Anja Rossmeissl

Aerobic, resistance and combined exercise training on arterial stiffness in normotensive and hypertensive adults: A review

Abstract Exercise training has different effects on arterial stiffness according to training modalities. The optimal exercise modality for improvement of arterial function in normotensive and hypertensive individuals has not been well established. In this review, we aim to evaluate the effects of aerobic, resistance and combined aerobic and resistance training on arterial stiffness in individuals with and without hypertension. We systematically searched the Pubmed and Web of Science database from 1985 until December 2013 for relevant randomised controlled trials (RCTs). The data were extracted by one investigator and checked by a second investigator. The training effects on arterial stiffness were estimated using weighted mean differences of the relative changes (%) with 95% confidence intervals (CIs). We finally reviewed the results from 17 RCTs. The available evidence indicates that aerobic exercise tends to have a beneficial effect on arterial stiffness in normotensive and hypertensive patients, but does not affect arterial stiffness in patients with isolated systolic hypertension. Resistance exercise has differing effects on arterial stiffness depending on type and intensity. Vigorous resistance training is associated with an increase in arterial stiffness. There seem to be no unfavourable effects on arterial stiffness if the training is of low intensity, in a slow eccentric manner or with lower limb in healthy individuals. Combined training has neutral or even a beneficial effect on arterial stiffness. In conclusion, our review shows that exercise training has varying effects on arterial stiffness depending on the exercise modalities.

Dose-response relationship between light exposure and cycling performance

Light has a stimulating effect on physical performance if scheduled according to the chronotype, but dose‐dependent effects on performance have not yet been examined. Three groups of healthy men (25.1 ± 3.1 years) were exposed to light for different durations in a parallel group design before a 40‐min time‐trial. In each group, subjects were exposed to either bright light (BL, 4420 lx) or moderate light (ML, 230 lx) in a randomized order in a crossover design. The durations of light exposure were 120 min prior to and during exercise (2HEX; n = 16), 60 min prior to and during exercise (1HEX; n = 10), or only for 60 min prior to exercise (1H; n = 15). Total work performed during the time‐trial in kJ in the 2HEX group was significantly higher in the BL setting (527 kJ) than in ML (512 kJ) (P = 0.002), but not in 1HEX (BL: 485 kJ; ML: 498 kJ) or 1H (BL: 519 kJ; ML: 514 kJ) (P = 0.770; P = 0.485). There was a significant (P = 0.006) positive dose–response relationship between the duration of light exposure and the work performed over the three doses of light exposure. A long duration light exposure is an effective tool to increase total work in a medium length time‐trial in subjects normalized for their individual chronotype.

Prime Time Light Exposures Do Not Seem to Improve Maximal Physical Performance in Male Elite Athletes, but Enhance End-Spurt Performance

Many sports competitions take place during television prime time, a time of the day when many athletes have already exceeded their time of peak performance. We assessed the effect of different light exposure modalities on physical performance and melatonin levels in athletes during prime time. Seventy-two young, male elite athletes with a median (interquartile range) age of 23 (21; 29) years and maximum oxygen uptake (VO2max) of 63 (58; 66) ml/kg/min were randomly assigned to three different light exposure groups: bright light (BRIGHT), blue monochromatic light (BLUE), and control light (CONTROL). Each light exposure lasted 60 min and was scheduled to start 17 h after each individuals midpoint of sleep (median time: 9:17 pm). Immediately after light exposure, a 12-min time trial was performed on a bicycle ergometer. The test supervisor and participants were blinded to the light condition each participant was exposed to. The median received light intensities and peak wavelengths (photopic lx/nm) measured at eye level were 1319/545 in BRIGHT, 203/469 in BLUE, and 115/545 in CONTROL. In a multivariate analysis adjusted for individual VO2max, total work performed in 12 min did not significantly differ between the three groups. The amount of exposure to non-image forming light was positively associated with the performance gain during the time trial, defined as the ratio of the work performed in the first and last minute of the time trial, and with stronger melatonin suppression. Specifically, a tenfold increase in the exposure to melanopic light was associated with a performance gain of 8.0% (95% confidence interval: 2.6, 13.3; P = 0.004) and a melatonin decrease of −0.9 pg/ml (95% confidence interval: −1.5, −0.3; P = 0.006). Exposure to bright or blue light did not significantly improve maximum cycling performance in a 12-min all-out time trial. However, it is noteworthy that the estimated difference of 4.1 kJ between BRIGHT and CONTROL might represent an important performance advantage justifying further studies. In conclusion, we report novel evidence that evening light exposure, which strongly impacts the human circadian timing system, enables elite athletes to better maintain performance across a 12-min cycling time trial.

Effects of different endurance exercise modalities on migraine days and cerebrovascular health in episodic migraineurs: A randomized controlled trial

Aerobic exercise training is a promising complementary treatment option in migraine and can reduce migraine days and improve retinal microvascular function. Our aim was to elucidate whether different aerobic exercise programs at high vs moderate intensities distinctly affect migraine days as primary outcome and retinal vessel parameters as a secondary. In this randomized controlled trial, migraine days were recorded by a validated migraine diary in 45 migraineurs of which 36 (female: 28; age: 36 (SD:10)/BMI: 23.1 (5.3) completed the training period (dropout: 20%). Participants were assigned (Strata: age, gender, fitness and migraine symptomatology) to either high intensity interval training (HIT), moderate continuous training (MCT), or a control group (CON). Intervention groups trained twice a week over a 12‐week intervention period. Static retinal vessel analysis, central retinal arteriolar (CRAE) and venular (CRVE) diameters, as well as the arteriolar‐to‐venular diameter ratio (AVR) were obtained for cerebrovascular health assessment. Incremental treadmill testing yielded maximal and submaximal fitness parameters. Overall, moderate migraine day reductions were observed ( ηP2 = .12): HIT revealed 89% likely beneficial effects (SMD = 1.05) compared to MCT (SMD = 0.50) and CON (SMD = 0.59). Very large intervention effects on AVR improvement ( ηP2 = 0.27), slightly favoring HIT (SMD=‐0.43) over CON (SMD=0), were observed. HIT seems more effective for migraine day reduction and improvement of cerebrovascular health compared to MCT. Intermittent exercise programs of higher intensities may need to be considered as an additional treatment option in migraine patients.

ZumBeat: Evaluation of a Zumba Dance Intervention in Postmenopausal Overweight Women

Physical inactivity is a major public health concern since it increases individuals’ risk of morbidity and mortality. A subgroup at particular risk is postmenopausal overweight women. The aim of this study was to assess the feasibility and effect of a 12-week ZumBeat dance intervention on cardiorespiratory fitness and psychosocial health. Postmenopausal women with a body mass index (BMI) >30 kg/m2 or a waist circumference >94 cm who were not regularly physically active were asked to complete a 12-week ZumBeat dance intervention with instructed and home-based self-training sessions. Before and after the intervention, peak oxygen consumption (VO2peak) was assessed on a treadmill; and body composition and several psychometric parameters (including quality of life, sports-related barriers and menopausal symptoms) were investigated. Of 17 women (median age: 54 years; median BMI: 30 kg/m2) enrolled in the study, 14 completed the study. There was no apparent change in VO2peak after the 12-week intervention period (average change score: −0.5 mL/kg/min; 95% confidence interval: −1.0, 0.1); but, quality of life had increased, and sports-related barriers and menopausal symptoms had decreased. A 12-week ZumBeat dance intervention may not suffice to increase cardiorespiratory fitness in postmenopausal overweight women, but it increases women’s quality of life.

Correlates and outcomes of alcohol use after single solid organ transplantation: a systematic review and meta-analysis

BACKGROUND Reviews on alcohol use in transplant recipients focus on liver recipients and their risk of post-transplant rejection, but do not assess alcohol use in kidney, heart, or lung transplant recipients. This systematic review and meta-analysis aims to synthesize the evidence on correlates and outcomes of any alcohol use and at-risk drinking after solid organ transplantation (Tx). METHODS We searched 4 databases for quantitative studies in adult heart, liver, kidney and lung Tx recipients, investigating associations between post-Tx alcohol use and correlates and/or clinical, economic or quality of life outcomes. Paper selection, data extraction and quality assessment were performed by 2 reviewers independently. A pooled odds ratio (OR) was computed for each correlate/outcome reported ≥5 times. RESULTS Of the 5331 studies identified, 76 were included in this systematic review (93.3% on liver Tx; mean sample size 148.9 (SD = 160.2); 71.9% male; mean age 48.9 years (SD = 6.5); mean time post-Tx 57.7 months (SD = 23.1)). On average, 23.6% of patients studied used alcohol post-transplant. Ninety-three correlates of any post-Tx alcohol use were identified, and 9 of the 19 pooled ORs were significantly associated with a higher odds for any post-Tx alcohol use: male gender, being employed post-transplant, smoking pre-transplant, smoking post-transplant, a history of illicit drug use, having first-degree relatives who have alcohol-related problems, sobriety <6 months prior to transplant, a history of psychiatric illness, and having received treatment for alcohol-related problems pre-transplant. On average 15.1% of patients had at-risk drinking. A pooled OR was calculated for 6 of the 47 correlates of post-Tx at risk drinking investigated, of which pre-transplant smoking was the only correlate being significantly associated with this behavior. None of the outcomes investigated were significantly associated with any use or at-risk drinking. CONCLUSION Correlates of alcohol use remain under-investigated in solid organ transplant recipients other than liver transplantation. Further research is needed to determine whether any alcohol use or at-risk drinking is associated with poorer post-transplant outcomes. Our meta-analysis highlights avenues for future research of higher methodological quality and improved clinical care. PROTOCOL REGISTRATION PROSPERO protocol CRD42015003333.

The Obesity Factor: How Cardiorespiratory Fitness is Estimated More Accurately in People with Obesity: The Obesity Factor: VO2peak and Body Composition

Cardiopulmonary exercise testing is clinically used to estimate cardiorespiratory fitness (CRF). The relation to total body mass (TBM) leads to an underestimation of CRF in people with obesity and to inappropriate prognostic and therapeutic decisions. This study aimed to determine body composition‐derived bias in the estimation of CRF in people with obesity.

Association of cardiorespiratory fitness with retinal vessel diameters as a biomarker of cardiovascular risk

OBJECTIVE We aimed to investigate the association of retinal microvascular health with cardiorespiratory fitness (VO2peak) and cardiovascular risk factors. METHODS In a population of 260 obesity-enriched participants we investigated the association of retinal vessel diameters with cardiorespiratory fitness (CRF), body mass index (BMI) and blood pressure (BP). Retinal vessel imaging was performed by use of a fundus camera and a semi-automated processing software, calculating the central retinal arteriolar (CRAE) and venular equivalent (CRVE) as well as the arteriolar-to-venular diameter ratio (AVR). RESULTS Participants had a mean age of 45.8 ± 12.5 years and a BMI of 35.8 ± 6.8 kg/m2. 45% of patients were diagnosed with hypertension, 26% with diabetes and 30% with dyslipidemia. Increasing VO2peak was independently associated with lower CRVE (β = -0.600; CI -1.141, -0.060; p = 0.030). Higher BMI and mean arterial pressure were independently associated with narrower CRAE (β = -0.492; CI -0.909, -0.076; p = 0.021 and β = -0.268; CI -0.471, -0.066; p = 0.009, respectively) and lower AVR (β = -0.002; CI -0.003, -0.000; p = 0.026 and β = -0.001; CI -0.002, -0.000; p = 0.001, respectively). CONCLUSIONS Higher cardiorespiratory fitness is associated with beneficial retinal microvascular health. Higher BMI and BP were associated with an impairment of retinal microvascular health. Exercise is known for its potential to improve body composition and reduce BP but may also prove to be an efficient therapy to counteract small vessel disease in cardiometabolic disease.

Oxygen uptake during mini trampoline exercise in normal-weight, endurance-trained adults and in overweight-obese, inactive adults: A proof-of-concept study

Abstract Objectives: To examine cardiorespiratory exertion during mini trampoline exercises of different intensities in both endurance-trained athletes and overweight-obese adults. Methods: Physically healthy participants (Group A: normal-weight, endurance-trained athletes; Group B: inactive, overweight-obese adults) participated in two measurement appointments and three training sessions in between appointments, in which participants familiarized themselves with the use of the mini trampoline and the execution of the exercises. The primary outcome was the ⩒O2peak for each of the six mini trampoline exercises relative to the ⩒O2peak as established during an all-out exercise test on a bike ergometer during the first measurement appointment. Secondary outcomes were average ⩒O2 as well as maximum and average heart rate. Results: The six mini trampoline exercises generated ⩒O2peak values between 42% and 81% in the endurance-trained athletes and between 58% and 87% in the overweight-obese participants, both in relation to the bike ergometer ⩒O2peak. Average ⩒O2 values ranged from 35% to 69% (endurance-trained athletes) and from 48% to 71% (overweight-obese participants), depending on exercise. Average heart rate likewise lay in a range that can be categorized as moderate-to-vigorous aerobic exercise for both groups. A moderate-to-strong correlation (0.658 to 0.875, depending on exercise) between bike ergometer ⩒O2peak and mini trampoline ⩒O2peak was found for all six exercises. Conclusions: Mini trampoline exercise has the potential to produce training intensities that concur with established exercise guidelines. The exercise intensity is self-adjusting and allows for an effective and safe workout for different users with a wide range of fitness levels.

Morning bright light exposure has no influence on self-chosen exercise intensity and mood in overweight individuals – A randomized controlled trial

ABSTRACT Overweight is a worldwide increasing public health issue. Physical exercise is a useful countermeasure. Overweight individuals choose rather low exercise intensities, but especially high exercise intensities lead to higher energy expenditure and show beneficial health effects compared to lower exercise intensities. However, especially in the morning higher exercise intensities are likely to be avoided due to higher subjective effort. Bright light exposure has shown to increase maximum performance. The aim of this study was to investigate if bright light exposure can also increase self-chosen exercise intensity. We hypothesized that morning bright light exposure increases self-chosen exercise intensity of subsequent exercise through increased mood and reduced sleepiness in overweight individuals. In this randomized controlled single-blind parallel group design, 26 overweight individuals (11 males, 15 females; age 25 ± 5.7 years; body mass index 28.9 ± 2.1 kg/m2) underwent three measurement appointments. On the first appointment, subjects performed a cardiopulmonary exercise test to measure maximum oxygen uptake (VO2max). Two days later a 30-min exercise session with self-chosen exercise intensity was performed for familiarization. Then subjects were randomly allocated to bright light (~4400 lx) or a control light (~230 lx) condition. Three to seven days later, subjects were exposed to light for 30 min starting at 8:00 am, immediately followed by a 30-min exercise session with persisting light exposure. Multidimensional mood questionnaires were filled out before and after the light exposure and after the exercise session. The primary outcome was the mean power output during the exercise session and the secondary outcome the rating on the three domains (i.e. good-bad; awake-tired; calm-nervous) of the multidimensional mood questionnaire. Mean power output during the exercise session was 92 ± 19 W in bright light and 80 ± 37 W in control light, respectively. In the multivariate analysis adjusted for VO2max, the mean power output during the exercise session was 8.5 W higher (95% confidence interval −12.7, 29.7; p = 0.416) for participants in bright light compared to control light. There were no significant differences between the groups for any of the three domains of the questionnaire at any time point. This is in contrast to longer lasting intervention studies that show positive influences on mood and suggests that bright light therapy requires repetitive sessions to improve mood in overweight individuals. In conclusion bright light exposure does not acutely increase self-chosen exercise intensity or improve mood in a 30-min exercise session starting at 08:30. However, regarding the fact that overweight is a worldwide and rapidly increasing public health issue even small increases in exercise intensity may be relevant. The trend toward superiority of bright light over control light implicates that further studies may be conducted in a larger scale. Abbreviations: VO2max: maximum oxygen uptake; 95% CI: 95% confidence interval; SD: standard deviation