Physical activity, genes, and lifetime predisposition to chronic disease

This mini-review summarizes the main associations between physical activity and chronic diseases and discusses the basic concepts related to the role of genetic factors in studies evaluating the effects of physical activity/exercise therapy on chronic disease prevention/treatment during the life course. Many observational cohort studies have shown that high physical activity during young adulthood or middle age is associated with reduced later life morbidity, mobility limitations and mortality. Physical activity or exercise therapy has a positive effect on health via many disease-specific mechanisms. The most consistent finding of the various randomized controlled studies conducted to date is that aerobic/functional capacity and/or muscle strength can be improved by exercise training among patients with different chronic diseases. Genes are known to play a role in chronic disease predisposition and to contribute to physical fitness levels, physical activity participation and ageing. Physical fitness, physical activity and health outcomes may be partly due to underlying genetic factors that have a favourable effect on all these traits (genetic pleiotropy). This means that in observational studies, the relationship between baseline activity and the later occurrence of diseases may not be interpreted entirely as causal. Increased knowledge on the role of nuclear genome, mitochondrial genome, epigenetics, telomeres and regulation of gene expression will increase our understanding of their relationships with physical activity and morbidity.     

Exercise in the setting of hematopoietic stem cell transplantation

The procedure of hematopoietic stem cell transplantation (HSCT) is an intense treatment approach to cure patients from leukemia or lymphoma. Prior, during, and after HSCT, patients experience considerable physical and psychosocial distress. In light of the increasing number of successfully treated patients, the need is growing for evidence-based adjuvant therapy options, which are able to reduce treatment-related side effects and enhance the rehabilitation process. Exercise constitutes to be a promising intervention in this setting due to its multidimensional effectiveness. The purpose of this article was to review the current knowledge in the field of exercise and HSCT. Therefore, an electronic literature search in PubMed on the topic was performed. Twenty-nine articles could be identified and classified as relevant for this paper. Reviewed studies suggest that exercise training is an important therapeutic approach in the supportive care for transplant patients. Significant benefits from the exercise interventions have been reported for physical performance, quality of life (QoL), and fatigue status. Several other benefits, such as a more rapid immune recovery or alleviation of therapy-related side effects have been reported in some studies. Future studies should address existing methodological problems, identify further effect levels of exercise and integrate a long-term perspective for the participants in the context of hematopoietic stem cell transplantation. Furthermore, potential biological pathways of exercise in HSCT patients should be investigated.     

Type of activity and fitness benefits as moderators of the effect of physical activity on affect in advanced age: a review

This study aimed to review studies exploring the effect of physical activity on affect in advanced age with a special focus on the moderating role of fitness improvement and mode of exercise and to examine those studies in relation to the potential mechanisms for explaining the physical activity–affect relationship. Studies were assembled through a computer search of online psychological, medical, and exercise science databases. Randomized controlled studies having as their purpose the examination of physical activity effects on affect, with a mean sample population age of at least 50 years, were included. Thirty-nine studies were collated and divided into three groups: those applying aerobic activity, those applying strength training, and those applying non-specific physical activity. The main finding was that aerobic exercise and aerobic fitness do not moderate the effect of physical activity on affect. While fewer than 50% of the aerobic studies reporting fitness improvement also reported improvement in affect, over 50% of the strength training studies and of the non-specific exercise studies reported improvement in affect. Theories with a physiological orientation claiming that aerobic fitness is the mediator between physical activity and affect are not supported, whereas theories with a psychological orientation maintaining that alterations in affect are not dependent on physiological alterations do receive support. It is argued that the differentiation between physiologically and psychologically oriented theories is arbitrary. It is recommended that the relationship between physical activity and affect be explored further, embracing a psychophysiological perspective in which the psychological and physiological perspectives are complementary.     

Physical exercise programs following cancer treatment

Oncological patients should engage in physical activities during the entire period of medical treatment and aftercare taking into account the contraindications. Therapeutic exercises should be customized, according to the individuals’ cancer entity, medical side effects, and exercise experience—personalized exercise therapy. After medical treatment, cancer patients in Germany have a legal right to visit an oncological rehabilitation clinic. In addition, they have the opportunity to attend a rehabilitative sports group, which is funded by the health insurance companies. The aim of therapeutic exercises in the curative and palliative phase is prevention of negative physical and psychological consequences. The aim of therapeutic exercises in the rehabilitation phase is physical and mental recovery as well as psychosocial stabilization or improvement. During aftercare, cancer patients should also be encouraged to engage in home-based programs; however, these are not as effective as supervised therapy. Future studies must consider aspects of training control, specific assessments and exercise programs for palliative patients.     

Endurance training for cancer patients during and shortly after completion of the anti-cancer treatment

Cardiorespiratory fitness is one of the most important indicators of health and improves length of life. The attention and acceptance for endurance training in patients with several cancer diagnoses increased during the last decade. This review highlight’s the effect of endurance training in cancer patients by summarizing exemplary randomized clinical trials and systematic reviews both within the acute hospital treatment context, as in a rehabilitation setting. To date, most studies focus on endurance training in patient groups with moderate to good prognosis. The studies within these patient groups evaluate the endurance training in cancer patients using a moderate training intensity between 50 and 75 % of the VO₂ peak with an exercise time varying from 20 min (five times per week) in hospital up to 45 min (two to three times per week) in an ambulatory setting. Recently, the American College of Sports Medicine indicated that cancer survivors should follow the Physical Activity Guidelines for Americans, which represents ≥150 min per week of moderate intensity, ≥75 min per week of vigorous intensity aerobic exercise, or an equivalent combination of moderate and vigorous intensity aerobic exercises. To date, fewer studies evaluate the effects of endurance training in a palliative setting to maintain physical function of the patient. Future studies should investigate the effect of endurance training by evaluating different types of intensity training (moderate vs. high intensity training), the use of high-tech devices to improve physical activity, and to evaluate the effect of endurance training in patients with a palliative intention.     

An examination of the mechanisms underlying the effects of physical activity on brain and cognition

Physical activity positively influences brain health and cognitive functioning in older adults. Several physiological and psychological mechanisms have been identified to underlie such a relationship. Cardiovascular fitness is accompanied with changes in mechanisms such as cerebral blood flow, neurotrophic factors, neurotransmitter systems and neural architecture that have themselves been associated with cognitive performance. Factors associated with exercise such as arousal, mood and self-perception of competence seem also to influence cognitive performance. Other explanation for the benefits of exercise in cognition, results from the fact that the performance of motor skills involve an important cognitive component (e.g., executive functions and information processing speed). Evidence of brain plasticity and behavior has been provided from studies where animals are exposed to enriched or complex environments. Exposure to such paradigms in which physical activity plays an important role has been found to influence various aspects of brain function and structure. Studies using neuroimaging techniques have established a link between the acquisition of different motor skills and the occurrence of neuroplasticity in human adults. This literature review indicates that the type of exercise and its specific perceptual and cognitive characteristics may influence cognitive performance. However, most of the research has been focused on self-paced movements or automatized skills and few intervention studies have examined the results of merging exercise and cognitive training in a single program. An important scientific challenge for the coming years is to design exercise programs capable of mobilizing several type of mechanisms underlying the effects of physical activity on brain and cognition.     

From bedside to bench: does mental and physical activity promote cognitive vitality in late life?

A wide range of animal and human studies provide evidence for the potential of physical and cognitive exercise in promoting cognitive health later in life. The effects of such activities on intermediate outcomes, such as cognitive performance, are becoming clearer, as are the molecular mechanisms involved. Physical and cognitive exercise might increase "cognitive reserve" and increase the overall health of the brain, thereby reducing or delaying cognitive impairment and dementia. However, conclusive evidence for such benefits is not yet established. The third annual Bedside to Bench conference, cosponsored by The American Geriatrics Society and the National Institutes of Health's National Institute on Aging, reviewed current knowledge regarding the role of physical and cognitive exercise in promoting cognitive vitality. Conference attendees identified gaps in our current understanding of these processes and recommended next steps for research. In particular, researchers will need to explore clinical issues related to the timing, intensity, and duration of various types and combinations of physical and cognitive activities in animal models to elucidate the mechanisms involved and inform the design of future human studies. The concept of the enriched environment currently employed in animal studies to promote physical activity, socialization, and problem solving should be explored in human studies.     

Thirty years of physical activity in oncology in Germany—from the birth of the first rehabilitative cancer sports group until today

Since 1978, exercise and sport therapy for oncological patients is a research and education focus at the German Sport University of Cologne. Back then, the top priority for almost all oncological patients was to “rest”. Therefore, uncharted territory was entered. Aside from acute care hospitals, rehabilitation hospitals especially for oncological patients exist in Germany. In terms of the rehabilitation chain, which consists of acute care hospital, rehabilitation center, and home-based training, and the aspect of exercise therapy for breast cancer patients, the following progress could be observed in the last 30 years: In the 1980s, less than 50 % of the breast cancer patients received supervised exercise therapy during their 2- to 3-week hospital stay. Today, the length of hospital stay was reduced to 4 to 6 days and some hospitals have gym equipment to increase strength and endurance. In the beginning of the 1980s, passive applications (physiotherapy, massages, bubble baths, short hikes) were still dominant. While the rehabilitation stay took 6 weeks back then, it was reduced to 3 weeks today. Further, mainly group-based and active measures are applied today. The aim is to encourage and motivate patients to long-term physical exercise. In the meantime, mainly exercise and sports therapists are employed, in order to meet the holistic bio-psychosocial requirements. The first cancer sports groups for breast cancer patients in the aftercare were founded in 1981 in Germany. Today, nearly 1,000 groups exist. Breast cancer and 15 other entities are represented, however mainly women take part. In the early days, research focused on the influence of physical activities on psychosocial aspects. Lately the effects on molecular, biological, and immunological parameters are also examined, in order to explore canceroprotective mechanisms.     

Effect of resistance-exercise training on cognitive function in healthy older adults: a review

Several studies have demonstrated that exercise helps reduce or prevent cognitive deterioration among older adults, and recent studies have further examined the effects of resistance-exercise training on cognition. The purpose of this review was to examine the role of resistance-exercise training on cognition in healthy older adults. Specifically, it describes the definition, health benefits, and the design of resistance-exercise training. The authors also review the research related to resistance exercises and cognition and found that this exercise modality may enhance specific cognitive performances. Next, they examine the potential mechanisms underlying resistance exercise and cognitive enhancement. Finally, they consider potential therapeutics and recommendations for further research on resistance-exercise training and cognition in older adults.     

Hypertension in aging: physical activity as primary prevention

In most physiologic systems, there is considerable evidence that the normal aging processes do not result in significant impairment or dysfunction in the absence of pathology and under resting conditions. However, in response to a stress, the age-related reduction in physiologic reserves causes a loss of regulatory or homeostatic balance. This happens before an individual notices that something is wrong. An additional consequence of age-related changes is an increased perception of effort associated with submaximal work. Thus, a vicious cycle is set up, leading to decreasing exercise capacity, resulting in an elevated perception of effort, subsequently causing avoidance of activity, and finally feeding back to exacerbation of the age-related declines secondary to disuse. Sedentary behavior is an important risk factor for chronic disease morbidity and mortality in aging. However, there is a limited amount of information on the type and amount of activity needed to promote optimal health and function in older people [19]. The purpose of this review is to discuss the important role of exercise training as a primary prevention tool to hypertension. In addition, this review will address the topic of the recommended amount of physical activity required for health promotion along with the current exercise guidelines.     

The effect of aging on skeletal-muscle recovery from exercise: possible implications for aging athletes

Recovery from exercise is integral to the physical training process. There is a perception among older athletes that aging negatively affects the recovery process. Plausible arguments for an impaired recovery with aging are a greater susceptibility of older muscle to exercise-induced skeletal-muscle damage and a slower repair and adaptation response. Differences in the physical activity level of the research participants are rarely considered, however. This makes it difficult to differentiate the respective roles of declining physical activity and aging on the recovery process. Furthermore, the type of exercise used to induce damage and monitor recovery is often not indicative of a normal training stimulus for athletes. This review discusses the effects of aging on skeletal-muscle damage and recovery processes and highlights the limitations of many of these studies with respect to older athletes. Future research should use an exercise intervention representative of a normal training stimulus and take the physical activity level of the participants into account.     

Affective and self-efficacy responses to acute aerobic exercise in sedentary older and younger adults

This study examined the psychological responses to an acute bout of aerobic exercise in sedentary older and younger adults. Eighteen young (mean age 24 years) and 15 older adults (mean age 64 years) completed a 20-min bout of stationary cycling at 65% of VO2peak. Affective responses were assessed before, during, and immediately after exercise. Participants'exercise self-efficacy beliefs were assessed before and immediately after exercise. Both groups reported reduced pleasant feeling states and self-efficacy and increased physical exhaustion in response to acute exercise. Older adults also demonstrated a significant decrease in revitalization during and after cycling. Correlation analyses revealed that self-efficacy was related to feelings of fatigue during exercise and postexercise feelings of energy and fatigue. Both groups reported negative shifts in affect and self-efficacy during and 5 min after cycling.Acute affective and self-efficacy responses might influence one's motivation to adopt and maintain regular physical activity. The relationship between these acute responses and physical activity behavior across the life span warrants future inquiry.     

The effect of three different exercise training modalities on cognitive and physical function in a healthy older population

Background

Older adults are encouraged to participate in regular physical activity to counter the age-related declines in physical and cognitive health. Literature on the effect of different exercise training modalities (aerobic vs resistance) on these health-related outcomes is not only sparse, but results are inconsistent. In general, it is believed that exercise has a positive effect on executive cognitive function, possibly because of the physiological adaptations through increases in fitness. Indications are that high-intensity interval training is a potent stimulus to improve cardiovascular fitness, even in older adults; however, its effect on cognitive function has not been studied before.Therefore, the purpose of this study was to compare the effects of resistance training, high-intensity aerobic interval training and moderate continuous aerobic training on the cognitive and physical functioning of healthy older adults.

Methods

Sixty-seven inactive individuals (55 to 75 years) were randomly assigned to a resistance training (RT) group (n = 22), high-intensity aerobic interval training (HIIT) group (n = 13), moderate continuous aerobic training (MCT) group (n = 13) and a control (CON) group (n = 19) for a period of 16 weeks. Cognitive function was assessed with a Stroop task and physical function with the Timed-Up-and-Go (TUG) and submaximal Bruce treadmill tests.

Results

No significant GROUP x TIME interaction was found for Stroop reaction time (P > .05). The HIIT group showed the greatest practical significant improvement in reaction time on the information processing task, i.e. Stroop Neutral (ES = 1.11). MCT group participants had very large practical significant improvements in reaction time on the executive cognitive tasks, i.e. Stroop Incongruent and Interference (ES = 1.28 and 1.31, respectively). The HIIT group showed the largest practically significant increase in measures of physical function, i.e. walking endurance (ES = 0.91) and functional mobility (ES = 0.36).

Conclusions

MCT and RT proved to be superior to HIIT for the enhancement of older individuals’ executive cognitive function; whereas HIIT were most beneficial for improvement in information processing speed. HIIT also induced the largest gains in physical function.

     

Nutrition of the elderly: Interactions with physical activity

Elderly subjects have a lower energy requirement compared to young adults as a result of lower physical activity and a lower basal metabolic rate. A lower energy intake in the elderly could lead to undesirable low intakes of essential nutrients. The reduction of the energy turnover is caused by, or a consequence of, a decrease in active cell mass. Thus, the effect of exercise training on habitual activity across age ranges, and age-related changes in body composition in relation to habitual activity level, are investigated here. The focus is on data on physical activity and body composition obtained with doubly labelled water. The results suggest that exercise training does not affect energy requirement in the elderly and the age-related decrease in fat-free mass is not delayed in subjects with a relatively high habitual activity level. Beneficial effects of exercise training in the elderly are endurance, flexibility, range of motion and balance control, all contributing to a delay in the age-induced impairment of personal mobility. Energy intake will inevitably go down as a result of a reduction of the energy requirement. Thus, the nutrition of elderly subjects needs more attention with regard to the essential nutrients than the nutrition of younger adults.     

Aging, physical activity, and hormones in women--a review

Women experience significant changes in endocrine function during aging. Decreasing levels of anabolic hormones may be associated with musculoskeletal atrophy and decrease in function that is observed in older women and, as a result, there has been an increase in the use of pharmacological hormone therapies. It is difficult to distinguish, however, between physiological changes that are truly age related and those that are associated with lifestyle factors such as physical activity participation. Some research has shown that circulating levels of anabolic hormones such as DHEA(S) and IGF-I in older women are related to physical activity, muscle function, and aerobic power. Exercise-intervention studies have generally shown that increasing age blunts the acute hormonal response to exercise, although this might be explained by a lower exercise intensity in older women. There have been relatively few studies that examine hormonal adaptations to exercise training. Physical activity might have an effect on hormone action as a result of changes in protein carriers and receptors, and future research needs to clarify the effect of age and exercise on these other components of the endocrine system. The value and safety of hormone supplements must be examined, especially when used in combination with an exercise program.     

Gender and racial/ethnic differences in predicting adolescent sexual risk: athletic participation versus exercise

Though often conflated, informal physical exercise and organized athletic participation have very different implications for adolescent sexual risk outcomes. The purpose of this research is to disaggregate strenuous exercise from sports, examine how each is associated with sexual risk, and explain the observed differences using the conceptual lens of cultural resource theory. Using a nationally representative sample of over 16,000 public and private high school students, we employ logistic regression to test hypotheses about the gender-specific and race-specific effects of strenuous exercise and athletic participation on adolescent sexual risk behavior. The results show that both forms of physical activity buffer sexual risk for girls. Strenuous exercise is associated with increased odds of sexual risk for boys. Sports and race interact to influence boys' sexual risk outcomes: Athletic participation is associated with lowered odds of sexual risk for white male adolescents, but heightened odds of sexual risk for black male adolescents.     

Exercise or physical activity and cognitive function in adults with type 2 diabetes,insulin resistance or impaired glucose tolerance: a systematic review

Background

Diabetes is an important risk factor for cognitive impairment. Although some studies suggest that physical exercise can minimize age-related cognitive declines or improve brain morphology or function, benefits in diabetes or impaired glucose tolerance are unclear. Therefore, our aim was to evaluate the efficacy of exercise or physical activity on cognition in adults with type 2 diabetes, insulin resistance or impaired glucose tolerance.

Methods

An electronic search for studies published from the earliest record until February 2017 was conducted using Medline, EMBASE, SPORTDiscus, CINAHL, and PsycINFO. Any experimental or observational study designs were included, as long as they were conducted in individuals of any age with type 2 diabetes, insulin resistance or impaired glucose tolerance, and they directly examined exercise/physical activity effects on cognitive outcomes or the relationship between changes in cognition and changes in either insulin resistance and glucose homeostasis. Study quality was assessed using the PEDro scale; data on participant and intervention characteristics and outcomes were extracted.

Results

Six studies enrolling 2289 participants met the eligibility criteria. Quality was modest and effect sizes variable and mostly small or negligible. Overall, four of the six studies (67%) reported significant benefits of greater exercise/physical activity participation for some aspects of cognition, but only 26% of cognitive outcomes were significant across all trials. Clinical improvements in insulin resistance/glucose homeostasis were related to improvements in cognitive function in three studies. Overall results were inconsistent, with benefits varying across exercise types and cognitive domains.

Conclusions

Literature does not provide evidence that physical activity or exercise interventions contribute to a better cognitive function in patients with type 2 diabetes or impaired glucose tolerance. Large-scale, long-term, robust randomized controlled trials are required to determine if exercise improves cognition in this high-risk cohort, and to investigate putative mechanistic links between cognition, body composition, metabolism, and inflammation in diabetes and related metabolic syndromes.

     

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.     

Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.