MedicalResearch.com Interview with:
Peter Kokkinos, PhD, FAHA, FACSM
Veterans Affairs Medical Center
Professor, Georgetown University School of Medicine
George Washington University School of Medicine and Health Sciences
Director, LIVe Program
Medical Research: What is the background for this study?
Dr. Kokkinos: This is a prospective study and part of a larger cohort, the Veterans Exercise Testing Study (VETS) designed to assess the association between aerobic fitness and the risk of developing Chronic Kidney Disease or CKD. Our cohort included 5,812 middle-aged male Veterans from the Washington, DC Veterans Affairs Medical Center. All participants were CKD-Free prior to entering the study.
Exercise capacity was assessed by a graded exercise test and peak Metabolic Equivalents or METs were determined. Accordingly, we established the following four age-adjusted fitness categories based on Quartiles of peak METs achieved: Least-fit (≤25%; 4.8±0.90 METs; n=1258); Low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); Moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and High-fit (>75%; 9.5±1.0 METs; n=1436).
Multivariable Cox proportional hazard models were used to assess the exercise capacity-CKD association. The models were adjusted for age, BMI, blood pressure, medications, CVD, Risk factors, race, and history of alcoholism.
Medical Research: What are the main findings?
Dr. Kokkinos: During a median follow-up period of 7.9 years, 1,000 individuals developed CKD. The CKD-fitness association was independent, inverse and graded. The CKD risk was 22% lower for every 1-MET increase in exercise capacity.
When considering fitness categories, CKD risk decreased progressively as fitness status increased. Specifically, when compared to the Least-Fit individuals the risk of developing CKD was 13% 45% and 58% lower for individuals in the Low-Fit; Moderate and High-Fit categories, respectively.
These findings support that higher aerobic fitness lowers the risk of developing CKD. The average exercise capacity necessary to realize these health benefits was just over 6.5 METs (Low-fit). This level of fitness is achievable by many middle-aged and older individuals by daily exercises such as brisk walking. Moderate intensity exercises are effective in improving aerobic fitness regardless of age or comorbidities. Thus, exercise interventions for individuals at risk for CKD and those with preclinical CKD may be implemented to prevent or at least attenuate the rate of developing CKD.
MedicalResearch.com Interview with:
Harold P. Erickson Ph.D.
James B. Duke Professor, Department of Cell Biology
Duke Univ. Med. Center Durham, NC 27710
MedicalResearch: What is the background for this study?
Dr. Erickson: In Jan 2012 a paper reported the discovery of irisin, a hormone reportedly lopped off a precursor in muscle and sent through the bloodstream to fat tissue, where it turned white fat into brown fat. Brown fat burns calories, and is what hibernating animals – and even human babies -- use to keep warm. Turning on brown fat had exciting promise for obesity, diabetes, etc. Dozens of labs around the world jumped on the discovery and started trials in animals and humans of how irisin levels in blood were altered by exercise and a variety of metabolic challenges.
MedicalResearch: What are the main findings? Early reports.
Dr. Erickson: The follow-up studies from different labs reported a huge range of values for the level of irisin in blood, so they could not all be right. And most of them failed to find any significant effect of exercise. In 2013 two papers criticized the irisin study. A commentary article by Harold Erickson (Adipocyte 2:289-93) reported two substantial flaws in the original study. A research paper by S. Raschke, J. Eckel and colleagues (PloS one 8:e73680) concluded that humans did not make significant amount of irisin. The human gene for irisin has a deleterious mutation in the start codon, and Raschke et al showed that this reduced irisin expression to only 1% the level with the normal start. These two reports may have slowed new labs entering the field, but many groups already invested continued to publish.
MedicalResearch.com Interview with:
Dr. Liana Machado PhD
Department of Psychology Brain Health Research Centre
University of Otago Dunedin New Zealand
Medical Research: What is the background for this study? What are the main findings?
Response: A large body of data indicates links between chronic physical activity levels and cognitive performance in healthy populations. Although the bulk of evidence comes from studies in older adults, a number of studies have established links in children and in young adults. However, the mechanisms supporting the exercise-cognition links have remained unclear. Finding from an earlier study of ours, published in the journal Neuropsychology, pointed toward cerebrovascular factors as potentially important. In our new study in Psychophysiology, we found evidence suggesting that higher oxygen availability in the brain is one of the cerebrovascular factors that helps support better cognitive performance in people who exercise more regularly, thus providing important insight toward understanding why cognitive performance improves with regular exercise.
MedicalResearch.com Interview with:
Prof. Francesca Mallamaci
Professor of Nephrology
Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
Medical Research: What is the background for this study? What are the main findings?
Dr. Mallamaci: It is well known that physical activity is beneficial both in normal individuals and in patients with heart failure which represent a high risk category of patients. We have scanty information about physical activity in dialysis patients. So the aim of our study was to test the effectiveness of a low-intensity, easy to implement, home exercise program on physical performance in about 300 dialysis patients in a multicenter, randomized, controlled clinical trial (EXCITE, ClinicalTrials.gov NCT01255969). What we found in our study was that dialysis patients who performed exercise improved their physical performance and this was documented by 2 well known and validated performance tests such as the Six Minute Walking Test and the Sit-to-stand-to sit test. We found also that after 2 year follow-up dialysis patients who were in the active exercise arm had a lower rate of hospitalization and a trend to a better survival, compared to dialysis patients in the control arm of the study.
MedicalResearch.com Interview with:
Professor Emrah Düzel
Director, Institute of Cognitive Neurology and Dementia Research, OvG Univ. Magdeburg, Germany
Institute of Cognitive Neuroscience
University College London
Medical Research: What are the main findings of the study?
Professor Düzel: We found that even in old age, intensive and long-term (3 months) aerobic exercise can improve blood flow in the hippocampus, a brain structure that is of critical importance for memory. The increase in blood flow is evident during a resting state and this means that the exercise improves the overall perfusion of the hippocampus. Such effects had previously only been reported in young adults. As previously observed in young adults, the change in blood flow after exercise is related to the improvement of specific memory skills. We found the closest relationship between improved blood flow and recognition memory for complex objects. This is interesting because this type of memory is likely to benefit from “pattern separation”, a process that in animal studies of exercise is tightly associated with hippocampal neurogenesis.
However, we also found that the exercise-related improvement in hippocampal blood flow and in recognition memory was absent in the older seniors of our study cohort. Those who were beyond 70 did not show any improvement. We reasoned that this may have been due to higher levels of stress in the older seniors. Therefore, we investigated whether elevated serum cortisol levels dampened the benefits of exercise in the older seniors. But this was not the case making it unlikely that stress levels can account for these findings.
MedicalResearch.com Interview Invitation with:
Dr. Iffat Rahman Ph.D.
Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177 Stockholm, Sweden
Medical Research: What are the main findings of the study?
Dr. Rahman: Our study suggests that moderate to high level of physical activity could protect against heart failure in women.
MedicalResearch.com Interview with:
Pietro Manuel Ferraro, MD PhD Candidate
Division of Nephrology
Catholic University of the Sacred Heart
Rome Italy
Medical Research: What are the main findings of the study?
Dr. Ferraro: We analyzed the association between physical activity and energy intake and the risk of developing kidney stones in three large cohorts of U.S. health professionals. The 215,133 participants included did not have any history of kidney stones when follow-up began. During 20 years of follow-up, 5,355 of them developed a kidney stone. Initially, we found that participants with higher physical activity levels had a reduced risk of developing stones in two of the three cohorts. However, after accounting for a number of factors that could potentially confound the association such as age, body mass index and dietary intake, the association was no longer significant. Similarly, energy intake was not associated with a reduced risk of developing kidney stones.
MedicalResearch.com Interview with:
Saurabh S. Thosar, Ph.D.,
Postdoctoral Researcher
Oregon Institute for Occupational Health Sciences,
Oregon Health & Science University
Medical Research: What are the main findings of the study?
Dr. Thosar: We discovered that 3 hours of sitting leads to an impairment in shear rate and an impairment in femoral artery endothelial function. When systematic breaks are added in the sitting time the shear rate and the endothelial function are preserved.
MedicalResearch.com Interview with
Marco Perez, MD
Instructor in Cardiovascular Medicine
Director, Inherited Cardiac Arrhythmia Clinic
Stanford University Medical Center
Cardiac Electrophysiology & Arrhythmia Service
Stanford, CA 94305-5233
Medical Research: What are the main findings of the study?
Dr. Perez: It was already known that obesity is an important risk factor for atrial fibrillation. We studied over 80,000 postmenopausal women enrolled in the Women’s Health Initiative who were followed for the onset of atrial fibrillation, an irregular heart rhythm associated with stroke and death. We found that those who exercised more than 9 MET-hours/week (equivalent to a brisk walk of 30 minutes six days a week) were 10% less likely to get atrial fibrillation than those who were sedentary. Importantly, the more obese the women were, the more they benefited from the exercise in terms of atrial fibrillation risk reduction.
MedicalResearch.com Interview with:
Dr Ellen Flint, BA MSc PhD, Research Fellow
Department of Social & Environmental Health Research
London School of Hygiene & Tropical Medicine
Tavistock Place, London
Medical Research: What are the main findings of the study?
Dr. Flint: Men and women who commuted to work by cycling, walking or public transport had significantly lower BMI and percentage body fat than their car-using counterparts. This was the case despite adjustment for a range of factors which may affect both body weight and commuting mode preference (e.g. limiting illness, age, socioeconomic position, sports participation and diet). The differences were of a clinically meaningful magnitude. For example, compared to car users, men who commuted via active or public transportation modes were on average 1 BMI point lighter. For the average man in the sample this would equate to a difference in weight of almost half a stone (3kg).
MedicalResearch.com Interview with:
Kristian Karstoft MD
The Centre of Inflammation and Metabolism and The Centre for Physical Activity ResearchDepartment of Infectious Diseases and CMRC, Rigshospitalet
Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
Medical Research: What are the main findings of the study?
Dr. Karstoft: Four months of Interval-walking training (IWT; five sessions/week, one hour/session) in individuals with type 2 diabetes mellitus maintained insulin secretion, improved insulin sensitivity index and disposition index in opposition to energy-expenditure and time-duration matched continuous walking training (CWT).
MedicalResearch.com Interview with:
James Fisher BSc (Hons) MSc PGCLT(HE)
Senior Lecturer Sports Conditioning and Fitness
IFBB Certified Weight Training Prescription Specialist
Centre for Health, Exercise and Sport Science
Faculty of Business, Sport and Enterprise
Southampton Solent University, Southampton
Medical Research: What are the main findings of the study?
Answer: The study reports that pre-conceived ideas about exercise order, and rest intervals are not substantiated by evidence, and that advanced training routines such as pre-exhaustion appear to induce no greater strength adaptations than simpler training methods. Ultimately, that a single set of each exercise performed at a repetition duration which maintains muscular tension is all that is necessary to induce significant increases in strength in even trained persons.
MedicalResearch.com: Interview with:
Lukas Schwingshackl, MSc
Department of Nutritional Sciences
University of Vienna
Vienna, AUSTRIA
Medical Research: What are the main findings of the study?
Lukas Schwingshackl: The results of the present meta-analyses showed that, in patients with established diabetes, aerobic training might be more effective in reducing glycosylated haemoglobin and fasting glucose when compared with resistance training. Combined aerobic and resistance training was more powerful in reducing glycosylated haemoglobin compared with aerobic training, and more effective in reducing glycosylated haemoglobin, fasting glucose and tricylglycerols when compared with resistance training. However, these results could not be confirmed when only low risk of bias studies were included.
MedicalResearch.com Interview with:
Peter Kokkinos PhD
Veterans Affairs Medical Center, Cardiology Division
Washington, DC 20422
Medical Research: What are the main findings of the study?
Dr. Kokkinos: The main finding of the study is that we defined an exercise capacity threshold for each age category (<50; 50-59; 60-69; and ≥70 years of age). The mortality risk increases progressively below this threshold and decreases above it. We then calculated the 5 and 10-year mortality risk for each age category.
MedicalResearch.com Interview with:
Xuemei Sui, MD, MPH, PhD
Assistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
MedicalResearch: What are the main findings of the study?
Dr. Sui: In the present study, cancer survivors who reported performing resistance exercise (RE) at least 1 day of the week had a 33% lower risk of all-cause mortality compared with individuals who did not report participation in resistance exercise. Further, there was an inverse relationship between resistance exercise and all-cause mortality in those who were physically active, but not in those who were physically inactive. Although leisure-time physical activity was not associated with a lower risk of all-cause mortality, the present results support the benefits of resistance exercise and physical activity was during cancer survival.
MedicalResearch.com Interview
Fergus Shanahan, MD, DSc
Professor and Chair,
Department of Medicine, and
Director, Alimentary Pharmabiotic Centre
University College Cork, National University of Ireland
MedicalResearch: What are the main findings of the study?
Professor Shanahan: We already know that most (if not all) of the elements of a modern lifestyle in socio-economically developed societies influence the composition and performance of the microbiota colonising the human body. The composition of the microbiota or disturbances of it have been linked with an increased risk of various chronic non-communicable diseases including immune-allergic disorders and metabolic diseases including obesity. In particular, loss of microbial diversity is a feature of many of these disorders. The most important aspect of our study is that draws attention to the possibility that exercise may have a beneficial effect on the microbiota and is associated with a more diverse microbiota.
MedicalResearch.com Interview with:
Wei Bao MD, PhD
Postdoc fellow, Epidemiology Branch
Division of Intramural Population Health Research
NICHD/National Institutes of Health
Rockville, MD 20852
MedicalResearch: What are the main findings of the study?
Dr. Wei Bao: This study, to our knowledge, is the first attempt to examine the associations of physical activity and sedentary behaviors with risk of type 2 diabetes mellitus (T2DM) among women with a history of gestational diabetes mellitus (GDM), which is a high-risk population of T2DM. The main findings are:
(1) Physical activity is inversely associated with risk of progression from GDM to T2DM. Each 5-metabolic equivalent hours per week increment of total physical activity, which is equivalent to 100 minutes per week of moderate-intensity physical activity or 50 minutes per week of vigorous physical activity, was related to a 9% lower risk of T2DM; this inverse association remained significant after additional adjustment for body mass index (BMI).
(2) An increase in physical activity is associated with a lower risk of progression from gestational diabetes mellitus to T2DM. Compared with women who maintained their total physical activity levels, women who increased their total physical activity levels by 7.5 MET-h/wk or more (equivalent to 150 minutes per week of moderate-intensity physical activityor 75 minutes per week of vigorous physical activity) had a 47% lower risk of T2DM; the association remained significant after additional adjustment for BMI.
(3) Prolonged time spent watching TV, as a common sedentary behavior, is associated with an increased risk of progression from gestational diabetes mellitus to T2DM. Compared with women who watched TV 0 to 5 hours per week, those watched TV 6 to 10, 11 to 20, and 20 or more hours per week had 28%, 41%, and 77%, respectively, higher risk of T2DM. The association was no longer significant after additional adjustment for BMI.
MedicalResearch.com Interview with:
Luisa Soares-Miranda, PhD
Research Center in Physical Activity, Health and Leisure
Faculty of Sport, University of Porto
Rua Dr. Plácido Costa,
Porto PORTUGAL
MedicalResearch: What are the main findings of the study?
Dr. Soares-Miranda: Modest physical activity, such as the distance and pace of walking, is important for the heart’s electrical well being of older adults. In our study, older adults that increased their walking pace or distance had a better heart rate variability when compared with those that decreased their walking pace or distance. Our results suggest not only that regular physical activity later in life is beneficial, but also that certain beneficial changes that occur may be reduced when physical activity is reduced. This supports the need to maintain modest physical activity throughout the aging process. Even small increases can lead to a better health, while reducing physical activity has the opposite effect. So, any physical activity is better than none, and more is better.
Dorothy D Dunlop, PhD
Professor, Medicine-Rheumatology
Center for Healthcare Studies - Institute for Public Health and Medicine and Preventive Medicine
Northwestern University Feinberg School of Medicine
MedicalResearch.com: What are the main findings of the study?
Dr. Dunlop: We know being active, especially doing moderate activity like taking a brisk walk, is good for health. We know a sedentary lifestyle leads to health problems. What we do not know is whether or not those are two ways of looking at the same question. Does being sedentary like sitting just reflect insufficient activity OR is sedentary time is a separate and distinct risk factor for health problems. Our physical activity research group looked at national US data from the National Health and Nutrition Examination Survey. This is an important study because they monitored physical activity using an accelerometer. We found sedentary behavior such as sitting was its own separate risk factor for disability.
Matthew Buman PhD
School of Nutrition and Health Promotion, Arizona State University
Arizona State University, School of Nutrition and Health Promotion
Phoenix, AZ
MedicalResearch.com: What are the main findings of the study?
Dr. Buman: We found that that exercise at night (within 4 hours of bedtime) was not associated with poor sleep compared with individuals that did not exercise before bed. However, we also found that morning exercise appears to be associated with optimal sleep quality.