Lynnette M. Jones

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

Persons with spinal cord injury lose lean tissue mass and bone but gain body fat. There is a need to quantify the magnitude of these changes in body composition because there are associated skeletal and cardiovascular health risks. We have compared total body and regional (lower limb) differences in body composition in a group of males with paraplegia and in healthy able-bodied males matched for age, and height using dual energy X-ray absorptiometry. Although patients and controls had similar body mass indices, significant reductions in lean tissue mass (16% less) and bone (12% less) were observed in those with spinal cord injury. Group differences were even more pronounced in the lower limb. DEXA also revealed large increases in fat mass in subjects who did not look obese, total fat mass being 47% higher in the paraplegic group. We suggest that DEXA provides a simple and practical means to quantify both whole body and regional changes in body composition associated with spinal cord injury.

Intensive exercise may preserve bone mass of the upper limbs in spinal cord injured males but does not retard demineralisation of the lower body

Study design: Cross-sectional study comparing a group of active spinal cord injured (SCI) males carefully matched for age, height, and weight with active able-bodied male controls.Objectives: To compare bone mass of the total body, upper and lower limbs, hip, and spine regions in active SCI and able-bodied individuals.Setting: Outpatient study undertaken in two centres in New Zealand.Methods: Dual energy X-ray absorptiometry (DEXA) scanning was used to determine bone mass. Questionnaires were used to ascertain total time spent in weekly physical activity for each individual. The criterion for entry into the study was regular participation in physical activity of more than 60 min per week, over and above that required for rehabilitation.Results: Seventeen SCI and their able-bodied controls met our required activity criterion. Bone mineral density (BMD) values of the total body and hip regions were significantly lower in the SCI group than in their controls (P=0.0001). Leg BMD and bone mineral content (BMC) were also significantly lower in the SCI group (P=0.0001). By contrast, lumbar spine BMD and arm BMD and BMC did not differ between the SCI and control groups. Arm BMD and BMC were greater (not significant) than the reference norms (LUNAR database) for both groups.Conclusion: Intensive exercise regimens may contribute to preservation of arm bone mass in SCI males, but does not prevent demineralisation in the lower body.Sponsorship: Funding provided by the DEXA Group Bone Health Dunedin, New Zealand and The Lamar Trust, Christchurch, New Zealand.

Inflammatory biomarkers for predicting cardiovascular disease.

The pathology of cardiovascular disease (CVD) is complex; multiple biological pathways have been implicated, including, but not limited to, inflammation and oxidative stress. Biomarkers of inflammation and oxidative stress may serve to help identify patients at risk for CVD, to monitor the efficacy of treatments, and to develop new pharmacological tools. However, due to the complexities of CVD pathogenesis there is no single biomarker available to estimate absolute risk of future cardiovascular events. Furthermore, not all biomarkers are equal; the functions of many biomarkers overlap, some offer better prognostic information than others, and some are better suited to identify/predict the pathogenesis of particular cardiovascular events. The identification of the most appropriate set of biomarkers can provide a detailed picture of the specific nature of the cardiovascular event. The following review provides an overview of existing and emerging inflammatory biomarkers, pro-inflammatory cytokines, anti-inflammatory cytokines, chemokines, oxidative stress biomarkers, and antioxidant biomarkers. The functions of each biomarker are discussed, and prognostic data are provided where available.

Upright water-based exercise to improve cardiovascular and metabolic health: A qualitative review

Research regarding the benefits of exercise for cardiovascular and metabolic health is extensive and well-documented. However, weight-bearing exercise may not be suitable for individuals with orthopaedic or musculoskeletal limitations, excess adiposity or other medical conditions. Water-based exercise may provide an attractive alternative to land-based exercise for achieving improved health and fitness in these populations. Although swimming is a popular form of water-based exercise it requires specific skills and is often undertaken at intensities that may not be safely prescribed in patient populations. Therefore upright, water-based exercise has been suggested as a viable water-based alternative. However, surprisingly little is known about the effects of upright water-based exercise on improvements in cardiovascular and metabolic health. Limited evidence from water-based studies indicate that regular deep or shallow water exercise can exert beneficial effects on cardiorespiratory fitness, strength, and body fat distribution. However, the impacts of water-based exercise on lipid profile, bodyweight, and carbohydrate metabolism are still unclear. Further studies are warranted to establish the effects of non-swimming, water-based exercise on cardiometabolic risks in humans.

Maximal physiological responses between aquatic and land exercise in overweight women.

PURPOSE To investigate the maximal physiological responses between aquatic and land-based graded exercise tests in overweight women. METHODS Twenty healthy, overweight (body mass index (BMI) > or = 25 kg.m(-2)), Caucasian women (mean +/- SD; age 48 +/- 7 yr, BMI 30 +/- 4 kg.m(-2)) completed a deep water running (DWR) and treadmill walking (TMW) graded exercise test. Maximal responses during the DWR and TMW graded exercise tests were compared using paired t-tests. Comparisons were made in the incidence of achievement of maximal oxygen consumption (VO2max) criteria between DWR and TMW protocols. Criteria were a plateau in VO2 (change < 2.1 mL.kg.min(-1)), heart rate (HR) equal to or above the age-adjusted maximum, and respiratory exchange ratio (RER) > or = 1.15. RESULTS Maximal responses for VO2max (22.5 +/- 4.86 vs 27.7 +/- 4.73 mL.kg.min(-1)), HRmax (159 +/- 16 vs 170 +/- 12 bpm), and RER (1.03 +/- 0.06 vs 1.10 +/- 0.06) were significantly lower (P < 0.01) for the DWR test compared with the TMW test, respectively. Achievement of various VO2max criteria was demonstrated more consistently during the TMW test than the DWR test. CONCLUSION Maximal physiological responses of overweight women to DWR and TMW are significantly different but are comparable with other populations. As the maximal responses for DWR compared with TMW differ, the use of land-based criteria for VO2max is not recommended for a graded DWR exercise test.

The Effect of Water-Based Exercise on Glucose and Insulin Response in Overweight Women: A Pilot Study

OBJECTIVE The aim of this study was to investigate the effectiveness of a 12-week moderate intensity, water-based circuit-type training intervention on glucose and insulin responses in overweight women with normal or impaired glucose tolerance. METHODS Fifteen overweight women (body mass index [BMI] > 25 kg/m(2)) with normal glucose tolerance (NGT; n = 7) or impaired glucose tolerance (IGT; n = 8) were recruited for this study. All women completed a 12-week training intervention utilizing a combination of aerobic and resistance exercises in an aquatic environment, 3 days per week and 60 min per session at 70-75% mode-specific maximum heart rate. A standard 75-g oral glucose tolerance test (OGTT) was administered pre- and post-intervention, from which fasting and post-load plasma insulin and glucose levels were assessed. RESULTS Following the 12-week period, fasting insulin levels had decreased by 44% and 2-h glucose by 30.4% in the group with IGT. Waist circumference (WC) had decreased by 5.3% in this group at the end of the intervention. Only WC and waist-to-hip ratio (WHR) decreased (6.0% and 5.5%, respectively) following the intervention in the NGT group. CONCLUSIONS Moderate intensity, water-based circuit-type exercises appear to be an effective exercise modality to improve glucose and insulin response to a glucose challenge in overweight women with IGT.

Chemotherapy Agents Alter Plasma Lipids in Breast Cancer Patients and Show Differential Effects on Lipid Metabolism Genes in Liver Cells.

Cardiovascular complications have emerged as a major concern for cancer patients. Many chemotherapy agents are cardiotoxic and some appear to also alter lipid profiles, although the mechanism for this is unknown. We studied plasma lipid levels in 12 breast cancer patients throughout their chemotherapy. Patients received either four cycles of doxorubicin and cyclophosphamide followed by weekly paclitaxel or three cycles of epirubicin, cyclophosphamide and 5’-fluorouracil followed by three cycles of docetaxel. Patients demonstrated a significant reduction (0.32 mmol/L) in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (apoA1) levels (0.18 g/L) and an elevation in apolipoprotein B (apoB) levels (0.15 g/L) after treatment. Investigation of the individual chemotherapy agents for their effect on genes involved in lipoprotein metabolism in liver cells showed that doxorubicin decreased ATP binding cassette transporter A1 (ABCA1) via a downregulation of the peroxisomal proliferator activated receptor γ (PPARγ) and liver X receptor α (LXRα) transcription factors. In contrast, ABCA1 levels were not affected by cyclophosphamide or paclitaxel. Likewise, apoA1 levels were reduced by doxorubicin and remained unaffected by cyclophosphamide and paclitaxel. Doxorubicin and paclitaxel both increased apoB protein levels and paclitaxel also decreased low density lipoprotein receptor (LDLR) protein levels. These findings correlate with the observed reduction in HDL-C and apoA1 and increase in apoB levels seen in these patients. The unfavourable lipid profiles produced by some chemotherapy agents may be detrimental in the longer term to cancer patients, especially those already at risk of cardiovascular disease (CVD). This knowledge may be useful in tailoring effective follow-up care plans for cancer survivors.

Cardiovascular disease among breast cancer survivors: the call for a clinical vascular health toolbox

With better detection and treatment, breast cancer is less likely to be the primary cause of death in the majority of breast cancer survivors; mortality due to cardiovascular disease (CVD) is now more common. Given the long latency periods between cancer treatment completion and potential symptomatic CVD, there is a need to detect vascular changes before symptoms appear. This short review provides an overview of non-invasive, widely available, and relatively inexpensive techniques for assessing endothelial function, central and regional arterial stiffness, central blood pressures, and intima-media thickness. These tools exhibit acceptable reliability and validity, and are relatively practical. Clinical assessment recommendations are also provided. There is sufficient evidence to encourage the use of these techniques as a component of routine serial assessments, and to help guide appropriate treatment strategies.

Current nutrition promotion, beliefs and barriers among cancer nurses in Australia and New Zealand

Rationale. Many cancer patients and survivors do not meet nutritional and physical activity guidelines, thus healthier eating and greater levels of physical activity could have considerable benefits for these individuals. While research has investigated cancer survivors’ perspective on their challenges in meeting the nutrition and physical guidelines, little research has examined how health professionals may assist their patients meet these guidelines. Cancer nurses are ideally placed to promote healthy behaviours to their patients, especially if access to dieticians or dietary resources is limited. However, little is known about cancer nurses’ healthy eating promotion practices to their patients. The primary aim of this study was to examine current healthy eating promotion practices, beliefs and barriers of cancer nurses in Australia and New Zealand. A secondary aim was to gain insight into whether these practices, beliefs and barriers were influenced by the nurses’ hospital or years of work experience. Patients and Methods. An online questionnaire was used to obtain data. Sub-group cancer nurse comparisons were performed on hospital location (metropolitan vs regional and rural) and years of experience (<25 or ≥25 years) using ANOVA and chi square analysis for continuous and categorical data respectively. Results. A total of 123 Australasian cancer nurses responded to the survey. Cancer nurses believed they were often the major provider of nutritional advice to their cancer patients (32.5%), a value marginally less than dieticians (35.9%) but substantially higher than oncologists (3.3%). The majority promoted healthy eating prior (62.6%), during (74.8%) and post treatment (64.2%). Most cancer nurses felt that healthy eating had positive effects on the cancer patients’ quality of life (85.4%), weight management (82.9%), mental health (80.5%), activities of daily living (79.7%) and risk of other chronic diseases (79.7%), although only 75.5% agreed or strongly agreed that this is due to a strong evidence base. Lack of time (25.8%), adequate support structures (17.3%) nutrition expertise (12.2%) were cited by the cancer nurses as the most common barriers to promoting healthy eating to their patients. Comparisons based on their hospital location and years of experience, revealed very few significant differences, indicating that cancer nurses’ healthy eating promotion practices, beliefs and barriers were largely unaffected by hospital location or years of experience. Conclusion. Australasian cancer nurses have favourable attitudes towards promoting healthy eating to their cancer patients across multiple treatment stages and believe that healthy eating has many benefits for their patients. Unfortunately, several barriers to healthy eating promotion were reported. If these barriers can be overcome, nurses may be able to work more effectively with dieticians to improve the outcomes for cancer patients.

Is self-management feasible and acceptable for addressing nutrition and physical activity needs of cancer survivors?

Self‐management is recommended for patients with chronic conditions, but its use with cancer survivors is underexplored. Optimal strategies for achieving lifestyle changes in cancer survivors are not known.