Christie L. Ward-Ritacco

Effect of exercise training on C-reactive protein: a systematic review and meta-analysis of randomised and non-randomised controlled trials

Purpose C-reactive protein (CRP) is a marker of chronic systemic inflammation frequently used in cardiovascular disease risk assessment. The purpose of this meta-analysis was to provide a quantitative estimate of the magnitude of change in CRP following participation in physical exercise interventions. Methods All studies included in the meta-analysis were peer reviewed and published in English. Human participants were assigned to a non-exercise comparison group or exercise training group, with the intervention lasting ≥2 weeks. CRP levels were measured at baseline, during and/or after completion of the exercise training programme. Random-effects models were used to aggregate a mean effect size (ES), 95% CIs and potential moderators. Results 83 randomised and non-randomised controlled trials met the inclusion criteria and resulted in 143 effects (n=3769). The mean ES of 0.26 (95% CI 0.18 to 0.34, p<0.001) indicated a decrease in CRP following exercise training. A decrease in body mass index (BMI; β=1.20, SE=0.25, p<0.0001) and %Fat (β=0.76, SE=0.21, p=0.0002) were associated with a decrease in CRP, independently accounting for 11.1% and 6.6% of the variation in response, respectively. Exercise training led to a greater reduction in CRP when accompanied by a decrease in BMI (ES=0.38, 95% CI 0.26 to 0.50); however, a significant improvement in CRP occurred in the absence of weight loss (ES=0.19, 95% CI 0.10 to 0.28; both p<0.001). Conclusions These results suggest that engaging in exercise training is associated with a decrease in CRP levels regardless of the age or sex of the individual; however, greater improvements in CRP level occur with a decrease in BMI or %Fat.

Feelings of energy are associated with physical activity and sleep quality, but not adiposity, in middle-aged postmenopausal women.

ObjectiveFeelings of fatigue and low energy are widespread among middle-aged women and have been shown to negatively affect quality of life. The aim of the present study was to examine the associations among adiposity, physical activity, and feelings of fatigue and energy in postmenopausal women. MethodsPostmenopausal women (N = 74; mean [SD] age, 58.9 [3.8] y) were assessed for adiposity (via dual-energy x-ray absorptiometry), steps per day, minutes of moderate to vigorous physical activity per day (via an accelerometer), prior week intensity of psychological vigor (via the Profile of Mood States—Short Form), and prior month frequency of energy feelings (via the vitality scale of the 36-item Medical Outcomes Survey—Short Form). Sleep quality was measured using the Pittsburgh Sleep Quality Index, depression was measured using the Beck Depression Inventory-II, and perceived stress was measured using the Perceived Stress Scale. ResultsAdiposity was negatively related to steps per day (r = −0.55, P < 0.05) and minutes of moderate to vigorous physical activity per day (r = −0.48, P < 0.05). Adiposity was not significantly related to vigor, vitality, or any other psychological measures. Greater vitality was associated with lower total number of medications (r = −0.31, P < 0.01), more steps per day (r = 0.28, P < 0.05), and higher minutes of moderate to vigorous physical activity per day (r = 0.37, P < 0.01). Prior week feelings of vigor were unrelated to any variable of interest. Regression analyses revealed that minutes of moderate to vigorous physical activity per day independently explained 8% of the variance in vitality, whereas sleep quality was also a significant predictor of vitality (both P < 0.05). ConclusionsEngaging in recommended amounts of moderate to vigorous physical activity per day is associated with higher monthly frequency of energy feelings, regardless of adiposity status, in middle-aged postmenopausal women.

Association between accelerometer-measured physical activity and muscle capacity in middle-aged postmenopausal women.

Objective:Greater muscle strength and power are associated with better physical function in middle-aged and older women. The aim of the present study was to determine whether accelerometer-measured physical activity was associated with muscle strength and power in middle-aged postmenopausal women. Methods:Postmenopausal women (N = 60; mean [SD] age, 58.9 [3.9] y) were assessed for physical activity (step count and moderate to vigorous physical activity [MVPA]) via accelerometer, for body composition via dual-energy x-ray absorptiometry, for concentric isokinetic knee torque at 60°/s and 180°/s using isokinetic dynamometry, and for leg extensor power with the Nottingham power rig. Results:In linear regression analysis, daily step count was independently associated with isokinetic knee torque at 60°/s (standardized &bgr; = 0.32, P = 0.01), isokinetic knee torque at 180°/s (standardized &bgr; = 0.32, P = 0.01), and total leg extensor power (&bgr; = 0.36, P = 0.01) after adjustment for covariates. Daily MVPA had similar associations with isokinetic knee torque at 60°/s (&bgr; = 0.38, P < 0.01), isokinetic knee torque at 180°/s (&bgr; = 0.41, P < 0.01), and leg power (&bgr; = 0.31, P = 0.02). Analysis of covariance indicated that women who engaged in MVPA for 30 minutes or more per day produced significantly greater isokinetic knee torque (60°/s and 180°/s) and leg extensor power compared with women not meeting this guideline (all P < 0.05). Conclusions:These findings suggest that daily step count and MVPA are independently associated with muscle strength and power in middle-aged postmenopausal women. Future studies should determine whether interventions that increase habitual physical activity in middle-aged women are associated with concomitant improvements in muscle capacity.

Adiposity, physical activity, and muscle quality are independently related to physical function performance in middle-aged postmenopausal women.

ObjectivePoor physical function performance is associated with risks for disability in late life; however, determinants of physical function are not well characterized in middle-aged women. The aim of this cross-sectional study was to examine the contributions of body composition, physical activity, muscle capacity, and muscle quality to physical function performance. MethodsPostmenopausal women (N = 64; mean [SD] age, 58.6 [3.6] y) were assessed for body composition via dual-energy x-ray absorptiometry, for physical activity via accelerometer (steps per day), and for physical function via Timed Up and Go, 30-second chair stand, and 6-minute walk. Leg strength was assessed using isokinetic dynamometry at 60° second−1. Leg power was assessed with the Nottingham Leg Extensor Power Rig. Muscle quality was calculated as (1) the ratio of leg strength at 60° second−1 to upper leg lean mass and (2) the ratio of leg power to total lower body lean mass. ResultsRegression analyses revealed the following: (1) age and muscle quality calculated with leg power are independently related to Timed Up and Go, explaining 12% and 11% of the variance, respectively (P < 0.05); (2) age and muscle quality calculated with leg strength are independently related to 30-second chair stand, explaining 12% and 10% of the variance, respectively (P < 0.05); and (3) number of medical conditions, muscle quality calculated with leg strength, steps per day, and adiposity are independent predictors of 6-minute walk, collectively explaining 51% of the variance. ConclusionsIn postmenopausal women, a more optimal body composition (including lower adiposity and higher lean mass) and higher levels of physical activity are associated with better physical function performance at midlife.

Muscle strengthening exercises during pregnancy are associated with increased energy and reduced fatigue.

Abstract Introduction: Physical inactivity likely contributes to fatigue and low energy during pregnancy but whether acute resistance exercise attenuates these symptoms is unknown. Methods: Twenty-six women performed six low-to-moderate intensity resistance exercises twice per week from weeks 23 to 35 of pregnancy and measurements were made before and after each workout using the Mental and Physical State Energy and Fatigue Scales. Results: Acute resistance exercise usually increased perceived physical and mental energy (92% to 96% of workouts, respectively). These increases did not differ significantly across the 24 exercise sessions for feelings of physical energy or mental energy, even after adjusting for variations in attendance (median = 22/24 workouts). Acute resistance exercise usually decreased perceived physical and mental fatigue (79% to 88% of workouts, respectively), and ANCOVA showed these decreases did not differ significantly across the 24 exercise sessions for feelings of physical fatigue or mental fatigue even after adjusting for variations in attendance. Discussion: The results suggest acute, low-to-moderate intensity muscle strengthening exercise during pregnancy is effective for transiently improving feelings of energy and fatigue.

Physical activity, pain responses to heat stimuli, and conditioned pain modulation in postmenopausal women.

ObjectivePostmenopausal women (PMW) are at high risk for disabling pain and physical inactivity. This study sought to enhance the understanding of relationships between physical activity (PA) and pain among PMW using heat pain sensitivity test and conditioned pain modulation test. We hypothesized that, compared with active women, (i) inactive women would report higher pain intensity and pain unpleasantness ratings; (ii) inactive women in disabling pain would report higher pain intensity and pain unpleasantness at high, but not low, stimulus intensities; and (iii) inactive women would have less modulation. MethodsSixty-eight PMW rated the pain intensity and pain unpleasantness of hot stimuli presented to the thenar eminence of the hand. A subset of 31 women rated the pain intensity of a test stimulus (noxious heat) and a conditioning stimulus (cold water) as part of the conditioned pain modulation task. PA was assessed objectively with accelerometry. ResultsMixed-model analysis of variance (2 × 4 × 2; PA × Temperature × Pain Status) showed that inactive women in disabling pain rated pain unpleasantness higher than active women in disabling pain (F3,192 = 3.526, ∂&eegr;2 = 0.052, P = 0.016). Significantly lower pain unpleasantness ratings were found at the highest stimulus intensity (49°C) only for active women in disabling pain compared with inactive women in disabling pain (t11 = 2.523, P = 0.028). The other hypotheses were not supported. ConclusionsPA is associated with a reduced sensitivity to the unpleasantness of painful high-intensity heat stimuli among women in disabling pain.

Comparison of Intake of Animal and Plant Foods and Related Nutrients in Postmenopausal Breast Cancer Survivors and Controls

ABSTRACT This study’s objective is to assess differences in dietary intakes in breast cancer survivors (n = 13) and women without a history of breast cancer (controls, n = 71). In a cross-sectional design, intake of foods, food groups, nutrients, and non-nutritive sweeteners was assessed using participant-completed three-day food records. All women were postmenopausal (mean age (SD) 58.5 (±3.8) y, 95% White, 2.4% Asian Pacific, and 2.4% Black). The two groups did not differ in age, energy intake, or body mass index (p > 0.05). Compared to controls, survivors consumed less dairy products, animal protein, total protein, and calcium, but more legumes, noncitrus fruit, and carbohydrates (p ≤ 0.05). Calcium intakes were of particular concern in survivors who consumed an average of 686 mg calcium/d, which is <60% of the recommended 1200 mg/d. Given the important role of calcium in bone health and protein in muscle function among aging women, breast cancer survivors may benefit from consultation with a Registered Dietitian or other health professional knowledgeable in nutritional recommendations for postmenopausal breast cancer survivors.