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Tag: Exercise

  • DASH diet may lower the risk of cardiovascular disease in breast cancer survivors

    DASH diet may lower the risk of cardiovascular disease in breast cancer survivors

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    A new paper in JNCI Cancer Spectrum, published by Oxford University Press, finds that following a healthy diet lowers the risk of cardiovascular disease in breast cancer survivors.

    Cardiovascular disease is the top non-breast cancer related cause of death in women with breast cancer. There are more than 3.8 million female breast cancer survivors in the United States. These women are at higher risk for cardiovascular disease than women who have not had breast cancer. This is likely due to the cardiotoxic effects of breast cancer treatment, as well as common risk factors for both breast cancer and cardiovascular disease, such as aging, lack of exercise, and smoking. Dietary guidance for breast cancer survivors is limited and until recently has been based primarily on research related to cancer prevention.

    Researchers used data from the Pathways Study, a prospective cohort study of women diagnosed with invasive breast cancer, to examine associations between diet quality and cardiovascular-related events. The analysis included 3,415 women diagnosed with invasive breast cancer at Kaiser Permanente Northern California between 2005 and 2013 and monitored through 2021.

    To assess diet quality, researchers used a scoring system based on the Dietary Approaches to Stop Hypertension (DASH) diet which was developed in the 1990s to manage and treat hypertension. The diet emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy. It also limits sodium, red and processed meats, and sugar sweetened beverages. The diet is similar to that recommended by the American Cancer Society, but also encourages consumption of low-fat dairy and nuts, and discourages sodium. The study evaluated heart health tied to these two diets as well as a plant-based diet, the 2020 Healthy Eating Index, and the alternate Mediterranean diet. 

    The researchers found that women whose diets were most similar to DASH at the time of their breast cancer diagnosis had a 47% lower risk of heart failure, a 23% lower risk of arrhythmia, a 23% lower risk of cardiac arrest, a 21% lower risk of valvular heart disease, and a 25% lower risk of venous thromboembolic disease than the women whose diets were least aligned with DASH.

    In a closer examination the researchers found that higher consumption of low-fat dairy reduced the risk for cardiovascular disease-related death, after adjusting for all other food groups. They also found that the relationship between DASH and cardiovascular disease appeared to be modified by the type of chemotherapy treatment a woman received. For example, women whose treatment included an anthracycline and had diets closely aligned with the diet had a lower risk of cardiovascular disease than women least aligned with DASH, a relationship that was not apparent among women on other types of chemotherapy regimens.

    Our findings suggest that we need to begin talking to breast cancer survivors about the potential heart benefits of the DASH diet. We know that breast cancer survivors have an elevated risk for cardiovascular disease, and the diet might be able to help improve the overall health of this population.”


    Isaac J. Ergas, PhD, paper’s lead author, staff scientist at the Kaiser Permanente Division of Research

    Source:

    Oxford University Press USA

    Journal reference:

    Ergas, I. J., et al. (2024) Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study. JNCI Cancer Spectrum. doi.org/10.1093/jncics/pkae013.

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  • Vaccines targeting chronic diseases show promise in combatting age-related conditions

    Vaccines targeting chronic diseases show promise in combatting age-related conditions

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    In a recent review published in Nature Aging, researchers explored vaccine-based therapeutics for age-related disorders.

    Study: Targeting aging and age-related diseases with vaccines. Image Credit: Ground Picture/Shutterstock.comStudy: Targeting aging and age-related diseases with vaccines. Image Credit: Ground Picture/Shutterstock.com

    Background

    Aging is a primary risk factor for chronic illnesses, marked by reduced physiological capabilities. Cell senescence, genomic instability, stem cell fatigue, and mitochondrial failure are characteristics.

    Aging also increases the risk of chronic illnesses such as Alzheimer’s disease, atherosclerosis, osteoarthritis, type 2 diabetes, chronic obstructive pulmonary disease (COPD), and cancer. Healthy habits like calorie control and regular physical exercise help prevent age-related disorders.

    However, small-molecule therapies have limits, and vaccines provide a potential technique to target specific antigens to generate immune responses.

    About the review

    In the present review, researchers present new developments in vaccines using senescent cells to target the etiological agents of aging and related diseases.

    Immunology of senolytic vaccines that target aging

    Vaccines stimulate the innate immunological system, making it rapidly respond to infection. This reaction activates adaptive immune cells, causing humoral antibodies to manufacture antibodies and cell-mediated immunity to attack infected cells. Vaccinations lead to pathogen-targeted memory cell development to accelerate response to reinfections.
    Vaccines targeting microbes, cell populations, or chemicals can prevent and treat disease development. Senolytic vaccines, which target senescent cells, have been demonstrated to reduce arterial plaque development.

    These vaccination techniques provide new pathways for managing age-associated disorders, with advantages such as fewer injections, increased patient adherence, cost-effectiveness, and improved targeting efficiency.

    Senolytic vaccinations target senescent cells by targeting chemicals on their surfaces, using peptide-based platforms to eradicate them through complement-dependent cytotoxicity (CDC) or natural killer (NK) cell-mediated and antibody-dependent cell-mediated cytotoxicity (ADCC).

    Membrane proteins overexpressed in senescent cells are used as vaccine antigens or immune cell targets to stimulate the development of specific antibodies.

    Tumor-associated antigens (TAAs) and tumor-specific antigens (TSAs) trigger a cluster of differentiation 4-expressing helper T cells, CD8+ cytotoxic T cells, and B cells to kill cancer cells.

    Cancer vaccines use cell-based, virus-based, peptide-based, and nucleic acid-based platforms to stimulate adaptive immunity.

    Research on vaccine-based strategies for age-related disorders

    Alzheimer’s disease (AD) vaccinations attempt to lower the brain’s amyloid-beta (Aβ) and tau protein levels by stimulating the adaptive immune system to produce antibodies. Peptides with neuroprotective properties are potentially possible therapies.

    Vaccines like ACI-24, UB-311, AV-1959D, ABvac40, ACI-35, AADvac1, and GV1001 target Aβ and tau proteins in innate immune cells. ACI-24 targets Aβ1-15 liposomes, UB-311 targets Aβ protein, AV-1959D targets deoxyribonucleic acid (DNA), ABvac40 targets Aβ protein, ACI-35 targets tau protein accumulation, and AADvac1 and GV1001 demonstrate long-term safety, tolerance, and immunogenicity.

    Type 2 diabetes vaccinations target molecules like dipeptidyl-peptidase 4 (DPP4) and interleukin-1 beta (IL-1β) to restore levels and prevent problems.

    The vaccines use peptide sequences to produce anti-DPP4 antibodies, increase glucose tolerance, restore beta cell mass, and reduce IL-1β production. They also couple prorenin epitopes with keyhole limpet hemocyanin (KLH), improving retinal blood circulation, decreasing microglia activation, and reducing gliosis and vascular leakage in diabetic rats.

    Vaccines for age-related vascular diseases such as hypertension, abdominal aortic aneurysm (AAA), and atherosclerosis target molecules that regulate blood pressure, cholesterol, and blood vessel function. PMD-2850, PMD-3117, CYT006-AngQb, AT1R, ATRQβ-001, and ADR-004 inhibit angiopoietin 1 (Ang I) and age-related accumulation in hypertensive rats.

    Vaccines containing KLH and Ang II decreased macrophage aggregation in the AAA wall, suppressed tumor necrosis factor (TNF) expression, and protected against elastic fiber injury.

    The nerve growth factor (NGF) protein is an osteoarthritis target. Researchers covalently linked recombinant NGF proteins to virus-like particles (VLPs) derived from a cucumber mosaic virus with tetanus toxoid epitopes.

    Vaccinated mice developed measurable antibodies against NGF and showed reversed pain behavior. ADAM metallopeptidase domain 12 (ADAM12) and GLI family zinc finger 1 (GLI1) levels are associated with fibrosis. Lentiviral vectors that encode these proteins decrease fibrotic activity in mice.

    Proprotein convertase subtilisin/kexin type 9 (PCSK9) can treat fibrosis. PCSK9Qβ-003, an epitope peptide, enhanced kidney fibrosis, and increased fatty acid beta-oxidation-associated variables among Ldlr+/− murine animals. The vaccine can treat kidney fibrosis, hypercholesterolemia, and atherosclerosis.

    Conclusions

    Based on the review findings, senescent cells play a significant role in age-related chronic disorders and demonstrate immunogenicity, making them candidates for targeted vaccine elimination.

    However, vaccinations can cause adverse effects such as injection site redness, discomfort, fever, and headaches. Continuous evaluation of vaccination safety is required to comprehend long-term adverse effects.  

    Vaccines targeting key mediators in age-related disorders have seldom proven efficacy in slowing disease development. Researchers must select antigens from key disease drivers or investigate epitopes generating robust immune responses to boost vaccination effectiveness.

    Combinatorial therapy incorporating vaccinations and immunomodulatory medications may be more effective.

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  • Is spousal cardiovascular disease associated with an increased risk for depression?

    Is spousal cardiovascular disease associated with an increased risk for depression?

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    Cardiovascular disease (CVD) is among the leading causes of illness and death in the current age. While CVD has long been linked to the onset of depression, not much is known about whether the spouses of those affected are more likely to become depressed after such events.

    A study recently published in JAMA Network Open explored this topic, laying the foundation for future prospective studies in this field.

    Study: Depression Onset After a Spouse’s Cardiovascular Event. Image Credit: Chay_Tee/Shutterstock.comStudy: Depression Onset After a Spouse’s Cardiovascular Event. Image Credit: Chay_Tee/Shutterstock.com

    Depression and health

    Depression has become 65% more prevalent, and it stands as the predominant mental health disorder worldwide, not only diminishing quality of life but also adversely affecting overall health.

    Depression is associated with a higher risk of CVD, dementia, poor cognition, and death.

    How is CVD linked to depression?

    CVD and depression are both more common in people who are obese, and both share inflammation in the immune system. When someone suffers a CVD event such as a stroke or a heart attack, the family also suffers from mental stress, anxiety, and even depression.

    The current study was designed to explore the association between CVD and depression at the household level. The data came from a national database maintained by the Japan Health Insurance Association (JHIA).

    This included about 40% of the Japanese working-age population or 30 million individuals in this age group.

    What did the study show?

    The researchers found that among nearly 278,000 married couples matched for important characteristics, the vast majority (95%) reported a CVD-related event in the male partner. The mean age of the patients was 58 years.

    Those whose spouses had a CVD event were more likely to be diabetic, hypertensive, or depressed compared to the other group. The spousal group had an increased cumulative incidence of depression, between 4% to 5% for males and females, respectively.

    For spouses between 20 and 59 years, about 4% of spouses became depressed vs 3% of those aged 60 years or more.

    New-onset depression was observed in nearly 2% of individuals. Spousal risk for depression after a CVD was 13% higher than in the group without such an event.

    This did not show any change by age, sex, income, or a previous CVD history.

    However, depression risk was higher by 13% to 15% after spousal stroke or heart failure, but not after a heart attack.

    Other potentially confounding factors included smoking, drinking, exercise, or whether the index patient was using drugs to reduce blood pressure. None of these showed any impact on the risk of depression in the spouse, however.

    The researchers also checked for the possible interaction of these results with the spouse’s health status.

    They examined the body mass index (BMI), blood pressure, cholesterol levels, blood sugar concentrations, and kidney function. They found that the same increased risk was manifested after controlling for these factors.

    The study corroborates the depressive effect of a spousal CVD event, which could involve a need to be a caregiver for the sick spouse.

    This could mean inevitable lifestyle alterations, lack of other social interactions, sleep disruptions, and lack of exercise. All these are associated with chronic mental stress, which increases with the level and duration of caregiving.

    Financial problems due to the forced loss of employment to manage the spouse’s needs, with additional caregiving-related costs, are another source of stress.

    Finally, grief at the loss of a spouse or distress related to the stay of the loved one in the intensive care unit may trigger depression.

    Conclusions

    “These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.”

    By paying attention to possible confounders such as a history of other diseases, individual practice of healthy habits, and physical health parameters, the study fills a knowledge gap and provides stronger evidence.

    Community-level and multidisciplinary clinical support systems should be studied as a possible intervention to reduce this risk for spouses of CVD patients through a wide-spectrum preventive care approach.

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  • Exercise shown to curb appetite in diabetes and prediabetes patients

    Exercise shown to curb appetite in diabetes and prediabetes patients

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    In a recent study published in the journal Nutrients, researchers evaluated the effects of exercise on appetite in people with type 2 diabetes mellitus (T2DM) or prediabetes.

    The global prevalence of T2DM and prediabetes has been steadily growing, with about 537 million people living with diabetes in 2021, compared to 108 million in 1980. Obesity and overweight are major risk factors for diabetes, and weight reduction reduces the risk of diabetes. Therefore, a normal body weight is essential for diabetes prevention and treatment.

    Lifestyle interventions and greater physical activity are preferred options for T2DM treatment and prevention. The impact of exercise on energy balance, appetite, and body weight has been studied less in T2DM or prediabetes patients. Thus, a better understanding of the effects of exercise on appetite and its regulation in prediabetes or T2DM patients may improve existing exercise recommendations.

    Study: The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Image Credit: Benedek Alpar / ShutterstockStudy: The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Image Credit: Benedek Alpar / Shutterstock

    About the study

    The present study evaluated how acute and chronic exercise affects appetite and its regulation in T2DM or prediabetes patients. Studies were eligible if they incorporated a bout of acute physical activity or physical training intervention, reported appetite sensation ratings, and compared exercise and non-exercise groups, different exercise regimes, or participants with and without T2DM or prediabetes following the same intervention.

    The Cochrane Central Register of Controlled Trials (CINAHL), PubMed, and Web of Science databases were searched for studies. References from included studies were also explored to identify additional studies. Following deduplication, titles/abstracts were screened, and full texts were reviewed.

    The following data were extracted: sample size, participants’ age, sex, body mass index (BMI), exercise details, dietary regimens, study duration, medications, appetite ratings, adverse events, and appetite ratings. The risk of bias was assessed using the physiotherapy evidence database scale. The team performed a narrative synthesis of the results.

    Findings

    Of over 4,000 records identified in database searches, seven studies were included. They were published between 2013 and 23 and included 211 participants. Of these, 183 participants were diagnosed with T2DM and 28 with prediabetes. Two studies examined the effects of chronic exercise on appetite, four evaluated acute exercise, and one investigated both. The quality of evidence for chronic and acute interventions was rated as good.

    For assessments of satiety, nausea, hunger, and prospective food consumption, the directions of effects were relatively congruent in acute intervention studies. No study showed a simultaneous increase in satiety and hunger; thus, individual rating scales could be translated into a general trend of appetite. After acute endurance exercise, there was either appetite suppression or no effect for up to 180 minutes following the session.

    Two studies measured appetite ratings a day after exercise, and one observed an increase in appetite. Further, two studies investigated resistance exercise; one reported an acute increase in appetite with resistance exercise, whereas the other reported suppressive effects at some time points. In addition, the former study reexamined the acute effects after 12 weeks of training; the results remained unchanged, with no chronic changes in appetite ratings.

    Besides, there were no significant changes in appetite hormone levels in the two studies, albeit the feeling of fullness increased at some time points. Likewise, appetite ratings declined, or there was no change following chronic exercise. In a chronic intervention study with 108 participants, satiety increased while hunger decreased in the aerobic endurance and resistance training plus aerobic endurance exercise groups.

    In the endurance training group, pre-meal satiety increased; in the combined training group, pre- and post-meal satiety increased after six months. Notably, chronic effects on appetite ratings were inconsistent with changes in appetite hormones. Two acute intervention studies compared participants with and without T2DM.

    In one study, there were no differences in appetite ratings between T2DM and non-T2DM groups following exercise. In the other, there were differences in desire to eat and fullness between T2DM and non-T2DM subjects. Further, postprandial fullness declined a day after exercise only in T2DM subjects. No study explicitly reported adverse events.

    Conclusions

    The study observed that the effects on appetite varied in people with T2DM or prediabetes following acute exercise, whereas appetite ratings declined or were unchanged after chronic exercise. In acute intervention studies, the most consistent finding was increased perceived fullness in T2DM patients after exercise. Overall, the findings provide more evidence for the appetite-reducing effect of (chronic) exercise in prediabetes or T2DM subjects.

    Journal reference:

    • Konitz C, Schwensfeier L, Predel HG, Brinkmann C. The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus—A Systematic Review. Nutrients, 2024, DOI: 10.3390/nu16081126, https://www.mdpi.com/2072-6643/16/8/1126

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  • Study shows exercise can reverse age-related lipid accumulation

    Study shows exercise can reverse age-related lipid accumulation

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    Scientists have discovered that a type of fat accumulates as tissue ages and that this accumulation can be reversed through exercise. Researchers from Amsterdam UMC, together with colleagues from Maastricht UMC+, analyzed both mice and human tissue before and after exercise allowing them to draw this conclusion. The results are published today in Nature Aging. 

    The idea that we could reverse aging is something that was long considered science fiction, but these findings do allow us to understand a lot more about the aging process.”


    Riekelt Houtkooper, Professor at the laboratory Genetic Metabolic Diseases of Amsterdam UMC

    “Everyone says that ‘it’s just part of getting older,’ but this doesn’t actually have to be true. By understanding more about the aging process, we can also look into new ways of intervening,” says Georges Janssens, first author of the paper and assistant professor at Amsterdam UMC. 

    In recent years, laboratory research has shown that we may be able to counteract age-related diseases by intervening in the fundamental processes that lead to aging. Although science has increasingly mapped out how metabolism changes during aging, large parts remained uncharted. “We wanted to add a new chapter to the atlas. Lipids are an important part of our diet, and crucial for the functioning of our body cells. Specific lipids make up the membrane of cells, which ensures that the inside and outside remain separate,” says Houtkooper.

    In order to add this new chapter, the research team investigated how the composition of fats changes in mice. They looked at ten different tissues, including muscles, kidneys, liver and heart. It was noticed that one type of lipid, the bis(monoacylglycero)phosphates (or BMPs), were elevated in all tissues from the older animals. Suggesting an accumulation of these lipids during aging. They then investigated whether this also happens in humans. Although it was not possible to obtain as many different tissues, the accumulation of BMP was also visible in muscle biopsies of older people. Finally, they then completed more muscle biopsies from people before and after a healthy intervention that included one hour of exercise a day and saw the level of BMPs decreased in the active participants. 

    “These results are an important new step for our understanding of the aging process, but they are certainly not the final answer. We plan to conduct follow-up studies to better understand how BMPs contribute to aging, what are the consequences of BMP accumulation on the aging process, and whether this can only be influenced by exercise or are the other ways to affect BMPs levels,” concludes Houtkooper. 

    Source:

     Amsterdam University Medical Center

    Journal reference:

    Janssens, G. E., et al. (2024). A conserved complex lipid signature marks human muscle aging and responds to short-term exercise. Nature Aging. doi.org/10.1038/s43587-024-00595-2.

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  • Exercise boosts beneficial hormone transfer in breastfeeding mothers

    Exercise boosts beneficial hormone transfer in breastfeeding mothers

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    Although women have breastfed since the beginning of time, there is very little scientific research on how exercise affects breast milk.

    Different online forums for pregnant women and new mothers are full of questions about this exact issue:

    Can exercise cause breast milk to go sour? What happens to breast milk if you do high-intensity interval training? Will strenuous exercise affect your milk supply?

    There are so many myths about exercise and breast milk. We simply need more knowledge.”

    Trine Moholdt, researcher, Norwegian University of Science and Technology (NTNU)

    She leads several international research projects on how exercise can prevent and treat lifestyle diseases.

    Limiting overweight in children

    Last year, Moholdt received NOK 23.5 million from the EU and NTNU to find out if breast milk is extra healthy for babies if mothers exercise.

    “The primary aim of our research is to find out if we can limit the development of overweight in children,” says Moholdt.

    In 2020, the World Health Organization estimated that 39 million children under the age of five were overweight or obese. They also found that the incidence of overweight and obesity among children and adolescents aged 5-19 rose from four per cent in 1975 to 18 per cent in 2018.

    Research shows that one possible contributing factor in the rapid rise in obesity in children is that nutrition during the early phase of life partially determines your health later in life.

    “In fact, the period from conception to two years of age is considered the most critical period for possible development of obesity later in life,” says Moholdt.

    Important hormone

    20 new mothers have given 240 samples of breast milk. The samples were taken before and at specific times after two exercise sessions, and then compared with the corresponding times after the participants had been more sedentary.

    The first piece of the puzzle is ready, and it concerns a hormone called adiponectin.

    This hormone regulates the body’s metabolism to ensure a supply of energy and substances that the body needs to function.

    It is probable that this hormone is absorbed through the intestines of breastfeeding babies, thus changing how their metabolism functions.

    Having low levels of this hormone is associated with insulin resistance and type 2 diabetes.

    Good for the child

    Moholdt’s study shows that mothers who did high-intensity interval training had higher levels of this hormone in their breast milk after their exercise session.

    It is the first time that someone has investigated the effect exercise has on this hormone in breast milk.

    “The hormone is secreted from fatty tissue and enters the bloodstream, and much of what is in the blood goes into the milk. We were not that surprised by the findings, but now we know for certain,” says Moholdt.

    Intense exercise gives the best effect

    The study shows that moderately intense exercise did not have the same effect on this particular hormone.

    “Intense exercise led to a higher response. In my opinion, new mothers don’t have to worry about lactic acid in their breast milk. There is no research suggesting that this is unfortunate, and lactic acid is energy-rich,” says Moholdt.

    One of the reasons why the WHO recommends breastfeeding during the first six months of life is that breast-fed children are less likely to be overweight and obese than formula-fed children. However, new research shows that the composition of breast milk varies between mothers who have high and low body mass indexes, and that differences in breast milk composition can play a role in the transfer of obesity from mother to child.

    “We now have the first result of all the work we are doing, and many more results are on the way. It will be very exciting going forward,” says Moholdt.

    Source:

    The Norwegian University of Science and Technology (NTNU)

    Journal reference:

    Holmen, M., et al. (2023). High-intensity exercise increases breast milk adiponectin concentrations: a randomised cross-over study. Frontiers in Nutrition. doi.org/10.3389/fnut.2023.1275508.

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  • New study reveals lifestyle factors boosting IVF success

    New study reveals lifestyle factors boosting IVF success

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    In a recent study published in the journal Frontiers in Endocrinology, researchers examined how lifestyle factors and fertility-specific quality of life (QOL) influence the outcomes of assisted reproductive technology (ART) treatments.

    Study: Lifestyle and fertility-specific quality of life affect reproductive outcomes in couples undergoing in vitro fertilization. Image Credit: Corona Borealis Studio / ShutterstockStudy: Lifestyle and fertility-specific quality of life affect reproductive outcomes in couples undergoing in vitro fertilization. Image Credit: Corona Borealis Studio / Shutterstock

    Background 

    Infertility impacts around 48.5 million couples worldwide, leading to an increase in ART treatments, with 2.5-3 million cycles annually and nearly 450,000 in Japan alone. With 1 in every 13.9 Japanese babies born via ART, the influence of factors like age, ovarian reserve, and lifestyle choices- including diet, smoking, exercise, and sleep- on treatment success is recognized. The World Health Organization (WHO) highlights the need to assess QOL, including fertility-specific QOL, via tools like the Fertility Quality of Life tool (FertiQoL). The relationship between fertility-specific QOL and ART outcomes, however, requires further research to understand their complex interactions better.

    About the study 

    The present study focused on infertile couples undergoing their first in vitro fertilization (IVF) treatment in Japan, selecting participants based on specific health and demographic criteria. At the outset, participants detailed their dietary habits, modeled after the Mediterranean diet but tailored to Japanese preferences, and lifestyle choices, including sleep patterns, work habits, computer usage, smoking status, and physical activity, measured by metabolic equivalent tasks (METs). Additionally, the fertility-specific quality of life was assessed using the Japanese version of the FertiQoL questionnaire, exploring its influence on treatment outcomes.

    The study outlined the protocols for controlled ovarian stimulation, laboratory procedures, and embryo transfer (ET), including medication dosages and administration schedules based on individual patient profiles. The selection of good-quality blastocysts for transfer was based on the Gardner classification, with a wash-out period required between stimulation and ET. Outcomes of the IVF/intracytoplasmic sperm injection (ICSI) were precisely recorded, from hormone levels to the rates of fertilization, embryo development, and pregnancy confirmation via serum Human Chorionic Gonadotropin (hCG) test and transvaginal ultrasound for gestational sac (GS) detection.

    Statistical analysis aimed to explore the relationship between patient background, dietary and exercise habits, FertiQoL scores, and IVF outcomes, using a multivariable approach to identify significant factors. The study attempted to recruit 286 patients to detect a clinically relevant difference in the primary outcome, the good-quality blastocyst rate, with comprehensive statistical analysis performed using SAS software.

    Study results 

    Between May 2019 and March 2022, 291 women seeking their first IVF treatment at clinics within the IVF Japan Group and the University of Tokyo Hospital were initially considered for the study. After excluding those who discontinued treatment, became pregnant spontaneously, or met exclusion criteria, 281 women proceeded with controlled ovarian stimulation and oocyte retrieval. Various reasons, including lack of fertilization, absence of good-quality embryos, and loss of follow-up, further narrowed the participants to 260 who underwent ET, with 200 undergoing single blastocyst embryo transfers (blast-SETs). Of these, 139 women showed positive hCG levels, indicating pregnancy, and in 121 women, a single GS was detected without instances of multiple GSs.

    The study examined the rate of good-quality blastocysts per oocyte retrieval, revealing that women over 36 years old or those with Hashimoto’s disease had significantly lower rates, while frequent fish consumption was also tentatively linked to lower rates. Analysis of all ET cycles showed that older women had lower chances of a positive pregnancy test. In contrast, adequate sleep, computer use, and non-smoking partners were associated with higher chances. GS detection post-ET was more likely with the use of olive oil, more prolonged computer use, and a body mass index (BMI) of 20.8  kg/m2 or higher, with older age decreasing the likelihood.

    Explicitly focusing on blast-SET cycles, computer use for four or more hours a day significantly improved the chances of a positive pregnancy test and GS detection. Older age tended to decrease the likelihood of a positive pregnancy test, while a higher FertiQoL Total scaled treatment score and a certain BMI threshold appeared to favor GS detection, however, with a trend towards significance rather than definitive proof.

    Conclusions 

    To summarize, the study explored the effects of lifestyle, dietary habits, and fertility-specific QoL on ART outcomes among Eastern Asian women. Key findings include the negative impacts of advanced age and Hashimoto’s disease on blastocyst quality and positive associations between adequate sleep, computer use, and pregnancy success. Olive oil consumption emerged as beneficial for gestational sac detection, challenging assumptions about dietary impacts on fertility. Notably, male smoking negatively affected outcomes, highlighting the importance of lifestyle factors in reproductive success. 

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  • How incentives and games encourage exercise

    How incentives and games encourage exercise

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    In a recent study published in the journal Circulation, researchers evaluated the effects of gamification and financial incentives on physical activity in individuals at risk of adverse cardiovascular events.

    Higher physical activity is associated with a lower risk of adverse cardiovascular events and improved control of cardiovascular risk factors. By leveraging behavioral economic concepts, such as loss-framing, immediacy, and endowment effects, shorter-term analyses have implemented financial incentives and gamification interventions and observed increased physical activity in patients at risk of or with atherosclerotic cardiovascular disease (ASCVD). Nevertheless, the effect of these interventions over the long term remains unclear.

    Study: Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial. Image Credit: Alliance Images / ShutterstockStudy: Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial. Image Credit: Alliance Images / Shutterstock

    About the study

    In the present study, researchers evaluated the efficacy of financial incentives, gamification, or both to improve physical activity over the long term in individuals at risk of major cardiovascular events. This randomized controlled trial was conducted between May 2019 and January 2024. Eligible participants had ASCVD or a 10-year risk of stroke, myocardial infarction, or cardiovascular death.

    Eligible subjects received a wearable device to track their step count. During the two-week run-in period, a baseline step count was established. Subsequently, participants were instructed to set a goal to increase their step count relative to baseline. Next, participants were randomized to attention control, financial incentives, gamification, or financial incentives plus gamification (combination).

    The control group received text messages daily for 18 months, inquiring if they had achieved their step goal the previous day. In the gamification arm, participants signed a pre-commitment pledge to reach their step goal. They received 70 points at the beginning of each week. Points were retained if they succeeded in their daily goal; otherwise, 10 points were removed.

    Their levels, viz., platinum, gold, silver, bronze, and blue, changed based on points at the end of the week. All participants began at the silver level; blue- or bronze-level participants were restarted at the silver level every eight weeks. Gold- or platinum-level participants were awarded a trophy after the intervention.

    On the other hand, the financial incentives group was informed that $14 would be deposited in a virtual account each week. The balance did not change if the goal was achieved; otherwise, $2 was deducted. In the combination arm, participants completed interventions from both arms. After 12 months, interventions were discontinued; however, daily text messages recording the count continued for six additional months (follow-up).

    The primary outcome was the change in daily step count from baseline to the end of the intervention. Secondary outcomes were the average changes in daily step count from baseline to follow-up, weekly moderate-to-vigorous physical activity (MVPA) minutes, and the proportion of participant weeks with at least 150 MVPA minutes.

    Findings

    Overall, 151, 304, 302, and 304 individuals were randomized to control, gamification, financial incentives, and combination arms, respectively. The average age of participants was 66.7 years; 60.5% were female, and 25% were Black. At baseline, the average daily step count was 5081, mean MVPA minutes were 5.8, and the average step count increase was 1867.

    In total, 89.8% of participants completed the 18-month study. The control, financial incentives, gamification, and combination groups achieved a mean increase of 1418, 1915, 1954, and 2297 steps from baseline to the intervention period, respectively. The corresponding figures over the follow-up period were 1245, 1576, 1708, and 1831, respectively.

    Over the 12-month intervention, compared to the control arm, participants had a greater increase in average daily step count. The combination arm was superior to financial incentives during the intervention period. Weekly MVPA increased by 39.6, 56.6, 54.7, and 65.4 minutes, on average, for control, financial incentives, gamification, and combination arms from baseline to intervention.

    Over the follow-up period, weekly MVPA minutes increased by 37.3 for control, 50.7 for gamification, 50.9 for financial incentives, and 57.6 for combination groups. The proportion of participant weeks with at least 150 MVPA minutes was 0.16, 0.24, 0.23, and 0.27 for control, financial incentives, gamification, and combination arms, respectively. The combination group had greater odds of a week with at least 150 minutes of MVPA.

    Conclusions

    Taken together, interventions with financial incentives, gamification, or both significantly improved physical activity in adults at risk of cardiovascular events compared to attention control over the 12-month intervention. This effect was sustained over the six-month follow-up period after the end of the intervention in the combination group. The combination group also increased weekly MVPA minutes more than the control group. These interventions could be helpful components of strategies aimed at alleviating cardiovascular risks.

    Journal reference:

    • Fanaroff AC, Patel MS, Chokshi N, et al. Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial. Circulation, 2024, DOI: 10.1161/CIRCULATIONAHA.124.069531, https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069531

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  • Consistent walking improves brain function in older adults

    Consistent walking improves brain function in older adults

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    In a recent study published in the journal Scientific Reports, researchers explored how changes in daily step counts and variability affect cognitive function in older adults during a 10-week physical activity intervention.

    Study: Association between changes in habitual stepping activity and cognition in older adults. Image Credit: SibRapid / ShutterstockStudy: Association between changes in habitual stepping activity and cognition in older adults. Image Credit: SibRapid / Shutterstock

    Background 

    Aging often leads to cognitive decline, particularly in executive functions and inhibitory control, which are early indicators of conditions like Alzheimer’s disease. Engaging in regular physical activity can reduce or even reverse these declines in older adults. As the population ages, identifying strategies to preserve cognitive function becomes crucial. While structured exercise in controlled settings has been linked to cognitive health, the effects of habitual, daily physical activity on cognition remain underexplored. Further research is needed to clarify the mechanisms linking physical activity patterns to cognitive improvements and to establish customized intervention strategies for diverse aging populations.

    About the study 

    In the present study, 43 older adults were recruited, with 37 completing due to incomplete stepping data. Participants were over 55, able to walk independently, cognitively healthy, and free from significant health issues, though some were on medication. They engaged in a 10-week intervention focused on improving cognitive function through group aerobic and resistance activities, aligning with a dynamic socio-ecological model. Participants committed to a minimum of 150 minutes of moderate-to-vigorous activity weekly, with adherence verified by activity logs.

    Activity was monitored with Fitbit devices, requiring consistent wear for accurate step count and variability data. Step count validity and variability (using average real variability, ARV) were assessed, focusing on the day-to-day differences in activity levels.

    Physical and cognitive assessments pre- and post-intervention included heart rate, blood pressure, body mass index, a six-minute walk test for aerobic fitness, and a computerized Stroop task for cognitive function. The Stroop task evaluated processing speed, inhibitory control, and cognitive flexibility through different stages, with high accuracy and reaction times recorded.

    Data analysis, adhering to normality checks and parametric statistics, modeled step counts and variability non-linearly, assessing changes in physical and cognitive measures via paired t-tests and Analysis of Covariance (ANCOVA), and adjusting for demographic factors. Regression analyses explored the relationship between activity changes and cognitive performance, with statistical significance set at p < 0.05.

    Study results 

    In this study, the majority of participants were female (33 out of 37), and all demonstrated cognitive health with Mini-Mental State Examination (MMSE) scores exceeding 24. Following the intervention, a significant reduction in body mass and body mass index was observed alongside an increase in distance covered during the six-minute walk test (6MWT), indicating physical improvements (all, p < 0.001).

    Analysis of stepping data revealed that total step counts increased and day-to-day step variability decreased over the course of the 10-week intervention. These changes were most pronounced at the start and end of the period, with the data fitting best to a cubic model, signifying a non-linear relationship in both total steps taken and in the variability of these steps from day to day. The intervention increased overall physical activity levels, as evidenced by higher step counts while promoting more consistent activity patterns among participants, as shown by reduced variability in day-to-day step counts.

    Cognitive outcomes measured through a computerized Stroop task before and after the intervention revealed notable improvements. Specifically, reaction times during the simple naming condition were faster post-intervention, indicating enhanced processing speed. Although the inhibition condition did not significantly improve, the switching condition, which tests cognitive flexibility and is considered the most challenging, exhibited faster completion times post-intervention. 

    When examining the relationship between changes in physical activity and cognitive performance, the study found no significant association between the increase in total step counts and improvements in reaction time for any of the Stroop task conditions (naming, inhibition, and switching). However, a significant positive association was observed between reductions in day-to-day step variability and faster reaction times in the switching condition. 

    Conclusions 

    To summarize, this study confirmed that stabilizing daily step variability, rather than increasing total step count, led to faster reaction times in the Switching task of the Stroop test, indicating improved cognitive flexibility in older adults. This suggests promoting consistent daily physical activity as a potential strategy for enhancing executive function. The Stroop task showed that such cognitive flexibility improvements could significantly lower the risk of cognitive disorders. The findings challenge current physical activity guidelines by suggesting that daily consistency, alongside a high number of steps, may better support cognitive health in older adults. This personalized physical activity intervention increased average step counts, reduced variability, and enhanced cognitive flexibility, indicating its potential as a model for encouraging consistent daily activity among older adults. 

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  • Type 2 diabetes patients’ willingness to engage varies

    Type 2 diabetes patients’ willingness to engage varies

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    Type 2 diabetes (T2D) may occur as a result of unhealthy lifestyle habits. People with T2D are often associated with diets with excessive sugar, high alcohol consumption, smoking, and have sedentary habits.

    This has sparked much interest in determining the optimal lifestyle changes that could help normalize dysfunctional metabolic pathways in T2D patients.

    A recent study in Primary Care Diabetes explores the willingness to engage in various management options for T2D among recently diagnosed patients.

    Study: Willingness of people with type 2 diabetes to engage in healthy eating, physical activity and medication taking. Image Credit: urbans/Shutterstock.comStudy: Willingness of people with type 2 diabetes to engage in healthy eating, physical activity and medication taking. Image Credit: urbans/Shutterstock.com

    Healthy lifestyle in T2D

    Obesity characterizes most T2D patients. As such, most of them show a reduction in their glycated haemoglobin A1c (HbA1c) 0.6–1.2% if they lose 5% or more of their body weight. If this fails to restore glucose levels to normal, medication is initiated, usually metformin, as the first step.

    Lifestyle adjustments are key to managing T2D. However, not much is known about how possible it is to achieve these changes. Earlier research revealed that there are several types of barriers to adopting healthy lifestyle habits.

    These include beliefs that lifestyle modification is not worthwhile or that medication works just as well or better while being easier to implement. Poverty, ignorance, and lack of adequate support also pose barriers.

    The current study aimed to evaluate the level of willingness among recently diagnosed T2D patients towards three types of modifications comprising healthy diet, adequate physical exercise, and proper use of medications.

    About the study

    The researchers used an online survey to assess patient factors among recently diagnosed type 2 diabetes patients living in either the Netherlands or in the UK.

    The mean age was 57 years, over half were on metformin as part of T2D treatment, and one in three lived in the UK.

    What did the study show?

    There were 67 patients included in the survey. About half of them reported their willingness to use any of the three management options, in contrast to 6% who rejected all three.

    A healthy diet was an acceptable option for three out of four of the participants. The same proportion was willing to perform physical exercise and medication, respectively.

    People who were more willing to exercise or take medications were more likely to have a higher combined score for all three areas: their capability, opportunity, and motivation to make lifestyle changes.

    Factors like educational level, body mass index (BMI), smoking or drinking, eating habits, or exercise levels, were not found to be independently associated with willingness to change lifestyle patterns.

    Diet

    Patients in the Netherlands were significantly more favorable towards the adoption of a healthy diet. UK patients often thought poorly of the recommended diets.

    A doctor’s recommendation was more often found to underpin those patients who showed greater willingness to eat healthy compared with the other group.

    Interestingly, both willing and unwilling groups believed in the effectiveness of a healthy diet in managing weight and blood glucose levels, as well as similar hindrances vs. facilitating factors.

    Healthy eating was often opposed by beliefs that the recommended diet was not suitable for the patient, usually because they had other illnesses as well.

    Thus,  individual beliefs about what comprises a healthy diet must be specifically asked for and addressed when prescribing such an approach.

    Exercise

    Especially with respect to exercising, people who were ready to take it up believed it was a feasible option compared to those who were unwilling. The former also perceived more positive outcomes compared to the latter.  

    Barriers like poor motivation and the difficulty of exercising in hot surroundings and sticking to it when away from home were more likely to be unwilling to exercise.

    Those who expressed willingness to exercise were more likely to have companions and to find it easier, as well as feeling better while exercising.

    Both groups showed the same beliefs regarding the efficacy of exercise in managing T2D and in overall health and weight management.

    Medication

    People willing to take medication were more likely to believe that medication helps reduce blood glucose and to have acquaintances who were helped by medication.

    Conversely, unwillingness was associated with beliefs that without a reminder, medication intake would be low or that there were significant side effects.

    Conclusions

    People who have recently been diagnosed with type 2 diabetes are often encouraged to change lifestyle habits, including their eating patterns and physical activity, and to begin medication.

    The vast majority are willing to use any of these options to manage their condition. This may be in part because they have not had time to experience any negative outcomes of these management choices.  

    Only half of the patients were willing to use all three approaches to manage their diabetes.

    “Most of the recently diagnosed patients not willing to manage T2D with medication were willing to engage in healthy eating or physical activity. Nonetheless, a substantial proportion was not willing to engage in both healthy eating and physical activity.”

    Compliance with healthy eating or exercise patterns does not seem to be influenced by their beliefs about the available management options.

    Country-wise variability was observed in the degree of willingness to follow dietary recommendations.

    The presence of obstacles, irrespective of willingness to use one or more approaches indicates that “willingness to engage in something does not guarantee successful implementation and tailored support should be part of personalized diabetes care.”

    This is shown to be essential for helping T2D patients achieve good diabetic control, beginning with the approach most agreeable to the patient.

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