical activity level, smoking habits, alcohol consumption, ponderosity, and plasma lipid profiles of 688 middle-aged male reserve officers. When adjusting for Body Mass Index (BMI), individuals who reported physical activity of three or more times per week had significantly higher levels of high density lipoprotein cholesterol (HDL-C), lower total cholesterol (TC) to HDL-C, and low density lipoprotein cholesterol (LDL-C) to HDL-C ratios than inactive individuals of similar age and body weight. Triglyceride, TC, and LDL-C concentrations were similar in both active and inactive subjects.

Adult↗