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Tag: Exercise

  • Women gain more health benefits from exercise than men

    Women gain more health benefits from exercise than men

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    In a recent study published in the Journal of the American College of Cardiology, researchers investigated the sex-specific all-cause and cardiovascular mortality risk reductions derived from physical activity. They used a large (n = 412,313) cohort American cohort to identify this association and found that women derived greater benefits than their male counterparts from equivalent amounts of physical activity.

    Historically, however, women have generally lagged men in exercise engagement. These findings may help inform clinicians and the health-minded of the advantages of physical exercise in combatting chronic cardiovascular disease (CVD) and bridge observed “gender gaps” by encouraging women to take up leisure-time physical activity.

    Study: Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality.

    Study: Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality.

    The gender gap and what this means for sex-specific cardiac health

    Cardiovascular mortality remains one of the leading causes of global human loss of life, alarmingly a likely underestimation when considering that cardiovascular disease (CVD) is a commonly reported comorbidity in numerous non-transmissible and transmissible pathologies. Decades of research have revealed that physical activity (PA) can substantially reduce all-cause and cardiovascular mortality, but records reveal that public involvement in leisure time PA is sorely lacking.

    In the United States of America (US) alone, fewer than 25% of citizens meet the minimum PA recommendations of 150 min/wk. of moderate PA or 75 min/wk. of vigorous PA prescribed by the US Centers for Disease Control and Prevention (CDC) and the American College of Cardiology. Significant inter-sex differences in PA engagement further skew these already suboptimal observations – a substantially larger proportion of men are known to engage in leisuretime PA than women, which, when combined with differences in physiological responses, exercise capacities, and activity tolerances between the sexes, might result in significantly different mortality outcomes between these cohorts.

    Unfortunately, the empirical outcomes of these “gender gaps” between men and women have never been tested within a scientific framework, denying clinicians, policymakers, and the health conscious of the information they need to optimize PA-related outcomes. Understanding the role of sex in these associations would allow for improved guidelines aimed at bridging the gender gap, fostering increased female PA engagement, and reducing overall mortality risk.

    About the study

    In the present study, researchers aimed to elucidate if PA-derived health benefits differ depending on the sex of the PA-engaging individual. Their cohort was derived from the National Health Interview Survey (NHIS), a large-scale collaboratory effort carried out by the CDC and the National Center for Health Statistics. Established in 1957, the NHIS is a prospective cohort maintaining health records of Americans across 50 states and the District of Columbia, representing a proxy for America’s health.

    The current study used participant data from 1997 to 2017 and was initially comprised of 646,279 individuals. Excluding participants with severe cardiovascular conditions (e.g., coronary heart disease), cancers, or missing demographic or medical data resulted in a final cohort of 412,413 adults. Data collection included demographic and medical information (from the NHIS database) and a consistent, standardized questionnaire for PA frequency, duration, and type assessment, presented at both baseline and follow-up evaluations.

    Cox proportional hazard regression models corrected from demographic and clinical covariates were used to assess primary outcomes. Likelihood ratio tests were used to compute sex-specific differences in outcome estimates.

    Study findings

    Demographic data collation revealed that 54.7% of included participants were women, more than 68% of whom were of White ethnicity. The average age of the study cohort was 43.9 years, and the study collected a total of 4,911,178 person-years of follow-up data. During the course of the study, 39,935 participants died from all causes, 11,670 of which were cardiovascular.

    Previously observed discrepancies in sex-specific PA engagement were validated in this study, with only 32.5% of women engaging in weekly aerobic PA compared to 43.1% of male participants. Every PA metric measured in the survey revealed greater male engagement than female, with 15.2% of men achieving the prescription weekly PA goal of 150 min/wk. In contrast, only 10.3% of women met this goal.

    However, hazard analyses present that the few women who do engage in physical activity derive far greater relative health benefits than their male counterparts. Compared to inactivity, female PA engagement results in a 24% risk reduction (all-cause mortality), while equivalent PA engagement in men only decreased their mortality risk by 15%.

    “In dose-dependent analyses for the entire cohort, the benefit of PA on all-cause mortality peaked at ∼300 min/wk of MVPA and then plateaued. The greatest mortality benefit in men was achieved at 300 min/wk of MVPA with an 18% lower hazard in all-cause mortality. Women derived a similar magnitude of benefit at 140 min/wk of MVPA, and continued to benefit with increasing min/wk of MVPA until the greatest benefit of 24% lower hazard (HR: 0.76; 95% CI: 0.72-0.80) was achieved at ∼300 min/wk.”

    While these findings do require validation in non-American cohorts, where observed results, especially those pertaining to engagement, might vary drastically from those observed herein, this study highlights the profound benefits of PA engagement for both sexes and may play a crucial role in motivating traditionally hesitant women to take up these activities given the health rewards they provide.

    Journal reference:

    • Ji, H., Gulati, M., Huang, T. Y., Kwan, A. C., Ouyang, D., Ebinger, J. E., Casaletto, K., Moreau, K. L., Skali, H., & Cheng, S. (2024). Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality. Journal of the American College of Cardiology, 83(8), 783-793, DOI – 10.1016/j.jacc.2023.12.019,  https://www.sciencedirect.com/science/article/pii/S0735109723083134?via%3Dihub

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  • High-intensity exercise affects motor skill learning in older adults

    High-intensity exercise affects motor skill learning in older adults

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    In a recent study published in the journal NPJ Science of Learning, researchers investigated the impacts of high-intensity interval training (HIIT) on the subsequent motor skill acquisition efficiency in older adults. They conducted visual isometric pinch task (SVIPT) assays on a cohort of 24 adults aged 55 to 75 years and found that, while HIIT improves the early offline consolidation of novel motor skills, their acquisition of these skills was not benefitted, and at times even negatively impacted, contrasting previous findings. These findings provide valuable insights for experts involved in exercise-assisted motor learning, especially in older populations.

    Study: High-intensity acute exercise impacts motor learning in healthy older adults. Image Credit: Air Images / ShutterstockStudy: High-intensity acute exercise impacts motor learning in healthy older adults. Image Credit: Air Images / Shutterstock

    The link between exercise and motor skills

    One of the most crucial aspects of routine daily functioning is motor learning, the acquisition and familiarization (gradual improvements in efficiency) of novel motor tasks. Previous research has categorized this process into two interrelated steps: the online learning of a new skill, which encapsulates repletion-aided efficiency improvements over time, and the offline consolidation period, during which the skill is encoded into memory.

    Studies comparing age-relative motor learning capacities between younger and older cohorts suggest that while younger individuals learn simple tasks at approximately the same online pace as their older counterparts, their capacity for acquiring complex or cognitively demanding skills far outweighs those of the older populations. Experiments investigating the consolidation potential of individuals reveal similar findings, with younger individuals observed to have better retention test performances and be less susceptible to retention interference than older individuals.

    Recent research indicates that exercise may play a crucial role in memory and motor skill acquisition and learning, with evidence available for both online and offline learning benefits. However, while few studies have found positive associations between acute cardiorespiratory exercise and motor learning and performance, most of the literature elucidates the offline consolidation benefits of this and other high-intensity interval training (HIIT) regimes. Some studies further hypothesize that exercise may improve cognitive and motor function outcomes in chronic diseases like Parkinson’s and Huntington’s.

    Unfortunately, while these findings have been extensively validated in younger cohorts, evidence from senior citizens remains lacking. Acute exercise’s potential benefits mainly, remain unexplored. Verifying these benefits and elucidating the mechanisms governing them may result in the development of novel interventions aimed at delaying cognitive and motor-function decline among the world’s growing aged population.  

    “In older adults, greater cardiorespiratory fitness and increased engagement in leisure activities are associated with better motor sequence learning and greater capacity to induce plasticity in the motor cortex. However, a single bout of exercise may be more accessible compared to longer exercise interventions for older adults, who face increased barriers to exercise.”

    About the study

    In the present study, researchers used the sequential visual isometric pinch task (SVIPT) to evaluate the associations between acute exercise and motor learning in an elderly cohort comprising 24 participants between 55 and 75 years old. The SVIPT test evaluates both explicit and implicit motor learning stages, making it ideal for these investigations. The study employed a between-group study design, with each included participant randomly assigned to a case (exercise) or control (active rest) cohort.

    a Overview of testing schedule. An incremental exercise test was conducted at least 48 hours before subsequent testing. Participants were randomised into Rest or Exercise conditions. Acquisition and retention of the motor task were completed on the same day with a 6 ± 1-hour delay between testing. b Depiction of SVIPT motor task adapted from Stavrinos & Coxon. In this version of the SVIPT, three motor sequences are presented in a pseudorandom order within each block of 12 trials. This is a more cognitively challenging version of the SVIPT that requires the trial-to-trial recall, planning, execution, and learning of multiple sequences.

    a Overview of testing schedule. An incremental exercise test was conducted at least 48 hours before subsequent testing. Participants were randomised into Rest or Exercise conditions. Acquisition and retention of the motor task were completed on the same day with a 6 ± 1-hour delay between testing. b Depiction of SVIPT motor task adapted from Stavrinos & Coxon. In this version of the SVIPT, three motor sequences are presented in a pseudorandom order within each block of 12 trials. This is a more cognitively challenging version of the SVIPT that requires the trial-to-trial recall, planning, execution, and learning of multiple sequences.

    Data collection comprised demographic and anthropometric records and medical assessments. Individuals with preexisting chronic conditions were excluded from analyses. Study interventions included a baseline cardiorespiratory fitness assessment (using a peak oxygen consumption [VO2 peak] during graded physical exercise), a subsequent 48-hour delay, and finally, an experimental session comprising 20 min of HIIT followed by SVIPT.

    The HIIT exercise was conducted using a Wattbike Atom stationary bicycle with a Polar H10 used for continuous heart rate monitoring. Baseline SVIPT readings were used to compute each participant’s unique maximum voluntary pinch contraction (MVC), which was incorporated as a standardizing variable in subsequent follow-ups.

    “Performance on the SVIPT was assessed by calculating a skill measure, with higher values reflecting a shift in the speed-accuracy trade-off function towards faster and more accurate task performance.”

    Independent sample t-tests and linear mixed models were used to evaluate between-cohort differences.

    Study findings

    Baseline between group comparisons revealed no statistically significant differences in case and control cohorts based on age, sex, physical activity level, body mass index (BMI), resting heart rate (HR), and, notably, retention test delay and force error. SVIPT performance assays revealed profound age- and block-related differences in motor tasks – younger individuals were observed to display improved motor learning during both active exercise and rest phases (online and offline) compared to older individuals.

    Furthermore, older individuals displayed improved resting retention performance following HIIT compared to control groups devoid of exercise. In contrast, acute exercise was observed to reduce online motor skill acquisition, with participants who partook in physical exercise performing worse than those who did not.

    Conclusions

    The present study aims to investigate the association between acute exercise and motor learning in older human populations. While validating hypotheses postulating the benefits of HIIT in promoting memory retention time and offline motor task consolidation, this study’s findings challenge previous literature wherein improvements to online motor acquisition were observed. Surprisingly, participants who took the SVIPT test immediately after acute exercise displayed poorer motor skill acquisition than those who did not.

    “Overall, these results demonstrate the importance of individual factors such as age when designing exercise interventions. Furthermore, these results suggest that the benefits of high-intensity exercise on early motor consolidation extend to older adult populations. These findings have implications for supporting older adults in motor rehabilitation settings, providing a potential avenue to ameliorate reductions in motor learning associated with age.”

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  • Women reap greater health benefits from exercise than men

    Women reap greater health benefits from exercise than men

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    Women who exercise regularly have a significantly lower risk of an early death or fatal cardiovascular event than men who exercise regularly, even when women put in less effort, according to a National Institutes of Health-supported study. The findings, published in the Journal of the American College of Cardiology, are based on a prospective analysis of data from more than 400,000 U.S. adults ages 27-61 which showed that over two decades, women were 24% less likely than those who do not exercise to experience death from any cause, while men were 15% less likely. Women also had a 36% reduced risk for a fatal heart attack, stroke, or other cardiovascular event, while men had a 14% reduced risk. 

    We hope this study will help everyone, especially women, understand they are poised to gain tremendous benefits from exercise. It is an incredibly powerful way to live healthier and longer. Women on average tend to exercise less than men and hopefully these findings inspire more women to add extra movement to their lives.” 


    Susan Cheng, M.D., cardiologist and the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Smidt Heart Institute at Cedars-Sinai, Los Angeles

    The researchers found a link between women experiencing greater reduced risks for death compared to men among all types of exercise. This included moderate aerobic activity, such as brisk walking; vigorous exercise, such as taking a spinning class or jumping rope; and strength training, which could include body-weight exercises.

    Scientists found that for moderate aerobic physical activity, the reduced risk for death plateaued for both men and women at 300 minutes, or five hours, per week. At this level of activity, women and men reduced their risk of premature death by 24% and 18% respectively. Similar trends were seen with 110 minutes of weekly vigorous aerobic exercise, which correlated with a 24% reduced risk of death for women and a 19% reduced risk for men.

    Women also achieved the same benefits as men but in shorter amounts of time. For moderate aerobic exercise, they met the 18% reduced risk mark in half the time needed for men: 140 minutes, or under 2.5 hours, per week, compared to 300 minutes for men. With vigorous aerobic exercise, women met the 19% reduced risk mark with just 57 minutes a week, compared to 110 minutes needed by men.

    This benefit applied to weekly strength training exercises, too. Women and men who participated in strength-based exercises had a 19% and 11% reduced risk for death, respectively, compared to those who did not participate in these exercises. Women who did strength training saw an even greater reduced risk of cardiovascular-related deaths – a 30% reduced risk, compared to 11% for men. 

    For all the health benefits of exercise for both groups, however, only 33% of women and 43% of men in the study met the standard for weekly aerobic exercise, while 20% of women and 28% of men completed a weekly strength training session.

    “Even a limited amount of regular exercise can provide a major benefit, and it turns out this is especially true for women,” said Cheng. “Taking some regular time out for exercise, even if it’s just 20-30 minutes of vigorous exercise a few times each week, can offer a lot more gain than they may realize.”

    “This study emphasizes that there is no singular approach for exercise,” said Eric J. Shiroma, Sc.D., a program director in the Clinical Applications and Prevention branch at the National Heart, Lung, and Blood Institute (NHLBI). “A person’s physical activity needs and goals may change based on their age, health status, and schedule – but the value of any type of exercise is irrefutable.”

    The authors said multiple factors, including variations in anatomy and physiology, may account for the differences in outcomes between the sexes. For example, men often have increased lung capacity, larger hearts, more lean-body mass, and a greater proportion of fast-twitch muscle fibers compared to women. As a result, women may use added respiratory, metabolic, and strength demands to conduct the same movement and in turn reap greater health rewards.

    The Physical Activity Guidelines for Americans recommend adults get at least 2.5-5 hours of moderate-intensity exercise or 1.25-2.5 hours of vigorous exercise each week, or a combination of both, and participate in two or more days a week of strength-based activities.

    Source:

    NIH/National Heart, Lung and Blood Institute

    Journal reference:

    Ji, H., et al. (2024) Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2023.12.019.

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  • Pilates lowers blood pressure in hypertensive patients, study finds

    Pilates lowers blood pressure in hypertensive patients, study finds

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    A study published in the Journal of Human Hypertension reveals that Pilates training programs are safe for patients with hypertension and that these programs can be incorporated as a part of their rehabilitation.

    Study: The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. Image Credit: ESB Professional / ShutterstockStudy: The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. Image Credit: ESB Professional / Shutterstock

    Background

    Hypertension or high blood pressure is a major public health concern because of its widespread prevalence. The condition significantly increases the risk of cardiovascular disease and associated disability and mortality. Although medicines can effectively treat hypertension, consistent treatment adherence is the primary requisite for optimal outcomes.

    Available evidence indicates that a combination of pharmacological and non-pharmacological interventions is highly effective in managing all risk factors associated with hypertension. In particular, physical exercise is considered to be an excellent intervention to reduce blood pressure in hypertensive patients. This intervention effectively reduces blood pressure even in patients who are low responsive to anti-hypertension medications.

    Among various types of physical activities, aerobic exercise is considered the primary option for managing blood pressure. In addition, isometric exercise, dynamic resistance exercise, and high-intensity interval training have shown positive effects in hypertensive patients. However, despite many health benefits, these physical activities are generally associated with a low adherence rate.

    In this systematic review and meta-analysis, scientists have explored the effectiveness of Pilates training programs in managing blood pressure in hypertensive patients. They have considered Pilates an alternative physical exercise option because of its adaptability in various conditions, such as rehabilitation and fitness.   

    Study design

    The scientists searched across four electronic databases for randomized clinical trials and comparative studies that investigated the effect of Pilates training on blood pressure in patients with hypertension.

    A total of four randomized clinical trials and seven comparative studies were included in the final analysis. All these studies were published between 2015 and 2023. Regarding the methodological quality of selected studies, one was low quality, four were good quality, and six were high quality.

    The selected studies included a total of 458 participants with decompensated hypertension, arterial hypertension, or normal tension. All arterial hypertensive participants received anti-hypertensive treatment during the Pilates training.

    Nine out of eleven selected studies used Pilates-based Mat as their study intervention; one used Pilates with apparatus, and one used both. In comparative studies, the control groups performed aerobic exercises or daily life activities.   

    Important observations

    A considerable proportion of selected studies described the positive impacts of Pilates training programs in managing blood pressure in hypertensive patients. Data from three randomized controlled trials and two comparative studies was included in the meta-analysis.

    The findings revealed that Pilates has significantly higher potency in reducing systolic, diastolic, and mean blood pressure compared to other physical activity interventions employed in control groups.

    The meta-analysis of data from four comparative studies indicated that Pilates exerts similar blood pressure-lowering effects in hypertensive and normotensive participants. However, these effects were not statistically significant.

    Study significance

    The meta-analysis finds that Pilates is safe and effective for managing blood pressure in hypertensive patients. However, it might not necessarily have superior effects compared to other physical exercise interventions.

    Most studies included in the systematic review and meta-analysis highlight the significant positive effects of Mat Pilates on blood pressure. This suggests that the incorporation of exercises that require isometric strength could be helpful in lowering blood pressure.

    Mat Pilates is a low-to-moderate-intensity exercise. In contrast, Pilates with apparatus is a high-intensity exercise. Studies that employed Pilates with apparatus could not find any significant blood pressure-lowering effects. This indicates that the intensity of Pilates is an important factor to consider while applying this intervention for blood pressure management. In support of this hypothesis, existing literature depicts that light or moderate aerobic exercise is more effective than high-intensity aerobic exercise in reducing blood pressure.

    Although the findings of the meta-analysis indicated blood pressure-lowering effects of Pilates, overall, it was found that Pilates does not have greater effects than aerobic exercises. Moreover, a combination of aerobic exercise and Pilates failed to demonstrate greater benefits.

    Based on these observations, scientists advise incorporating Pilates as a part of the rehabilitation approach to manage blood pressure in hypertensive patients. However, it should be noted that Pilates may not necessarily offer greater benefits than aerobic exercises and that it may not necessarily help improve adherence to training programs.

    Journal reference:

    • Daniel González-Devesa. 2024. The efficacy of Pilates method in patients with hypertension: systematic review and meta-analysis. Journal of Human Hypertension. DOI: 10.1038/s41371-024-00899-110.10,  https://www.nature.com/articles/s41371-024-00899-1

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  • Exercise is an effective treatment for depression, with walking, jogging, yoga, and strength training more effective than other exercises

    Exercise is an effective treatment for depression, with walking, jogging, yoga, and strength training more effective than other exercises

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    In a recent systematic review and network meta-analysis published in the British Medical Journal, researchers determined the potentially most effective exercise regimen and dosage in managing major depressive disorder (MDD) in comparison to antidepressants, psychotherapy, and control interventions.

    Study: Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. Image Credit: Dmytrenko Vlad/Shutterstock.com
    Study: Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. Image Credit: Dmytrenko Vlad/Shutterstock.com

    They found that exercise, in the form of yoga, walking, jogging, or strength training, is an effective and well-tolerated treatment for depression, suggesting its potential as a core intervention alongside antidepressants and psychotherapy, regardless of comorbidities or baseline depression levels.

    Background

    MDD is a leading global cause of disability, impacting life satisfaction significantly and exacerbating comorbidities. Despite the availability of treatments, the potential resistance and limited access to them emphasize the urgent need for evidence-based interventions. Although exercise is suggested as a potential adjunct or alternative to traditional treatments for depression, backed by international guidelines, the recommendations on dose and modality vary across regions. Guidelines suggest diverse approaches, including group exercise programs, aerobic or resistance training, or a combination of both.

    Existing pairwise meta-analyses assessing specific exercise modalities versus comparators face challenges due to heterogeneous treatments and comparisons, leading to ambiguous effect estimates. Overviews of reviews have attempted to address this by combining pairwise meta-analyses, but differences in analytical methods can still lead to confusion.

    In this regard, network meta-analyses may offer a more precise approach by simultaneously modeling direct and indirect comparisons between interventions. Previous network meta-analyses have examined the effects of exercise on various outcomes, including depression, but may have been underpowered to explore moderators such as dose and modality.

    To address this gap, researchers in the present study conducted a comprehensive search of randomized trials to identify the optimal dose and modality of exercise for depression, considering factors like participants’ sex, age, and baseline depression level. To enhance the intervention effects for depression, they investigated autonomy support and behavior change techniques, examining their associations with intervention outcomes. Additionally, they explored intervention mechanisms, including self-confidence and affect, through formal mediation analyses in the included studies.

    About the studyTop of Form

    In the present study, randomized controlled trials investigating exercise as a treatment for depression were included, with participants meeting the criteria for MDD, either clinically diagnosed or self-reported to exceed established clinical thresholds. Data were sourced from Medline, Embase, Cochrane Library, SPORTDiscus, and PsycINFO databases. Studies were eligible whether all participants or only a subgroup had depression.

    Studies with various comparison conditions, participant profiles, and languages were considered, aiming to evaluate exercise’s efficacy in depression treatment comprehensively. Exclusion criteria were interventions shorter than a week, insufficient depression outcome data, and inability to calculate effect sizes. A total of 218 studies were included, with 495 arms and 14,170 participants.

    For each study, intervention details, including exercise frequency, intensity, type, and duration, were assessed alongside behavior change techniques, level of autonomy, comparison conditions, and participant characteristics. The energy expenditure dose of exercise was determined for each arm in the form of metabolic equivalents of task (METs) min/week.

    The risk of bias in the included studies was assessed using Cochrane’s tool. Bayesian arm-based multilevel network meta-analysis models were employed for main and moderation analyses, using standardized mean change from baseline as the summary measure. Active control conditions were grouped together (such as usual care and placebo tablet), while waitlist control was considered separately due to its typically poorer effects. Netmeta and CINeMA were used for assessing credibility and modeling acceptability. Prespecified moderation and sensitivity analyses were performed to assess the robustness of the findings.

    Results and discussion

    Compared to active controls, dance showed large reductions in depression (Hedges’ g -0.96), followed by moderate reductions for walking or jogging (g -0.63), yoga (g -0.55), strength training (g -0.49), mixed aerobic exercises (g -0.43), and tai chi or qigong (g -0.42). Moderate effects were also seen on combining exercise with SSRIs (short for selective serotonin reuptake inhibitor, g -0.55) or combining aerobic exercise with psychotherapy (g -0.54).

    These treatments outperformed the clinically important difference threshold (g -0.20). Strength training and yoga had lower dropout rates compared to active controls and were perceived as the most acceptable options. Effects were moderate for cognitive behavior therapy alone (g -0.55) and small for SSRIs (g -0.26). However, while the publication bias was found to be low, only one study met the criteria for low risk of bias.

    Although the review provides insights into the potential of dance for the treatment of depression, the small number of studies, bias in study designs, and lack of blinding in interventions limit the strength of the overall recommendations.

    Conclusion

    In conclusion, as per the study, exercises including walking, strength training, and yoga show promise as a treatment for depression, although the confidence in the findings may vary. In the future, tailoring exercise-based interventions to suit individual characteristics and combining them as core treatment along with antidepressants and psychotherapy may improve the outcomes for patients with MDD, offering accessible options, particularly for those with barriers to participation.

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  • School uniforms may prevent children from getting enough exercise

    School uniforms may prevent children from getting enough exercise

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    School uniforms may restrict movement, making children less active

    Dan Kenyon/Getty Images

    Wearing a uniform to school has been linked to young children getting insufficient amounts of exercise, particularly girls.

    With many children missing the World Health Organization (WHO) recommendation of at least 60 minutes of exercise per day, Mairead Ryan at the University of Cambridge and her colleagues decided to look into why.

    They analysed existing data about the physical activity levels of more than 1 million children aged 5 to 17 years old from 135 countries and territories, which they compared with the results of their own online survey on how common school uniforms are in these places.

    Overall, boys were 1.5 times more likely than girls to meet the WHO recommendation for physical activity. But that gap is nearly twice as great among younger children who live in places where school uniforms are the norm, says Ryan.

    Among secondary school students (generally aged 11 to 17), uniforms didn’t appear to be linked to any sex-related differences in physical activity. However, in primary schools (aged 5 to 10), the gap between girls and boys was 9.8 percentage points in areas where at least 50 per cent of schools required uniforms, compared with 5.5 percentage points where such requirements were lower.

    The difference in results between the older and younger children might be because children of primary school age get more physical activity from sporadic movements throughout the day, whereas adolescents get most of their total physical activity from structured activities, according to the researchers.

    “Girls might feel less confident about doing things like cartwheels and tumbles in the playground, or riding a bike on a windy day, if they are wearing a skirt or dress,” says team member Esther van Sluijs, also at the University of Cambridge.

    While the findings don’t show that uniforms are the cause of lower rates of exercise, they align with other studies that suggest children, particularly girls, find uniforms restrictive.

    A study in Chile, for example, found that when children wore sport-friendly uniforms to school rather than traditional attire, such as skirts, blouses, ties and blazers, they had better cardio-respiratory fitness. Concerned that uniforms were inhibiting athletic activity in children, Ireland’s former minister of sport Jack Chambers mentioned the issue in a December 2022 report on youth sport.

    While the findings don’t support a “blanket ban” on uniforms, they suggest that further research is needed, particularly into whether changing uniforms could help. “We don’t know, for example, whether it’s the design of the uniform, the fabric or the shoes, specifically, that might be the factor,” says Ryan.

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  • Managing migraines and menopausal symptoms to reduce cardiovascular risks in middle-aged women

    Managing migraines and menopausal symptoms to reduce cardiovascular risks in middle-aged women

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    For middle-aged women plagued by migraines, or hot flashes and night sweats, another worry may linger in the backs of their minds: whether these experiences have set them up for a heart attack, a stroke or another cardiovascular crisis.

    After all, past research suggesting such a link during and after menopause has gotten a lot of attention.

    But a pair of new studies in the journal Menopause suggest that most of them don’t need to worry as much, especially if they don’t have both migraines and long-term hot flashes and night sweats.

    Instead, they should focus on tackling the other factors that can raise their cardiovascular risk by getting more sleep, exercise and healthy foods, quitting tobacco, and minding their blood pressure, blood sugar, cholesterol and weight.

    For women who have experienced both migraines and hot flashes or night sweats over many years, one of the new studies does suggest an extra level of cardiovascular risk. That makes heart disease and stroke prevention even more important in this group, says study leader Catherine Kim, M.D., M.P.H., of the University of Michigan.

    And for women currently in their 20s and 30s who experience migraines, the new research suggests that they might be heading for a higher risk of long-term menopause-related symptoms when they get older.

    Long-term study yields important insights

    Kim and her colleagues at Michigan Medicine, U-M’s academic medical center, published the new pair of studies based on an in-depth analysis of data from a long-term study of more than 1,900 women who volunteered to have regular physical exams and blood tests, and to take yearly health surveys, when they were in their late teens to early 30s.

    Those women, now in their 50s and 60s, have provided researchers with a priceless view of what factors shape health in the years leading up to menopause and beyond, through their continued participation in the CARDIA study.

    “The anxiety and dread that women with migraines and menopausal symptoms feel about cardiovascular risk is real – but these findings suggest that focusing on prevention, and correcting unhealthy habits and risk factors, could help most women,” said Kim, who is an associate professor of internal medicine at U-M and a primary care physician.

    “For the subgroup with both migraines and early persistent hot flashes and night sweats, and for those currently experiencing migraines in their early adulthood, these findings point to an added need to control risks, and address symptoms early,” she adds.

    Just over 30% of the middle-aged women in the study reported they had persistent hot flashes and night sweats, which together are called vasomotor symptoms or VMS because they relate to changes in the diameter of blood vessels.

    Of them, 23% had reported also having migraines. This was the only group for whom Kim and her colleagues found extra risk of stroke, heart attack or other cardiovascular events that couldn’t be explained by other risk factors that have long been known to be linked to cardiovascular problems.

    In addition to those with persistent vasomotor symptoms starting in their 40s or before, 43% of the women in the study had minimal levels of such symptoms in their 50s, and 27% experienced an increase in VMS over time into their 50s and early 60s.

    The latter two groups had no excess cardiovascular risk once their other risk factors were taken into account, whether or not they had migraines. Use of hormone-based birth control and estrogen to address medical issues did not affect this risk.

    Controlling destiny

    In the study of data from the same women in their earlier stages of life, the researchers found that the biggest factors in predicting which ones would go on to have persistent hot flashes and night sweats were having migraines, having depression, and smoking cigarettes, as well as being Black or having less than a high school education.

    These two studies, taken together, underscore that not all women have the same experiences as they grow older, and that many can control the risk factors that might raise their chances of heart disease and stroke later in life. In other words, women can do a lot to control their destiny when it comes to both menopause symptoms and cardiovascular diseases.”


    Catherine Kim, M.D., M.P.H., University of Michigan

    She notes that the American Heart Association calls these risk factors the “Essential 8” and offers guides for what women, men and even children and teens can do to address them.

    Evolving knowledge and treatment

    The long-term study that the two new findings come from was specifically designed to look at cardiovascular risks when it launched in the mid-1980s. CARDIA stands for Coronary Artery Risk Development in Young Adults.

    Back in the 80s, knowledge about the biology of blood vessels, down to the cellular and molecular level, was nowhere near where it is today. Both vasomotor symptoms in menopause and migraines have to do with blood vessel contraction and dilation.

    But decades of research has shown the microscopic impacts on blood vessels of years of smoking, poor sleep, poor eating habits and lack of activity, as well as a person’s genetic inheritance, life experiences and hormonal history.

    Newer injectable migraine medications called calcitonin gene-related peptide (CGRP) antagonists have reached the market in recent years.

    Using monoclonal antibodies, they target a key receptor on the surface of blood vessel cells to prevent migraines and cluster headaches. But they are expensive and not covered by insurance for all people with migraines.

    While the new study is based on data from years before these medications became available, Kim said she recommends them to her patients with persistent migraines, as well as working with them to understand what triggers their migraines and how to use other medications including pain relievers and antiseizure medications to prevent them.

    She also notes that the paper on future risk of persistent hot flashes and night sweats echoes the recent trend of using antidepressant medications to try to ease these menopause effects.

    Kim also says that evidence has grown about the importance of healthy sleep habits for reducing hot flashes, as well the short-term use of estradiol-based hormone therapy patches, which have not been shown to have a link to cardiovascular risk. And, she notes that research has not shown any over-the-counter supplement or herbal remedy to be effective, and that these are far less regulated than medications.

    Additional authors:

    Kim and Deborah Levine, M.D., M.P.H., senior author of the paper on cardiovascular risk, are both on the faculty in the Division of General Medicine, and members of the U-M Institute for Healthcare Policy and Innovation. Levine heads the Cognitive Health Services Research Program or COG-HSR. Other authors on this paper are Pamela J. Schreiner, Ph.D., of the University of Minnesota, Zhe Yin, M.S., formerly of IHPI, Rachael Whitney, Ph.D., lead statistician at COG-HSR; Stephen Sidney, MD, MPH, of Kaiser Permanente Northern California and Imo Ebong, M.D. of the University of California, Davis.

    Schreiner is the senior author of the paper on later persistent VMS risk in younger women. Other authors on that paper are U-M’s Abbi Lane, Ph.D.; Zhe Yin, M.S.; Hui Jiang, Ph.D. and Richard Auchus, M.D., Ph.D.; as well as Thanh-Huyen Vu M.D., Ph.D. of Northwestern University and Cora Lewis, M.D. of the University of Alabama.

    The study was funded by the National Heart, Lung and Blood Institute (HL169167), which also sponsors the CARDIA study.

    Source:

    Michigan Medicine – University of Michigan

    Journal reference:

    Kim, C., et al. (2024) Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study. Menopause. doi.org/10.1097/GME.0000000000002311.

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  • Trial investigates efficacy of online supervised group mental and physical rehabilitation program for long COVID patients

    Trial investigates efficacy of online supervised group mental and physical rehabilitation program for long COVID patients

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    In a recent study published in the BMJ, researchers evaluated the efficacy of an online supervised group mental and physical rehabilitation program in adults with long COVID.

    Study: Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. Image Credit: Dmitry Demidovich/Shutterstock.com
    Study: Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. Image Credit: Dmitry Demidovich/Shutterstock.com

    Background

    Over 17 million people in the European region of the World Health Organization (WHO) may have experienced coronavirus disease 2019 (COVID-19) symptoms longer than four weeks. Common symptoms of this multisystem condition, known as long COVID or post-COVID-19 condition, include muscle aches, fatigue, dyspnea, and cognitive dysfunction that can profoundly impact quality of life, societal participation, and economic productivity. The pathophysiology of long COVID has not been fully characterized.

    As such, current medical management and treatments have limited efficacy. The biopsychosocial care model may improve outcomes for long COVID patients. Multicomponent mental and physical rehabilitation could improve fatigue, quality of life, and breathlessness. So far, few quasi-experimental studies evaluated exercise-based interventions for individuals with long COVID, with no definitive, high-quality evidence.

    About the study

    In the present study, researchers evaluated the clinical effectiveness of a group rehabilitation program for people with long COVID. The rehabilitation exercise and psychological support after COVID-19 infection (REGAIN) was a multi-center, parallel-group, pragmatic, randomized controlled trial. Participants were recruited in England and Wales. Adults (26-86 years) discharged at least three months after hospitalization with COVID-19 who had ongoing mental and physical sequelae were recruited.

    Subjects were excluded if they had severe mental health problems, contraindications to exercise training, or were enrolled in other rehabilitation programs. A baseline questionnaire was administered before randomization to REGAIN or usual care. Usual care participants received the best practice usual care; this involved an online consultation with a trained practitioner, wherein generic advice was provided on recovery and physical activity.

    The REGAIN intervention was an eight-week, supervised, home-based, group rehabilitation program, providing online consultation with a REGAIN practitioner. REGAIN participants joined weekly live online group exercise and psychological support sessions. Equipment-free, supervised, personalized exercise sessions were delivered in online groups to improve fatigue, cardiovascular fitness, balance, and strength and restore confidence in daily living activities.

    Psychological support sessions were aimed at augmenting psychological capability and increasing COVID-19-related knowledge and its impact on everyday life. The primary outcome of the study was health-related quality of life, determined using the patient-reported outcomes measurement information system (PROMIS). Secondary outcomes included dyspnea, cognitive function, physical activity, anxiety, depression, and general health, among others. Outcomes were assessed at three, six, and 12 months.

    Findings

    Of over 39,000 people invited to participate between January 2021 and July 2022, 1,043 expressed interest. Following exclusions, 298 and 287 subjects were randomized to REGAIN and usual care, respectively. Most participants were female (52%), White (88%), and obese/overweight (88%). One-third of participants required intensive care during COVID-19 hospitalization.

    The average time from discharge to randomization was 323 days. The baseline health-related quality of life was low; around 40% had low physical activity. More than a third of participants could not work due to long COVID. Primary outcome data were available for 80% of REGAIN and 86% of usual care participants. The health-related quality of life improved more for REGAIN participants than usual care recipients at three months.

    There was a significant group difference in health-related quality of life, primarily driven by three PROMIS sub-scores – fatigue, depression, and pain interference. While the effect of the intervention was not evident at six months, it was sustained at 12 months. REGAIN participants had increased odds of being more physically active than usual care recipients. At three months, 7% more REGAIN subjects met the physical activity guideline (> 150 minutes of moderate-intensity activity per week).

    Furthermore, more REGAIN participants reported feeling much better compared to three months than usual care subjects. Adverse events were reported in both groups. Most serious adverse events were related to hospitalization or extended stay at the hospital. Two adverse events were related to the REGAIN intervention. One serious adverse event was possibly related to the intervention. Post-exertional exacerbation of symptoms was not observed.

    Conclusions

    In sum, the REGAIN intervention was clinically effective in improving health-related quality of life for adults with post-COVID-19 condition compared to usual care at three months post-randomization. This effect was mainly due to improvements in pain interference, fatigue, and depression. Moreover, the effect was sustained at 12 months. In both groups, there were improvements in the overall quality of life and other well-being indices.

    Journal reference:

    • Gordon McGregor, Harbinder Sandhu, Julie Bruce, et al. Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial. BMJ, 2024. doi: 10.1136/bmj-2023-076506
      https://www.bmj.com/content/384/bmj-2023-076506
       

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  • Air Force cadets’ nutrition knowledge linked to success in gravitational acceleration test, study finds

    Air Force cadets’ nutrition knowledge linked to success in gravitational acceleration test, study finds

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    In a recent study published in Scientific Reports, researchers explored how nutrition knowledge, physical strength and activity, and body composition are related to whether Air Force cadets lose consciousness during the Gravitational Acceleration Test (G-test).

    The findings indicate that cadets who remained conscious and passed the test had better nutrition knowledge and were more physically active; these learnings have applications in improving training and test outcomes for cadets in the coming years.

    Study: Physical strength, body composition, and G-test results of air force cadets based on nutrition knowledge differences. Image Credit: John Hoffman/Shutterstock.comStudy: Physical strength, body composition, and G-test results of air force cadets based on nutrition knowledge differences. Image Credit: John Hoffman/Shutterstock.com

    Background

    Research in sports nutrition and training has applications in military training and nutritional management to maintain optimal physical and mental functioning while preventing disease. This requires an interdisciplinary approach that includes exercise, rest, recovery, and diet.

    Soldiers in the Air Force work under extreme physiological stress in aerial environments, where they may suffer from hypoxia, hearing loss, flight illusion, cognitive dissonance, and gravity-induced loss of consciousness (G-LOC).

    Enduring G-tests requires adequate nutrition and physical strength, but further understanding is required of how physical activity and strength can be improved among Air Force cadets.

    About the study

    Participants in the study were male senior cadets at the Air Force Academy in the Republic of Korea who took the G-test in 2022.

    Those who were injured or unwilling to participate were excluded from the study. All sampled participants followed the same training, sleep, meal, and work schedules.

    The G-test involved participants sitting in a cockpit-style seat of a high-speed centrifugal motion gondola for 30 seconds at an acceleration of 5 G.

    Losing consciousness before 30 seconds meant failing the test. Based on their test results, participants were divided into those who passed the 30 s G-test (GP) and those who failed (GF).

    Body strength was measured three months before the G-test, while body composition was assessed five days prior on an empty stomach. The strength test included a three-kilometer run, sit-ups, and push-ups.

    Participants were asked to avoid high-intensity activities and sleep sufficiently on the previous day. Measures taken included skeletal muscle mass, body fat percentage, body fat mass, body mass index, height, and weight.

    Participants also completed questionnaires assessing their physical activity levels and knowledge of nutrition-related topics. The data were analyzed using independent sample t-tests and logistic regressions at a significance level of 5%.

    Findings

    Of the 105 male cadets who participated in the study, those who passed the G-test weighed, on average, 3.5 kg more than those who failed and had a slightly higher BMI (24.05 compared to 23.08 on average).

    Skeletal muscle mass, though higher in the GP group, was not significantly different. Similarly, GP cadets had lower body fat mass and body fat ratio, but the difference was not significant.

    Cadets who passed were more physically active, working out for 22.2 minutes daily and 1.1 more reps each week on average. However, they did not perform significantly better in the physical strength evaluation.

    Cadets in the GP group performed significantly better in the general nutrition knowledge questionnaire, with an overall score of 6.6 points higher on average.

    The logistic regression showed significantly higher results for two sections (daily recommendation and food group) out of the four in the test questionnaire.

    There were no significant differences for the sections on healthy food choices and diet, disease, and weight associations.

    Conclusions

    Cadets who passed the G-test were significantly different in terms of their weight and BMI, with indications that higher skeletal muscle mass and lower body fat mass may be beneficial during the test.

    Specifically, higher muscle mass may facilitate better blood supply to the brain and prevent cadets from losing consciousness during the G-test. This indicates the need for a program design that balances aerobic and muscle training.

    The GP cadets were also more physically active and more knowledgeable on nutrition-related topics.

    While their food intake, energy metabolic rate, and activity were not measured, and how this knowledge translates into practice could not be observed, previous research indicates that people who understand nutrition benefits make more informed health decisions in terms of dietary intake. The authors recommend the introduction of a nutrition education program at the academy to address this.

    The findings indicate that nutritional knowledge and overall physical condition promote better performance at an acceleration equivalent to five times that of the Earth’s gravitational pull.

    In addition to continuous technological research, systematic nutrition management and education can improve and maintain optimal body composition, improving health outcomes under extreme physiological stress in aerial environments.

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  • Study reveals limited access to pulmonary rehabilitation for millions of Americans

    Study reveals limited access to pulmonary rehabilitation for millions of Americans

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    Pulmonary rehabilitation, an essential component of care for patients with chronic respiratory conditions, is difficult for millions of Americans to access, a new Yale-led study reveals. The findings, researchers say, reveal geographic regions where this type of care is most lacking and illustrate the potential for telemedicine in helping to bridge this gap.

    The study was published Feb. 5 in JAMA Network Open.

    Pulmonary rehabilitation is a multidisciplinary program that incorporates exercise and strategic techniques to improve quality of life and overall health for patients with respiratory conditions like chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pulmonary hypertension. Programs typically include a structured exercise component supervised by nurses and/or exercise specialists, as well as educational sessions that teach patients techniques that can help them better manage their illness day to day, such as energy conservation, supplemental oxygen therapy, and methods for capitalizing on periods of higher energy.

    It has been demonstrated across almost the entirety of pulmonary medicine to improve patient health and patient-reported outcomes. Through these programs, patients not only gain a more comprehensive understanding of their condition, but also improve their exercise tolerance in a meaningful way.” 


    Dr. Peter Kahn, a pulmonary and critical care fellow at Yale School of Medicine and lead author of the study

    However, despite the demonstrated importance of critical pulmonary rehabilitation, many people in the United States must travel long distances to utilize programs.

    For the study, researchers used massive geographic data sets and computational infrastructure to compute hundreds of millions of travel times. 

    Technologies enabling travel time computations at a massive scale are not just innovative but transformative, providing us with nuanced insights into national data sets previously unavailable to researchers.”


    Dr. Walter Mathis, senior author, psychiatrist and health services researcher at Yale School of Medicine

    While around 80% of Americans live within a 30-minute drive of a pulmonary rehabilitation program, the researchers found, over 14 million people -; mostly living in the country’s western and mid-western regions -; must travel more than an hour away for access to their nearest offering.

    They also uncovered racial disparities in access to pulmonary rehabilitation. For example, nearly 30% of the American Indian and Alaska Native population lives more than an hour away from the closest program.

    “Access to programs within a reasonable amount of travel time is key,” said Kahn. “First, many patients with chronic respiratory conditions require oxygen supplementation. Long commutes may mean they have to transport multiple oxygen tanks or battery supplies, which may cause patients to forgo the treatment. Second, because exertional intolerance is a symptom of these diseases, long travel can be incredibly taxing and also serve as a barrier to participation.”

    Telemedicine and virtual rehabilitation can help bridge this gap need in the short term, said Kahn, though the long-term effectiveness of this approach across different diseases still needs additional evaluation. 

    Helping patients in the long term will require more accessible in-person rehabilitation options, he added. That will require collaboration between policy makers and health care providers and different approaches to insurance reimbursement.

    “Insurance payers, both government and private, do not sufficiently reimburse pulmonary rehabilitation programs for the people, equipment, and supplies needed to effectively run them,” said Kahn. That represents a barrier to offering these programs. Of equal importance, insurance limits how many rehabilitation sessions a patient can attend, he added.

    “If you’re someone with a chronic respiratory condition like advanced COPD, you really need ongoing therapeutic sessions,” he added. “But right now, payers limit patients to a small number of lifetime sessions relative to the long-term burden of the disease. And that needs to change.”

    Source:

    Journal reference:

    Kahn, P. A., & Mathis, W. S. (2024). Accessibility of Pulmonary Rehabilitation in the US. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2023.54867.

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