Eszter Füzéki

Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES)

BackgroundThe health effects of light-intensity physical activity (PA) are not well known today.ObjectiveWe conducted a systematic review to assess the association of accelerometer-measured light-intensity PA with modifiable health outcomes in adults and older adults.MethodsA systematic literature search up to March 2016 was performed in the PubMed, EMBASE, Web of Science and Google Scholar electronic databases, without language limitations, for studies of modifiable health outcomes in adults and older adults in the National Health and Nutrition Examination Survey accelerometer dataset.ResultsOverall, 37 cross-sectional studies and three longitudinal studies were included in the analysis, with considerable variation observed between the studies with regard to their operationalization of light-intensity PA. Light-intensity PA was found to be beneficially associated with obesity, markers of lipid and glucose metabolism, and mortality. Few data were available on musculoskeletal outcomes and results were mixed.ConclusionsObservational evidence that light-intensity PA can confer health benefits is accumulating. Currently inactive or insufficiently active people should be encouraged to engage in PA of any intensity. If longitudinal and intervention studies corroborate our findings, the revision of PA recommendations to include light-intensity activities, at least for currently inactive populations, might be warranted.

Activities of Daily Living and Health

Summary Activities of daily living, such as household, gardening, stair climbing, walking and cycling are now acknowledged as a major health resource, and explicitly advocated by many health authorities. Of activities of daily living, walking has received by far the most scientific interest both in prevention and therapy of chronic diseases. A considerable body of scientific evidence suggests that activities of daily living yield health benefits meaningful at the public health level. Promotion of these activities might be a promising way to improve health in unfit and elderly population disinclined to exercise.

Effects of aerobic exercise on brain metabolism and grey matter volume in older adults: results of the randomised controlled SMART trial

There is mounting evidence that aerobic exercise has a positive effect on cognitive functions in older adults. To date, little is known about the neurometabolic and molecular mechanisms underlying this positive effect. The present study used magnetic resonance spectroscopy and quantitative MRI to systematically explore the effects of physical activity on human brain metabolism and grey matter (GM) volume in healthy aging. This is a randomised controlled assessor-blinded two-armed trial (n=53) to explore exercise-induced neuroprotective and metabolic effects on the brain in cognitively healthy older adults. Participants (age >65) were allocated to a 12-week individualised aerobic exercise programme intervention (n=29) or a 12-week waiting control group (n=24). The main outcomes were the change in cerebral metabolism and its association to brain-derived neurotrophic factor (BDNF) levels as well as changes in GM volume. We found that cerebral choline concentrations remained stable after 12 weeks of aerobic exercise in the intervention group, whereas they increased in the waiting control group. No effect of training was seen on cerebral N-acetyl-aspartate concentrations, nor on markers of neuronal energy reserve or BDNF levels. Further, we observed no change in cortical GM volume in response to aerobic exercise. The finding of stable choline concentrations in the intervention group over the 3 month period might indicate a neuroprotective effect of aerobic exercise. Choline might constitute a valid marker for an effect of aerobic exercise on cerebral metabolism in healthy aging.

Sedentäres Verhalten und Gesundheit – Eine selektive Literaturübersicht

Exercise-related public health recommendations and research for increased fitness and health had long focused on vigorous exercise or the lack thereof. Recently scientific interest in possible effects of sedentary behaviour (SB) (sitting) independent of moderate-vigorous intensity exercise has been growing.We conducted a selective literature search in Pubmed and the Sedentary Research Database with the outcomes SB, risk factors, mortality and morbidity in adults. We included only reviews and systematic reviews.Observational studies suggest an association between SB and all-cause and cardiovascular, but not cancer mortality. SB also seems to be associated with diabetes and overweight/weight gain. Evidence for other diseases, such as cardiovascular diseases, hypertension, cancer, and mental diseases is limited also because of the heterogeneity and poor methodology of the -studies. Intervention studies found inconsistent evidence that SB is associated with detrimental effects on markers of cardiometabolic risk.The evidence on the detrimental effects of sedentary behaviour is decreasingly convincing with the endpoints of mortality, -morbidity, and markers of metabolic risk, in that order. Higher TV and screen time, but not total SB seems to be associated with higher all-cause and cardiovascular, but not cancer mortality. Further intervention studies are needed to establish -dose-response relationships and potentially protective effects of cardiorespiratory fitness and physical activity.

Physical Activity Recommendations for Health and Beyond in Currently Inactive Populations

Widespread persistent inactivity makes continued efforts in physical activity promotion a persistent challenge. The precise content of physical activity recommendations is not broadly known, and there are concerns that the general messaging of the guidelines, including the recommendations to perform at least 150 min of at least moderate intensity physical activity per week might seem unattainable for and even actually discourage currently inactive people. Here we show that there are a myriad of ways of being physically active, and provide (in part) out-of-the-box examples of evidence based, pragmatic, easily accessible physical activity regimes below 150 min and/or with lower than moderate intensity that yield meaningful health benefits for currently inactive people.

Lifespan leisure physical activity profile, brain plasticity and cognitive function in old age

ABSTRACT Objectives: Despite the evidence suggesting physical activity (PA) as a major factor for the prevention of age-related cognitive decline, only a few studies have systematically investigated the impact of leisure PA during the lifespan (LLPA). This study investigates the effects of LLPA on cognitive function (CF) and brain plasticity (BP) in old age. Method: Participants’ (n = 50, 72 ± 5 yrs, 27 females) LLPA energy expenditure and volume was assessed via a validated questionnaire investigating five epochs (14–80 yrs). Using current WHO PA recommendations as reference, participants were stratified into energy expenditure and volume groups. CF outcomes were attention, executive functions, working memory and memory. BP was assessed using magnetic resonance spectroscopy (MRSI) and brain derived neurotropic factor (BDNF). Results: Correlation analysis revealed associations of mean LLPA energy expenditure with attention (CF) and N-acetylaspartate to choline ratios (NAA/Cho) (MRSI). ANOVA revealed higher interference control performance (CF) and NAA/Cho in participants complying with current PA recommendations (2-3 h per week) compared to non-compliers. Further CF and BP outcomes including BDNF were not associated with LLPA. Conclusion: Lifelong adherence to minimum recommended PA seems to be associated with markers of cognitive function and neuronal integrity in old age.

Sitzender Lebensstil und Gesundheit

Die meisten Menschen verbringen in Freizeit und Beruf viel Zeit in sitzender oder angelehnter Korperhaltung. Beobachtungsstudien ermitteln eine Verbindung dieses »sedentaren Verhaltens« (engl.: sedentary behavior) mit kardiometabolischen Erkrankungen, einigen Krebsarten sowie einem erhohten Sterberisiko. Als mogliche Wirkmechanismen werden akute und langerfristige Veranderungen des Energiestoffwechsels diskutiert. Speziell die Funktion einiger Schlusselenzyme des Glukose- und Fettstoffwechsels konnte bei diesen pathophysiologischen Veranderungen eine zentrale Rolle spielen. Erste Untersuchungen zeigen, dass sowohl die Unterbrechung sedentaren Verhaltens durch korperliche Aktivitat als auch die Vermeidung langer Sitzphasen einen positiven Einfluss haben konnen.

Breaking up sedentary time, physical activity and lipoprotein metabolism

OBJECTIVES Some authors report delayed responses of lipid metabolism after prolonged and interrupted sitting. To date no experimental studies have shown acute physical activity (PA) related changes of lipoprotein metabolism during sedentary behavior (SB). The purpose of this study was to examine immediate effects of a single PA-bout vs. regular PA-breaks on lipoprotein metabolism during postprandial SB. DESIGN Eighteen female subjects (25.6years±2.6; 21.5kg/m2±2.0) participated in a balanced crossover experiment with three trials: (1) 30min PA prior to 4h sitting (PRE), (2) 5×6min PA within 4h sitting (BREAK) (3) 4h sitting (CTRL). PA was ergometer cycling at 70%VO2max. Participants consumed one standardized breakfast in each trial. METHODS Total cholesterol (tChol), high density lipoprotein (HDL), low density lipoprotein (LDL) and triacylglycerol (TAG) readings were taken in fasted state at the beginning (before), and immediately after each trial. Multiple 2×3-ANOVAs (trial-arm*time) and post hoc t-tests were used. RESULTS ANOVAs revealed trial*time-effects for tChol (p=0.043) and HDL (p=0.007) and a tendency for LDL (p=0.078). Before-to-after differences (Δ) of tChol during BREAK-trial (-0.89±5.49mg/dl) significantly differed to Δ during PRE-trial (+3.56±5.32mg/dl) (p=0.005) but not to ΔCTRL (+2.16±8.72). ΔHDL during BREAK-trial (-2.11±3.31mg/dl) significantly differed to ΔPRE (+0.83±4.26mg/dl) (p=0.007) and ΔCTRL (+0.06±4.15mg/dl) (p=0.028). Analysis of TAG revealed a time effect (p=0.007) and significant differences between TAG before and after trial within BREAK (79.22±38.69mg/dl to 94.78±44.86mg/dl) and CTRL (80.94±32.94mg/dl to 97.72±41.19mg/dl) but not in PRE (78.83±33.13mg/dl to 89.06±33.83mg/dl). CONCLUSIONS Breaking sedentary behavior with vigorous intensity PA seem to decelerate postprandial lipoprotein metabolism during sitting. In contrast, prior PA, might be a stimulus for lipid metabolization.

Physical Exercise in Advanced Malignant Diseases

Patients with advanced cancer in which the primary aim of therapy is controlling symptoms are still capable of participating in appropriately designed exercise programs and may significantly benefit, both physically and psychologically, from such interventions. Overall, exercise regimens for patients with advanced cancer should be tailored on a personal basis to accommodate health status and limitations imposed by disease and should be part of an overall comprehensive plan of palliative care developed and administered by an interdisciplinary team. In general, palliative – symptomatic therapy measures may be most effective when introduced early in the course of disease management, even during the curative phase of therapy. In this chapter, approaches to palliative medicine are discussed in general and specifically for patients with tumors of the lung and respiratory track, prostate cancer, gynecologic tumors and gastrointestinal tumors. The effects of exercise interventions are reviewed also for symptom clusters that occur frequently in advanced cancer patients including chronic fatigue syndrome, the anorexia-cachexia syndrome and the chronic severe pain syndrome. Overall, it is important to note, that regardless of the course of the disease, the majority of advanced cancer patients who obtain measurable increase in performance with exercise training, report considerable improvement in quality of life.

Author’s Reply to Lopez: Comment on “Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES)”

Thank you for the opportunity to respond to Dr. Lopez’s letter [1]. Dr. Lopez expresses his doubts whether light intensity physical activity (LIPA) might be relevant for health and argues that we misinterpret current scientific evidence on the potential health effect of LIPA. We would like to take the opportunity to emphasize some important points he seems to have overlooked or disregarded in our work [2]. We are aware of the fact that the investigation of potential health effects of LIPA is a new and emerging field, with methodological limitations and many unanswered questions. To systematically assess the current state of evidence, we included both longitudinal and cross-sectional data and applied a rigorous quality rating. Since the necessary evidence for causal links is currently missing, we repeatedly underlined in our paper that further studies in this field are necessary. We explicitly acknowledged the limitations inherent in cross-sectional studies and the sparseness of experimental data to date. We were consciously cautious in formulating our interpretation regarding our findings. We stated, for example, that a ‘‘nuanced [italics added] view is warranted and LIPA should not ... be regarded as a panacea’’. We agree with Dr. Lopez that adjustments for moderatevigorous physical activity (MVPA) are necessary for a sound statistical analysis. Therefore we examined whether studies adjusting for MVPA contradict those that did not, and found that this was not the case. Of the three longitudinal studies we identified, two did adjust for MVPA [3, 4] and the third one applied the isotemporal substitution model, which also accounts for the effects of different intensity ranges [5]. Also, Fishman et al. used sensitivity analysis to limit the probability of reverse causality, excluding participants with mobility limitations and chronic diseases, which did not alter their results [5]. The body of literature concerning the effects of LIPA is growing fast. Since the completion of our literature review, at least two further longitudinal studies using NHANES data have been published, besides the one quoted by Dr. Lopez [6]. One, with a mean follow-up of 6.75 years, adjusted not only for MVPA but also for muscle strengthening activities, and excluded participants who died in the first year of follow-up and who had coronary artery disease, congestive heart failure or stroke at baseline [7]. The other study, with a mean follow-up of 6.35 years, applied the isotemporal substitution model and sensitivity analyses [8]. Both studies found a beneficial association between LIPA and mortality. Dr. Lopez further argues that ‘any acute exercise signal needs to exceed a certain ‘‘threshold stimulus’’,’ which we fully agree with. The intriguing question is at what intensity this threshold is. We propose—based on data we identified—that ‘‘health benefits of LIPA might be driven more by high LIPA than low LIPA, or, in other words, that there may be a minimal intensity threshold below which activities provide no quantifiable health benefits.’’ Our findings and interpretation of the data are upheld by & Eszter Füzéki fuezeki@sport.uni-frankfurt.de