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PubMed1987

Exercise training ameliorates progressive renal disease in rats with subtotal nephrectomy.

To determine the effect of chronic exercise training on renal function in animals with moderate renal insufficiency, rats with 75% renal ablation were either exercise trained by swimming for two months or remained sedentary. Glomerular filtration rate was significantly higher in trained (1.89 +/- 0.07 ml/min) than in sedentary rats (1.52 +/- 0.11 ml/min). No change was observed in renal blood flow or the degree of hypertension. Proteinuria was reduced in trained (13.6 +/- 4.9 mg/24 hr) compared to sedentary animals (33.5 +/- 9.2 mg/24 hr). The degree of glomerulosclerosis was much less prominent in trained animals. Plasma, low-density lipoprotein cholesterol-levels and total triglycerides were reduced in trained compared to sedentary rats. This study suggests that chronic exercise training ameliorates the progression of renal disease and improves plasma lipids in rats with moderate renal insufficiency. The mechanism for this improvement in renal function appears to be independent of the influence of systemic blood pressure.

Animals↗

PubMed2006

Long-term cardiac rehabilitation and exercise training programs improve metabolic parameters in metabolic syndrome patients with and without coronary heart disease.

BACKGROUND AND AIMS: The effectiveness of long-term cardiac rehabilitation and exercise training programs on metabolic parameters was evaluated in metabolic syndrome subjects with and without coronary heart disease (CHD). METHODS AND RESULTS: Fifty-nine CHD and 81 non-coronary patients with metabolic syndrome (59+/-8 vs 56+/-9years) were identified retrospectively at entry into identical cardiac rehabilitation and exercise-training programs. Metabolic syndrome was defined using modified Adult Treatment Panel III criteria. Exercise training occurred approximately twice per week. Metabolic and exercise testing data were collected at baseline and after 12months during the course of the program. Mean duration of cardiac rehabilitation and exercise training programs was over one year in both coronary and non-coronary patients (366+/-111 vs 414+/-102days for CHD and non-coronary CHD cohorts respectively, p<0.01). Significant improvements in bodyweight, body mass index, blood lipids, triglyceride/HDL ratio and exercise tolerance were noted in both cohorts. At the end of follow-up, 31% of CHD and 20% of non-CHD subjects no longer possessed diagnostic criteria for metabolic syndrome (p<0.0001 and p<0.001 respectively). CONCLUSIONS: A long-term cardiac rehabilitation program reduces metabolic syndrome prevalence in CHD patients and results in a similar improvement in risk factor control for metabolic syndrome patients without CHD.

Aged↗

PubMed1991

Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics.

Left ventricular (LV) myocardial atrophy and diminished cardiac function have been shown to accompany chronic human tetraplegia. These changes are attributable both to physical immobilisation and abnormal autonomic circulatory regulation imposed by a spinal cord injury (SCI). To test whether exercise training increases LV mass following chronic SCI, 8 neurologically complete quadriplegic males at 2 SCI rehabilitation and research centres underwent one month of electrically-stimulated quadriceps strengthening followed by 6 months of electrically-stimulated cycling exercise. Resting M-mode and 2-D echocardiograms were measured before and after exercise training to quantify the interventricular septal and posterior wall thicknesses at end-diastole (IVSTED and PWTED, respectively), and the LV internal dimension at end-diastole (LVIDED). LV mass was computed from these measurements using standard cube function geometry. Results showed a 6.5% increase in LVIDED following exercise training (p less than 0.02), with increases in IVSTED and PWTED of 17.8 (p less than 0.002) and 20.3% (p less than 0.01), respectively. Computed LV mass increased by 35% following exercise training (p = 0.002). These data indicate that myocardial atrophy is reversed in tetraplegics following electrically-stimulated exercise training, and that the changes in cardiac architecture are likely to be the result of both pressure and volume challenge to the heart imposed by exercise.

Adaptation, Physiological↗

PubMed2006

Influence of exercise order in a resistance-training exercise session.

The order of resistance exercises within a training session may have a vital impact on the quality of the constituent exercises performed. However, very few studies have documented the specific influence of exercise order. Therefore, the purpose of this study was to examine the effect of exercise order on back squat performance in the context of a whole-body workout. Nine resistance-trained male subjects (age: 24 +/- 4 years, body mass: 81.5 +/- 15.3 kg, resistance-training experience: 7 +/- 4 years) performed the back squat exercise (4 sets at 85% of 1 repetition maximum) on 2 separate occasions in a balanced, crossover design. During one protocol, the squat exercise was performed first (protocol A); during the other protocol, it was performed after a whole-body resistance-exercise session (protocol B). Number of repetitions, average power, and rating of perceived exertion (RPE) were collected during each set of the squat exercise. All subjects performed significantly (p < 0.01) more repetitions during set 1 when they performed protocol A (8.0 +/- 1.9 repetitions) compared with protocol B (5.4 +/- 2.7 repetitions). The average power for each set was higher during protocol B compared with protocol A. There were no significant differences in RPE values between the 2 protocols. In conclusion, performing the barbell back squat first in an exercise session allowed the completion of more total repetitions. However, this study showed that performing the squat exercise after a whole-body workout session may result in greater power output if the squat is preceded by a power exercise (i.e., hang pull). This phenomenon may have been due to postactivation potentiation.

Adult↗

PubMed2003

Effects of exercise training on acclimatization to hypoxia: systemic O2 transport during maximal exercise.

Acclimatization to hypoxia has minimal effect on maximal O2 uptake (Vo2 max). Prolonged hypoxia shows reductions in cardiac output (Q), maximal heart rate (HR-max), myocardial beta-adrenoceptor (beta-AR) density, and chronotropic response to isoproterenol. This study tested the hypothesis that exercise training (ET), which attenuates beta-AR downregulation, would increase HRmax and Q of acclimatization and result in higher Vo2 max. After 3 wk of ET, rats lived at an inspired Po2 of 70 Torr for 10 days (acclimatized trained rats) or remained in normoxia, while both groups continued to train in normoxia. Controls were sedentary acclimatized and nonacclimatized rats. All rats exercised maximally in normoxia and hypoxia (inspired Po2 of 70 Torr). Myocardial beta-AR density and the chronotropic response to isoproterenol were reduced, and myocardial cholinergic receptor density was increased after acclimatization; all of these receptor changes were reversed by ET. Normoxic Vo2 max (in ml.min-1.kg-1) was 95.8 +/- 1.0 in acclimatized trained (n = 6), 87.7 +/- 1.7 in nonacclimatized trained (P < 0.05, n = 6), 74.2 +/- 1.4 in acclimatized sedentary (n = 6, P < 0.05), and 72.5 +/- 1.2 in nonacclimatized sedentary (n = 8; P > 0.05 acclimatized sedentary vs. nonacclimatized sedentary). A similar distribution of Vo2 max values occurred in hypoxic exercise. Q was highest in trained acclimatized and nonacclimatized, intermediate in nonacclimatized sedentary, and lowest in acclimatized sedentary groups. ET preserved Q in acclimatized rats thanks to maintenance of HRmax as well as of maximal stroke volume. Q preservation, coupled with a higher arterial O2 content, resulted in the acclimatized trained rats having the highest convective O2 transport and Vo2 max. These results show that ET attenuates beta-AR downregulation and preserves Q and Vo2 max after acclimatization, and support the idea that beta-AR downregulation partially contributes to the limitation of Vo2 max after acclimatization in rats.

Acclimatization↗

PubMed1991

Exercise training elevates RMR during moderate but not severe dietary restriction in obese male rats.

This study examined the effects of 11 wk of exercise training (E) on resting O2 uptake (RMR) and the composition of diet-induced weight loss in obese male Sprague-Dawley rats (n = 48). The rats underwent one of three levels of dietary treatment: ad libitum (AL), moderate restriction (MR), and severe restriction (SR). Compared with AL-CC (cage confined; 647 +/- 13 g), the AL-E (84% of AL-CC), MR-CC (77%), MR-E (77%), SR-CC (63%), and SR-E (63%) groups were all reduced in body mass. At the MR level, E significantly reduced fat mass (FM; MR-CC 73 +/- 5, MR-E 45 +/- 5 g) and increased water mass (WM; MR-CC 307 +/- 5, MR-E 329 +/- 5 g) compared with CC. In contrast, no significant differences existed between the SR-CC and SR-E groups. Exercise training did not result in conservation of protein mass at any level of dietary intake. Exercise training significantly elevated RMR (on a kg0.75 basis) by approximately 7% for the AL-E and MR-E groups compared with their respective dietary counterparts. These findings may help reconcile the conflicting results present in the literature with respect to the effects of exercise training during diet-induced weight loss. That is, studies using relatively severe dietary restrictions are less likely to demonstrate exercise-induced changes in RMR, FM, and WM than those employing moderate dietary restrictions.

Animals↗

PubMed1997

Influence of exercise training on heart rate variability in post-menopausal women with elevated arterial blood pressure.

Low heart rate variability (HRV) has been reported to be an independent risk factor for the development of coronary heart disease in women and has recently been identified as a risk factor for cardiac sudden death and all-cause mortality. We have recently demonstrated that endurance-trained post-menopausal women demonstrate higher levels of HRV than sedentary control subjects. The purpose of the present study was to test the hypothesis that 12 weeks of regular aerobic exercise would increase HRV in sedentary post-menopausal women with elevated arterial blood pressure (BP) (i.e. either high normal BP or stage I hypertension). A secondary aim was to test the hypothesis that the increase in HRV with exercise training, if observed, would be associated with an increase in spontaneous cardiac baroreflex sensitivity (SBRS), an important physiological determinant of HRV. To accomplish these aims, we studied eight sedentary post-menopausal women (age = 54.5 +/- 1.3 years) before and after 12 weeks of aerobic exercise training (3.3 +/- 0.3 days per week at 70% +/- 2% of maximal heart rate for 43 +/- 3 min per day). Maximal oxygen uptake and body weight did not change (P > 0.05) with training, but percentage fat (35.5 +/- 2.6% vs. 34.5 +/- 2.3%, P < 0.05) decreased and treadmill time to exhaustion increased (9.8 +/- 0.5 vs. 11.3 +/- 0.5 min, P < 0.05). Supine resting levels of heart rate, RR interval and the standard deviation of the RR interval (time domain measure of HRV) were unchanged (all P > 0.05) from baseline levels after 12 weeks of aerobic training. Similarly, the high-frequency, low-frequency and total power of HRV (frequency domain measures) were also unchanged from baseline (all P > 0.05). SBRS was also not different before and after aerobic exercise training (10 +/- 2 vs. 13 +/- 3 ms mmHg-1 respectively, P > 0.05). In contrast, systolic and diastolic BP were reduced approximately 8 and approximately 5 mmHg with training (both P < 0.05) respectively. These results indicate that 12 weeks of moderate-intensity aerobic exercise training does not increase HRV or SBRS, despite producing a clinically significant reduction in BP at rest in post-menopausal women with elevated BP. Considered together with our previous findings in female master endurance athletes, these findings suggest that more intense and prolonged exercise training may be required to produce increases in HRV and SBRS in sedentary post-menopausal women.

Exercise↗

PubMed2000

Effects of exercise training on autonomic and myocardial dysfunction in streptozotocin-diabetic rats.

Several investigators have demonstrated that diabetes is associated with autonomic and myocardial dysfunction. Exercise training is an efficient non-pharmacological treatment for cardiac and metabolic diseases. The aim of the present study was to investigate the effects of exercise training on hemodynamic and autonomic diabetic dysfunction. After 1 week of diabetes induction (streptozotocin, 50 mg/kg, iv), male Wistar rats (222 +/- 5 g, N = 18) were submitted to exercise training for 10 weeks on a treadmill. Arterial pressure signals were obtained and processed with a data acquisition system. Autonomic function and intrinsic heart rate were studied by injecting methylatropine and propranolol. Left ventricular function was assessed in hearts perfused in vitro by the Langendorff technique. Diabetes (D) bradycardia and hypotension (D: 279 +/- 9 bpm and 91 +/- 4 mmHg vs 315 +/- 11 bpm and 111 +/- 4 mmHg in controls, C) were attenuated by training (TD: 305 +/- 7 bpm and 100 +/- 4 mmHg). Vagal tonus was decreased in the diabetic groups and sympathetic tonus was similar in all animals. Intrinsic heart rate was lower in D (284 +/- 11 bpm) compared to C and TD (390 +/- 8 and 342 +/- 14 bpm, respectively). Peak systolic pressure developed at different pressures was similar for all groups, but +dP/dt max was decreased and -dP/dt max was increased in D. In conclusion, exercise training reversed hypotension and bradycardia and improved myocardial function in diabetic rats. These changes represent an adaptive response to the demands of training, supporting a positive role of physical activity in the management of diabetes.

Animals↗

PubMed1999

Exercise training protects against contraction-induced lipid peroxidation in the diaphragm.

Endurance exercise training promotes a small but significant increase in antioxidant enzyme activity in the costal diaphragm (DIA) of rodents. It is unclear if these training-induced improvements in muscle antioxidant capacity are large enough to reduce oxidative stress during prolonged contractile activity. To test the hypothesis that training-related increases in DIA antioxidant capacity reduces contraction-induced lipid peroxidation, we exercise trained adult female Sprague-Dawley (n = 7) rats on a motor-driven treadmill for 12 weeks at approximately 75% maximal O2 consumption (90 min/day). Control animals (n = 8) remained sedentary during the same 12-week period. After training, DIA strips from animals in both experimental groups were excised and subjected to an in vitro fatigue contractile protocol in which the muscle was stimulated for 60 min at a frequency of 30 Hz, every 2 s, with a train duration of 330 m. Compared to the controls, endurance training resulted in an increase (P < 0.05) in diaphragmatic non-protein thiols and in the activity of the antioxidant enzyme superoxide dismutase. Following the contractile protocol, lipid peroxidation was significantly lower (P < 0.05) in the trained DIA compared to the controls. These data support the hypothesis that endurance exercise training-induced increases in DIA antioxidant capacity protect the muscle against contractile-related oxidative stress.

Animals↗

PubMed1989

Effects of exercise training on serum lipid and lipoprotein concentrations in women: a meta-analysis.

It has been suggested that regular exercise produces favorable changes in serum lipid and lipoprotein-cholesterol concentrations. However, most of the subjects in this area of research have been men. Given the differences in lipid profiles between men and women, we wanted to determine if these same favorable changes took place in women. Of the 145 longitudinal studies available in this area, 27 met the criteria for inclusion in this analysis (i.e., an exercise training study that used women subjects and measured changes in lipid concentrations). Results show that exercise does favorably alter serum lipid profiles in women by reducing total cholesterol (194 to 190 mg.dl-1; P = 0.02), triglyceride (91 to 82 mg.dl-1; P = 0.01), and the ratio of total cholesterol to high-density lipoprotein-cholesterol (3.28 to 3.16; mg.dl-1; P = 0.03). However, a significant increase in high-density lipoprotein-cholesterol or decrease in low-density lipoprotein-cholesterol concentration was not observed. Results also show that changes in body weight during exercise are associated with changes in total cholesterol (r = 0.56; P = 0.01) and triglyceride (r = 0.42; P = 0.06) concentrations, indicating that greater body weight losses resulted in larger decreases in cholesterol and triglyceride concentrations. Further analysis indicates that those women most at risk for heart disease (elevated pre-exercise cholesterol concentrations) responded most favorably to exercise training. These results suggest that exercise training, especially for those at risk for heart diseases is beneficial to the lipid profile of women.

Adult↗

PubMed1992

Effect of a six-month aerobic exercise training program on cardiovascular responsivity in healthy middle-aged adults.

The purpose of this study was to determine the effects of a six month aerobic exercise training regimen on cardiovascular responsivity to mental arithmetic in healthy middle-aged men and women. Subjects were randomly assigned to a moderate intensity exercise intervention or to an assessment-only control group. Before and after the intervention subjects' heart rates and blood pressures were measured doing a mental arithmetic task (N = 83). Other physiological and psychosocial measures included the Type A structured interview and a maximal exercise treadmill test. Validated adherence to the exercise regimen exceeded 75% and there were significant increases in aerobic capacity in those subjects receiving exercise training. Exercise did not significantly reduce cardiovascular responsivity to the stress task. Type A behavior did not interact with reactivity across exercisers or controls nor was it significantly correlated with adherence. The results are discussed with respect to factors that have been previously reported to potentially influence the exercise/reactivity relationship.

Arousal↗

PubMed2003

Creatine supplementation enhances isometric strength and body composition improvements following strength exercise training in older adults.

We sought to determine whether creatine monohydrate (CrM) supplementation would enhance the increases in strength and fat-free mass that develop during resistance exercise training in older adults. Twenty-eight healthy men and women over the age of 65 years participated in a whole-body resistance exercise program 3 days per week for 14 weeks. The study participants were randomly allocated, in a double-blind fashion, to receive either CrM (5 g/d + 2 g of dextrose; n = 14) or placebo (7 g of dextrose; n = 14). The primary outcome measurements included the following: total body mass, fat-free mass, one-repetition maximum strength for each body part, isometric knee extension, handgrip, and dorsiflexion strength, chair stand performance, 30-m walk test, 14-stair climb performance, muscle fiber type and area, and intramuscular total creatine. Fourteen weeks of resistance exercise training resulted in significant increases in all measurements of strength and functional tasks and muscle fiber area for both groups (p <.05). CrM supplementation resulted in significantly greater increases in fat-free mass and total body mass, as compared with placebo (p <.05). The CrM group also showed a greater increase in isometric knee extension strength in men and women, as compared with placebo (p <.05), and also greater gains in isometric dorsiflexion strength (p <.05), but in men only. There was a significant increase in intramuscular total creatine in the CrM group (p <.05). Finally, there were no significant side effects of treatment or exercise training. This study confirms that supervised heavy resistance exercise training can safely increase muscle strength and functional capacity in older adults. The addition of CrM supplementation to the exercise stimulus enhanced the increase in total and fat-free mass, and gains in several indices of isometric muscle strength.

Age Factors↗

PubMed1995

Benefits of Cardiac Rehabilitation and Exercise Training in Older Persons.

Despite the well-proved benefits of cardiac rehabilitation and exercise training, older persons are frequently not referred to or vigorously encouraged to pursue this therapy after major coronary heart disease (CHD) events. Therefore, we determined the effects of this therapy on plasma lipids, indices of obesity, and exercise capacity in older CHD patients compared with the benefits obtained in a younger cohort. At baseline, the older persons had lower body mass indices (BMI), triglycerides levels, and estimated metabolic equivalent (METs), and the elderly had higher levels of high-density lipoprotein cholesterol (HDL-C). Most other parameters were statistically similar in the older and younger patients. After cardiac rehabilitation, the elderly had significant improvements in METs, BMI, percent body fat, HDL-C, and low-density lipoprotein cholesterol (LDL-C)/HDL-C but not in total cholesterol or LDL-C. However, improvements in all of these parameters were statistically similar in older and younger patients. We conclude that despite baseline differences, improvements in exercise capacity, obesity indices, and lipid levels were statistically similar in older and younger patients enrolled in formal, phase II, cardiac rehabilitation and exercise training programs. Therefore, our data emphasized that the elderly should not be categorically denied the benefits of vigorous secondary CHD prevention, including formal cardiac rehabilitation and exercise training programs.

Journal Article↗

PubMed1983

Effects of diet and exercise training on thermogenesis in adult female rats.

The effects of a cafeteria diet on body weight gain, food intake, resting metabolic rate (RMR) and the thermic effect of food (TEF) were compared in female Charles River albino rats that were either sedentary or exercise-trained. The food intakes of the exercise-trained rats on the cafeteria diet were increased to the same degree as those of the sedentary rats, however, they gained less body weight and body fat than sedentary controls. The exercise training increased RMR independent of diet, but differentially increased TEF in rats given the cafeteria diet. Conversely, sedentary rats on the cafeteria diet had significantly lower RMR, but their TEF were not different from control animals on lab chow. Thus, in addition to the direct cost of the exercise, training increased thermogenesis (RMR and TEF) which also helped prevent the dietary obesity which normally occurs with cafeteria diets.

Animals↗

PubMed1995

Low intensity exercise training in patients with chronic heart failure.

OBJECTIVES: The present study was designed to evaluate whether a specific program of low intensity exercise training may be sufficient to improve the exercise tolerance of patients with chronic heart failure. BACKGROUND: Recent studies have shown that exercise training can improve exercise tolerance in patients with stable chronic heart failure, mainly through peripheral adaptations. These changes have been observed with exercise regimens at intensities of 70% to 80% of peak oxygen uptake and > 8 weeks. METHODS: We studied 27 patients (23 men, 4 women; mean [+/- SD] age 57 +/- 6 years) with mild chronic heart failure. We classified patients into two groups: trained group and untrained group. The trained group underwent a low intensity (40% of peak oxygen uptake) training program three times/week for 8 weeks. The untrained group performed no exercise. RESULTS: An increase in peak oxygen uptake (17%, p < 0.0001), lactic acidosis threshold (20%, p < 0.0002) and peak work load (21%, p < 0.0002) were obtained in the trained group only. Cardiac output and stroke volume were unchanged. A high correlation was found between the increases in peak oxygen uptake and volume density of mitochondria of vastus lateralis muscle (r = 0.77, p < 0.0002). CONCLUSIONS: Patients with stable chronic heart failure can achieve significant improvement in functional capacity from a low intensity exercise training regimen. The mechanism responsible for this favorable effect involves an increase in mitochondrial density, which reflects an improvement in oxidative capacity of trained skeletal muscles.

Anaerobic Threshold↗

PubMed1993

[Effect of physical exercise training on graft patency after aortocoronary bypass grafting].

This study evaluated the effect of physical exercise training on graft patency after aortocoronary bypass grafting (ACBG). Patients who underwent ACBG were randomized into the training (17 patients, 43 grafts) and nontraining groups (18 patients, 45 grafts). Tissue plasminogen activator (TPA) antigen, TPA activity, plasminogen activator inhibitor-1 (PAI-1) antigen and PAI-1 activity as fibrinolysis variables, and an angiographic study were performed 2 and 26 weeks after ACBG. Plasma TPA activity increased significantly in the training group, but not in the nontraining group after 24 weeks of training. Plasma PAI-1 antigen and activity decreased significantly in the training group, while PAI-1 levels remained unchanged in the nontraining group. Grafts were patent in 93% (40 of 43) of the training group and 76% (34 of 45) of the nontraining group (p < 0.05). A high plasma concentration of PAI-1 may interfere with the natural thrombolytic process. Exercise training can decrease PAI-1 levels and increase TPA activity after ACBG. Improved fibrinolysis obtained by exercise training may have beneficial effects on graft patency.

Adult↗

PubMed1999

Physiological response to a short period of exercise training in patients with chronic heart failure.

BACKGROUND AND PURPOSE: Whilst cardiac rehabilitation is regularly offered to patients recovering from a myocardial infarction, people with chronic heart failure are often excluded from exercise training programmes. This study was designed to investigate the effects of eight weeks' exercise training in patients with moderate chronic heart failure. METHOD: Eight male patients entered a 16-week randomized, controlled, crossover study of two months' exercise training versus a control period. They performed supervised training three times a week and measures of indices of aerobic function and exercise tolerance were performed monthly throughout the study period. RESULTS: After training, the time walked on a treadmill during an exercise tolerance test increased from 14.8 min (95% CI; range 10.4-18.1 min) to 15.9 min (range 12.1-15.9 min). Significant changes at peak exercise levels (p < 0.05) were seen in oxygen uptake increasing from 3.4 metabolic equivalents (METs) (95% CI; range 2.6-4.2 METs) to 4.0 METs (range 3.2-4.9 METs), and in cardiac index, improving from 5.0 l/min-1/m-2 (95% CI; range 2.9-8.1 l/min-1/m-2) to 5.5 l/min-1/m-2 (range 3.0-9.4 l/min-1/m-2). Resting heart rate decreased significantly (p < 0.05), from 84 beats/min-1 (95% CI; range 73-105 beats/min-1) to 76 beats/min-1 (range 64-90 beats/min-1). Blood flow measurements by venous occlusion plethysmography showed a 21.5% decrease (range 58.5-238.9%) in resting blood flow to the lower leg and a 31.6% increase (range -7.2% to 52.5%) after submaximal exercise, but these changes were not significant (p > 0.05). All benefits were lost within two months of ceasing regular exercise. CONCLUSION: This study demonstrated that patients with moderate chronic heart failure derived beneficial physiological responses from eight weeks' exercise training, but these were soon lost after cessation of regular exercise.

Adult↗

PubMed1975

Heart norepinephrine levels after exercise training in the rat.

Rats exercise trained by swimming one hour daily five days per week for three months developed cardiac hypertrophy. The NE concentration (0.469 mug/g) and total NE content (0.741/mug) of the hypertrophied hearts were not significantly different from levels in hearts of unexercised control rats.

Animals↗