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Metabolic Effects of Diet and Exercise in Patients with Moderate to Severe CKD: A Randomized Clinical Trial.
Ikizler TA, Robinson-Cohen C, Ellis C, Headley SAE, Tuttle K, Wood RJ, Evans EE, Milch CM, Moody KA, Germain M, Limkunakul C, Bian A, Stewart TG, Himmelfarb J
(2018) J Am Soc Nephrol 29: 250-259
MeSH Terms: Adiposity, Aged, Albuminuria, Body Weight, Caloric Restriction, Creatinine, Exercise, F2-Isoprostanes, Female, Glomerular Filtration Rate, Humans, Interleukin-6, Male, Middle Aged, Oxidative Stress, Oxygen Consumption, Pilot Projects, Renal Insufficiency, Chronic
Show Abstract · Added October 24, 2017
CKD is steadily increasing along with obesity worldwide. Furthermore, obesity is a proinflammatory risk factor for progression of CKD and cardiovascular disease. We tested the hypothesis that implementation of caloric restriction and aerobic exercise is feasible and can improve the proinflammatory metabolic milieu in patients with moderate to severe CKD through a pilot, randomized, 2×2 factorial design trial. Of 122 participants consented, 111 were randomized to receive caloric restriction and aerobic exercise, caloric restriction alone, aerobic exercise alone, or usual care. Of those randomized, 42% were women, 25% were diabetic, and 91% were hypertensive; 104 started intervention, and 92 completed the 4-month study. Primary outcomes were a change from baseline in absolute fat mass, body weight, plasma F-isoprostane concentrations, and peak oxygen uptake (VO). Compared with usual care, the combined intervention led to statistically significant decreases in body weight and body fat percentage. Caloric restriction alone also led to significant decreases in these measures, but aerobic exercise alone did not. The combined intervention and each independent intervention also led to significant decreases in F-isoprostane and IL-6 concentrations. No intervention produced significant changes in VO, kidney function, or urine albumin-to-creatinine ratio. In conclusion, 4-month dietary calorie restriction and aerobic exercise had significant, albeit clinically modest, benefits on body weight, fat mass, and markers of oxidative stress and inflammatory response in patients with moderate to severe CKD. These results suggest healthy lifestyle interventions as a nonpharmacologic strategy to improve markers of metabolic health in these patients.
Copyright © 2018 by the American Society of Nephrology.
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18 MeSH Terms
Submaximal Blood Pressure Responses to Exercise in Young Adulthood and Long-Term Cardiovascular Health.
Shah R, Murthy VL, Colangelo LA, Reis JP, Carr JJ, Sidney S, Siddique J, Lewis CE, Lima JAC, Lewis GD, CARDIA Investigators
(2017) J Am Coll Cardiol 70: 1941-1943
MeSH Terms: Adult, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Exercise, Exercise Test, Female, Humans, Male, Risk Factors, Vascular Calcification, Young Adult
Added January 10, 2020
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The Mediating and Moderating Effect of Volunteering on Pain and Depression, Life Purpose, Well-Being, and Physical Activity.
Salt E, Crofford LJ, Segerstrom S
(2017) Pain Manag Nurs 18: 243-249
MeSH Terms: Aged, Chronic Pain, Depression, Exercise, Female, Humans, Kentucky, Middle Aged, Quality of Life, Volunteers
Show Abstract · Added March 25, 2020
To improve function and quality of life in patients with chronic pain, a prevalent and costly condition, an understanding of the relationships among well-being, physical activity, depression, and life purpose with pain is needed. Because of the role loss experienced by people with chronic pain, activities such as volunteering could have an important role in improving health and well-being. In one study, chronic pain patients who participated in volunteer activities reported both decreased pain and "a sense of purpose." The aim of this study is to test the relationships among pain and well-being, physical activity, depression, and life purpose and then to determine if volunteering activities mediated or moderated these relationships. This observational study was conducted in a large university setting in Kentucky and used a sample of 200 women older than age 50. We found that people with higher pain were more depressed and had lower life purpose and well-being. People who volunteered less had more pain, lower perceived life purpose, more depressive symptoms, and decreased physical activity. Volunteer activities did have a significant mediating effect on the relationship between pain and depression; approximately 9% of the relationship between pain and depression can be accounted for by volunteering. Moderation by volunteering was found between pain and life purpose. We identified important relationships among pain, volunteering, and health outcomes and found that volunteering has a role in improving depressive symptoms and life purpose in women with pain.
Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
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Efficacy of Flecainide in the Treatment of Catecholaminergic Polymorphic Ventricular Tachycardia: A Randomized Clinical Trial.
Kannankeril PJ, Moore JP, Cerrone M, Priori SG, Kertesz NJ, Ro PS, Batra AS, Kaufman ES, Fairbrother DL, Saarel EV, Etheridge SP, Kanter RJ, Carboni MP, Dzurik MV, Fountain D, Chen H, Ely EW, Roden DM, Knollmann BC
(2017) JAMA Cardiol 2: 759-766
MeSH Terms: Adolescent, Adrenergic beta-Antagonists, Anti-Arrhythmia Agents, Cross-Over Studies, Death, Sudden, Cardiac, Defibrillators, Implantable, Drug Therapy, Combination, Exercise, Exercise Test, Female, Flecainide, Humans, Male, Maximum Tolerated Dose, Single-Blind Method, Tachycardia, Ventricular, Young Adult
Show Abstract · Added March 24, 2020
Importance - Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially lethal genetic arrhythmia syndrome characterized by polymorphic ventricular tachycardia with physical or emotional stress, for which current therapy with β-blockers is incompletely effective. Flecainide acetate directly suppresses sarcoplasmic reticulum calcium release-the cellular mechanism responsible for triggering ventricular arrhythmias in CPVT-but has never been assessed prospectively.
Objective - To determine whether flecainide dosed to therapeutic levels and added to β-blocker therapy is superior to β-blocker therapy alone for the prevention of exercise-induced arrhythmias in CPVT.
Design, Setting, and Participants - This investigator-initiated, multicenter, single-blind, placebo-controlled crossover clinical trial was conducted from December 19, 2011, through December 29, 2015, with a midtrial protocol change at 10 US sites. Patients with a clinical diagnosis of CPVT and an implantable cardioverter-defibrillator underwent a baseline exercise test while receiving maximally tolerated β-blocker therapy that was continued throughout the trial. Patients were then randomized to treatment A (flecainide or placebo) for 3 months, followed by exercise testing. After a 1-week washout period, patients crossed over to treatment B (placebo or flecainide) for 3 months, followed by exercise testing.
Interventions - Patients received oral flecainide or placebo twice daily, with the dosage guided by trough serum levels.
Main Outcomes and Measures - The primary end point of ventricular arrhythmias during exercise was compared between the flecainide and placebo arms. Exercise tests were scored on an ordinal scale of worst ventricular arrhythmia observed (0 indicates no ectopy; 1, isolated premature ventricular beats; 2, bigeminy; 3, couplets; and 4, nonsustained ventricular tachycardia).
Results - Of 14 patients (7 males and 7 females; median age, 16 years [interquartile range, 15.0-22.5 years]) randomized, 13 completed the study. The median baseline exercise test score was 3.0 (range, 0-4), with no difference noted between the baseline and placebo (median, 2.5; range, 0-4) exercise scores. The median ventricular arrhythmia score during exercise was significantly reduced by flecainide (0 [range, 0-2] vs 2.5 [range, 0-4] for placebo; P < .01), with complete suppression observed in 11 of 13 patients (85%). Overall and serious adverse events did not differ between the flecainide and placebo arms.
Conclusions and Relevance - In this randomized clinical trial of patients with CPVT, flecainide plus β-blocker significantly reduced ventricular ectopy during exercise compared with placebo plus β-blocker and β-blocker alone.
Trial Registration - clinicaltrials.gov Identifier: NCT01117454.
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Exercise and CKD: Skeletal Muscle Dysfunction and Practical Application of Exercise to Prevent and Treat Physical Impairments in CKD.
Roshanravan B, Gamboa J, Wilund K
(2017) Am J Kidney Dis 69: 837-852
MeSH Terms: Aged, Exercise, Exercise Therapy, Frail Elderly, Hand Strength, Humans, Kidney Failure, Chronic, Male, Mobility Limitation, Muscle Weakness, Muscle, Skeletal, Physical Endurance, Renal Insufficiency, Chronic, Sarcopenia, Walk Test
Show Abstract · Added April 26, 2017
Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. As kidney disease progresses, skeletal muscle dysfunction forms a common pathway for mobility limitation, loss of functional independence, and vulnerability to disease complications. Screening for those at high risk for mobility disability by self-reported and objective measures of function is an essential first step in developing an interdisciplinary approach to treatment that includes rehabilitative therapies and counseling on physical activity. Exercise has beneficial effects on systemic inflammation, muscle, and physical performance in chronic kidney disease. Kidney health providers need to identify patient and care delivery barriers to exercise in order to effectively counsel patients on physical activity. A thorough medical evaluation and assessment of baseline function using self-reported and objective function assessment is essential to guide an effective individualized exercise prescription to prevent function decline in persons with kidney disease. This review focuses on the impact of kidney disease on skeletal muscle dysfunction in the context of the disablement process and reviews screening and treatment strategies that kidney health professionals can use in clinical practice to prevent functional decline and disability.
Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Ideal Cardiovascular Health, Cardiovascular Remodeling, and Heart Failure in Blacks: The Jackson Heart Study.
Spahillari A, Talegawkar S, Correa A, Carr JJ, Terry JG, Lima J, Freedman JE, Das S, Kociol R, de Ferranti S, Mohebali D, Mwasongwe S, Tucker KL, Murthy VL, Shah RV
(2017) Circ Heart Fail 10:
MeSH Terms: Adult, African Americans, Aged, Blood Glucose, Blood Pressure, Comorbidity, Diabetes Mellitus, Exercise, Female, Health Status Disparities, Heart Failure, Humans, Hypertension, Incidence, Kaplan-Meier Estimate, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Mississippi, Prospective Studies, Risk Assessment, Risk Factors, Risk Reduction Behavior, Sedentary Behavior, Smoking, Smoking Cessation, Smoking Prevention, Ventricular Function, Left, Ventricular Remodeling
Show Abstract · Added September 11, 2017
BACKGROUND - The lifetime risk of heart failure (HF) is higher in the black population than in other racial groups in the United States.
METHODS AND RESULTS - We measured the Life's Simple 7 ideal cardiovascular health metrics in 4195 blacks in the JHS (Jackson Heart Study; 2000-2004). We evaluated the association of Simple 7 metrics with incident HF and left ventricular structure and function by cardiac magnetic resonance (n=1188). Mean age at baseline was 54.4 years (65% women). Relative to 0 to 2 Simple 7 factors, blacks with 3 factors had 47% lower incident HF risk (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.39-0.73; <0.0001); and those with ≥4 factors had 61% lower HF risk (HR, 0.39; 95% CI, 0.24-0.64; =0.0002). Higher blood pressure (HR, 2.32; 95% CI, 1.28-4.20; =0.005), physical inactivity (HR, 1.65; 95% CI, 1.07-2.55; =0.02), smoking (HR, 2.04; 95% CI, 1.43-2.91; <0.0001), and impaired glucose control (HR, 1.76; 95% CI, 1.34-2.29; <0.0001) were associated with incident HF. The age-/sex-adjusted population attributable risk for these Simple 7 metrics combined was 37.1%. Achievement of ideal blood pressure, ideal body mass index, ideal glucose control, and nonsmoking was associated with less likelihood of adverse cardiac remodeling by cardiac magnetic resonance.
CONCLUSIONS - Cardiovascular risk factors in midlife (specifically elevated blood pressure, physical inactivity, smoking, and poor glucose control) are associated with incident HF in blacks and represent targets for intensified HF prevention.
© 2017 American Heart Association, Inc.
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29 MeSH Terms
Reduced effects of age on dopamine D2 receptor levels in physically active adults.
Dang LC, Castrellon JJ, Perkins SF, Le NT, Cowan RL, Zald DH, Samanez-Larkin GR
(2017) Neuroimage 148: 123-129
MeSH Terms: Adult, Aged, Aged, 80 and over, Aging, Benzamides, Brain, Cross-Sectional Studies, Exercise, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Positron-Emission Tomography, Radiopharmaceuticals, Receptors, Dopamine D2, Receptors, Dopamine D3, Young Adult
Show Abstract · Added April 6, 2017
Physical activity has been shown to ameliorate dopaminergic degeneration in non-human animal models. However, the effects of regular physical activity on normal age-related changes in dopamine function in humans are unknown. Here we present cross-sectional data from forty-four healthy human subjects between 23 and 80 years old, showing that typical age-related dopamine D2 receptor loss, assessed with PET [18F]fallypride, was significantly reduced in physically active adults compared to less active adults.
Copyright © 2017 Elsevier Inc. All rights reserved.
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Childhood obesity prevention cluster randomized trial for Hispanic families: outcomes of the healthy families study.
Hull PC, Buchowski M, Canedo JR, Beech BM, Du L, Koyama T, Zoorob R
(2018) Pediatr Obes 13: 686-696
MeSH Terms: Adult, Body Mass Index, Child, Child, Preschool, Emigrants and Immigrants, Exercise, Family, Female, Follow-Up Studies, Health Promotion, Healthy Lifestyle, Hispanic Americans, Humans, Male, Pediatric Obesity, Program Evaluation, Tennessee, Weight Gain
Show Abstract · Added February 21, 2017
BACKGROUND - Obesity prevalence is disproportionately high among Hispanic children.
OBJECTIVES - The Healthy Families Study assessed the efficacy of a culturally targeted, family-based weight gain prevention intervention for Hispanic immigrant families with children ages 5-7 years.
METHODS - The study used a two-group, cluster randomized trial design, assigning 136 families (clusters) to the active intervention (weight gain prevention) and 136 families to attention control (oral health). The active intervention included a 4-month intensive phase (eight classes) and an 8-month reinforcement phase (monthly mail/telephone contact). Children's body mass index z-score (BMI-Z) was the primary outcome.
RESULTS - The BMI-Z growth rate of the active intervention group did not differ from the attention control group at short-term follow-up (median 6 months; 168 families, 206 children) or long-term follow-up (median 16 months; 142 families, 169 children). Dose response analyses indicated a slower increase in BMI-Z at short term among overweight/obese children who attended more intervention classes. Moderate physical activity on weekends increased at short term. Weekend screen time decreased at short term among those attending at least one class session.
CONCLUSION - Low class attendance likely impacted intention-to-treat results. Future interventions targeting this population should test innovative strategies to maximize intervention engagement to produce and sustain effects on weight gain prevention.
© 2016 World Obesity Federation.
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18 MeSH Terms
Physical activity and metabolic health in chronic kidney disease: a cross-sectional study.
Bowlby W, Zelnick LR, Henry C, Himmelfarb J, Kahn SE, Kestenbaum B, Robinson-Cohen C, Utzschneider KM, de Boer IH
(2016) BMC Nephrol 17: 187
MeSH Terms: Absorptiometry, Photon, Accelerometry, Adipose Tissue, Aged, Aged, 80 and over, Blood Pressure, C-Reactive Protein, Case-Control Studies, Cholesterol, HDL, Cross-Sectional Studies, Exercise, Female, Glomerular Filtration Rate, Homeostasis, Humans, Insulin Resistance, Male, Middle Aged, Renal Insufficiency, Chronic, Triglycerides
Show Abstract · Added September 19, 2017
BACKGROUND - Patients with chronic kidney disease (CKD) are at high risk of progression to end stage renal disease and cardiovascular events. Physical activity may reduce these risks by improving metabolic health. We tested associations of physical activity with central components of metabolic health among people with moderate-severe non-diabetic CKD.
METHODS - We performed a cross-sectional study of 47 people with CKD (estimated GFR <60 ml/min/1.73 m) and 29 healthy control subjects. Accelerometry was used to measured physical activity over 7 days, the hyperinsulinemic-euglycemic clamp was used to measure insulin sensitivity, and DXA was used to measured fat mass. We tested associations of physical activity with insulin sensitivity, fat mass, blood pressure, serum lipid concentrations, and serum high sensitivity C-reactive protein concentration using multivariable linear regression, adjusting for possible confounding factors.
RESULTS - Participants with CKD were less active than participants without CKD (mean (SD) 468.1 (233.1) versus 662.3 (292.5) counts per minute) and had lower insulin sensitivity (4.1 (2.1) versus 5.2 (2.0 (mg/min)/(μU/mL)), higher fat mass (32.0 (11.4) versus 29.4 (14.8) kg), and higher triglyceride concentrations (153.2 (91.6) versus 99.6 (66.8) mg/dL). With adjustment for demographics, comorbidity, medications, and estimated GFR, each two-fold higher level of physical activity was associated with a 0.9 (mg/min)/(μU/mL) higher insulin sensitivity (95% CI 0.2, 1.5, p = 0.006), an 8.0 kg lower fat mass (-12.9, -3.1, p = 0.001), and a 37.9 mg/dL lower triglyceride concentration (-71.9, -3.9, p = 0.03). Associations of physical activity with insulin sensitivity and triglycerides did not differ significantly by CKD status (p-values for interaction >0.3).
CONCLUSIONS - Greater physical activity is associated with multiple manifestations of metabolic health among people with moderate-severe CKD.
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Associations of the Transforming Growth Factor β/Smad Pathway, Body Mass Index, and Physical Activity With Breast Cancer Outcomes: Results From the Shanghai Breast Cancer Study.
Su Y, Cai H, Zheng Y, Qiu Q, Lu W, Shu XO, Cai Q
(2016) Am J Epidemiol 184: 501-509
MeSH Terms: Adult, Biomarkers, Tumor, Body Mass Index, Breast Neoplasms, Cell Nucleus, China, Disease Progression, Disease-Free Survival, Exercise, Female, Humans, Middle Aged, Prognosis, Proportional Hazards Models, Protein-Serine-Threonine Kinases, Receptor, Transforming Growth Factor-beta Type II, Receptors, Transforming Growth Factor beta, Signal Transduction, Smad2 Protein
Show Abstract · Added April 3, 2018
The transforming growth factor β (TGF-β) pathway plays an important role in breast cancer progression and in metabolic regulation and energy homeostasis. The prognostic significance of TGF-β interaction with obesity and physical activity in breast cancer patients remains unclear. We evaluated the expression of TGF-β type II receptor and pSmad2 immunohistochemically in breast cancer tissue from 1,045 patients in the Shanghai Breast Cancer Study (2002-2005). We found that the presence of nuclear pSmad2 in breast cancer cells was inversely associated with overall and disease-free survival, predominantly among participants with lower body mass index (BMI; weight (kg)/height (m)) and a moderate level of physical activity. However, the test for multiplicative interaction produced a significant result only for BMI (for disease-free survival and overall survival, adjusted hazard ratios were 1.79 and 2.05, respectively). In 535 earlier-stage (T1-2, N0) invasive cancers, nuclear pSmad2 was associated with improved survival among persons with higher BMI (overall survival: adjusted hazard ratio = 0.27, 95% confidence interval: 0.09, 0.86). The cytoplasmic pattern of TGF-β type II receptor expression in cancer cells was significantly associated with a lower survival rate but was not modified by BMI or physical activity. Our study suggests that the TGF-β pathway in tumor cells is involved in breast cancer prognosis and may be modified by BMI through pSmad2.
© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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