Peter M. Magyari

Resistance exercise training and alendronate reverse Glucocorticoid-Induced osteoporosis in heart transplant recipients ☆

BACKGROUND Immunosuppression therapy with bolus glucocorticoids causes regional osteoporosis in the axial skeleton of heart transplant recipients (HTR). No preventive strategy is generally accepted for steroid-induced bone loss. METHODS To determine the efficacy of an anti-osteoporosis regimen that combined a bisphosphonate agent (alendronate sodium) with the osteogenic stimulus of mechanical loading, 25 HTRs were randomly assigned either to a group that received alendronate (10 mg/day) for 6 months (ALEN; n = 8), a group that received alendronate (10 mg/day) and performed specific resistance exercises for 6 months (ALEN + TRN; n = 8) or to a non-intervention control group (CONTR; n = 9). Alendronate was initiated at 2 months after transplantation. Bone mineral density (BMD) of the total body, femur neck and lumbar spine (L-2 and L-3) was measured by dual-energy X-ray absorptiometry before and 2, 5 and 8 months after transplantation. Resistance training consisted of lumbar extension exercise (MedX) performed 1 day/week and 8 variable resistance exercises (MedX) performed 2 days/week. RESULTS Pre-transplantation BMD values did not differ among the 3 groups. BMD of the total body, femur neck and lumbar vertebra were significantly decreased below baseline at 2 months after transplantation in CONTR (-2.6 +/- 0.9%, -5.1 +/- 1.8%, -12.5 +/- 4.2%, respectively), ALEN (-2.8 +/- 0.8%, -5.3 +/- 1.6%, -12.0 +/- 3.9%) and ALEN + TRN groups (-2.7 +/- 1.0%, -5.6 +/- 2.1%, -11.2 +/- 3.7%). CONTR had further significant losses of BMD after 3 and 6 months. ALEN had no further regional BMD losses after initiation of alendronate therapy. ALEN + TRN restored BMD of the whole body, femur neck and lumbar vertebra to within 0.9%, 2.1%, and 3.4% of pre-transplantation levels, respectively. CONCLUSIONS Resistance exercise plus alendronate was more efficacious than alendronate alone in restoring BMD in HTRs. Our results indicate that anti-osteoporosis therapy in this population should include both an anti-resorptive agent as well as an osteogenic stimulus, such as mechanical loading.

Muscular strengthening activity patterns and metabolic health risk among US adults

Background:  Many studies have examined the relationship between physical activity and metabolic disorders. However, few have focused on specific associations between these disorders and muscular strengthening activity (MSA) patterns. The aim of the present study was to examine the association(s) for each metabolic syndrome criterion and MSA patterns.

Comparison of calcitonin versus calcitonin + resistance exercise as prophylaxis for osteoporosis in heart transplant recipients.

Background. Rapid bone loss occurs early after heart transplantation. There is no standard therapeutic intervention to prevent osteoporosis in heart transplant recipients (HTR). The purpose of this study was to determine the effectiveness of a regimen combining the antiresorptive properties of nasal calcitonin with the osteogenic stimulus of resistance exercise. Methods. Eighteen candidates for heart transplantation were randomly assigned either to a group that received calcitonin and participated in 6 months of resistance exercise (n=10) or to a group that received only calcitonin (n=8). Calcitonin therapy (200 IU daily for 8 months) was initiated 48 hr after transplantation. Resistance exercise was initiated 2 months after transplantation. Bone mineral density (BMD) of the total body, femur neck, and lumbar vertebra (L2-3) were assessed before, and at 2 and 8 months after transplantation. Results. Total body and femur neck BMD did not decrease (P≥0.05) below pretransplantation values at 2 months after transplantation in either group. BMD of the lumbar spine was significantly (P≤0.05) and comparably decreased at 2 months after transplantation in the calcitonin (–10.1±1.8%) and calcitonin + training groups (–12.9±2.7%). At 8 months after transplantation lumbar BMD was –16.9% below pretransplant values in the calcitonin group. In contrast, lumbar BMD was restored to within 5% of pretransplant levels in the calcitonin + training group. Conclusions. Calcitonin attenuates BMD loss in the total body and femur neck but not in trabecular bone of the lumbar vertebra. Mechanical loading, through progressive resistance exercise, is an osteogenic stimulus in HTR.

Effect of heart transplantation on skeletal muscle metabolic enzyme reserve and fiber type in end-stage heart failure patients

Abstract:  Background:  Skeletal muscle myopathy is a hallmark of chronic heart failure (HF). Phenotypic changes involve shift in myosin heavy chain (MHC) fiber type from oxidative, MHC type I, towards more glycolytic MHC IIx fibers, reductions in oxidative enzyme activity, and increase in glycolytic enzyme activity. However, it is unknown if muscle myopathy is reversed following heart transplantation. The purpose of this study was to determine the effect of heart transplantation on skeletal muscle metabolic enzyme reserve and MHC fiber type in end‐stage HF patients.

Association between lifting weights and metabolic syndrome among U.S. Adults: 1999-2004 National Health and Nutrition Examination Survey.

Abstract Magyari, PM and Churilla, JR. Association between lifting weights and metabolic syndrome among U.S. adults: 1999–2004 National Health and Nutrition Examination Survey. J Strength Cond Res 26(11): 3113–3117, 2012—The purpose of this cross-sectional study was to determine the proportion of U.S. adults who participate in the resistance exercise modality of lifting weights (LWs) by demographic characteristics and to investigate the impact of LWs on the prevalence and risk of metabolic syndrome (MetS) in a national representative sample of U.S. adults. The sample (n = 5,618) in this cross-sectional study included adults aged ≥20 years who participated in the 1999–2004 National Health and Nutrition Examination Survey. Approximately twice as many men (11.2%; 95% confidence interval [CI] 9.5, 13.1) reported LWs as women did (6.3%; 95% CI 5.2, 7.6) with non-Hispanic Whites (9.6%; 95% CI 8.1, 11.4) reporting the highest levels and Mexican Americans reporting the lowest levels (5.6%; 95% CI 4.4, 7.2) of engaging in LWs. Additionally, higher levels of socioeconomic status were associated with greater levels of self-reported LWs. MetS prevalence was found to be significantly lower among U.S. adults reporting LWs (24.6%; 95% CI 19.3, 30.9) compared with adults not reporting LWs (37.3%; 95% CI 35.5, 39.2) with associated risk reductions of 58% (p < 0.001) and 37% (p < 0.01) in the unadjusted model and model adjusted for demographic variables, respectively. These findings suggest that LWs may play a role in reducing the prevalence and risk of MetS among U.S. adults. Therefore, exercise professionals should strongly encourage the activity of LWs among adults of all ages to promote metabolic health and focus programs designed to increase the adoption of LWs among the subgroups who report the lowest levels of LWs.

Descriptive analysis of resistance exercise and metabolic syndrome

BACKGROUND Resistance exercise (RE) is an important mode of physical activity in the management of metabolic syndrome (MetS). However, little is known about the patterns of RE participation among U.S. adults with and without MetS. METHODS Utilizing data from 1999-2006 National Health and Nutrition Examination Survey, we examined the association(s) between MetS and RE in a representative sample (n=7432) of the U.S. adult population. RESULTS U.S. adults with MetS were found to be approximately 50% less likely to report engaging in RE compared to U.S. adults without MetS. Across all demographic categories those who did not meet the criteria for MetS reported engaging in significantly greater levels of RE compared to their counterparts with MetS. Furthermore, a potential inverse dose-response relationship was seen for engaging in RE and the prevalence of MetS. CONCLUSIONS In a diverse representative sample, significantly fewer U.S. adults with MetS report engaging in RE compared to adults without MetS. Engaging in two or more days per week of RE may attenuate MetS prevalence and risk estimates in U.S. adults.

PHYSICAL TRAINING IN PATIENTS WITH HEART FAILURE

Summary Heart failure is a primary health concern in North and South America, with hospitalizations for heart failure as the primary diagnosis continuing to rise. There is a positive relationship between the prevalence of heart failure and age. However, mortality from heart failure is on the decline due to medical advancements, pharmacotherapy and nonpharmacological interventions. One of these nonpharmacological interventions is physical training or exercise. Physical training or exercise is becoming widely accepted by the medical community as a viable option in the medical management of stable heart failure patients. Both aerobic and resistance type exercise have been shown to be efficacious in stable heart failure patients. Evidence now exists not only supporting exercise to improve or maintain physical function in heart failure patients, but also quality of life. Many studies have shown that utilizing exercise in this population improves mood and overall self-reported well being. While the myocardial benefits from exercise may be minimal in heart failure patients, the peripheral benefits leading to improved physical function and preservation of independence are indispensible. Based on the research that has been conducted in the area of exercise and heart failure to this point, clinicians working with this population have the data necessary to prescribe evidence-based exercise prescriptions that can be utilized as part of a comprehensive medical management approach. Currently, several medical position statements endorse exercise as a safe and effective modality in heart failure patients.

Entrenamiento físico en pacientes con insuficiencia cardíaca

Resumen La insuficiencia cardiaca constituye una prioridad esencial en el ambito de la salud, tanto en Norteamerica como en Sud-america, donde incluso se llega a las hospitalizaciones cuando el diagnostico principal presenta condiciones graves. Hay una relacion directamente proporcional entre prevalencia de insuficiencia cardiaca y edad. Sin embargo, la mortalidad por insuficiencia cardiaca esta en declinacion debido a los avances medicos, administracion de medicamentos, e intervenciones no farmacologicas. Una de estas intervenciones es, el entrenamiento fisico o el ejercicio, los cuales estan siendo ampliamente aceptados por la comunidad medica como una opcion viable en el manejo medico de pacientes con insuficiencia cardiaca permanente. Tanto los ejercicios aerobicos como de fuerza han demostrado ser eficaces en este tipo de pacientes. Actualmente la evidencia no solo respalda el ejercicio para mejorar o mantener la funcion fisica en pacientes con insuficiencia cardiaca, sino tambien la calidad de vida en general. Muchos estudios han demostrado que el ejercicio en la poblacion mejora el caracter de las personas y el bienestar general reconocido por ellas mismas. Aunque los beneficios al miocardio producidos por el ejercicio pueden ser minimos en pacientes con insuficiencia cardiaca, los beneficios perifericos que dan como resultado una mejor capacidad fisica y la conservacion de la independencia son muy significativos. Basados en la evidencia cientifica existente en el ambito del ejercicio y la insuficiencia cardiaca, los medicos que trabajan con esta poblacion tienen la informacion necesaria para recomendar prescripciones de ejercicios. Actualmente, diversas declaraciones de puntos de vista medicos confirman el ejercicio como una modalidad segura y efectiva para pacientes con insuficiencia cardiaca.