Health span, that period between birth and onset of major disease(s), when adequate physical and cognitive function permit those daily living activities essential to life quality, is lower in the United States than other developed countries. Physical inactivity and excessive calorie intake occupy dominant roles both in the problem, and by redressing them, in the solution. Consequently, this review focuses on evidence that appropriate exercise engagement and calorie restriction (CR) can improve physical and mental health with a view to extending the health span. Humanity, writ large, has grasped these underlying concepts for Millennia but has been largely intransigent to them. Thus, the final section proposes a novel Monty Python-esque approach that encompasses humanity's inimical sense of humor to increase physical fitness and mental health, restore energy balance, sustain better cognitive function, and extend the health span.

Sedentary lifestyle is a major risk factor for cardiovascular diseases (CVDs) which account for 8% of Kenya's non-communicable disease (NCD) burden. Prevalence of physical inactivity remains high globally. There is paucity of data on physical activity levels in rural Sub-Saharan Africa to inform effective interventions. This study sought to establish levels and factors associated with physical activity in a rural population in Kenya. This was a cross-sectional study in Vihiga, a predominantly rural County in Kenya. Participants were adults aged ≥18 years drawn from four community markets. Stratified sampling by ecological zones and rural/urban status was used to select the four markets and Sampling the Next Customer Exiting the Market method for the respondents. Researcher administered e-questionnaire adapted from International Physical Activity Questionnaire (IPAQ) was used to collect data. Physical activity was calculated as the sum of all Metabolic Equivalents (MET)-minutes/week. Multivariable binary logistic regression analysis was used to identify correlates of physical activity. Out of the total 375 (m: 49%; f: 51%) participants, 27% were physically inactive (m: 22%; f: 32%;) and 42% engaged in low level physical activity. Majority of the respondents (75.5%) engaged in transportation-related physical activity while 32% engaged in leisure physical activities. The odds of being physically inactive were 1.93 times higher for females, 2.62 higher for those aged ≥65 years, and 3.62 higher for those with high health literacy. 48% with high health literacy were in the early working age group (15-24 years). Majority (53%) received health information from healthcare workers, especially for the 60% physically inactive participants. This study highlights the need for targeted community interventions to address the observed physical inactivity especially among women and older adults in rural Kenya.

The health benefits of physical activity (PA) are now widely accepted and proven. Promoting PA in the workplace is therefore of major public health interest, but is limited by employees' adherence.

A systematic review was therefore carried out to identify factors for adherence to PA promotion program in the workplace (primary outcome); health outcomes were to be regarded as secondary outcomes. Four databases, PubMed, Web of Science, Cochrane Central Register of Controlled Trials (Cochrane CRCTs) and PsycInfo were searched to find all pertinent articles published from 2000 until June 2024. Only randomized controlled trials (RCTs) and clinical trials were selected.

More than 9000 publications were analyzed and 91 were retrieved. Two main types of study were identified: 46 non-supervised PA programs (NSPAPs) supported by socio-cognitive theories, and 45 supervised (tailored) programs (SPAPs). Concerning the primary outcome, the main factors identified for adherence were the levels of baseline PA, health and motivation of the individual; intervention individualization at the interventional level; and work environment quality at the organizational level. This review highlighted significant health benefits in both types of study, with effect sizes ranging from small to large.

Assessing these factors for adherence emerges as an essential prerequisite before implementing a PA promotion program in the workplace. According to our results, implementing NSPAPs, supported by socio-cognitive theories, is rather complex, and such programs can be difficult to operationalize in their entirety; consequently, coach-supervised PAPs based on RCT programs tend to be more effective.

Our results prove the short and medium-term beneficial effect on health of PAP in the workplace based on rigorous methodology such as RCTs. Management's support through work organization and the follow-up of actions in the long term are an essential factor for adherence to these programs. Finally, we suggest what this literature review contributes for future research or entrepreneurial and/or political projects. In fine, new models of working time will have to be considered.

Cardiovascular diseases (CVDs) represent a major public health concern globally, being one of the leading causes of illness and death across populations. While physical activity is widely recognized as a protective factor against these diseases, the exact biological mechanisms that explain this relationship are still not fully understood. This study utilized a two-sample Mendelian randomization (MR) method to investigate the potential role of circulating cytokines in mediating the effects of physical activity on major CVD outcomes, including coronary artery disease (CAD), heart failure (HF), and ischemic heart disease (IHD). Our primary MR analysis revealed an inverse association between physical activity and IHD risk. Moreover, a two-step MR mediation approach identified IL10RB (Interleukin-10 receptor subunit beta) as an intermediate mediator, explaining about 6.65% of the observed contribution of physical activity to IHD. These results indicate that physical activity may mitigate CVD risk through modulation of immune pathways, particularly via IL10RB signaling. Our findings underscore the significance of cytokine networks in mediating the cardiovascular benefits of exercise and suggest potential therapeutic strategies for CVD risk reduction through immune system modulation.

High-volume physical activity (PA) is associated with a higher prevalence of subclinical coronary artery disease (CAD). However, the clinical significance of subclinical CAD among high-volume exercisers remains incompletely understood, and the dose-response relationship between high-volume PA and clinical CAD events remains uncertain.

Individual participant data from the Cooper Center Longitudinal Study (1987-2018) were linked to Medicare claims files. PA volume was determined by self-report and categorized as <500, 500 to 1499, 1500 to 2999, and ≥3000 metabolic equivalent of task (MET)-minutes per week. Subclinical CAD (coronary artery calcium [CAC]) was measured by cardiac computed tomography. All other risk factors were measured in the standard fashion. Composite CAD events (acute myocardial infarction and revascularization) and all-cause mortality were determined from Medicare claims files. A multivariable-adjusted proportional hazards illness-death model with random shared frailty was used to estimate the association between PA volume, CAC, and both clinical CAD and death. Heterogeneity in the association between CAC and clinical CAD across levels of PA was determined with multiplicative interaction terms.

We included 26 724 participants (54 years of age; 28% women). Mean exercise volume was 1130 MET-minutes per week, with 1997 (7.5%) reporting ≥3000 MET-minutes per week. After a mean follow-up of 20.5 years, we observed 811 acute myocardial infarction events, 1636 composite CAD events, and 2857 deaths without CAD. Compared with individuals exercising <500 MET-minutes per week, the lowest risk for acute myocardial infarction occurred among individuals with intermediate PA volumes (500-1499 MET-minutes per week: hazard ratio [HR], 0.77 [95% CI, 0.65-0.91]; 1500-2499 MET-minutes per week: HR, 0.78 [95% CI, 0.63-0.95]). There was no association between high-volume PA (>3000 MET-minutes per week) and risk for acute myocardial infarction (HR, 0.95 [95% CI, 0.72-1.25]). In contrast, the lowest risk for death was observed among the high-volume PA group (HR, 0.71 [95% CI, 0.60-0.83]). CAC (on log scale) was associated with a higher risk for composite CAD across all PA categories, including among the high-volume PA subgroup (HR, 1.29 [95% CI, 1.16-1.44]; P<0.001; Pinteraction= 0.969).

Compared with low-volume PA, high-volume PA was associated with a lower risk for all-cause mortality but a similar risk for clinical CAD. CAC was associated with an increased risk for clinical CAD regardless of the volume of PA.

Exercise has been shown to reduce platelet reactivity and increase platelet sensitivity to prostacyclin, an endothelium-derived inhibitor of platelet activation, in middle-aged men and women. It is currently unknown if these beneficial effects can also be observed in young women and the intracellular mechanisms involved have not been identified. In this study, the feasibility of detecting changes in platelet reactivity, prostacyclin sensitivity and cAMP signalling were tested.

10 well-trained and 10 sedentary but healthy young women participated in this study. Responses of washed platelets to thrombin receptor activating peptide 6, the thromboxane A2 receptor agonist U46619, and prostaglandin E1 were measured by light transmission aggregometry. Expression levels of proteins in the cAMP pathway including phosphorylation of the vasodilator-stimulated phosphoprotein were analysed by western blotting.

There was no evidence of reduced basal reactivity in platelets from the well-trained group (V ˙ O 2 max  = 51.1 ± 3.6 ml/kg/min) compared to the untrained group (V ˙ O 2 max  = 31.1 ± 4.7 ml/kg/min). Platelets from the trained group showed evidence of greater sensitivity to the anti-aggregatory effects of prostaglandin E1. The slope of the aggregation curves indicated an overall faster rate of aggregation in the untrained group. Mean phosphorylation levels of vasodilator-stimulating phosphoprotein were consistently higher in the trained group, indicative of increased protein kinase A activity.

Platelets from young women may exhibit an exercise-induced increase in sensitivity to prostacyclin leading to stimulation of the cAMP pathway. A larger study is warranted to explore this vasoprotective effect further.

To investigate the associations of education level, marital status, and physical activity with dementia risk and brain MRI markers.

Data from six community-based samples from the Cross-Cohort Collaboration Consortium were analyzed. Self-reported education level, marital status, and physical activity at age 60 to 75 years were harmonized. Subsamples of participants with brain MRI markers at time of exposure were selected. Associations with dementia risk and cross-sectional MRI markers were meta-analyzed.

Higher education level was associated with lower dementia risk (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.59; 0.72 vs low level) but not significantly with brain MRI markers. Compared with being unmarried, being married was only associated with higher total brain and hippocampal volumes. Being physically active was associated with lower dementia risk (HR = 0.73, 95% CI = 0.52; 1.04), as well as larger total brain volume and smaller white matter hyperintensity volume.

This study provides further evidence regarding the contribution of education level and physical activity to dementia resilience.

Education level, marital status, and physical activity are thought to contribute to resilience against ADRD. We used random-effects meta-analysis to summarize results from six community-based samples from the CCC. In this cross-cohort meta-analysis, higher education level and being physically active were associated with lower risk of dementia. In cross-sectional analyses, being married was associated with larger TBV and HV, while being physically active was associated with larger TBV and lower WMHV.

Although the 5-item modified frailty index (mFI-5) has been found to be associated postoperative outcomes, there are limited studies examining its utility in urologic surgery. Our purpose is to evaluate the association between the mFI-5 and postoperative mortality and complications among patients undergoing urologic surgery.

This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020. All adult patients who underwent urologic procedures were included. The mFI-5 includes five items: hypertension, diabetes, congestive heart failure, chronic obstructive pulmonary disease, and physical function status. Each item is assigned one point, and an mFI-5 score of 2 or greater indicates frailty. The primary outcome was postoperative mortality, while secondary outcomes were postoperative complications. Propensity score analysis was employed to control for confounders.

After propensity score matching, each group contained 55,322 surgical patients. The patients in the frailty group were at risks of in-hospital mortality (absolute risk increase [ARI] 0.29%) and higher postoperative complications, including acute myocardial infarction (ARI 0.25%), pneumonia (ARI 0.42%), sepsis (ARI 0.41%), and septic shock (0.2%). Compared to the non-frailty group, the length of hospital stay was higher in the frailty group.

Patients with an mFI-5 score of 2 or greater were associated with an increased risk of postoperative mortality and complications, including myocardial infarction, pneumonia, sepsis, and septic shock. The mFI-5 is a simple index that quickly identifies frail patients. This allows for the implementation of prehabilitation and nutritional strategies targeted at enhancing their physiological reserve and optimizing their surgical outcomes.

Cardiovascular disease (CVD) risk factors lead to morbidity and mortality among adults globally. In Ghana, there is a lack of coordinated efforts at all levels of healthcare service to prevent risk factors of cardiovascular disease (CVD). This study assessed cardiovascular disease risk factors among residents of resource-limited rural settings.

This descriptive cross-sectional design is the first phase of a two-year community-level study aimed at implementing an intervention to reduce CVD risk in a rural community in Ghana. The study population included 379 people living in the Avenui community. We conducted a nurse-led door-to-door visit, screened for CVD risk, provided health education, and collected data using an adapted questionnaire. The data were analyzed using SPSS. Categorical data were expressed as frequencies and proportions, and the Chi-Square test of associations. A multivariable logistic regression analysis with a backward elimination method was used to examine the association of the risk factors with the risk of developing CVD.

The CVD risk among participants was categorized as 'very high' (35.4%), high (55.4%), and low or moderate (9.2%). There was a positive correlation between lifestyle (r = 0.126, p-value < 0.05), stress (r = 0.114, p-value < 0.05), blood sugar level (r = 0.102, p-value < 0.05) inflammation and pain (r = 0.109, p-value < 0.05), and high blood pressure (r = 0.268, p-value < 0.01) with history of CVD. CVD high risk was significantly associated with marital status (p-value = 0.001), employment status (p-value = 0.001), perception of personal health (p-value = 0.045), lifestyle (p-value = 0.034), knowledge of peripheral arterial disease (p-value = 0.018), and knowledge on deep vein thrombosis and pulmonary embolism (p-value = 0.002). The backward multiple logistic regression model was significant (78.912, p-value < 0.001) with a non-significant Hosmer and Lemeshow Test (2.145, p-value = 0.976) and a Cox & Snell R Square and Nagelkerke R Square of 0.393 and 0.619, respectively. The significant predictors of a 'very high' CVD risk include marital status being single (p-value = 0.001), those that exercise only two (2) times a week (p-value = 0.001) employment status being part-time worker (p-value = 0.015), poor perception of overall personal health (p-value < 0.001), and those listening to the radio (p-value = 0.024).

The risk factors associated with CVD were identified to be multiple and interacted variable among rural community dwellers. These factors included marital status, exercise, employment, perception of health, and listening to the radio. We recommend implementing primary prevention strategies that involve adopting a comprehensive assessment and management of the risk factors of CVD in Ghana.

This study examined the psycho-physical demands experienced by Aboriginal and Torres Strait Islander women during several Traditional Indigenous Games (TIGs). Women engaged in three TIGs (Kai Wed, Ilye, Edor) with psycho-physical demands (i.e. heart rate; movement distance and speed; rating of perceived exertion, RPE) recorded. Significant differences were noted between TIGs with Ilye inducing greater maximum and average heart rate (5-14 %), absolute and relative distances (146-282 %), speed (3-29 %) and lower RPE (48 %) compared to Kai wed and/or Edor. Results will guide future, culturally relevant interventions to improve physical activity levels and health outcomes for Aboriginal and Torres Strait Islander women.

Exercise is an essential component of the cardiac care of children with congenital heart disease (CHD), and safe and effective exercise counselling by the medical team is important early in life to develop positive physical activity and exercise habits. Without it, children are at risk for sedentariness and related comorbidities in childhood and adulthood. Pediatric cardiologists can guide patients to a cycle of positive fitness through exercise counselling, promotion, prescription, and/or supervised exercise training similar to adult cardiac rehabilitation (ACR). ACR has improved exercise capacity, mortality, and quality of life in adults with acquired heart disease. Similar outcomes have been shown in exercise training for adult and pediatric CHD. Exercise training specific to pediatric CHD is not widely available but is expanding in response to growing need and increasing demand. Although ACR provides a framework for structured exercise training, approaches to pediatric exercise training must be individualized and innovated upon to be successful for children. I propose that the ACR model must be reinvented for children with CHD by integrating 6 missing pieces. First, the underlying goal should be to optimize fitness, not rehabilitate to a previous state of health. Second and third are training mental skills and motor skills. Fourth, play-based exercise training is needed to foster a positive relationship with exercise. Fifth, family-focused exercise interventions can address root causes of sedentariness. Finally, building communities in which positive fitness is a priority will be essential to long-term sustainability.

The association of physical activity (PA) with coronary artery calcification (CAC), one of the strongest predictors of cardiovascular disease, is unclear. Moreover, different domains of PA (e.g., exercise/sports vs. work) and extra-coronary calcification (ECC) have not been extensively studied. We comprehensively evaluated the association of PA with CAC and ECC.

We investigated 2025 ARIC participants (age 73-95 years) without coronary heart disease at visit 7 (2018-19). Mid-life total and domain-specific (sport, leisure, and work) PA scores were estimated using a modified Baecke questionnaire. We modeled the averaged PA scores at visit 1 (1987-89; age 44-65 years) and visit 3 (1993-95; age 49-70 years). We explored continuous CAC and ECC (log-transformed [Agatston score+1]) or the presence of any CAC and ECC (Agatston score >0 vs. 0) as dependent variables using multivariable linear regression and logistic regression models, as appropriate.

Total PA scores showed a U-shaped association with both continuous and any vs. no CAC. Higher total PA scores were associated inversely with ECC and most pronounced for the descending aorta calcification. The associations were generally consistent across demographic subgroups. When specific PA domains were examined, higher sport and work PA scores were significantly associated with lower descending aorta calcification.

Mid-life PA showed a U-shaped association with late-life CAC. Among ECC, the association of higher PA with lower calcification of the descending aorta was the most consistent. Our results further corroborate a complex interplay between PA and vascular health and unique pathological processes across different vascular beds.

It remains unclear whether the cardiovascular benefits of physical activity (PA) vary across populations with different predicted atherosclerotic cardiovascular disease (ASCVD) risks. This study aimed to determine the modification of predicted cardiovascular risk on the association between PA and ASCVD incidence.

A total of 94,734 participants without ASCVD in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project were included, with a median follow-up of 6.0 years. PA volume (metabolic equivalent of task (MET)-h/day) and intensity (%, percentage of moderate-to-vigorous PA (MVPA)) were assessed by questionnaires. Based on the ASCVD 10-year and lifetime risk prediction scores, participants were classified into low-to-medium-risk and high-risk groups. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) for ASCVD were calculated using Cox proportional hazards models.

During 679,438 person-years of follow-up, 3470 ASCVD events occurred. Higher PA volume was associated with lower ASCVD incidence, which was more pronounced among high-predicted-risk individuals than their low-to-medium-risk counterparts, with HRs (95%CIs) of 0.58 (0.50-0.67) and 0.62 (0.53-0.71) for the highest vs. lowest quartiles of PA volume, respectively. Additionally, analyses for PA intensity showed similar results. Compared with inactive individuals, there was a 32% (95%CI: 25%-38%) and 23% (95%CI: 13%-32%) risk reduction in high- and low-to-medium-risk groups, respectively, when over half of the PA volume was from MVPA. Furthermore, the additive interactions between PA and predicted risk indicated a further risk reduction by increasing PA, especially MVPA, in high-risk individuals.

Engaging in more PA, especially MVPA, reduced the risk of ASCVD incidence, with greater benefits among high-risk individuals. These findings emphasize the imperative for personalized PA recommendations tailored to distinct risk populations-in particular, reinforcing PA guidance for high-risk individuals.

Left ventricular global longitudinal strain (LVGLS) is a highly sensitive echocardiographic biomarker that detects signs of myocardial dysfunction. It has been proven that exercise-based cardiac rehabilitation (CR) improves LV-GLS but whether high-intensity interval training (HIIT) is more efficient than moderate-intensity interval training (MIIT) to improve LV-GLS as cardiac deformation index in cardiovascular patients is debatable. In the current systematic review and meta-analysis, different digital databases including PubMed, Scopus, Web of Science (ISI), and Google Scholar were searched systematically with no time restriction to answer the abovementioned question. Studies were included that reported GLS as the outcome in CVD subjects before and after enrolling in HIIT and/or MITT. A random effects model was used for meta-analysis. Eleven sets of results from nine articles-two of which had two sets of results-were included. The result of the sensitivity test to check the publication bias was not significant either for MIIT (p=0.211) or for HIIT (p=0.238). Our findings showed that GLS was improved significantly after both MIIT (-1.72. [-2.68, -0.77]) and HIIT (-1.86 [-3.01, -0.71]) in CVD patients; however, the effect of HIIT was greater than MIIT. Subgroup analysis results showed that baseline disease and duration of exercises do not influence the effect of training on GLS. More studies are needed to confirm the conclusion.

This study aimed to investigate the effects of Nordic walking on cardiovascular risk factors in the elderly population through a systematic review and meta-analysis of randomized controlled trials.

Literature searches were conducted in PubMed, Embase, Cochrane Library, and Web of Science through November 2023. Two authors independently assessed heterogeneity in subgroups, performed sensitivity and meta-regression analyses, and extracted data. Outcomes were measured using mean difference (MD) or standardized mean difference (SMD), each with a corresponding 95 % confidence interval (CI).

A total of 22 studies comprising 1,271 subjects, with an average age of 62.21±7.76 years were included in the meta-analysis. Nordic walking significantly reduced body mass index (MD = -0.67, 95 % CI [-1.12; -0.23], p < 0.01), body weight (MD = -1.76, 95 % CI [-2.91; -0.62], p < 0.01), waist circumference (MD = -2.21, 95 % CI [-4.13; -0.29], p = 0.02), and body fat percentage (MD = -1.54, 95 % CI [-2.61; -0.48], p < 0.01). It also significantly enhanced maximal oxygen consumption (SMD = 0.60, 95 % CI [0.11; 1.10], p < 0.01), and reduced systolic blood pressure (MD = -2.92, 95 % CI [-5.23; -0.60], p < 0.01), low-density lipoprotein (SMD = -0.27, 95 % CI [-0.43; -0.12], p < 0.01), total cholesterol (SMD = -0.20, 95 % CI [-0.35; -0.05], p < 0.01), triglycerides (SMD = -0.30, 95 % CI [-0.47; -0.13], p < 0.01) in older adults, while also improving diastolic blood pressure in people over 65 years of age (MD =-5.26, [-8.79,-1.72], p < 0.01).

Nordic walking mitigates cardiovascular risk factors in older adults and is particularly effective in improving diastolic blood pressure in individuals over 65 years of age.

Physical activity is protective against cardiovascular disease (CVD) and favorably improves CVD risk profile. However, more than 25 % of American adults report no participation in physical activity. Whole body electronic muscle stimulation (WB-EMS) training is a novel FDA-cleared technology which offers a time-efficient and adaptable method for physical training by simultaneously stimulating the main muscle groups using percutaneous electrical impulse transmission. Studies have demonstrated increased muscle mass, reduced fat mass, and improved functional capacity in sedentary individuals after training with WB-EMS, but studies evaluating the role of WB-EMS training on CVD risk profile are lacking.

We performed a pilot randomized controlled trial in healthy adults randomized to physical training with versus without WB-EMS for one session of 20 min duration per week across 16-weeks. Study participants were asked to perform their usual activities but to abstain from any strength training during the study. During each training session, all study participants wore a specifically designed vest and arm and leg straps that were connected with electrical wires to the WB-EMS device (Miha Bodytec Gersthofen, Germany). Biphasic electrical stimulation was delivered through the vest and straps (4 s on, 4 s off) at a frequency that elicited a score of 5 or 6 on the Borg rating of perceived exertion scale from study participants when each of the following muscle groups was stimulated: thighs, buttocks, lower back, upper back, latissimus dorsi, abdomen, chest and arms. These frequencies were 'titrated' during the first 4 weeks and were then fixed at each muscle group for each participant. Individuals randomized to no WB-EMS wore the same equipment but received no electrical stimulation. Physical training sessions were provided by personal trainers certified for WB-EMS training and consisted of a fixed number of exercises and repetitions. We measured and compared several clinically important cardiovascular parameters at baseline and post-intervention.

Seventy-eight participants were recruited between January 2021 and March 2022 with a mean age of 35.9 ± 11.2, 61.3 % females, median BMI 24.3 (21.8, 28.1); N = 46 were randomized to intervention group and N = 32 were randomized to the control group. Eighteen (23 %) participants dropped out of the trial, including 9 participants from the EMS arm (19.6 %), and 9 participants in control arm (28.1 %). There was no significant differences in the rate of dropping out of the WB-EMS and control groups (p = 0.27). Those in the intervention group compared to controls exhibited the following changes after 16-weeks of training: waist:hip ratio (∆ -0.03 ± 0.05, p = 0.01 vs. -0.01 ± 0.0, p = 0.1), peripheral endothelial function, measured using reactive hyperemia peripheral arterial tonometry (∆: 0.02 ± 0.1, p = 0.5 vs. -0.20 ± 0.3 p = 0.05), high-sensitivity C-reactive protein (∆: 0.06 ± 0.7, p = 0.3 vs. 0.20 ± 2.3 p = 0.02), total cholesterol (∆: -1.7 ± 25.1, p = 0.3 vs. 19.2 ± 26.5, p < 0.001), high density lipoprotein (∆: 2.02 ± 6.6, p = 0.2 vs. 3.6 ± 7.5 p = 0.01) and low density lipoprotein cholesterol (∆: 0.5 ± 26.7, p = 0.4 vs. 17.1 ± 23.2, p < 0.001).

Once weekly physical training with WB-EMS in healthy adults resulted in either improved or stable biomarkers of cardiovascular risk, which either remained stable or worsened in those undergoing conventional training alone. Thus WB-EMS may provide an effective and time-efficient form of physical training that may be considered in those unable or unwilling to perform exercise conventionally.

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among older adults. Lifestyle modifications, including diet, physical activity, and smoking cessation, are key to reducing cardiovascular risk. This study examines the combined effects of these behaviors on cardiovascular outcomes and their mediating mechanisms. Methods: A cross-sectional study was conducted among older adults (aged ≥ 60 years) in Riyadh, Saudi Arabia. Data on dietary quality, physical activity, and smoking status were collected using validated questionnaires. Cardiovascular outcomes, including low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), and body mass index (BMI), were measured. A composite cardiovascular risk score was computed. Path analysis was employed to assess direct and indirect effects of lifestyle factors on cardiovascular outcomes. Results: Participants adhering to a healthy diet, engaging in regular physical activity, and avoiding smoking had significantly lower composite cardiovascular risk scores. Non-smoking status showed the strongest direct effect (β = -0.20, p = 0.006), while dietary quality and physical activity exhibited significant indirect effects mediated by LDL, SBP, and BMI. Combined adherence to multiple healthy behaviors resulted in the greatest reductions in cardiovascular risk. The path analysis highlighted dietary quality and physical activity as critical mediators of cardiovascular health improvements. Conclusions: Lifestyle modifications significantly reduce cardiovascular risk in older adults, with cumulative benefits observed for combined adherence to healthy behaviors. These findings emphasize the importance of comprehensive lifestyle interventions targeting diet, physical activity, and smoking cessation to promote cardiovascular health in aging populations.

Physical activity is widely promoted as a preventive strategy against cardiovascular disease and death from this disease. However, the fact that some individuals are unable or unwilling to engage in physical activity highlights the need for alternative strategies. Passive heat exposure using hot water immersion could serve as an alternative to physical exercise, as it provides similar, if not greater, cardioprotection than physical activity. This perspective article presents evidence supporting our concept and provides recommendations for hot water immersion sessions.

Cholelithiasis, commonly known as gallstone disease, poses a significant public health concern globally, with a myriad of risk factors contributing to its development. Among these, lifestyle factors, particularly physical activity, have garnered considerable attention for their potential role in modulating the risk of gallstone formation. This review aims to synthesize the current landscape of physical activity and the risk of developing cholelithiasis and identify knowledge gaps. To identify relevant articles, an independent author conducted a literature search using the PubMed database including keywords "cholelithiasis," "gallstones," and "physical activity" with no restriction on publication date. Cohort studies or Mendelian randomization analyses that reported physical activity and risk of gallstone disease were included in the current review. 15 articles were included in this review. The review highlights evidence suggesting a protective effect of regular physical activity against the development of gallstones. Results of Mendelian randomization analyses similarly demonstrated that physical activity remains independently causally associated with cholelithiasis. This review underscores the potential of physical activity as a modifiable risk factor for cholelithiasis, advocating for further research to establish definitive guidelines for prevention through lifestyle modification.

Cancer survivors face an elevated risk of cardiovascular disease, with physical inactivity after cancer treatment potentially worsening this risk.

The aim of this study was to investigate the association between physical activity before and after a cancer diagnosis and the risk for heart disease.

A nationwide cohort of 269,943 cancer survivors (mean age 56.3, 45.7% men) was evaluated for physical activity adherence 2 years before and after diagnosis. The primary outcomes were the incidence of myocardial infarction (MI), heart failure (HF), and atrial fibrillation. Subdistribution HRs (sHRs) and 95% CIs were calculated using Gray's method, accounting for death as a competing risk.

Over a follow-up period of 1,111,329.28 person-years, compared with those who remained inactive, persistent physical activity was associated with a 20% reduction in MI risk (sHR: 0.80; 95% CI: 0.70-0.91) and a 16% reduction risk in HF risk (sHR: 0.84; 95% CI: 0.78-0.90). Initiating physical activity after a cancer diagnosis was linked to an 11% lower risk for MI (sHR: 0.89; 95% CI: 0.79-0.99) and a 13% lower risk for HF (sHR: 0.87; 95% CI: 0.82-0.93). Being active only before diagnosis was associated with a 20% lower risk for MI (sHR: 0.80; 95% CI: 0.71-0.91) and a 6% lower risk for HF (sHR: 0.94; 95% CI: 0.88-1.00). No association was observed between physical activity and atrial fibrillation risk. Associations varied by primary cancer site.

These findings underscore the importance of maintaining physical activity for cardiovascular health in cancer survivors and suggest that physical activity before a diagnosis may offer enduring protection against ischemic heart disease and cardiac dysfunction.

Ischemic heart disease (IHD) is the leading cause of death in the European Union (EU). Understanding variations by sex, income, and countries can help in tailoring effective public health policies.

The purpose of the study was to examine trends in sex differences in IHD prevalence and prognosis within the EU.

We conducted a cross-sectional analysis of IHD using the Global Burden of Disease Study Database to examine trends in sex-specific age-standardized mortality rate (ASMR)-to-age-standardized prevalence rate (ASPR) ratio (ASMR-to-ASPR index) per 100,000 inhabitants/year across the EU from 2005 to 2019.

Men showed higher ASMR than women. However, the ASMR-to-ASPR index was notably higher in women than in men indicating that women who develop IHD have a higher risk of dying from the disease compared with their male counterparts. Despite a significant decline in ASMR across EU from 2005 to 2019 both among women (from 1.752 to 1.662) and men (from 3.372 to 3.135), sex disparities in ASMR-to-ASPR index (EU average: 4.96% vs 4.34%) persisted (with a women-to-men ratio ranging from 1.05 to 1.44). No significant relationship was found between country-specific ASMR or country income status and ASMR-to-ASPR index. Examples include Romania, which displayed higher ASMR (men: 219.87, women: 143.54) compared with Germany (men: 107.22, women: 60.76), yet with smaller differences in ASMR-to-ASPR index between women and men (Romania: 6.54% vs 5.85%; ratio: 1.12, and Germany: 4.79% vs 3.80%; ratio: 1.26).

Mortality from IHD has decreased substantially among EU countries. However, the declines were accompanied by a persistently higher ASMR-to-ASPR index in women, indicating significant potential for further gains in closing the gender gap in IHD mortality.

Myocardial infarction (MI) remains the leading cause of death globally, imposing a significant burden on healthcare systems and patients. The gut-heart axis, a bidirectional network connecting gut health to cardiovascular outcomes, has recently emerged as a critical factor in MI pathophysiology. Disruptions in this axis, including gut dysbiosis and compromised intestinal barrier integrity, lead to systemic inflammation driven by gut-derived metabolites like lipopolysaccharides (LPSs) and trimethylamine N-oxide (TMAO), both of which exacerbate MI progression. In contrast, metabolites such as short-chain fatty acids (SCFAs) from a balanced microbiota exhibit protective effects against cardiac damage. This review examines the molecular mediators of the gut-heart axis, considering the role of factors like sex-specific hormones, aging, diet, physical activity, and alcohol consumption on gut health and MI outcomes. Additionally, we highlight therapeutic approaches, including dietary interventions, personalized probiotics, and exercise regimens. Addressing the gut-heart axis holds promise for reducing MI risk and improving recovery, positioning it as a novel target in cardiovascular therapy.

To evaluate the association between objectively measured walking speed and cardiovascular disease (CVD) risk in middle-aged and elderly Chinese adults.

A total of 3969 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. Multilevel logistic and linear regression models (community-household-individual) were used to estimate the association between walking speed and the risk of CVD.

A total of 1037 participants had a CVD event during the follow-up period, including 776 (19.6%) cases of cardiac disease and 353 (8.9%) cases of stroke. Participants who walked faster had a lower risk of CVD (tertile 2: OR = 0.80, 95% CI: 0.67-0.97, P = 0.022; tertile 3: OR = 0.73, 95% CI: 0.60-0.89, P = 0.002). Further analysis showed that participants who walked faster also had a lower risk of cardiac disease and stroke (cardiac disease: tertile 2: OR = 0.91, 95% CI: 0.74-1.12, P = 0.368; tertile 3: OR = 0.85, 95% CI: 0.68-1.07, P = 0.161; stroke: tertile 2: OR = 0.33, 95% CI: 0.14-0.78, P = 0.012; tertile 3: OR = 0.30, 95% CI: 0.11-0.82, P = 0.019). The results were consistent in pre-specified subgroups by sex, age, and body mass index.

We found that faster, objectively measured walking speed was significantly associated with a lower risk of CVD, especially stroke, in middle-aged and elderly Chinese people.

Objective: We recently demonstrated that upper-body rowing exercise (UBROW) improved aerobic fitness in individuals with spinal cord injury (SCI), with no effect on traditional cardiometabolic risk factors. Here, we tested the hypothesis that the exercise-induced increase in aerobic fitness was maintained at 6-month (6M) follow-up.Design: Six-month follow-up.Setting: University/hospital.Participants: Seventeen wheelchair-dependent participants with SCI.Interventions: 12-week of exercise training (UBROW) or control (CON).Outcome Measures: Aerobic fitness (POpeak and V̇O2peak), body composition, blood pressure, and blood biomarkers of cardiometabolic risk were assessed at 6M follow-up and compared to baseline (BL) and immediately post-intervention (12-week). Minutes of mild, moderate, and heavy intensity leisure time physical activity (LTPA) were assessed by self-report.Results: Fourteen participants returned at 6M follow-up (CON, n = 6; UBROW, n = 8). In UBROW, POpeak (median (Q1-Q3)) increased from BL (70 W (37-84)) to 12-week (77 W (58-109), P = 0.01) and 6M follow-up (81 W (51-96), P = 0.01), with no difference between 12-week and 6M follow-up (P = 0.21). Similarly, V̇O2peak increased from BL (15.4 ml/kg/min (10.5-19.4)) to 12-week (16.6 ml/kg/min (12.8-21.3), P = 0.01) with no difference between 12-week and 6M follow-up (16.3 ml/kg/min (12.9-19.7), P = 0.74). No differences were found in CON for either POpeak (P = 0.22) or V̇O2peak (P = 0.27). There were no changes over time in traditional cardiometabolic risk factors or for minutes of different LTPA intensities.Conclusion: We demonstrate that improvements in aerobic fitness are maintained for at least six months after completion of a 12-week exercise intervention, supporting the use of periodic exercise interventions to boost aerobic fitness level in individuals with SCI.Trial registration: ClinicalTrials.gov identifier: NCT04390087..

Cardiovascular disease (CVD) remains a leading cause of mortality and morbidity globally, particularly among older adults. In India, the rapid demographic transition has resulted in a significant increase in the aging population, necessitating a deeper understanding of the factors influencing CVD prevalence. This study examines the association between physical activity and the prevalence of CVD among individuals aged 60 and above.

This study utilized cross-sectional data from the LASI-Wave 1, comprising a nationally representative sample of 28,935 individuals. Logistic regression analysis was employed to investigate the relationship between physical activity and CVD. Population Attributable Factor (PAF) was calculated to determine the proportion of CVD cases preventable by recommended physical activity levels.

Adequate physical activity significantly lowered the risk of CVD by 28% (OR 0.72, 95% CI 0.67-0.78). Inadequate physical activity also showed a protective effect (OR 0.88, 95% CI 0.83-0.94) compared to those who were physically inactive. Other significant factors influencing CVD risk included age, sex, educational level, living arrangements, self-rated health status, body mass index, smoking habits, and multi-morbidity. The comparison between adequate physical activity levels and physically inactive shows a PAF estimate of 0.093 (95% CI: 0.071 - 0.114), indicating that 9.3% of cardiovascular disease cases could be prevented by increasing physical activity from inactive to adequate levels.

The findings highlight the significant role of physical activity in reducing CVD risk among older adults in India. Promoting regular physical activity through community-based programs and healthcare interventions could substantially lower the risk of CVD.

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of accessing secondary prevention programs, it is important to consider alternative ways that this information can be made available to survivors of stroke worldwide. Using the "design thinking" framework and drawing on principles of the integrated knowledge translation approach, we adapted 2 co-designed telehealth programs called i-REBOUND - Let's get moving (physical activity intervention) and i-REBOUND - Eat for health (diet Intervention) to create the i-REBOUND after stroke website. The aim of this paper is to describe the systematic process undertaken to adapt resources from the telehealth delivered i-REBOUND - Let's get moving and i-REBOUND - Eat for health programs to a website prototype with a focus on navigation requirements and accessibility for survivors of stroke. We engaged a variety of key stakeholders with diverse skills and expertise in areas of stroke recovery, research, and digital health. We established a governance structure, formed a consumer advisory group, appointed a diverse project team, and agreed on scope of the project. Our process of adaptation had the following 3 phases: (1) understand, (2) explore, (3) materialize. Our approach considered the survivor of stroke at the center of all decisions, which helped establish guiding principles related to our prototype design. Careful and iterative engagement with survivors of stroke together with the application of design thinking principles allowed us to establish the functional requirements for our website prototype. Through user testing, we were able to confirm the technical requirements needed to build an accessible and easy-to-navigate website catering to the unique needs of survivors of stroke. We describe the process of adapting existing content and co-creating new digital content in partnership with, and featuring, people who have lived experience of stroke. In this paper, we provide a road map for the steps taken to adapt resources from 2 telehealth-delivered programs to a website format that meets specific navigation and accessibility needs of survivors of stroke.

Physical inactivity is a major risk factor for noncommunicable diseases and a leading cause of premature death. The World Health Organization (WHO) recommends at least 150 minutes of moderate intensity physical activity (PA) weekly, regardless of age, gender, or personal habits. However, in both sports performance and clinical settings, personalized training (PT) regimens have shown superior efficacy over general guidelines.

We hypothesized that an automatic PT program, informed by initial physical evaluations, would increase overall quality of life, quality of sleep, and physical capabilities and reduce fatigue and depression compared with adherence to WHO recommendations.

This 5-month, randomized, single-blinded controlled trial involved 112 sedentary or minimally active participants, divided randomly into PT and free training (FT) groups. Physical capabilities and subjective measures such as quality of life, sleep, depression, and fatigue were evaluated for both groups. After 1 month, both groups were asked to perform 150 minutes of PA per week for 4 months; the PT group could either follow a "virtual coach" on a mobile app to follow some personalized PA or do what they would like, while the FT group was to follow the general PA recommendations of the WHO.

We did not find any group×time interaction for PA duration or intensity, physical qualities, and subjective measures. However, considering both groups together, there was a significant pretest and posttest time effect for duration of PA (18.2 vs 24.5 min/d of PA; P<.001), intensity (2.36 vs 3.11; P<.001), and workload (46.8 vs 80.5; P<.001). Almost all physical qualities were increased pretest and posttest (ie, estimated VO2max 26.8 vs 29 mL min-1 kg-1; P<.001; flexibility 25.9 vs 26.9 cm; P=.049; lower limb isometric forces 328 vs 347 N m; P=.002; reaction time 0.680 vs 0.633 s; P<.001; power output on cyclo-ergometer 7.63 vs 7.82 W; P<.003; and balance for the left and right leg 215 vs 163 mm2; P<.003 and 186 vs 162 mm2; P=.048, respectively). Finally, still considering the PT and FT groups together, there were significant pretest to posttest improvements in the mental component of quality of life using the 12-item Short Form Health Survey (41.9 vs 46.0; P<.006), well-being using the Warwick-Edinburgh Mental Well-Being Scale (48.3 vs 51.7; P<.002), depression using the Center for Epidemiologic Studies Depression Scale (15.5 vs 11.5; P=.02), and fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (37.1 vs 39.5; P=.048).

The individualized training was not more effective than the general recommendations. A slight increase in PA (from 18 to 24 min/d) in sedentary or poorly active people is enough for a significant increase in physical capabilities and a significant improvement in quality of life, well-being, depression, and fatigue.

ClinicalTrials.gov NCT04998266; https://clinicaltrials.gov/study/NCT04998266.

Hyperthyroidism impairs muscle mitochondrial metabolism and destroys many body systems. However, information is limited on how much physical and physiological outcomes are impaired in patients with newly diagnosed hyperthyroidism (NDH) and euthyroid. The comparison of pulmonary function, functional exercise capacity, respiratory muscle strength and endurance, physical activity levels (PAL), dyspnea, and quality of life (QoL) in patients and healthy controls was aimed.

Sixteen patients with hyperthyroidism (evaluated twice at new diagnosis and euthyroid state) and healthy controls were compared. Pulmonary function was evaluated with a spirometer, functional exercise capacity with a 6-min walking test (6-MWT), respiratory muscle strength with a mouth pressure device and endurance with threshold loading test, PAL with metabolic holter, dyspnea with Modified Medical Research Council (MMRC) scale, and QoL with Quality of Life in Thyroid Patients Scale (ThyPRO).

Six-MWT distance and respiratory muscle endurance significantly decreased, and MMRC dyspnea scale and ThyPRO scores were higher in patients with NDH and euthyroid compared to controls (p < 0.05). In addition, maximum inspiratory pressure and maximum expiratory pressure significantly decreased in patients with NDH compared to controls, and PAL was less active according to the number of steps in euthyroid patients (p < 0.05). The pulmonary function test was similar in both groups (p > 0.05).

Exercise capacity, respiratory muscle strength and endurance, PAL, dyspnea, and QoL were affected in patients. Patients with hyperthyroidism should be evaluated at the onset of diagnosis, followed up, and referred to cardiopulmonary rehabilitation programs at the earliest. ClinicalTrials number: NCT04825964.

Sedentary behavior (SB) is associated with health impairments, while physical activity (PA) has been a protective factor. It is unclear whether SB and PA are associated with occurrence of signs and/or symptoms (SS) during cardiac rehabilitation program (CRP) exercise sessions. The objective was to evaluate the association between SB and PA with occurrence of SS. Was included 48 patients from a CRP program (64.7 ± 10.4 years-old). Daily time and % of time of SB and weekly time in moderate-to-vigorous-intensity [MVPA], % of MVPA time, steps/day, and steps/minute were accelerometer-measured. Patients were followed-up during 24 CRP sessions, for accompaniment of SS. Age, sex, and comorbidities (hypertension, diabetes, dyslipidemia, obesity) were covariates. Log-transformed values of SB, MVPA and steps/day were also analyzed. As results, 43.7% (n = 21) of participants presented occurrence of signs, 62.5% (n = 30) presented occurrence of symptoms, and 81.2% (n = 39) present occurrence of SS. In fully adjusted model, % of time in MVPA (β: -0.449,p = 0.045) and steps/minute (β: -0.244,p = 0.026) were inversely associated with occurrence of symptoms. No association was observed between SB and PA and occurrence of signs. The occurrence of symptoms and SS among CRP participants was directly associated with SB and inversely associated with variables of PA.

Growing health care challenges resulting from a rapidly expanding aging population necessitate examining effective rehabilitation techniques that mitigate age-related comorbidity and improve quality of life. To date, exercise is one of a few proven interventions known to attenuate age-related declines in cognitive and sensorimotor functions critical to sustained independence.

This work aims to implement a multimodal imaging approach to better understand the mechanistic underpinnings of the beneficial exercise-induced adaptations to sedentary older adults' brains and behaviors. Due to the complex cerebral and vascular dynamics that encompass neuroplastic change with aging and exercise, we propose an imaging protocol that will model exercise-induced changes to cerebral perfusion, cerebral vascular reactivity (CVR), and cognitive and sensorimotor task-dependent functional magnetic resonance imaging (fMRI) after prescribed exercise.

Sedentary older adults (aged 65-80 years) were randomly assigned to either a 12-week aerobic-based interval-based cycling intervention or a 12-week balance and stretching intervention. Assessments of cardiovascular fitness used the YMCA submaximal VO2 test, basal cerebral perfusion using arterial spin labeling (ASL), CVR using hypercapnic fMRI, and cortical activation using fMRI during verbal fluency and motor tapping tasks. A battery of cognitive-executive and motor function tasks outside the scanning environment will be performed before and after the interventions.

Our studies and others show that improved cardiovascular fitness in older adults results in improved outcomes related to physical and cognitive health as well as quality of life. A consistent but unexplained finding in many of these studies is a change in cortical activation patterns during task-based fMRI, which corresponds with improved task performance (cognitive-executive and motor). We hypothesize that the 12-week aerobic exercise intervention will increase basal perfusion and improve CVR through a greater magnitude of reactivity in brain areas susceptible to neural and vascular decline (inferior frontal and motor cortices) in previously sedentary older adults. To differentiate between neural and vascular adaptations in these regions, we will map changes in basal perfusion and CVR over the inferior frontal and the motor cortices-regions we have previously shown to be beneficially altered during fMRI BOLD (blood oxygen level dependent), such as verbal fluency and motor tapping, through improved cardiovascular fitness.

Exercise is one of the most impactful interventions for improving physical and cognitive health in aging. This study aims to better understand the mechanistic underpinnings of improved health and function of the cerebrovascular system. If our hypothesis of improved perfusion and cerebrovascular reactivity following a 12-week aerobic exercise intervention is supported, it would add critically important insights into the potential of exercise to improve brain health in aging and could inform exercise prescription for older adults at risk for neurodegenerative disease brought on by cerebrovascular dysfunction.

ClinicalTrials.gov NCT05932069; https://clinicaltrials.gov/study/NCT05932069.

DERR1-10.2196/58316.

This study aimed to develop and validate distinct nomogram models for assessing CVD risk in individuals with prediabetes and diabetes. In a cross-sectional study design, we examined data from 2294 prediabetes and 1037 diabetics who participated in the National Health and Nutrition Examination Survey, which was conducted in the United States of America between 2007 and 2018. The dataset was randomly divided into training and validation cohorts at a ratio of 0.75-0.25. The Boruta feature selection method was used in the training cohort to identify optimal predictors for CVD diagnosis. A web-based dynamic nomogram was developed using the selected features, which were validated in the validation cohort. The Hosmer-Lemeshow test was performed to assess the nomogram's stability and performance. Receiver operating characteristics and calibration curves were used to assess the effectiveness of the nomogram. The clinical applicability of the nomogram was evaluated using decision curve analysis and clinical impact curves. In the prediabetes cohort, the CVD risk prediction nomogram included nine risk factors: age, smoking status, platelet/lymphocyte ratio, platelet count, white blood cell count, red cell distribution width, lactate dehydrogenase level, sleep disorder, and hypertension. In the diabetes cohort, the CVD risk prediction nomogram included eleven risk factors: age, material status, smoking status, systemic inflammatory response index, neutrophil-to-lymphocyte ratio, red cell distribution width, lactate dehydrogenase, high-density lipoprotein cholesterol, sleep disorder, hypertension, and physical activity. The nomogram models developed in this study have good predictive and discriminant utility for predicting CVD risk in patients with prediabetes and diabetes.

Physical inactivity is prevalent after cancer treatment, which could increase ischemic stroke risk in cancer survivors. This study investigated the association between physical activity change from pre- to post-diagnosis and ischemic stroke risk among cancer survivors.

Using data from the Korean National Health Insurance Service database, 269,943 cancer survivors (mean [SD] age, 56.3 [12.1] years; 45.7% male) with no history of cardiovascular disease were evaluated based on changes in physical activity from pre- to post-diagnosis. Using the Fine-Gray model, subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for ischemic stroke risk were calculated, considering death as a competing risk.

After cancer diagnosis, 62.0% remained inactive, 10.1% remained active, 16.6% became active, and 11.4% became inactive. During a mean (SD) follow-up of 4.1 (2.0) years, being active both pre- and post-diagnosis was associated with a 15% decreased risk of ischemic stroke (sHR, 0.85; 95% CI, 0.75-0.96), compared with those who remained inactive. Cancer survivors who became active and inactive post-diagnosis showed a 16% and 11% lower ischemic stroke risk (sHR, 0.84; 95% CI, 0.75-0.93; sHR, 0.89; 95% CI, 0.79-0.99), respectively, than those who remained inactive. Analysis by the primary cancer site did not substantially differ from the main findings.

Physical activity is associated with reduced ischemic stroke risk among cancer survivors. The potential benefits of physical activity are not limited to individuals who were physically active before cancer diagnosis, thus preventive strategies against ischemic stroke should emphasize physical activity throughout the cancer journey.

Physical inactivity impairs health by increasing morbidity. In childhood, modifiable risk factors associated with cardiovascular pathologies and related to mitochondrial function and structure are initiated by physical inactivity. The objective of this study was to analyze the effect of high-intensity swimming interval training (HIIT-swim) on cardiac mitochondrial ultrastructure in young Sprague Dawley rats compared with a sedentary group. Five-week-old Sprague Dawley rats (n = 18) were divided into a control group (C) (n = 6), a sedentary group (S) (n = 6) and an HIIT-swim group (H-s) (n = 6), the last of which performed HIIT-swim for 4 weeks. A mitochondrial ultrastructural evaluation was performed using transmission electron microscopy. In the H-s rats, mitochondrial areas and perimeters were found to be statistically significantly different from those of the C and S rats. In addition, no predominant intramitochondrial multifragmentation was observed in the mitochondria of H-s rats, but multifragmentation was evident in the mitochondria of S rats.

This study was performed to determine whether prolonged endurance running results in acute endothelial dysfunction and wave-reflection, as endothelial dysfunction and arterial stiffness are cardiovascular risk factors. Vascular function (conduit artery/macrovascular and resistance artery/microvascular) was assessed in 11 experienced runners (8 males, 3 females) before, during and after a 50 km ultramarathon. Blood pressure (BP), heart rate (HR), wave reflection, augmentation index (AIx) and AIx corrected for HR (AIx75) were taken at all time points-Baseline (BL), following 10, 20, 30 and 40 km, 1 h post-completion (1HP) and 24 h post-completion (24HP). Flow-mediated dilatation (FMD) and inflammatory biomarkers were examined at BL, 1HP and 24HP. Reactive hyperaemia area under the curve (AUC) and shear rate AUC to peak dilatation were lower (∼75%) at 1HP compared with BL (P < 0.001 for both) and reactive hyperaemia was higher at 24HP (∼27%) compared with BL (P = 0.018). Compared to BL, both mean central systolic BP and mean central diastolic BP were 7% and 10% higher, respectively, following 10 km and 6% and 9% higher, respectively, following 20 km, and then decreased by 5% and 8%, respectively, at 24HP (P < 0.05 for all). AIx (%) decreased following 20 km and following 40 km compared with BL (P < 0.05 for both) but increased following 40 km when corrected for HR (AIx75) compared with BL (P = 0.02). Forward wave amplitude significantly increased at 10 km (15%) compared with BL (P = 0.049), whereas backward wave reflection and reflected magnitude were similar at all time points. FMD and baseline diameter remained similar. These data indicate preservation of macrovascular (endothelial) function, but not microvascular function resulting from the 50 km ultramarathon.

Recent studies suggest that the application of exercise activity questionnaires, including the use of a single-item exercise question, can be additive to the prognostic efficacy of imaging findings. This study aims to evaluate the prognostic efficacy of exercise activity in patients undergoing coronary computed tomography angiography (CCTA).

We assessed 9772 patients who underwent CCTA at a single center between 2007 and 2020. Patients were divided into 4 groups of physical activity as no exercise (n ​= ​1643, 17%), mild exercise (n ​= ​3156, 32%), moderate exercise (n ​= ​3542, 36%), and high exercise (n ​= ​1431,15%), based on a single-item self-reported questionnaire. Coronary stenosis was categorized as no (0%), non-obstructive (1-49%), borderline (50-69%), and obstructive (≥70%). During a median follow-up of 4.64 (IQR 1.53-7.89) years, 490 (7.6%) died. There was a stepwise inverse relationship between exercise activity and mortality (p ​< ​0.001). Compared with the high activity group, the no activity group had a 3-fold higher mortality risk (HR: 3.3, 95%CI (1.94-5.63), p ​< ​0.001) after adjustment for age, clinical risk factors, symptoms, and statin use. For any level of CCTA stenosis, mortality rates were inversely associated with the degree of patients' exercise activity. The risk of all-cause mortality was similar among the patients with obstructive stenosis with high exercise versus those with no coronary stenosis but no exercise activity (p ​= ​0.912).

Physical activity as assessed by a single-item self-reported questionnaire is a strong stepwise inverse predictor of mortality risk among patients undergoing CCTA.