The epigenetic landscape of exercise in cardiac health and disease

With the rising incidence of cardiovascular diseases, the concomitant mortality and morbidity impose huge burdens on quality of life and societal costs. It is generally accepted that physical inactivity is one of the major risk factors for cardiac disease and that exercise benefits the heart in both physiological and pathologic conditions. However, the molecular mechanisms governing the cardioprotective effects exerted by exercise remain incompletely understood. Most recently, an increasing number of studies indicate the involvement of epigenetic modifications in the promotion of cardiac health and prevention of cardiac disease. Exercise and other lifestyle factors extensively induce epigenetic modifications, including DNA/RNA methylation, histone post-translational modifications, and non-coding RNAs in multiple tissues, which may contribute to their positive effects in human health and diseases. In addition, several studies have shown that maternal or paternal exercise prevents age-associated or high-fat diet-induced metabolic dysfunction in the offspring, reinforcing the importance of epigenetics in mediating the beneficial effects of exercise. It has been shown that exercise can directly modify cardiac epigenetics to promote cardiac health and protect the heart against various pathological processes, or it can modify epigenetics in other tissues, which reduces the risk of cardiac disease and affords cardioprotection through exerkines. An in-depth understanding of the epigenetic landscape of cardioprotective response to exercise will provide new therapeutic targets for cardiac diseases. This review, therefore, aimed to acquaint the cardiac community with the rapidly advancing and evolving field of exercise and epigenetics.     

运动干预改善慢性肾病的研究进展

慢性肾脏疾病是复杂的威胁公共健康的疾病。慢性肾病与高致死率、高发病率、高治疗费用相关。肾脏纤维化是肾脏慢性病变的病理形态表现,是指在各种致病因子如炎性因子,机械性损伤,药物等导致的细胞外基质（extracellarmatrix。ECM）合成增多降解减少,肾小球基底膜增厚,最终影响肾脏功能。目前关于慢性肾病的研究重要集中在药物筛选方面,而运动是否能改善慢性肾脏疾病的研究较少。本文通过文献资料法与逻辑推理相结合的方法总结运动与慢性肾脏疾病的研究,总结指出：1适当的运动通过减弱肾脏病变引起的纤维化程度,改善慢性肾脏疾病。2运动可以通过调解TGF-β1／Smad信号通路改善慢性肾脏疾病     

American adults' knowledge of exercise recommendations

Physical inactivity is a major risk factor for cardiovascular disease, stroke, hypertension, diabetes, obesity, osteoporosis, and some cancers. Approximately 950,000 Americans die annually from cardiovascular diseases. The purpose of this study was to determine whether American adults know which traditional and lifestyle physical activities affect health and how they should be physically active to achieve a health benefit. Secondary purposes were to determine whether this knowledge is a function of gender, ethnicity, education, or age and if those who are sufficiently active for a health benefit possess different knowledge levels than those not sufficiently active for a health benefit. Items based on the Centers for Disease Control and Prevention/American College of Sports Medicine principles included knowledge of exercise guidelines and traditional and lifestyle physical activities. This information was obtained from 20 questions that were part of a national random telephone survey of 2,002 American households in the 48 contiguous states and the District of Columbia. Respondents were most aware of traditional physical activities (M = 94%) that provide a health benefit and less aware of specific exercise guidelines (M = 68%) and lifestyle physical activities (M = 71%) that can result in a health benefit. Knowledge was not related to physical activity behavior sufficient for a health benefit and only slightly related to ethnicity, education, and age. These data suggest that physical activity knowledge alone is not sufficient to elicit a behavior; however, it provides educators with an understanding of the public's physical activity knowledge that could be helpful in developing health promotion and physical activity interventions.     

Potential adverse cardiac remodelling in highly trained athletes: still unknown clinical significance

Moderate endurance exercise has long been considered an essential element to maintain cardiovascular health, and sedentary behaviour in the general population has been related to a significant increase in all-causes of mortality, cardiovascular disease mortality and cardiovascular disease incidence. However, a growing group of people performs an intense exercise that leads to multiple heart adaptive changes that are collectively called “athlete’s heart”. In this review, we discussed the evidence of cardiac remodelling process secondary to repetitive and strenuous exercise in some predisposed athletes that produces intense and probably deleterious changes in cardiac morphology and function with no clear clinical significance in long-term follow-up. Moreover, we also discussed the individual biological response to exercise assessed by myocardial damage, inflammation, oxidative stress, fibrosis and ventricular hypertrophy biomarkers showing different intensities with equivalent exertion.     

Physical activity lowers the risk for acute respiratory infections: Time for recognition

Physical inactivity is a well-established risk factor for chronic diseases, such as cardiovascular disease, cancer, and diabetes mellitus. There is a growing awareness that physical inactivity should also be regarded as a risk factor for acute respiratory infections (ARIs). ARIs, such as the common cold, influenza, pneumonia, and coronavirus disease 2019 (COVID-19), are among the most pervasive diseases on earth and cause widespread morbidity and mortality. Evidence in support of the linkage between ARIs and physical inactivity has been strengthened during the COVID-19 pandemic because of increased scientific scrutiny. Large-scale studies have consistently reported that the risk for severe COVID-19 outcomes is elevated in cohorts with low physical activity and/or physical fitness, even after adjusting for other risk factors. The lowered risk for severe COVID-19 and other ARIs in physically active groups is attributed to exercise-induced immunoprotective effects, including enhanced surveillance of key immune cells and reduced chronic inflammation. Scientific consensus groups, including those who submitted the Physical Activity Guidelines for Americans, have not yet given this area of research the respect that is due. It is time to add “reduced risk for ARIs” to the “Exercise is Medicine” list of physical activity-related health benefits.     

Physical exercise in the prevention and treatment of Alzheimer's disease

Dementia is one of the greatest global challenges for health and social care in the 21st century. Alzheimer's disease (AD), the most common type of dementia, is by no means an inevitable consequence of growing old. Several lifestyle factors may increase, or reduce, an individual's risk of developing AD. Much has been written over the ages about the benefits of exercise and physical activity. Among the risk factors associated with AD is a low level of physical activity. The relationship between physical and mental health was established several years ago. In this review, we discuss the role of exercise (aerobic and resistance) training as a therapeutic strategy for the treatment and prevention of AD. Older adults who exercise are more likely to maintain cognition. We address the main protective mechanism on brain function modulated by physical exercise by examining both human and animal studies. We will pay especial attention to the potential role of exercise in the modulation of amyloid β turnover, inflammation, synthesis and release of neurotrophins, and improvements in cerebral blood flow. Promoting changes in lifestyle in presymptomatic and predementia disease stages may have the potential for delaying one-third of dementias worldwide. Multimodal interventions that include the adoption of an active lifestyle should be recommended for older populations.     

女大学生心血管功能对健身运动处方锻炼的应答

近1 0年对大学生体质健康的研究表明:大学生心功能有下降的趋势。因此,重视大学生心血管功能锻炼已刻不容缓。研制不同内容的健身运动处方,对女大学生进行课外体育锻炼实验,观察心血管功能对不同内容健身运动处方锻炼的应答。结果表明,女大学生的心血管功能对制定的健身运动处方产生不同程度的良性应答。其中,全面锻炼(1组)使用的健身运动处方对改善血管功能效果最明显。     

Running for your life: A review of physical activity and cardiovascular disease risk reduction in individuals with schizophrenia

Individuals with schizophrenia have a greater risk for cardiometabolic risk factors (e.g. central obesity, insulin resistance, hypertension and dyslipidaemia), cardiovascular diseases and mortality. This risky profile may be explained by the adverse effects of antipsychotic medications and an unhealthy lifestyle (e.g. smoking, poor nutrition and low physical activity). In the general population, physical activity has been shown to be the optimal strategy to improve both cardiometabolic parameters and cardiorespiratory fitness levels. Accordingly, an emerging literature of non-pharmacological interventions (e.g. cognitive behavioural therapy, diet and physical activity) has been studied in individuals with schizophrenia. Therefore, the purpose of this review was 1) to conduct a critical literature review of non-pharmacological interventions that included some kind of physical activity (including supervised and unsupervised exercise training) and target cardiometabolic risk factors in individuals with schizophrenia. 2) To describe the contribution of physical activity alone by reviewing trials of supervised exercise training programmes only. A literature review via systematic keyword search for publications in Medline, PubMed, Embase and PsycINFO was performed. Many non-pharmacological interventions are efficient in reducing cardiovascular disease risk factors when combined with physical activity. Supervised physical activity has been successful in decreasing cardiovascular disease risk, and aerobic interval training appears to provide more benefits by specifically targeting cardiorespiratory fitness levels. In conclusion, physical activity is an effective strategy for addressing cardiovascular disease risk in individuals with schizophrenia. Long-term studies are needed to evaluate the feasibility and impact of exercise training programmes in individuals with schizophrenia.     

Physical Therapists’ Perceptions of Knowledge and Clinical Behavior Regarding Cardiovascular Disease Prevention

Purpose

The study purpose was to assess perceptions of physical therapists (PTs) regarding the role of physical therapy in cardiovascular disease (CVD) prevention.

Methods

A 25-item survey, validated by expert cardiovascular/pulmonary (CVP) PTs, was sent electronically to 2,673 PTs. Each item represented an element of clinical practice behavior: education of CVD/risk factors (EDCVD), administration of primary CVD prevention (PRECVD), identifying underlying CVD/risk factors (IDCVD), monitoring CV status in patients with CVD (MONCVD). Responses were assigned numeric values (strongly agree = 5 to strongly disagree = 1), and mean element scores were analyzed.

Results

Most of the 516 respondents were APTA Section members (34% CVP Section, 42% other Section membership) and worked in academia (53%). Items showing a high (> 95%) level of agreement included patient education of smoking (97%) and monitoring exercise intensity (99%), assessing exercise benefits (99%), clinically identifying obesity (97%) and hypertension (97%), and monitoring CV response to exercise (99%). Items failing to reach 80% overall agreement were patient education of CVD medications (79%) and blood chemistry (72%), and assessing CVD family history (75%), patient BMI (60%), and body composition (33%). Identifying underlying CVD (77.2%) was the only practice behavior failing to reach 80% agreement. Outpatient PTs agreed significantly less to all elements vs. academics, and to IDCVD vs. all PTs except home health.

Conclusions

Physical therapists support most CVD prevention behaviors, but not given elements of patient education and identifying underlying CVD/risk factors.Key Words: cardiovascular disease, primary disease prevention, secondary disease prevention     

体力活动不足、久坐行为与糖代谢异常检出率的关系

目的：探讨体力活动（PA）不足和久坐行为（SB）与糖代谢异常检出率的关系。方法：对30~69岁具有至少3项DM危险因素者进行糖耐量筛查,采用国际体力活动问卷（IPAQ-SF）调查PA水平和SB,并利用加速度计对问卷进行效度检验。结果：研究纳入195人,平均年龄（51.92±10.64）岁。糖代谢异常检出率为67.18%,检出率随DM危险因素数量的增多而升高。IPAQ-SF中MPA、MVPA以及SB时间与加速度计测量结果的相关系数r分别为0.35、0.37和0.43。受试者中75.9%属于PA不足,同时具有"PA不足+（年龄≥ 40岁）+超重/肥胖"三项的受试者最多（48.21%）。在调整了混杂因素之后,与SB ≤ 6h/d组相比,SB>6h/d组受试者的糖耐量异常检出率更高（OR=2.37,95% CI：1.12~5.02）。结论：多种DM危险因素聚集者中糖代谢异常检出率较高,PA不足者较多,SB增加糖代谢异常风险,IPAQ-SF适用于对该人群进行PA评价。建议对糖尿病多危险因素聚集者,尤其是PA不足、SB较多、超重/肥胖者及时筛查并重点关注,降低糖代谢异常发病率。     

Health benefits of hard martial arts in adults: a systematic review

Participation in organized sports is promoted as a means of increasing physical activity levels and reducing chronic disease risk in adults. Hard martial arts practice (i.e. using body contact techniques), has gained in popularity over time. This review explores the evidence for health benefits of “hard” martial arts practice within the adult population. A systematic electronic database search was conducted, and quality assessments applied the Effective Public Health Practice Project tool. Twenty-eight studies met the inclusion criteria, examining balance, cognitive function, muscular skeletal status, psychological, cardiovascular fitness, and metabolic effects. The majority of studies reported positive effects resulting from hard martial arts practice, showing some improvement and maintenance of balance, cognitive function and psychological health. Benefits may be obtained regardless of the age of practice commencement. However, quality of the evidence is affected by methodological weaknesses across the studies. “Hard” martial arts seem to have potential to improve balance and cognitive functions that decline with age, which can lead to poorer health outcomes among the elderly (e.g. cognitive decline, falls and fractures). Benefits should be further investigated with improved intervention studies, representative samples and longer follow-up periods in order to establish associations with morbidity and mortality in the long term.     

河南省群众身体健康状况与参与体育锻炼关系的调查分析

对河南省 17个县 (市 )群众的身体健康状况与参与体育锻炼关系的调查分析结果表明 ,运动器官、心脑血管系统、消化系统、呼吸系统和神经系统疾病是影响河南省群众身体健康的主要慢性病 ;各种主要慢性病及人们对自身身体和心理感觉的认识与体育锻炼的综合效果有显著相关 ,但与锻炼次数、时间、强度有不同相关特征。慢性病患者参与体育锻炼时 ,既要注重锻炼次数、时间 ,又要注重锻炼强度 ,更要结合个人体质的实际情况合理安排锻炼计划。     

Exercise-mediated regulation of autophagy in the cardiovascular system

Cardiovascular disease is the leading cause of human death worldwide. Autophagy is an evolutionarily conserved degradation pathway,which is a highly conserved cellular degradation process in which lysosomes decompose their own organelles and recycle the resulting macromolecules.Autophagy is critical in maintaining cardiovascular homeostasis and function, and excessive or insufficient autophagy or autophagic flux can lead to cardiovascular disease. Enormous evidence indicates that exercise training plays a beneficial role in the prevention and treatment of cardiovascular diseases. The regulation of autophagy during exercise is a bidirectional process. For cardiovascular disease caused by either insufficient or excessive autophagy, exercise training restores normal autophagy function and delays the progression of cardiovascular disease.An in-depth exploration and discussion of exercise-mediated regulation of autophagy in the cardiovascular system can broaden our view about the prevention of various autophagy-related diseases through exercise training. In this article, we review autophagy and its related signaling pathways,as well as autophagy-dependent beneficial effects of exercise in cardiovascular system.     

Physical activity estimated by the bone-specific physical activity questionnaire is also associated with cardiovascular risk

The nature of physical activity that benefits bone is traditionally thought to differ from that benefiting cardiovascular health. Accordingly, exercise recommendations for improving bone health and cardiovascular health are largely incongruent. Our aim was to determine the associations between high-impact physical activity participation and both cardiovascular disease risk factors and bone mass. We recruited 94 men and women (age 34.0?±?13.3 years) to undergo measures of cardiovascular disease risk (BMI, total cholesterol, fasting blood glucose, waist-to-hip ratio, and mean arterial pressure) and dual-energy X-ray absorptiometry (DXA XR-800, Norland) measures of bone mass (femoral neck, lumbar spine, and whole body BMD) and body composition (whole body lean mass and fat mass). Physical activity participation was estimated using the bone-specific physical activity questionnaire (BPAQ). Those in the upper tertile for current BPAQ score exhibited lower total cholesterol, waist-to-hip ratio, and mean arterial pressure than those in the lower tertiles (P?r?=??0.49 to 0.29, P?P?=?0.008), with BPAQ score predicting 6% of the variance in BMD (P?=?0.02). We conclude that high-impact physical activity as captured by the BPAQ may be beneficial for both bone health and for attenuating cardiovascular disease risk.     

刍议体育健康咨询站在高校建立的必要性

目前体弱、残疾、慢性疾病学生在高校体育教学中是一个弱势群体，也是一种较为普遍的现象，制约着学生的体质发展。因此在高校建立体育健康咨询站，有助于指导这部分学生科学合理地进行体育健身，促进他们体质发展，同时也可以对其他正常学生进行体格、运动能力、运动疲劳恢复、心肺功能，心血功能等方面检查，来评价高校体育教学效果。     

Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults

BackgroundDelirium is a neurocognitive disorder characterized by an abrupt decline in attention, awareness, and cognition after surgical/illness-induced stressors on the brain. There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality. One common indicator for cardiovascular health is the heart rate response/recovery (HRR) to exercise, but how this relates to future delirium is unknown.MethodsElectrocardiogram data were examined in 38,740 middle- to older-aged UK Biobank participants (mean age = 58.1 years, range: 40–72 years; 47.3% males) who completed a standardized submaximal exercise stress test (15-s baseline, 6-min exercise, and 1-min recovery) and required hospitalization during follow-up. An HRR index was derived as the product of the heart rate (HR) responses during exercise (peak/resting HRs) and recovery (peak/recovery HRs) and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile, respectively. Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a 2-year landmark analysis to minimize reverse causation. Sociodemographic factors, lifestyle factors/physical activity, cardiovascular risk, comorbidities, cognition, and maximal workload achieved were included as covariates.ResultsDuring a median follow-up period of 11 years, 348 participants (9/1000) newly developed delirium. Compared with the high HRR group (16/1000), the risk for delirium was almost doubled in those with low HRR (hazard ratio = 1.90, 95% confidence interval (95%CI): 1.30–2.79, p = 0.001) and average HRR (hazard ratio = 1.54, 95%CI: 1.07–2.22, p = 0.020)). Low HRR was equivalent to being 6 years older, a current smoker, or ≥3 additional cardiovascular disease risks. Results were robust in sensitivity analysis, but the risk appeared larger in those with better cognition and when only postoperative delirium was considered (n = 147; hazard ratio = 2.66, 95%CI: 1.46–4.85, p = 0.001).ConclusionHRR during submaximal exercise is associated with future risk for delirium. Given that HRR is potentially modifiable, it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.