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BackgroundExercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.ObjectiveTo investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (axSpA).MethodAssessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with axSpA were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.Results97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: −0.6 [–0.8 to –0.3], p<0.001 and BASDAI: −1.2 [–1.8 to –0.7], p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.ConclusionHigh intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with axSpA. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with axSpA.Trial registration number NCT02356874.

White matter deterioration is associated with cognitive impairment in healthy aging and Alzheimer's disease. It is critical to identify interventions that can slow down white matter deterioration. So far, clinical trials have failed to demonstrate the benefits of aerobic exercise on the adult white matter using diffusion Magnetic Resonance Imaging. Here, we report the effects of a 6-month aerobic walking and dance interventions (clinical trial NCT01472744) on white matter integrity in healthy older adults (n = 180, 60–79 years) measured by changes in the ratio of calibrated T1- to T2-weighted images (T1w/T2w). Specifically, the aerobic walking and social dance interventions resulted in positive changes in the T1w/T2w signal in late-myelinating regions, as compared to widespread decreases in the T1w/T2w signal in the active control. Notably, in the aerobic walking group, positive change in the T1w/T2w signal correlated with improved episodic memory performance. Lastly, intervention-induced increases in cardiorespiratory fitness did not correlate with change in the T1w/T2w signal. Together, our findings suggest that white matter regions that are vulnerable to aging retain some degree of plasticity that can be induced by aerobic exercise training. In addition, we provided evidence that the T1w/T2w signal may be a useful and broadly accessible measure for studying short-term within-person plasticity and deterioration in the adult human white matter.

Both observational and interventional studies suggest an important role for physical activity and higher fitness in mitigating the metabolic syndrome. Each component of the metabolic syndrome is, to a certain extent, favorably influenced by interventions that include physical activity. Given that the prevalence of the metabolic syndrome and its individual components (particularly obesity and insulin resistance) has increased significantly in recent decades, guidelines from various professional organizations have called for greater efforts to reduce the incidence of this condition and its components. While physical activity interventions that lead to improved fitness cannot be expected to normalize insulin resistance, lipid disorders, or obesity, the combined effect of increasing activity on these risk markers, an improvement in fitness, or both, has been shown to have a major impact on health outcomes related to the metabolic syndrome. Exercise therapy is a cost-effective intervention to both prevent and mitigate the impact of the metabolic syndrome, but it remains underutilized. In the current article, an overview of the effects of physical activity and higher fitness on the metabolic syndrome is provided, along with a discussion of the mechanisms underlying the benefits of being more fit or more physically active in the prevention and treatment of the metabolic syndrome.

ObjectivesPatients with rheumatoid arthritis (RA) have substantially elevated risk for cardiovascular diseases, and low cardiorespiratory fitness (VO2max) is a major mediator. The aim of this assessor-blinded, two-armed multicentre randomised controlled trial was to evaluate the effects of high-intensity interval training (HIIT) and strength exercise on cardiovascular health, physical fitness and overall health in patients with RA.MethodsIn total, 87 patients (86% female; aged 20–60 years) were randomly assigned to an intervention group (IG) or a control group (CG). The IG performed HIIT and strength exercise for 12 weeks. The CG was instructed to be physically active on a moderately intensive level, ≥150 min/week. Primary outcome was change in VO2max. Secondary outcomes were changes in anthropometry measures, muscle strength, overall health (Visual Analogue Scale (VAS)-Global), Patient Global Impression of Change (PGIC), pain and disease activity (Disease Activity Score in 28 joints (DAS28)).ResultsThere was a significant mean group difference of change on VO2max (3.71 mL/kg/min; 95% CI 2.16, 5.25) in favour of the IG. Significant mean group differences of change were also seen for O2-pulse (1.38; 95% CI 0.85 to 1.91), waist circumference (−2.6; 95% CI −5.09 to –0.18), 1-minute sit-to-stand (5.0; 95% CI 3.35 to 6.72), handgrip strength (28.5; 95% CI 3.80 to 52.8), overall health (−14.7; 95% CI –23.8 to –5.50) and PGIC (p<0.0001) in favour of the IG. No significant mean group differences of change were found for pain (−4.0; 95% CI −13.07 to 5.06), DAS28 (−0.25; 95% CI −0.60 to 0.10) and erythrocyte sedimentation rate (−0.64; 95% CI −3.23 to 1.90).ConclusionSupervised HIIT and strength exercise improved cardiovascular health, physical fitness and overall health without a deterioration in pain and disease activity and should be considered in patients with well-controlled RA.Trial registration numberNCT05768165.

Background Breast cancer (BC) patients who undergo surgery followed by radiotherapy and chemotherapy have limitations on physical activity which will lead to a decreased quality of life and poor physical fitness level. The purpose of this study was to investigate the effects of the combined exercise intervention based on internet and social media software (CEIBISMS) on postoperative breast cancer patients by evaluating their quality of life, muscle strength and cardiorespiratory capacity. Methods This study was a randomized control trial with an intervention period of 12 weeks. Sixty participants (30 in each group, 42–60 years old, female) were recruited through an outpatient department. Procedure of exercise in the intervention group included: via phone step-recording app, ask the individuals to complete the target number of steps within a specified period of exercise, four times per week; face-to-face remote video instruction of individuals on muscle training, three times per week; via social media apps daily push common knowledge of physical exercise BC rehabilitation. The control group received traditional treatment and rehabilitation according to daily specifications of the hospital. The primary outcome was quality of life and the secondary outcomes were muscle strength and cardiorespiratory capacity. Results Experiments using a Short Form 36 showed that the CEIBISMS yielded significantly better results than traditional methods, in vitality ( p  = 0.009), mental health ( p  = 0.001) and reported health transition ( p  = 0.048) by week 12. The CEIBISMS resulted in significant improvement in the stand-up and sit-down chair test ( p  < 0.0001), arm lifting test ( p  = 0.017). Conclusion The CEIBISMS offered rehabilitative effects in quality of life (QOL) and muscle strength of postoperative patients with breast cancer (BC) in China. Trial registration ChiCTR-IPR-17012368 . Trial registered on 14 August, 2017.

Aims/hypothesisThe study aimed to quantitatively summarise the dose–response relationships between cardiorespiratory fitness and muscular strength on the one hand and risk of type 2 diabetes on the other and estimate the hypothetical benefits associated with population-wide changes in the distribution of fitness.MethodsWe performed a systematic review with meta-analysis. The PubMed and EMBASE electronic databases were searched from inception dates to 12 December 2018 for cohort studies examining the association of cardiorespiratory fitness or muscular strength with risk of incident type 2 diabetes in adults. The quality of included studies was evaluated using the Newcastle–Ottawa Scale.ResultsTwenty-two studies of cardiorespiratory fitness and 13 studies of muscular strength were included in the systematic review with both exposures having ten estimates available for the primary adiposity- or body size-controlled meta-analysis. In random-effects meta-analysis including 40,286 incident cases of type 2 diabetes in 1,601,490 participants, each 1 metabolic equivalent (MET) higher cardiorespiratory fitness was associated with an 8% (95% CI 6%, 10%) lower RR of type 2 diabetes. The association was linear throughout the examined spectrum of cardiorespiratory fitness. In 39,233 cases and 1,713,468 participants each 1 SD higher muscular strength was associated with a 13% (95% CI 6%, 19%) lower RR of type 2 diabetes. We estimated that 4% to 21% of new annual cases of type 2 diabetes among 45–64-year-olds could be prevented by feasible and plausible population cardiorespiratory fitness changes.Conclusions/interpretationRelatively small increments in cardiorespiratory fitness and muscle strength were associated with clinically meaningful reductions in type 2 diabetes risk with indication of a linear dose–response relationship for cardiorespiratory fitness.Registration: PROSPERO (CRD42017064526).

ObjectivesTo describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI).SettingInternational.MethodsUsing Appraisal of Guidelines, Research and Evaluation (AGREE) II reporting criteria, steps included (a) determining the guidelines’ scope; (b) conducting a systematic review of relevant literature; (c) holding three consensus panel meetings (European, Canadian and International) to formulate the guidelines; (d) obtaining stakeholder feedback; and (e) process evaluation by an AGREE II consultant. Stakeholders were actively involved in steps (c) and (d).ResultsFor cardiorespiratory fitness and muscle strength benefits, adults with a SCI should engage in at least 20 min of moderate to vigorous intensity aerobic exercise 2 times per week AND 3 sets of strength exercises for each major functioning muscle group, at a moderate to vigorous intensity, 2 times per week (strong recommendation). For cardiometabolic health benefits, adults with a SCI are suggested to engage in at least 30 min of moderate to vigorous intensity aerobic exercise 3 times per week (conditional recommendation).ConclusionsThrough a systematic, rigorous, and participatory process involving international scientists and stakeholders, a new exercise guideline was formulated for cardiometabolic health benefits. A previously published SCI guideline was endorsed for achieving fitness benefits. These guidelines represent an important step toward international harmonization of exercise guidelines for adults with SCI, and a foundation for developing exercise policies and programs for people with SCI around the world.

Background: Modern-day technology is appealing to children. Few studies, however, have conducted longitudinal analyses of a school-based exergaming program’s effect on physical activity (PA) behaviors and fitness in children. Therefore, this study examined the longitudinal effect of an 8-month school-based exergaming intervention on children’s objectively-measured PA and cardiorespiratory fitness (CRF). Materials and Methods: Eighty-one fourth grade students ( X ¯ age = 9.23 ± 0.62; 39 girls; 54.3% African American, 30.9% Non-Hispanic White, 14.8% other) participated in this study from 2014–2015. The intervention school’s children participated in a once-weekly 50-min exergaming intervention during recess throughout the school year, while the control school continued regular recess. Children’s in-school PA and sedentary behavior (SB) were measured with ActiGraphGT3X+ accelerometers, with CRF assessed via the half-mile run. All measurements were taken at baseline, mid-intervention (four months) and post-intervention (eight months). Repeated-measures two-way ANCOVAs using age and race as covariates were conducted to examine between-school differences over time for SB, light PA (LPA), moderate-to-vigorous PA (MVPA), and CRF. Results: Significant time by group interactions were observed for LPA, F(1, 79) = 7.82, η2 = 0.09, p < 0.01, and MVPA, F(1, 79) = 4.58, η2 = 0.06, p < 0.05, as LPA increased among the control group, while MVPA increased among intervention group. Children in both groups experienced decreased SB during the intervention (intervention: −7.63 min; control: −17.59 min), but demonstrated lower CRF over time (intervention: +46.73 s; control: +61.60 s). Conclusions: Observations suggested that school-based exergaming implementation may be effective in increasing children’s MVPA and decreasing their SB over the course an academic year (i.e., ~eight months). More research is needed, however, to discern how modifications to school-based exergaming might also promote improved CRF in children.

BackgroundThis study examined the effects of a single all-out bout of 30-s sprint-cycle performed daily for 5 consecutive days per week for 6 weeks, on aerobic fitness, muscle strength and metabolic-health markers in physically active young males and females.MethodsHealthy, physically active 20–28 year olds, were randomly assigned to either experimental (EXP, N = 11) or non-training control (CON, N = 8) group. With supervision, the EXP group performed one bout of 30-s sprint-cycle daily, Mondays to Fridays over 6 weeks, while CON group continued with their usual lifestyle. The followings were measured at pre- and post-intervention: maximal aerobic power, peak torque of knee extensors and flexors at velocities 30° s−1 and 300° s−1, resting heart rate, resting blood pressure, body fat percentage, fasting lipid profile, fasting blood glucose, and fasting insulin levels.ResultsThere were no significant improvements in the EXP group for all the measured variables (all P > 0.05); except for significant interaction effects in peak torque of knee extensors at 30° s−1 (P = 0.044) and low-density lipoprotein-cholesterol (P = 0.046). Post hoc test indicate that CON group showed decline in their low-density lipo-proteins levels (P = 0.024).ConclusionSix weeks of one all-out bout of 30-s sprint-cycle per day, for 5 consecutive days per week, was ineffective in improving cardiovascular fitness, maximal strength, and most health markers in physically active young adults. The present results when combined with the previous literature suggest that there is a possibility of a minimum threshold for a number of sprint-cycle bouts needed to be performed before any form of cardio-metabolic-health benefit is accrued.

Abstract Context Metabolic disturbances and a pro-inflammatory state associated with aging and obesity may be mitigated by physical activity or nutrition interventions. Objective The aim of this study is to assess whether physical fitness/exercise training (ET) alleviates inflammation in adipose tissue (AT), particularly in combination with omega-3 supplementation, and whether changes in AT induced by ET can contribute to an improvement of insulin sensitivity and metabolic health in the elderly. Design, Participants, Main Outcome Measures The effect of physical fitness was determined in cross-sectional comparison of physically active/physically fit (trained) and sedentary/less physically fit (untrained) older women (71 ± 4 years, n = 48); and in double-blind randomized intervention by 4 months of ET with or without omega-3 (Calanus oil) supplementation (n = 55). Physical fitness was evaluated by spiroergometry (maximum graded exercise test) and senior fitness tests. Insulin sensitivity was measured by hyperinsulinemic-euglycemic clamp. Samples of subcutaneous AT were used to analyze mRNA gene expression, cytokine secretion, and immune cell populations. Results Trained women had lower mRNA levels of inflammation and oxidative stress markers, lower relative content of CD36+ macrophages, and higher relative content of γδT-cells in AT when compared with untrained women. Similar effects were recapitulated in response to a 4-month ET intervention. Content of CD36+ cells, γδT-cells, and mRNA expression of several inflammatory and oxidative stress markers correlated to insulin sensitivity and cardiorespiratory fitness. Conclusions In older women, physical fitness is associated with less inflammation in AT. This may contribute to beneficial metabolic outcomes achieved by ET. When combined with ET, omega-3 supplementation had no additional beneficial effects on AT inflammatory characteristics.