Tai Ji Quan as an exercise modality to prevent and manage cardiovascular disease: A review

BackgroundRegular exercise is beneficial for adults with cardiovascular disease (CVD) and CVD risk factors. Tai Ji Quan is popular among older adults and may offer additional exercise options. The present article aims to review the scientific literature published within the past decade on Tai Ji Quan as an exercise modality to prevent and manage CVD.MethodsAn electronic literature search of four databases (PubMed, CINAHL, PsycINFO, and AMED) was conducted from April 2003 through March 2013. Studies that examined Tai Ji Quan, were published in English, and specified a target study population of participants with a known CVD condition (e.g., coronary artery disease, chronic heart failure, or stroke) or studies conducted among participants with a CVD risk factor (e.g., hypertension, dyslipidemia, or impaired glucose metabolism) were included.ResultsA total of 20 studies met the inclusion criteria: 11 randomized clinical trials, seven quasi-experimental studies and two cross-sectional studies. The effect of Tai Ji Quan was examined on more than 20 different study variables among persons with coronary artery disease (n = 5 studies), chronic heart failure (n = 5 studies), stroke (n = 4 studies), and CVD risk factors (n = 6 studies). These studies were conducted primarily in Asia (n = 9, 45%) or the United States (n = 8, 40%). Overall, participants enrolled in Tai Ji Quan had better outcomes, though mixed results were reported.ConclusionCollectively, these studies indicate that Tai Ji Quan is a safe form of exercise to prevent and manage CVD. Further research is needed with more rigorous study designs, larger sample sizes, adequate Tai Ji Quan exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Ji Quan, before widespread recommendations can be made.     

Impact of a physical education-based behavioural skill training program on cognitive antecedents and exercise and sport behaviour among adolescents: a cluster-randomized controlled trial

ABSTRACT

Background: School-based physical education has been associated with a multitude of potential learning outcomes. Representatives of a public health perspective suggest that promoting physical activity in and outside the context of school is an important endeavour. While the importance of behavioural skill training to improve (motor) learning is well documented in both general and physical education, the promotion of behavioural skills to foster physically active lifestyles constitutes a rather neglected area in physical education research.

Purpose: To examine whether a standardized physical education-based behavioural skill training program has the potential to positively impact on adolescents’ self-reported exercise and sport participation, as well as cognitive antecedents involved in the regulation of exercise and sport behaviour.

Research design: Cluster-randomized controlled trial.

Methods: A sample of 143 secondary school students (50% girls, aged 14–18 years) attending academic high schools in German-speaking Switzerland were assigned class-wise to the intervention (behavioural skill training) and control condition (conventional physical education lessons). Data were assessed prior and after completion of the 7-week intervention program, which was composed of four 20-min lessons and two reflection phases. Exercise and sport behaviour and cognitive antecedents (exercise/sport intention, motivation, implementation intentions, coping planning, self-efficacy) were assessed via self-reports. A multilevel mixed effects linear regression procedure was used to test the main hypotheses. The regression analyses were adjusted for clustering of school classes, and controlled for baseline levels of the outcome measure and potential confounders.

Results: Compared to a control condition, the intervention program resulted in significant improvements with regard to introjected motivation (p?<?.05), coping planning (p?<?.001) and self-efficacy (p?<?.01). The intervention also had a positive impact on adolescents’ self-reported sport/exercise behaviour (p?<?.001). Improvements in exercise/sport intention (p?<?.05), coping planning (p?<?.01), and self-efficacy (p?<?.01) were associated with increased levels of self-reported exercise/sport participation.

Conclusion: Behavioural skill training as part of compulsory physical education has the potential to improve cognitive antecedents of exercise and sport behaviour and to foster adolescents’ exercise and sport participation. Enhancing behavioural skills might be one way in which school physical education can contribute to the creation of more physically active lifestyles among adolescents.     

The Evidence Regarding Exercise Training in the Management of Cystic Fibrosis: A Systematic Review

Purpose: To conduct a systematic review of the evidence regarding the efficacy of exercise training in the management of cystic fibrosis (CF).Methods: Articles were found by searching PEDRO, MEDLINE, and CINAHL databases. Included articles involved exercise-related interventions for long-term adaptations (ie, not acute effects of exercise). Articles were excluded if the language was other than English or if other non-exercise interventions were used. Date of publication was not a factor for exclusion. Two independent reviewers evaluated the included articles using Sackett''s levels of evidence and select scoring criteria.Results: Twelve articles were eligible for inclusion. Interventions studied included various aspects of exercise training: anaerobic, aerobic, or resistance training. Study end-points included pulmonary function, aerobic capacity, strength, and health-related quality of life (HRQL).Conclusions: Exercise training in individuals with CF is beneficial, with aerobic and resistance training having the greatest support in the literature for improved aerobic capacity and strength, respectively. Exercise training does not appear to have an effect of improving pulmonary function, but may have a preservation effect. Strong conclusions about improvement in HQRL from exercise training cannot be made. However, greater consistency in measuring this outcome is needed in future trials. There is a paucity of evidence regarding the role of exercise training in reducing hospitalization and health care utilization, and questions raised by this review should be considered in the design of future trials.Key Words: cystic fibrosis, aerobic exercise, review     

Immune nutrition and exercise: Narrative review and practical recommendations

Abstract

Evidence suggests that periods of heavy intense training can result in impaired immune cell function, and whether this leaves elite athletes at greater risk of infections and upper respiratory symptoms (URS) is still debated. There is some evidence that episodes of URS do cluster around important periods of competition and intense periods of training. Since reducing URS, primarily from an infectious origin, may have implications for performance, a large amount of research has focused on nutritional strategies to improve immune function at rest and in response to exercise. Although there is some convincing evidence that meeting requirements of high intakes in carbohydrate and protein and avoiding deficiencies in nutrients such as vitamin D and antioxidants is integral for optimal immune health, well-powered randomised controlled trials reporting improvements in URS beyond such intakes are lacking. Consequently, there is a need to first understand whether the nutritional practices adopted by elite athletes increases their risk of URS. Second, promising evidence in support of efficacy and mechanisms of immune-enhancing nutritional supplements (probiotics, bovine colostrum) on URS needs to be followed up with more randomised controlled trials in elite athletes with sufficient participant numbers and rigorous procedures with clinically relevant outcome measures of immunity.     

Exercise interventions for older adults: A systematic review of meta-analyses

Background:The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented.We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of metaanalyses of exercise interventions in older adults.Methods:We searched the Cochrane Database of Systematic Reviews,PsycInfo,MEDLINE,Embase,CINAHL,AMED,SPORTDiscus,and Web of Science for articles that met the following criteria:(1)meta-analyses that synthesized measures of improvement(e.g.,effect sizes)on any outcome identified in studies of exercise interventions;(2)participants in the studies meta-analyzed were adults aged 65+or had a mean age of 70+;(3)meta-analyses that included studies of any type of exercise,including its duration,frequency,intensity,and mode of delivery;(4)interventions that included multiple components(e.g.,exercise and cognitive stimulation),with effect sizes that were computed separately for the exercise component;and(5)meta-analyses that were published in any year or language.The characteristics of the reviews,of the interventions,and of the parameters improved through exercise were reported through narrative synthesis.Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews.The study included 56 meta-analyses that were heterogeneous in relation to population,sample size,settings,outcomes,and intervention characteristics.Results:The largest effect sizes for improvement were found for resistance training,meditative movement interventions,and exercise-based active videogames.Conclusion:The review identified important gaps in research,including a lack of studies investigating the benefits of group interventions,the characteristics of professionals delivering the interventions associated with better outcomes,and the impact of motivational strategies and of significant others(e.g.,carers)on intervention delivery and outcomes.     

Does exercise have a protective effect on cognitive function under hypoxia? A systematic review with meta-analysis

ObjectiveThis study aimed to examine (1) the independent effects of hypoxia on cognitive function and (2) the effects of exercise on cognition while under hypoxia.MethodsDesign: Systematic review with meta-analysis. Data sources: PubMed, Scopus, Web of Science, PsychInfo, and SPORTDiscus were searched. Eligibility criteria for selecting studies: randomized controlled trials and nonrandomized controlled studies that investigated the effects of chronic or acute exercise on cognition under hypoxia were considered (Aim 2), as were studies investigating the effects of hypoxia on cognition (Aim 1).ResultsIn total, 18 studies met our inclusionary criteria for the systematic review, and 12 studies were meta-analyzed. Exposure to hypoxia impaired attentional ability (standardized mean difference (SMD) = –0.4), executive function (SMD = –0.18), and memory function (SMD = –0.26), but not information processing (SMD = 0.27). Aggregated results indicated that performing exercise under a hypoxia setting had a significant effect on cognitive improvement (SMD = 0.3, 95% confidence interval: 0.14 – 0.45, I² = 54%, p < 0.001). Various characteristics (e.g., age, cognitive task type, exercise type, exercise intensity, training type, and hypoxia level) moderated the effects of hypoxia and exercise on cognitive function.ConclusionExercise during exposure to hypoxia improves cognitive function. This association appears to be moderated by individual and exercise/hypoxia-related characteristics.     

Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease: The State of the Evidence

Purpose: The purpose of the present review was to assess the quality of evidence in the literature regarding the specific benefits of inspiratory muscle training (IMT) with an emphasis on training intensity and the relationships between changes in inspiratory muscle function and other clinical outcome measures. Methods: Articles were found by searching CINAHL, PubMed, Medline via First Search, and ProQuest databases. Articles used in the review were randomized trials of IMT vs. sham IMT or no intervention, published in English in a peer-reviewed journal, included patients with chronic obstructive pulmonary disease (COPD), and specified the intensity of training. The quality of the studies was evaluated by 2 independent reviewers using the methodological rigor scale described by Medlicott and Harris as well as Sackett''s levels of evidence. Fifteen articles met the inclusion criteria and were used in this review. Results: Consistent improvements in maximal inspiratory pressures (ranging from −11 to −30 cm H₂O) and inspiratory muscle endurance were found. Improvements in dyspnea and health-related quality of life were also observed. Inspiratory muscle training may result in improved exercise tolerance as measured using walking tests. High-intensity IMT resulted in improved training efficiency with respect to inspiratory muscle strength, but evidence of the effect of high-intensity IMT on other clinical outcomes is lacking. Conclusion: Despite research spanning decades, there are numerous limitations in the literature regarding IMT. IMT appears to improve dyspnea, waking test distance, and health-related quality of life in individuals with COPD, but it is not clear whether this improvement is mediated through improved inspiratory muscle strength and endurance. This review discussed several considerations critical to the design of future trials.Key Words: inspiratory muscle training, COPD     

Comparison between multiple sets and half-pyramid resistance exercise bouts for muscle damage profile

Abstract

The present study compared the changes in markers of muscle damage after bouts of resistance exercise employing the Multiple-sets (MS) and Half-pyramid (HP) training systems. Ten healthy men (26.1±6.3 years), who had been involved in regular resistance training, performed MS and HP bouts, 14 days apart, in a randomised, counter-balanced manner. For the MS bout, participants performed three sets of maximum repetitions at 75%-1RM (i.e. 75% of a One Repetition Maximum) for the three exercises, starting with the bench press, followed by pec deck and decline bench press. For the HP bout, the participants performed three sets of maximum repetitions with 67%-1RM, 74%-1RM and 80%-1RM for the first, second and third sets, respectively, for the same three exercise sequences as the MS bout. The total volume of load lifted was equated between both bouts. Muscle soreness, plasma creatine kinase (CK) activity, myoglobin (Mb) and C-reactive protein (CRP) concentrations were assessed before and for three days after each exercise bout, and the changes over time were compared between MS and HP using two-way repeated measures ANOVA. Muscle soreness developed significantly (P<0.01) after both bouts, but no significant difference was observed between MS and HP. Plasma CK activity and Mb concentration increased significantly (P<0.01) without significant differences between bouts, and CRP concentration did not change significantly after either bout. These results suggest that the muscle damage profile is similar for MS and HP, probably due to the similar total volume of load lifted.     

Acute cardiovascular responses to interval exercise: A systematic review and meta-analysis

ABSTRACT

Interval exercise training is increasingly recommended to improve health and fitness; however, it is not known if cardiovascular risk is different from continuous exercise protocols. This systematic review with meta-analyses assessed the effect of a single bout of interval exercise on cardiovascular responses that indicate risk of cardiac fibrillation and infarction compared to continuous exercise. Electronic databases Medline, CINAHL, Embase, Scopus and Cochrane were searched. Key inclusion criteria were: (1) intervals of the same intensity and duration followed by a recovery period and (2) reporting at least one of blood pressure, heart rate variability, arterial stiffness or function. Cochrane Risk of Bias tool and GRADE approach were used. Meta-analyses found that systolic blood pressure responses to interval exercise did not differ from responses to continuous exercise immediately (MD 8 mmHg [95% CI ?32, 47], p = 0.71) or at 60 min following exercise (MD 0 mmHg [95% CI ?2, 1], p = 0.79). However, reductions in diastolic blood pressure and flow-mediated dilation with interval exercise were observed 10–15 min post-exercise. The available evidence indicates that interval exercise does not convey higher cardiovascular risk than continuous exercise. Further investigation is required to establish the safety of interval exercise for clinical populations.     

Physiological Changes in Middle-Aged Men following a Ten-Week Jogging Program

Abstract

Twenty-one middle-aged males who participated in a jogging program performed a 6-minute submaximal exercise bout on a bicycle ergometer to determine if any differences existed between the results of heart rate and blood pressure tests taken before and after 10 weeks of training. Heart rates were obtained from electrocardiograph tracings and blood pressures were measured by a manual sphygmomanometer. The t test for differences between the means of related measures of heart rates and blood pressures was used with the .01 level selected for significance. Differences between the means of pre-and post tests of heart rate, under pre-exercise, submaximal exercise, and postexercise conditions, were all statistically significant. The jogging program did not produce any significant change in either systolic or disastolic blood pressure. It was concluded that 10 weeks of participation in a systematic jogging program will produce reductions in heart rates for middle-aged men at rest, during submaximal exercise, and during the recovery period following exercise.     

Intensity of Treadmill Training and its Effect on Body Composition in Rats

Abstract

The purpose of this study was to determine which of three intensities of treadmill training produced changes in body composition in rats as evidenced by body weight, percentage of fat and specific gravity. Subjects were 60 male Wistar rats 25 to 30 days old when obtained. They were randomly assigned to one of five groups: sedentary controls, spontaneously active controls, and three groups of rats forced to exercise on a treadmill at intensities of 75, 125 and 175 fpm. Forced exercise was applied three times a week for 8 weeks, after which measures of body weight, specific gravity, and percentage of body fat were obtained. Results indicated that the sedentary controls had significantly higher mean body weights than did those which exercised. Rats forced to exercise at 75 fpm had significantly lower specific gravity measures than rats trained at 125 fpm. Sedentary controls had lower specific gravity values than did all rats allowed to exercise. Intensity of treadmill training had no effect on percentage of body fat as determined chemically. However, exercise was effective in reduction of body fat.     

The relative contribution of training intensity and duration to daily measures of training load in professional rugby league and union

ABSTRACT

This study examined the relative contribution of exercise duration and intensity to team-sport athlete’s training load. Male, professional rugby league (n = 10) and union (n = 22) players were monitored over 6- and 52-week training periods, respectively. Whole-session (load) and per-minute (intensity) metrics were monitored (league: session rating of perceived exertion training load [sRPE-TL], individualised training impulse, total distance, BodyLoad?; union: sRPE-TL, total distance, high-speed running distance, PlayerLoad?). Separate principal component analyses were conducted on the load and intensity measures to consolidate raw data into principal components (PC, k = 4). The first load PC captured 70% and 74% of the total variance in the rugby league and rugby union datasets, respectively. Multiple linear regression subsequently revealed that session duration explained 73% and 57% of the variance in first load PC, respectively, while the four intensity PCs explained an additional 24% and 34%, respectively. Across two professional rugby training programmes, the majority of the variability in training load measures was explained by session duration (~60–70%), while a smaller proportion was explained by session intensity (~30%). When modelling the training load, training intensity and duration should be disaggregated to better account for their between-session variability.     

The acute effects of resistance exercise on affect,anxiety, and mood – practical implications for designing resistance training programs

ABSTRACT

Research in aerobic exercise has linked the affective responses (pleasure–displeasure) experienced during exercise to future exercise participation. While this is yet to be confirmed in anaerobic activities, it can be inferred that making resistance exercise (RE) more psychologically rewarding is an important consideration. The purpose of this article is to review the acute effects of RE on affect, anxiety, and mood and to draw conclusions on how to maximize feelings of pleasure in an effort to increase rates of participation. This review provides evidence to support lower training volumes performed at low to moderate intensities (50–70% 1RM) with long inter-set rest intervals (90–150 s). Additional recommendations are provided based on physiological and theoretical support, but there is a strong need for more research on the affective experience of RE.     

Immediate effect of high-intensity exercise on brain-derived neurotrophic factor in healthy young adults: A systematic review and meta-analysis

BackgroundAlthough brain-derived neurotrophic factor (BDNF) has been identified as a molecular biomarker of the neurophysiological effects induced by exercise, the acute effects of high-intensity exercise (HIE) on BDNF levels are inconclusive. This study aims to estimate the immediate effects of HIE on BDNF levels in healthy young adults.MethodsA systematic search was conducted in the MEDLINE, Scopus, Cochrane CENTRAL, and SPORTDiscuss databases up to December 2020. Randomized controlled trials (RCTs) and non-RCTs reporting pre–post changes in serum or plasma BDNF after an acute intervention of HIE compared to a control condition were included. Pooled effect sizes (p-ESs) and 95% confidence intervals (95%CIs) were calculated for RCTs using a random effects model with Stata/SE (Version 15.0; StataCorp., College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PROPERO registration number: CRD42020221047.ResultsA total of 22 studies with 552 individuals (age range: 20–31 years; 59.1% male) were included. The meta-analysis included 10 RCTs that reported valid outcome data. Higher BDNF levels were observed when HIE interventions were compared with non-exercise (p-ES = 0.55, 95%CI: 0.12–0.98; I² = 25.7%; n = 4 studies) and light-intensity exercise (p-ES = 0.78, 95%CI: 0.15–1.40; I² = 52.4%; n = 3 studies) but not moderate-intensity exercise (p-ES = 0.93, 95%CI: –0.16 to 2.02; I² = 88.5%; n = 4 studies) conditions.ConclusionIn comparison to non-exercise or light-intensity exercises, an immediate increase in BDNF levels may occur when young adults perform HIE. Given the benefits obtained maximizing circulating BDNF when performing HIE and its potential effects on brain health, our findings suggest that HIE could be recommended by clinicians as a useful exercise strategy to healthy adults.     

Impact of Overt and Subclinical Hypothyroidism on Exercise Tolerance: A Systematic Review

Purpose: This systematic review describes the state of the art of the impact of hypothyroidism on exercise tolerance and physical performance capacity in untreated and treated patients with hypothyroidism. Method: A systematic computer-aided search was conducted using biomedical databases. Relevant studies in English, German, and Dutch, published from the earliest date of each database up to December 2012, were identified. Results: Out of 116 studies, a total of 38 studies with 1,379 patients fulfilled the inclusion criteria. These studies emphasize the multifactorial causes of exercise intolerance in untreated patients by the impact of limitations in different functional systems, with cardiovascular, cardiopulmonary, musculoskeletal, neuromuscular, and cellular metabolic systems acting in concert. Moreover, the studies affirm that exercise intolerance in patients is not always reversible during adequate hormone replacement therapy. As a consequence, despite a defined euthyroid status, there remains a significant group of treated patients with persistent complaints related to exercise intolerance who are suffering from limitations in daily and sport activities, as well as an impaired quality of life. An explanation for this phenomenon is lacking. Only 2 studies investigated the effects of a physical training program, and they showed inconsistent effects on the performance capacity in untreated patients with subclinical hypothyroidism. Conclusions: A limited body of knowledge exists concerning exercise tolerance in treated patients with hypothyroidism, and there is an insufficient amount of quantitative studies on the effects of a physical training program. To enhance exercise and sports participation for this specific group, more research in this forgotten area is warranted.     

Cytokine responses to resistance training in people with multiple sclerosis

Abstract

Exercise for individuals with multiple sclerosis (MS) has been shown to improve cardiovascular function, increase strength and endurance, and reduce fatigue. The impact of exercise on immune function in the disease, however, remains mostly unexplored. Ten female MS patients participated in an 8 week programme of twice-weekly progressive resistance training, with pre- and post-training assessment of serum concentrations of cytokines IL-2, IL-4, IL-6, IL-10, CRP, TNF-α and IFN-γ. After training, IL-4, IL-10, CRP and IFN-γ showed statistically reduced resting concentrations in blood, while TNF-α showed non-significant reductions and IL-2 and IL-6 remained unchanged. These results suggest that progressive resistance training may have an impact on cytokine concentrations in individuals with MS and should be confirmed in studies with stronger statistical power. The impact of these changes on overall immune function in MS and on disease status and prognosis remains to be determined.     

Risk of bias and reporting practices in studies comparing VO2max responses to sprint interval vs. continuous training: A systematic review and meta-analysis

Background:It remains unclear whether studies comparing maximal oxygen uptake(VO_{2 max}) response to sprint interval training(SIT) vs.moderate-intensity continuous training(MICT) are associated with a high risk of bias and poor reporting quality.The purpose of this study was to evaluate the risk of bias and quality of reporting in studies comparing changes in VO_{2 max} between SIT and MICT.Methods:We conducted a comprehensive literature search of 4 major databases:AMED,CINAHL,E...     

Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity: A systematic review and meta-analysis

BackgroundWeight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity; however, weight loss can also result in bone loss and increased fracture risk. Weight-loss-induced bone loss may be attenuated with exercise. Our aim was to compare changes in bone mineral density (BMD) in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise.MethodsWe included randomized controlled trials (RCTs) in adults with overweight or obesity (aged ≥18 years; body mass index ≥25 kg/m²) that prescribed diet-induced weight loss alone or in combination with supervised exercise, and measured any bone structural parameters. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random-effects meta-analyses determined mean changes and net mean differences (95% confidence intervals (95%CIs)) in the percentage of areal BMD (aBMD) change between groups.ResultsWe included 9 RCTs. Diet-induced weight loss led to significant losses in femoral neck aBMD (mean change: −1.73% (95%CI: −2.39% to −1.07%), p < 0.001) and total hip aBMD (−2.19% (95%CI: −3.84% to −0.54%), p = 0.009). Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group (net difference: −0.88% (95%CI: −1.73% to −0.03%)); however, there were no differences in aBMD changes at any other skeletal site: total hip (−1.96% (95%CI: −4.59% to 0.68%)) and lumbar spine (−0.48% (95%CI: −1.81% to 0.86%)). aBMD changes did not differ significantly according to exercise modality (resistance exercise, aerobic exercise, or a combination of the two) during diet-induced weight loss.ConclusionDiet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise. Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss. The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions. Additional RCTs with appropriate, targeted exercise interventions should be conducted.