Daniel Bonner

Aerobic exercise training reduces arterial stiffness in metabolic syndrome

The metabolic syndrome (MetS) is associated with a threefold increase risk of cardiovascular disease (CVD) mortality partly due to increased arterial stiffening. We compared the effects of aerobic exercise training on arterial stiffening/mechanics in MetS subjects without overt CVD or type 2 diabetes. MetS and healthy control (Con) subjects underwent 8 wk of exercise training (ExT; 11 MetS and 11 Con) or remained inactive (11 MetS and 10 Con). The following measures were performed pre- and postintervention: radial pulse wave analysis (applanation tonometry) was used to measure augmentation pressure and index, central pressures, and an estimate of myocardial efficiency; arterial stiffness was assessed from carotid-femoral pulse-wave velocity (cfPWV, applanation tonometry); carotid thickness was assessed from B-mode ultrasound; and peak aerobic capacity (gas exchange) was performed in the seated position. Plasma matrix metalloproteinases (MMP) and CVD risk (Framingham risk score) were also assessed. cfPWV was reduced (P < 0.05) in MetS-ExT subjects (7.9 ± 0.6 to 7.2 ± 0.4 m/s) and Con-ExT (6.6 ± 1.8 to 5.6 ± 1.6 m/s). Exercise training reduced (P < 0.05) central systolic pressure (116 ± 5 to 110 ± 4 mmHg), augmentation pressure (9 ± 1 to 7 ± 1 mmHg), augmentation index (19 ± 3 to 15 ± 4%), and improved myocardial efficiency (155 ± 8 to 168 ± 9), but only in the MetS group. Aerobic capacity increased (P < 0.05) in MetS-ExT (16.6 ± 1.0 to 19.9 ± 1.0) and Con-ExT subjects (23.8 ± 1.6 to 26.3 ± 1.6). MMP-1 and -7 were correlated with cfPWV, and both MMP-1 and -7 were reduced post-ExT in MetS subjects. These findings suggest that some of the pathophysiological changes associated with MetS can be improved after aerobic exercise training, thereby lowering their cardiovascular risk.

Is obesity predictive of cardiovascular dysfunction independent of cardiovascular risk factors

Introduction:Obesity is thought to exert detrimental effects on the cardiovascular (CV) system. However, this relationship is impacted by the co-occurrence of CV risk factors, type 2 diabetes (T2DM) and overt disease. We examined the relationships between obesity, assessed by body mass index (BMI) and waist circumference (WC), and CV function in 102 subjects without overt CV disease. We hypothesized that obesity would be independently predictive of CV remodeling and functional differences, especially at peak exercise.Methods:Brachial (bSBP) and central (cSBP) systolic pressure, carotid-to-femoral pulse wave velocity (PWVcf) augmentation index (AGI; by SphygmoCor), and carotid remodeling (B-mode ultrasound) were examined at rest. Further, peak exercise cardiac imaging (Doppler ultrasound) was performed to measure the coupling between the heart and arterial system.Results:In backward elimination regression models, accounting for CV risk factors, neither BMI nor WC were predictors of carotid thickness or PWVcf; rather age, triglycerides and hypertension were the main determinants. However, BMI and WC predicted carotid cross-sectional area and lumen diameter. When examining the relationship between body size and SBP, BMI (β=0.32) and WC (β=0.25) were predictors of bSBP (P<0.05), whereas, BMI was the only predictor of cSBP (β=0.22, P<0.05) indicating a differential relationship between cSBP, bSBP and body size. Further, BMI (β=−0.26) and WC (β=−0.27) were independent predictors of AGI (P<0.05). As for resting cardiac diastolic function, WC seemed to be a better predictor than BMI. However, both BMI and WC were inversely and independently related to arterial-elastance (net arterial load) and end-systolic elastance (cardiac contractility) at rest and peak exercise.Conclusion:These findings illustrate that obesity, without T2DM and overt CV disease, and after accounting for CV risk factors, is susceptible to pathophysiological adaptations that may predispose individuals to an increased risk of CV events.

Exercise reveals impairments in left ventricular systolic function in patients with metabolic syndrome

•  What is the central question of this study? Metabolic syndrome (MetS) is associated with a threefold increase in risk of cardiovascular disease mortality, which may be mediated, in part, by impaired left ventricular systolic function. The severity of left ventricular and arterial dysfunction during dynamic exercise in individuals with MetS without diabetes and/or overt cardiovascular disease has not previously been explored. •  What is the main finding and its importance? Cardiovascular function was characterized at rest and during peak exercise using echocardiography and gas exchange. During exercise, individuals with MetS displayed impaired left ventricular contractility, a blunted arterial–ventricular coupling reserve and limited aerobic capacity. These findings provide insight into the pathophysiological changes that may occur to predispose individuals with MetS to an increased risk of cardiovascular disease.

A Mixed Methods Evaluation of a 12-Week Insurance-Sponsored Weight Management Program Incorporating Cognitive-Behavioral Counseling

Physical activity is critical in healthy weight loss, yet there is still much to be learned about psychosocial mechanisms of physical activity behavior change in weight loss. A sequential mixed methods approach was used to assess the physical and psychosocial impact of a 12-week cognitive—behavioral weight management program and explore factors associated with weight loss. Quantitative data (N = 55) revealed program completion rate and mean percentage weight loss that compare favorably with other interventions, and differential psychosocial impacts on those losing more weight. Telephone interviews (n = 11) revealed four potential mechanisms for these differential impacts: (a) fostering accountability, (b) balancing perceived effort and success, (c) redefining ‘‘success,’’ and (d) developing cognitive flexibility.

Resistance Exercise Reduces Skeletal Muscle Cachexia and Improves Muscle Function in Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune, inflammatory disease associated with cachexia (reduced muscle and increased fat). Although strength-training exercise has been used in persons with RA, it is not clear if it is effective for reducing cachexia. A 46-year-old woman was studied to determine: (i) if resistance exercise could reverse cachexia by improving muscle mass, fiber cross-sectional area, and muscle function; and (2) if elevated apoptotic signaling was involved in cachexia with RA and could be reduced by resistance training. A needle biopsy was obtained from the vastus lateralis muscle of the RA subject before and after 16 weeks of resistance training. Knee extensor strength increased by 13.6% and fatigue decreased by 2.8% Muscle mass increased by 2.1%. Average muscle fiber cross-sectional area increased by 49.7%, and muscle nuclei increased slightly after strength training from 0.08 to 0.12 nuclei/μm2. In addition, there was a slight decrease (1.6%) in the number of apoptotic muscle nuclei after resistance training. This case study suggests that resistance training may be a good tool for increasing the number of nuclei per fiber area, decreasing apoptotic nuclei, and inducing fiber hypertrophy in persons with RA, thereby slowing or reversing rheumatoid cachexia.

Resveratrol Enhances Exercise-Induced Cellular and Functional Adaptations of Skeletal Muscle in Older Men and Women.

Older men (n = 12) and women (n = 18) 65-80 years of age completed 12 weeks of exercise and took either a placebo or resveratrol (RSV) (500 mg/d) to test the hypothesis that RSV treatment combined with exercise would increase mitochondrial density, muscle fatigue resistance, and cardiovascular function more than exercise alone. Contrary to our hypothesis, aerobic and resistance exercise coupled with RSV treatment did not reduce cardiovascular risk further than exercise alone. However, exercise added to RSV treatment improved the indices of mitochondrial density, and muscle fatigue resistance more than placebo and exercise treatments. In addition, subjects that were treated with RSV had an increase in knee extensor muscle peak torque (8%), average peak torque (14%), and power (14%) after training, whereas exercise did not increase these parameters in the placebo-treated older subjects. Furthermore, exercise combined with RSV significantly improved mean fiber area and total myonuclei by 45.3% and 20%, respectively, in muscle fibers from the vastus lateralis of older subjects. Together, these data indicate a novel anabolic role of RSV in exercise-induced adaptations of older persons and this suggests that RSV combined with exercise might provide a better approach for reversing sarcopenia than exercise alone.

Improved arterial-ventricular coupling in metabolic syndrome after exercise training: a pilot study.

PURPOSE The metabolic syndrome (MetS) is associated with threefold increased risk of cardiovascular (CV) morbidity and mortality, which is partly due to a blunted CV reserve capacity, reflected by a reduced peak exercise left ventricular (LV) contractility and aerobic capacity and a blunted peak arterial-ventricular coupling. To date, no study has examined whether aerobic exercise training in MetS can reverse peak exercise CV dysfunction. Furthermore, examining how exercise training alters CV function in a group of individuals with MetS before the development of diabetes and/or overt CV disease can provide insights into whether some of the pathophysiological CV changes can be delayed/reversed, lowering their CV risk. The objective of this study was to examine the effects of 8 wk of aerobic exercise training in individuals with MetS on resting and peak exercise CV function. METHODS Twenty participants with MetS underwent either 8 wk of aerobic exercise training (MetS-ExT, n = 10) or remained sedentary (MetS-NonT, n = 10) during this period. Resting and peak exercise CV function was characterized using Doppler echocardiography and gas exchange. RESULTS Exercise training did not alter resting LV diastolic or systolic function and arterial-ventricular coupling in MetS. In contrast, at peak exercise, an increase in LV contractility (40%, P < 0.01), cardiac output (28%, P < 0.05), and aerobic capacity (20%, P < 0.01), but a reduction in vascular resistance (30%, P < 0.05) and arterial-ventricular coupling (27%, P < 0.01), were noted in the MetS-ExT but not in the MetS-NonT group. Furthermore, an improvement in lifetime risk score was also noted in the MetS-ExT group. CONCLUSIONS These findings have clinical importance because they provide insight that some of the pathophysiological changes associated with MetS can be improved and can lower the risk of CV disease.

Abstract P1-09-12: Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial

Regular physical activity and healthy body composition are important predictors of good outcomes for breast cancer survivors, especially in overweight/obese individuals. However, individualized exercise and healthy eating programs have not focused on lifestyle changes and outcomes among women recovering from triple-negative breast cancer. Our purpose was to examine the associations between baseline levels of inflammatory cytokines and obesity-related adipokines after weight loss, diet and physical activity intervention in survivors of triple-negative breast cancer. We enrolled overweight/obese survivors (average time since diagnosis, 4 years) and randomly assigned them to a 12-week supervised exercise and low-fat diet (n=18) or a usual care group (n=10). The program consisted of supervised exercise 3 times/week, as well as 2 unsupervised sessions per week. The goal of our Get Fit for the Fight® program was to complete 150 min/week of moderate-intensity aerobic exercise. Participants completed a 3-day diet record during baseline testing and the dietitian recommended ways to cut calories from these typical eating patterns. The goal of caloric restriction was to decrease dietary fat in order for the participant to consume 200 kcal/week less. Assessments included aerobic fitness, body composition, and self-reported physical activity, mood and quality of life. Blood cytokines and obesity-related adipokines were also analyzed before and after the intervention period. The intervention group lost an average of 2% body fat compared with the control group (p Citation Format: Linda Vona-Davis, Jame Abraham, Daniel Bonner, Diana Gilleland, Gerald Hobbs, Sobha Kurian, Mary Anne Yanosik, Anne Swisher. Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-12.

Potential clinical utility of partial body weight support on treadmill walking time in persons with intermittent claudication: a single case report.

Intermittent claudication can seriously limit an individuals walking capacity. Walking programs are known to improve this limitation but could be limited by a persons ability to carry his or her own full body weight to perform the walking. We theorized that decreasing body weight, through mechanical unloading, might allow longer pain-free walking, thus potentially accelerating exercise training. This case report describes the effect of partial body weight support (PBWS) on walking time in a patient with claudication. A 60-year-old male with calf pain that prevented him from walking long distances or walking quickly was studied. The patient completed three treadmill walking tests (0%, 25%, and 50% PBWS) until claudication pain stopped him or 15 minutes elapsed. The participant walked 4:31 minutes at 0% PBWS with a pain rating of 3/4. He walked the full 15 minutes under each support condition with the same or less claudication pain (3/4 for 25% PBWS, 2/4 for 50% PBWS). This case reports the successful use of PBWS treadmill training for increasing walking time in an individual with intermittent claudication. If this finding holds true for a larger sample, PBWS may be a way for these individuals to participate in exercise training programs with less pain.