Helena Santa-Clara

Effect of a one-year combined exercise training program on body composition in men with coronary artery disease

Increased fat mass, particularly abdominal fat mass, is associated with poor metabolic profiles and an increase in cardiovascular risk factors. The purpose of this study was to evaluate the effect of a 1-year combined aerobic and strength training regimen, compared to aerobic training only, on body composition in patients with coronary artery disease (CAD). Thirty-six males with CAD were assigned to 3 groups: 13 to weight training plus aerobic training (combined training group [CT]), 13 to aerobic training only (aerobic training group [AT]), and 10 to a control group (no exercise [CG]). Body composition was determined by dual-energy x-ray absorptiometry (DEXA). Differences were observed between groups at the end of the study, controlling for prevalues. The total and trunk percent fat mass (%FM) were lower in CT compared with AT and CG (P<.05). The total %FM in AT was significantly (P<.05) lower than in CG, but the %FM of the trunk did not differ between the 2 groups. Fat-free mass (FFM) was significantly higher in CT than in AT and CG (P<.05). The results suggest that a long-term CT program is more effective than an AT program alone in producing changes in body composition. The percentage changes in total and trunk fat mass were higher in CT (-11% and -12%, respectively) than in AT (-2.4% and -0.7%, respectively). Future studies need to investigate the specific health effects of trunkal fat mass loss in patients with CAD.

The impact of exercise training on liver transplanted familial amyloidotic polyneuropathy (FAP) patients.

Background Liver transplantation is nowadays the only effective answer to adjourn the outcome of functional limitations associated with familial amyloidotic polyneuropathy (FAP), a neurodegenerative disease characterized by sensory and motor polyneuropathies. Nevertheless, there is a detrimental impact associated with the after-surgery period on the fragile physical condition of these patients. Exercise training has been proven to be effective on reconditioning patients after transplantation. However, the effects of exercise training in liver transplanted FAP patients have not been scrutinized yet. Methods The study aimed to evaluate the effects of a 24-week exercise training program (supervised or home-based) on body composition, muscle strength, and walking capacity of liver transplanted FAP patients. To fulfill this goal, a sample corresponding to 33% of all FAP patients who undergone a liver transplantation in the area of Lisbon between January 2006 and December 2008 were followed over time. Three evaluation periods were accomplished: M1 (pre-exercise training period), M2 (immediate post-exercise training period), and M3 (24 weeks after M2). The former allowed an assessment of the impact of detraining in these patients. Results The exercise training program improved body composition (lean mass and total body skeletal muscle mass), weight, and walking capacity. The improvements were more pronounced within the patients with supervised exercise training compared with the patients on the home-based program. In general, the benefits of the exercise training perdure even after a 24-week detraining period. Conclusions Exercise training results in significant improvements on the physical condition of liver transplanted FAP patients.

Effect of exercise training on blood pressure in postmenopausal Caucasian and African-American women

T blood pressure (BP) response to submaximal exercise may be especially important because of its relation to the future risk of hypertension and development of left ventricular hypertrophy.1–5 Exercise BP tends to be higher in African-American (AA) than in Caucasian (C) subjects,6 but lower in fit than unfit persons in the AA and C groups.7,8 In the Health Risk Factors Exercise Training and Genetics (HERITAGE) Family Study9 submaximal BP was significantly reduced at both absolute (50 W) and relative (60%) power outputs after exercise training. The decrease was greater in AA than C men and women, and in older than younger subjects. However, the specific effect in postmenopausal women was not evaluated. Considering postmenopausal AA women have a high incidence of hypertension10 and little is known about the effect of exercise training on resting and exercise BP in this population, the purpose of this study was to determine the resting and exercise BP responses to aerobic exercise training in C and AA postmenopausal women. • • • This was a randomized, longitudinal, controlled trial examining the effects of a 6-month, moderate-tovigorous intensity, cardiovascular exercise training program on BP in C and AA postmenopausal women with normal and/or high normal BP. After undergoing baseline testing, women were randomly assigned to exercise or control groups. The exercise groups participated in a 6-month supervised exercise program, whereas the control group was instructed to maintain their current lifestyle. Written informed consent was obtained from all volunteers’ subjects before participation, and the study was approved by the University Medical Center Institutional Review Board. Sixty healthy sedentary postmenopausal women aged 45 to 70 years volunteered to serve as subjects. A postmenopausal subject was defined as one who had amenorrhea for 6 months or was aged 55 years with no bleeding for 6 months, and generally was in good health and was able to exercise at the rate described in our protocol; this subject was also sedentary for a minimum of 6 months before participation. Sedentary was defined as no 1 day/week of aerobic exercise activity lasting 20 minutes. Subjects were excluded if they had moderate to severe hypertension (defined as BP at rest 160/100 mm Hg at entry), diabetes, history of thyroid disease or use of thyroid medications, history of deep vein thrombosis, pulmonary embolism, cardiovascular disease, familial hypercoagulability, or if they were current cigarette smokers. Thirty-three C and 27 AA women were randomly assigned to supervised aerobic exercise training (C, n 17; AA, n 15) or nonexercise control (C, n 16; AA, n 12). Subjects visited the laboratory in the morning after a 12-hour fast, having refrained from physical activity for 24 hours. BP at rest was obtained through standard sphygmomanometry in the sitting position after 1 hour of rest in a quiet room with dim lighting. We measured BP in both arms, 3 times in each arm. The 3 BP determinations were made 2 minutes apart and the values were averaged to determine each subject’s BP at rest. The subjects then performed a maximal exercise test using a modified Bruce protocol on a motorized treadmill with continuous electrocardiographic and gas analysis measurements (Quinton Q-Plex, Bothell, Washington). Twelve-lead electrocardiograms, BP, and ratings of perceived exertion were recorded during the last minute of each exercise stage. Exercise BP was measured during graded exercise testing through standard sphygmomanometry. The maximal (or peak) oxygen uptake was defined as the highest 20-second value attained provided 2 of the following criteria were met: the subject was within 10 beats/min of predicted maximal heart rate; a plateau was reached in oxygen uptake with an increase in workload (an increase of 2.0 ml/ kg/min); ratings of perceived exertion were 18; and/or a respiratory exchange ratio was 1.05. These procedures were performed at baseline and at the end of the 6-month study. After completion of the test, each subject was randomly assigned to either the exercise or control group. The exercise training group entered the supervised exercise program and the control subjects were asked to maintain their current behavior throughout the 6-month study period. The aerobic exercise training consisted of 3 to 4 exercise sessions per week. Subjects were provided with Polar heart rate monitors (Polar Electro Inc, Port Washington, New York) to ensure and monitor adherence to the prescribed intensity. Exercise included treadmill walking/jogging, stationary cycling, and rowing. Intensity was prescribed at 70% to 85% of their measured maximal heart rate. Exercise duration was gradually increased during the first 8 weeks until subjects were exercising for 45 to 60 minutes/session, From the Exercise and Health Laboratory, Faculty of Human Movement, Technical University of Lisbon, Lisbon, Portugal; Human Performance Laboratory, Medical Center, George Washington University, Washington, DC; and Exercise Science Department, Syracuse University, Syracuse, New York. This study was supported by the American Heart Association, Washington, DC Affiliate, Washington, DC. Dr. Santa-Clara’s address is: Faculdade de Motricidade Humana, Estrada da Costa, 1495-688 Cruz-Quebrada, Portugal. E-mail: santaclara@fmh.utl.pt. Manuscript received August 26, 2002; revised manuscript received and accepted January 7, 2003.

Intima-Media Thickness in 11- to 13-Year-Old Children: Variation Attributed to Sedentary Behavior, Physical Activity, Cardiorespiratory Fitness, and Waist Circumference

BACKGROUND It is unclear how sedentary behavior (SED), physical activity (PA), and cardiorespiratory fitness (CRF) influence vascular structure in children of varying body size. This study examined whether associations between SED, PA, and CRF with intima-media thickness (IMT) added to that of abdominal fatness and IMT. Differences in physiological measures among waist circumference (WC) percentiles were tested. METHODS We assessed IMT of the carotid artery in 265 children aged 11 to 13 years (135 girls). Measures included IMT assessed with high-resolution ultrasonography, WC, body fat mass (BFM) from DXA, and CRF determined using a maximal cycle test. SED and PA were assessed by accelerometry. Association between IMT and CRF adjusted for PA variables, and body composition phenotypes were tested with multiple linear regression analysis. RESULTS CRF was related to IMT independently of moderate to vigorous PA (MVPA) and SED (P < .05). When WC was added to the model CRF was no longer associated with IMT (P > .05). Children in the higher WC group had increased mean values of BMI, BFM, WC, and IMT and lower MVPA and CRF (P < .05). CONCLUSION Full modeling of SED, MVPA, CRF, and WC revealed that regional adiposity appears to have the biggest role in arterial structure of children.

Body fat responses to a 1‐year combined exercise training program in male coronary artery disease patients

To analyze the body fat (BF) content and distribution modifications in coronary artery disease (CAD) patients in response to a 1‐year combined aerobic and resistance exercise training (CET) program.

Impacto do exercício físico combinado na percepção do estado de saúde da pessoa com doença pulmonar obstrutiva crónica

Aim: The aim of the study was to evaluate the effectiveness of a 10-week combined training programme (aerobic and strength exercise) compared to an aerobic training programme, and respiratory physiotherapy on COPD patients’ health. Metho ds: Fifty subjects with moderate to severe COPD were randomly assigned to two groups. Combined group (CG, n=25) who underwent combined training, and aerobic group (AG, n=25) who underwent aerobic training. These were compared with fifty

Body composition and body fat distribution are related to cardiac autonomic control in non-alcoholic fatty liver disease patients.

Background/Objectives:Heart rate recovery (HRR), a cardiac autonomic control marker, was shown to be related to body composition (BC), yet this was not tested in non-alcoholic fatty liver disease (NAFLD) patients. The aim of this study was to determine if, and to what extent, markers of BC and body fat (BF) distribution are related to cardiac autonomic control in NAFLD patients.Subjects/Methods:BC was assessed with dual-energy X-ray absorptiometry in 28 NAFLD patients (19 men, 51±13 years, and 9 women, 47±13 years). BF depots ratios were calculated to assess BF distribution. Subjects’ HRR was recorded 1 (HRR1) and 2 min (HRR2) immediately after a maximum graded exercise test.Results:BC and BF distribution were related to HRR; particularly weight, trunk BF and trunk BF-to-appendicular BF ratio showed a negative relation with HRR1 (r=−0.613, r=−0.597 and r=−0.547, respectively, P<0.01) and HRR2 (r=−0.484, r=−0.446, P<0.05, and r=−0.590, P<0.01, respectively). Age seems to be related to both HRR1 and HRR2 except when controlled for BF distribution. The preferred model in multiple regression should include trunk BF-to-appendicular BF ratio and BF to predict HRR1 (r2=0.549; P<0.05), and trunk BF-to-appendicular BF ratio alone to predict HRR2 (r2=0.430; P<0.001).Conclusions:BC and BF distribution were related to HRR in NAFLD patients. Trunk BF-to-appendicular BF ratio was the best independent predictor of HRR and therefore may be best related to cardiovascular increased risk, and possibly act as a mediator in age-related cardiac autonomic control variation.

The acute effect of maximal exercise on central and peripheral arterial stiffness indices and hemodynamics in children and adults

This study compared the effects of a bout of maximal running exercise on arterial stiffness in children and adults. Right carotid blood pressure and artery stiffness indices measured by pulse wave velocity (PWV), compliance and distensibility coefficients, stiffness index α and β (echo-tracking), contralateral carotid blood pressure, and upper and lower limb and central/aortic PWV (applanation tonometry) were taken at rest and 10 min after a bout of maximal treadmill running in 34 children (7.38 ± 0.38 years) and 45 young adults (25.22 ± 0.91 years) having similar aerobic potential. Two-by-two repeated measures analysis of variance and analysis of covariance were used to detect differences with exercise between groups. Carotid pulse pressure (PP; η(2) = 0.394) increased more in adults after exercise (p < 0.05). Compliance (η(2) = 0.385) decreased in particular in adults and in those with high changes in distending pressure, similarly to stiffness index α and β. Carotid PWV increased more in adults and was related to local changes in PP but not mean arterial pressure (MAP). Stiffness in the lower limbs decreased (η(2) = 0.115) but apparently only in those with small MAP changes (η(2) = 0.111). No significant exercise or group interaction effects were found when variables were adjusted to height. An acute bout of maximal exercise can alter arterial stiffness and hemodynamics in the carotid artery and within the active muscle beds. Arterial stiffness and hemodynamic response to metabolic demands during exercise in children simply reflect their smaller body size and may not indicate a particular physiological difference compared with adults.

Single and combined effects of body composition phenotypes on carotid intima‐media thickness

Central fatness might be a more sensitive predictor of atherosclerotic changes in children than are total body fat measures. However, it is unclear whether a total body fat measure coupled with an estimate of a more central pattern of fat accumulation predicts increased carotid intima‐media‐thickness (cIMT) better than either measure alone.

Finding the Best Waist Circumference Measurement Protocol in Patients With Nonalcoholic Fatty Liver Disease

BACKGROUND Central fat accumulation is important in nonalcoholic fatty liver disease (NAFLD) etiology. It is unknown whether any commonly used waist circumference measurement protocol (WCmp), as a whole and central fat accumulation marker, is preferable for patients with NAFLD. The present study sought to find a preferable WCmp to be used in patients with NAFLD, based on 3-fold criteria. METHODS Body fat (BF) was assessed through dual-energy x-ray absorptiometry in 28 patients with NAFLD (19 men, 51 ± 13 years; 9 women, 47 ± 13 years). WC was measured with 4 types of WCmp: WC1, narrowest torso; WC2, just above iliac crest; WC3, middistance between iliac crest and last rib; WC4, at the umbilicus. RESULTS All WC measurements were highly correlated with central BF depots, including trunk BF (r = 0.78, r = 0.82, r = 0.82, r = 0.84 for WC1, WC2, WC3, and WC4, respectively), abdominal BF (r = 0.78, r = 0.78, r = 0.80, r = 0.72 for WC1, WC2, WC3, and WC4, respectively), and central abdominal BF (r = 0.76, r = 0.77, r = 0.78, r = 0.68 for WC1, WC2, WC3, and WC4, respectively), controlling for age, sex, and body mass index. There were no differences between the correlation coefficients obtained between all studied waist circumference measurements and each whole and central analyzed BF variable. CONCLUSIONS All studied WCmps seem suitable for use in patients with NAFLD, particularly as a central BF clinical assessment tool, though not interchangeably. Hence, biological and precision criteria alone did not sanction the superiority of any WCmp. Practical criteria may endorse WC measured at the iliac crest.