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Treatment efficacy of intermittent claudication by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients I: one year results of functional and physiological improvements.

OBJECTIVES: to compare the effect of surgery, exercise and simple observation on maximum exercise power in claudicants. DESIGN: prospective, randomised study. METHODS: a total of 264 unselected claudicants were randomised to supervised exercise training, invasive treatment (open surgical or endovascular procedures) or observation. One year treatment outcomes were analysed on an intention to-treat basis. RESULTS: invasively treated patients showed a significant improvement in maximum walking power, stopping distance, post-ischaemic blood flow and big toe pressure at one year. Patients randomised to physical exercise training or to the control group did not improve in any outcome measure. CONCLUSION: invasive treatment increased walking capacity, leg blood pressure and flow. Supervised physical exercise training offered no therapeutic advantage compared to untreated controls.

Adult↗

[Expediency of long-term anti-angina therapy and physical exercises in patients with angina pectoris and a history of myocardial infarction].

Altogether 105 patients were investigated 1.5-2 mos after myocardial infarction. They were divided into 2 groups: 1) 57 patients on nitrates or anapriline for one year; 2) 48 patients on acetylsalicylic acid (0.25 g/day) and nitrates by strict indications. Patients of the both groups performed physical exercises for one year by the methods developed at the All-Union Cardiology Research Center. The differences between Groups 1 and 2 were statistically insignificant in deaths (3.5 and 4.2%, respectively), recurrent myocardial infarctions (8.8 and 6.3%), CHD exacerbations (12.2 and 20.8%), higher tolerance, performance volume, double product, and threshold oxygen consumption. It was concluded that during a year therapy in patients with myocardial infarction who performed physical exercises, the long-term antianginal therapy chosen on an individual basis had no advantages over low-dose acetylsalicylic acid and a single use of nitrates (according to strict indications).

Adult↗

Regular physical exercise normalizes elevated asymmetrical dimethylarginine concentrations in patients with type 1 diabetes mellitus.

INTRODUCTION: Levels of the endogenous nitric oxide synthase inhibitor asymmetrical dimethylarginine (ADMA) are elevated in patients with type 1 diabetes mellitus (DM1) and may contribute to vascular complications. In this study we tested the hypothesis that elevated ADMA in patients with DM1 can be reduced by regular physical exercise. METHODS: Plasma samples for analysis of L-arginine, ADMA, symmetrical dimethylarginine (SDMA) and metabolic parameters were obtained from 11 patients with DM1 who participated in a supervised aerobic exercise program for four months. Samples were collected before the training began, at two and four months after initiation, and eight months after cessation of regular training. Fifteen age- and sex-matched healthy persons who did not exercise regularly were examined once as controls and did not participate in the training program. RESULTS: The patients with DM1 had higher ADMA levels than the controls before the training program began (0.54 +/- 0.02 vs. 0.44 +/- 0.03 micromol/l; P < 0.05). After two and four months of exercise, ADMA concentrations in the patients decreased to those seen in healthy persons (0.42 +/- 0.02 and 0.43 +/- 0.03 micromol/l; P < 0.001 and P < 0.05 compared with ADMA levels before training began). Eight months after cessation of the exercise program, ADMA levels in the patients reverted to those observed before the start of training. The L-arginine-to-ADMA ratio increased slightly after two months; L-arginine, symmetrical dimethylarginine, blood lipids and HbA1c were not affected by the training program. CONCLUSIONS: Elevated ADMA levels in patients with DM1, who have a high risk for developing cardiovascular disease, can be lowered to those of healthy persons by regular physical exercise. This favorable effect on ADMA is not sustained when training is discontinued.

Adult↗

Adherence to structured physical exercise in overweight and obese subjects: a review of psychological models.

Regular physical exercise is a widely accepted means of reducing mortality and improving a number of health outcomes, which is also efficacious in the treatment of obesity. Unfortunately, despite the evidence of favourable short- and long-term effects, the results seem to be affected by a lack of adherence, particularly over the long term. It is very important to evaluate and predict good adherence in order to be able to assess the real efficacy of physical activity in the treatment of various diseases. In this paper, we describe most of the psychological models used to evaluate such adherence, and investigate the physiological and psychological bases of physical activity, the most suitable type of exercise for obese patients and some useful strategies for ensuring long-term adherence.

Exercise↗

Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden.

STUDY OBJECTIVE: To investigate differences between smokers and non-smokers in health behaviour, cardiovascular risk factors, coronary heart disease (CHD) risks, health knowledge, health attitudes, and compliance with a CHD prevention programme. DESIGN: Differences between smokers and non-smokers were studied via medical examinations, questionnaires, physical exercise activity logs, and food record sheets. Data were analysed using univariate and multivariate analyses. The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate. SETTING: The Karolinska Hospital, Stockholm, and Sollentuna Primary Health Centre, Sollentuna, Sweden. PARTICIPANTS: The analyses were based on 158 healthy smoking and non-smoking men aged 35-60 years with raised cardiovascular risk factors who enrolled in controlled, randomised six month diet and exercise programmes. MAIN RESULTS: Discriminant analysis suggested that smokers, compared with non-smokers, were characterised by a higher alcohol energy percent, lower HDL cholesterol concentration, lower systolic blood pressure, and a higher plasminogen activator inhibitor-1 (PAI-1) value. Knowledge of the risk factors for CHD was not a discriminating factor. Both smokers and non-smokers increased the exercise taken, improved their diet, and lowered their CHD risk. Before, as well as after the intervention, smokers had a higher CHD risk than non-smokers. CONCLUSIONS: The best CHD prevention action that could be taken by smokers would of course be to quit smoking. Those who cannot stop should be encouraged to improve their diet and increase the amount of physical exercise they take in order to reduce the health hazards of their smoking behaviour.

Adult↗

[Role of the hypophysis, hormonal growth inducers and physical exercises in the regulation of function of thyrocytes, C-cells and parathyrocytes in rats during simulated weightlessness].

Immunohistochemistry and histomorphometry were employed to assay thyroid and parathyroid glands in hypophysectomized rats following a10-day tail suspension in head-down position and daily injection of either physiological solution or growth hormone or insulin-like growth factor 1 on the background of physical exercise, i.e. ascent up a 1 m high staircase with a load fastened to the tail. Hypophysectomy was found to cause atrophic/sclerotic changes in the thyroid and parathyroid glands, and dramatically suppress the functional activity of thyrocytes, C-cells (calcitonin producers) and parathyrocytes (parathormone producers). Assumingly, the impairing effect of hypophysectomy on C-cells and parathyrocytes is consequent to the reduced production of thyroid hormones and concomitant moderation of metabolism. The suspension by tail added somewhat to the severity of changes in thyroid and parathyroid glands under the effect of hypophysectomy, whereas the injection of growth hormone or insulin-like growth factor 1 slightly stimulated thyrocytes, C-cells, and parathyrocytes activities; however, it failed to offset the hypophysectomy-provoked developments. Although the activities of thyrocytes, C-cells or parathyrocytes were not affected by physical exercise, there was a mild C-cell proliferation.

Animals↗

[Peculiarities of blood serum albumin transport function during physical exercise].

Physicochemical properties of blood serum albumin were studied in sportsmen during physical exercises. The "carbohydrate and lipid capacity' of blood serum albumin is found to increase under physical loads. Albumin is supposed to incorporate more actively into the transport of carbohydrates or lipids used as source of energy in the muscular work. No noticeable changes in the structure of albumin are found by the optical rotation dispersion technique.

Carbohydrates↗

Plasma cystine concentration and redox state in aging and physical exercise.

Because redox-regulated signalling pathways are often modulated by the thiol/disulfide redox state (REDST), changes in plasma REDST may possibly account for pathological processes. We, therefore, investigated the mechanisms that account for changes in the plasma REDST as derived in first approximation from the cystine and acid soluble thiol (mainly cysteine) concentrations. Elderly subjects (studies A) and younger subjects after intensive physical exercise (IPE) (study B) i.e. subjects in conditions typically associated with decreased insulin responsiveness, showed, on the average, an increase in the plasma total free amino acid (TAA) concentration to approximately 3000 microM, including an increase in cystine but no increase in the thiol concentration if compared with controls. The REDST was decreased accordingly. A study on the postabsorptive amino acid exchange rates across the lower extremities (study C) indicated that a TAA level > or =2800 microM supports a balanced net protein synthesis even under conditions of weak insulin stimulation, suggesting that high TAA levels may prevent the release of cysteine into the blood in the postabsorptive state. Collectively, these studies indicate that the age-related oxidative shift in plasma REDST may result from the decrease in amino acid clearance capacity and may be aggravated by excessive physical exercise.

Adult↗

Release of beta-endorphin in response to physical exercise in non-pregnant and pregnant women.

The effect of physical exercise on beta-endorphin (beta-E) concentration in plasma was studied in 8 non-pregnant and in 8 pregnant women in their last trimester of pregnancy, using a 10-min bicycle ergometer test. In the non-pregnant women the mean beta-E levels were 2.4 +/- 0.7 (S.E.) pmol/l before the test, 4.3 +/- 0.9 pmol/l at the end of the test, and 4.3 +/- 0.6 and 5.0 +/- 2.0 pmol/l 15 and 30 min after the test, respectively, declining thereafter. In the pregnant women the mean beta-E values were 5.1 +/- 2.0 pmol/l before the test, 7.3 +/- 1.7 pmol/l at the end of the test, 6.7 +/- 2.0 pmol/l 15 min after the test, and 12.6 +/- 4.1 pmol/l 60 min after the test, declining thereafter. Thus, beta-E secretion increased in response to exercise both in non-pregnant and in pregnant women, the response lasting longer in pregnant women.

Adult↗

Increased platelet sensitivity toward platelet inhibitors during physical exercise in patients with coronary artery disease.

Generalized atherosclerosis and coronary artery disease (CAD) are associated with endothelial dysfunction and during acute myocardial ischemia platelet activation has been reported. Activated platelets exert activated fibrinogen receptors (GP IIb/IIIa) and express CD 62p being regarded as reliable marker for platelet activation. Patients with angiographically proven CAD performed a bicycle exercise test until the onset of angina or ST-segment depression. We studied the ischemia-induced alterations in fibrinogen binding to activated platelet GP IIb/IIIa receptors and CD 62p expression. Therefore, the basal fibrinogen binding to GP IIb/IIIa and CD 62p expression and the thrombin-concentration for half-maximal platelet activation before and after exercise testing were determined. Additionally, inhibition of thrombin-induced platelet activation by increasing concentrations of the prostacyclin-analog iloprost and the NO-donor SIN-1 was examined. In patients with CAD, a significantly reduced basal activation and a highly significant reduction in sensitivity towards thrombin was measured. The thrombin-induced expression of GP IIb/IIIa and CD 62p was significantly diminished in patients with CAD after physical exercise and their platelets were significantly more sensitive towards the inhibitory effects of iloprost and SIN-1. These data demonstrate a significant reduction in platelet activation in response to physical exercise in patients with CAD and advanced atherosclerosis. Despite exercise induced myocardial ischemia as evidenced by angina and ECG-changes, the platelets are not generally activated, as it could be expected. Thus, patients with myocardial ischemia experienced a reduced platelet activity and enhanced sensitivity towards prostacyclin (PGI2) and nitric oxide, probably due to an augmented release of endogenous platelet inhibitory mediators.

Blood Platelets↗

Endogenous ouabain and its binding globulin: effects of physical exercise and study on the globulin's tissue distribution.

Ouabain, that has been isolated from bovine adrenals and hypothalamus, is a new cardiotonic steroid hormone, which is either synthesized in the adrenals or stored there after it has absorbed from the diet. Little is known in vivo which events may lead to the release of ouabain into blood. Moreover, a binding protein for cardiotonic steroids exists in blood, which binds cardiac glycosides with high affinity. It may affect the action of endogenous ouabain on heart and circulation, but the physiological function of this protein is unclear. To realize, which physiological stimuli in vivo may affect blood concentrations of endogenous ouabain and which function the cardiotonic binding protein may have in modulating ouabain effects, the effect of physical exercise on endogenous ouabain was studied and the tissue distribution of its binding protein was investigated. We found that endogenous ouabain changes rapidly in blood upon physical exercise and behaves like expected for a hormone of circulation. The cardiotonic steroid binding globulin shows the highest concentration in the kidney, which suggests that sodium pumps of the kidney are protected against its inhibition by ouabain which would lead not only to natriuresis but also to a deleterious loss of glucose, amino acids and phosphate.

Adult↗

Differential effects of voluntary physical exercise on behavioral and brain-derived neurotrophic factor expression deficits in Huntington's disease transgenic mice.

Huntington's disease is a fatal neurodegenerative disorder caused by a mutation of the huntingtin gene and involves progressive motor abnormalities (including chorea), cognitive deficits (dementia) as well as psychiatric symptoms. We have previously demonstrated that environmental enrichment slows the onset and progression of Huntington's disease in transgenic mice. Here, we investigated the effects of enhanced physical exercise on disease progression and brain-derived neurotrophic factor expression. Standard-housed Huntington's disease mice developed phenotypic rear-paw clasping by 16 weeks of age, displayed abnormal rearing behavior, deficits in motor co-ordination and of spatial working memory. Huntington's disease mice with access to running wheels exhibited delayed onset of rear-paw clasping, normalized levels of rearing behavior and amelioration of the cognitive deficits. However, in contrast to our previous environmental enrichment studies, there was no rescue of motor coordination deficits in wheel-running Huntington's disease mice. An abnormal accumulation of brain-derived neurotrophic factor protein in the frontal cortex of Huntington's disease mice was unaffected by running. Striatal and hippocampal brain-derived neurotrophic factor protein levels were unchanged. Brain-derived neurotrophic factor mRNA levels were reduced in the anterior cortex, striatum and hippocampus of Huntington's disease mice, and only striatal deficits were ameliorated by running. Overall, we show that voluntary physical exercise delays the onset of Huntington's disease and the decline in cognitive ability. In addition, our results reveal that some aspects of hippocampal dependent memory are not entirely reliant on sustained hippocampal brain-derived neurotrophic factor expression.

Age Factors↗

Evaluation by blue native polyacrylamide electrophoresis colorimetric staining of the effects of physical exercise on the activities of mitochondrial complexes in rat muscle.

Blue native polyacrylamide electrophoresis (BN-PAGE) is a technique developed for the analysis of membrane complexes. Combined with histochemical staining, it permits the analysis and quantification of the activities of mitochondrial oxidative phosphorylation enzymes using whole muscle homogenates, without the need to isolate muscle mitochondria. Mitochondrial complex activities were measured by emerging gels in a solution containing all specific substrates for NADH dehydrogenase and cytochrome c oxidase enzymes (complexes I and IV, respectively) and the colored bands obtained were measured by optique densitometry. The objective of the present study was the application of BN-PAGE colorimetric staining for enzymatic characterization of mitochondrial complexes I and IV in rat muscles with different morphological and biochemical properties. We also investigated these activities at different times after acute exercise of rat soleus muscle. Although having fewer mitochondria than oxidative muscles, white gastrocnemius muscle presented a significantly higher activity (26.7 +/- 9.5) in terms of complex I/V ratio compared to the red gastrocnemius (3.8 +/- 0.65, P < 0.05) and soleus (9.8 +/- 0.9, P < 0.001) muscles. Furthermore, the complex IV/V ratio of white gastrocnemius muscle was always significantly higher when compared to the other muscles. Ninety-five minutes of exhaustive physical exercise induced a decrease in complex I/V and complex IV/V ratios after all resting times (0, 3 and 6 h) compared to control (P < 0.05), probably reflecting the oxidative damage due to increasing free radical production in mitochondria. These results demonstrate the possible and useful application of BN-PAGE-histochemical staining to physical exercise studies.

Animals↗

Physical exercise, use of Plantago ovata and aspirin, and reduced risk of colon cancer.

To evaluate certain risk and protective factors for colon cancer in our population, we conducted a paired case-control study where cases were all people diagnosed with colon cancer who were registered at the Cancer Data Exchange Systems of the Community of Madrid between January 1995 and December 1996, and controls were randomly taken from electoral lists. The study population consisted of 424 persons. Using SPSS for Windows, variables were adjusted by multiple logistic regression. The results indicate that lack of physical exercise is associated with an increased risk of colon cancer, with an odds ratio (OR) of 2.8 (95% confidence interval (CI) 1.28-6.21) as compared with moderate activity 1-2 days a week. The risk decreases linearly with increasing physical exercise, and this association remains after stratifying the analysis for the existence of constipation. The consumption of is associated with a reduced risk of colon cancer in constipated patients, with an OR of 0.094 (0.014-0.639), as is aspirin use, with an OR of 0.980 (0.898-0.999). These results were obtained after adjusting all the ORs for diet, smoking, alcohol consumption, family history and socio-demographic factors such as marital status and educational level.

Aged↗

[Association of physiologic responses to metabolic changes in exhaustive physical exercise].

The purpose of this work was to identify changes in some hematic variables in recreational athletes of middle level competition exposed to exhaustive physical exercise, as well as the association among physiologic changes, personal characteristics, and physical level produced by marathon running. Ten healthy males participated (20-55 years of age). Blood cell count, blood chemistry, lipids, and enzymes were determined. Exercise produced hemoconcentration by reduction in plasma volume (8%; p<0.05). There was significant increment in leukocytes (149%) by neutrophilia (64%) and decrease in lymphocytes (74%). Fibrinogen increased 10.7% (p<0.05). Lipids (CT, C-HDL) did not modify, except C-LDL, which increased significantly (71%), attributing this response to stress of the marathon. Triglyceride decreased 47%. Enzymes increased significantly, particularly CK. Age and physical activity were related with physiologic and metabolic variables, as demonstrated by multivariate analysis. These data contributed to new knowledge in physiologic responses of our ethnic race when exposed to exhaustive exercise such as a marathon. To these results new approaches of risk and different schedules of intervention programs could be generated for better and effective practice of physical exercise in our population.

Adult↗

The group matters: an explorative study of group cohesion and quality of life in cancer patients participating in physical exercise intervention during treatment.

A series of studies have shown that physical activity improves cancer patients functional capacity and quality of life (QOL). Few of these studies have included physical exercise carried out in a group setting. However, patient's experience with the in-group processes remains unexplored. This study investigated group cohesion and changes in QOL in 55 cancer patients undergoing chemotherapy who participated in a 9 h weekly group exercise programme for 6 weeks. The study used a method triangulation component design. Seven qualitative group interviews were conducted post-intervention. QOL (SF-36; EORTC QLQ-C30) was assessed at baseline and after Week 6. The interviews revealed that group cohesion was an interim goal aimed to maximize peak performance potential by patients. Group cohesion was characterized by a special 'esprit de corps' and enabled the group members to feel like sport teams. The programme made purposeful togetherness possible while allowing the patients an opportunity to let their illness fade into the background. Questionnaire data showed significant improvements in mental health, social and emotional functioning. This study identified a conceptualization of group cohesion that forms a valuable basis for a larger randomized controlled trial to conclude whether the observed changes are a result of this specific intervention.

Adult↗

Lactate analyzer with continuous blood sampling for monitoring blood lactate during physical exercise.

To monitor changes in the concentration of blood lactate during physical exercise, we used an automated lactate analyzer based on an electro-enzymatic method with continuous blood sampling through a catheter. The lactate concentration was measured every 2 min; between measurements, the instrument was calibrated with a lactate standard. Ascorbic acid, bilirubin, hemoglobin, creatinine, uric acid, and glucose did not interfere with the measurements. The lactate concentrations in blood samples from apparently healthy subjects before and after exercise correlated well (r = 0.993) with results by the conventional enzymatic method. We measured the blood lactate concentrations in nine apparently healthy volunteers during exercise on a treadmill with an increasing workload. The point at which lactate concentrations started to increase was detected easily. Thus, the lactate analyzer is suitable for monitoring changes in blood lactate concentrations during exercise.

Autoanalysis↗

Creatine excretion in urine of man under hypokinesia and physical exercise.

It is known that hypokinesia (diminished muscular activity) induces changes in various biochemical parameters of the organism, including creatine. Thus the aim of this study was to determine daily excretion of creatine under 100-days' exposure to hypokinesia (HK) in essentially healthy men, aged 18-23 years. They were divided into two groups with 3 men in each. The control group of men was subjected to "pure" HK i.e. without the use of any preventive measures, and the experimental group was submitted to combined HK and PE (physical exercise). For the simulation of the hypokinetic effect both groups of men were kept under a rigorous bed rest regime. Creatine excretion was calculated by conventional methods. The results obtained were analyzed statistically. In the control group of men the increased renal excretion of creatine was found in the initial 60-days' period of HK and return to the baseline level during the 60th-90th days. In the experimental group of men a reduced delayed elevation of creatine elimination in urine was manifested only during the 60th-90th days of HK. It was concluded that increased creatine excretion in urine developed during initial HK. Physical exercise may be used to attenuate creatinuria under diminished muscular activity.

Adolescent↗