Effect of Cocoa Products and Its Polyphenolic Constituents on Exercise Performance and Exercise-Induced Muscle Damage and Inflammation: A Review of Clinical Trials

In recent years, the consumption of chocolate and, in particular, dark chocolate has been \u201crehabilitated\u201d due to its high content of cocoa antioxidant polyphenols. Although it is recognized that regular exercise improves energy metabolism and muscle performance, excessive or unaccustomed exercise may induce cell damage and impair muscle function by triggering oxidative stress and tissue inflammation. The aim of this review was to revise the available data from literature on the eects of cocoa polyphenols on exercise-associated tissue damage and impairment of exercise performance. To this aim, PubMed and Web of Science databases were searched with the following keywords: \u201cintervention studies\u201d, \u201ccocoa polyphenols\u201d, \u201cexercise training\u201d, \u201cinflammation\u201d, \u201coxidative stress\u201d, and \u201cexercise performance\u201d. We selected thirteen randomized clinical trials on cocoa ingestion that involved a total of 200 well-trained athletes. The retrieved data indicate that acute, sub-chronic, and chronic cocoa polyphenol intake may reduce exercise-induced oxidative stress but not inflammation, while mixed results are observed in terms of exercise performance and recovery. The interpretation of available results on the anti-oxidative and anti-inflammatory activities of cocoa polyphenols remains questionable, likely due to the variety of physiological networks involved. Further experimental studies are mandatory to clarify the role of cocoa polyphenol supplementation in exercise-mediated inflammation

Intra-Renal Hemodynamic Changes After Habitual Physical Activity in Patients with Chronic Kidney Disease

Background: Chronic Kidney Disease (CKD) is considered a silent epidemic with a continuously growing prevalence around the world. Due to uremia many functional and morphological abnormalities occur in almost all systems. Mostly affected, the cardiovascular system, leads to diminished cardiac function that affects patients’ functional capacity and physical activity levels, reducing survival and increasing all-cause mortality. Systematic exercise training ameliorates uremia induced body deficits and significantly improves the survival of CKD patients. Intradialytic exercise training has been recommended as a complementary therapeutic modality equally important to hemodialysis. Methods: The aim of this systematic review is to provide an update on recent advances in our understanding of how exercise training improves functionality of the cardiovascular system through the hemodynamic changes induced by habitual or intradialytic and/or home-based exercise training programs. Results: Systematic exercise training induces beneficial adaptive responses and influences many sensitive physiological biomarkers, such as oxidative stress biomarkers that are implicated in the development of atherosclerosis. Additionally, exercise training decreases the cardiovascular risk by improving the autonomic nervous system activity and the left ventricular function and by reducing nontraditional risk factors such as epicardial adipose tissue. It seems that all these central and peripheral adaptations to exercise training significantly contribute to improvements in functional capacity and exercise tolerance among CKD patients and result in the risk reduction of CKD-associated disorders. Conclusion: Exercise training could serve as a complimentary therapeutic strategy in CKD patients while health care providers should motivate patients to engage in any type of exercise training programs

Systemic Redox Imbalance in Chronic Kidney Disease: A Systematic Review.

Patients with chronic kidney disease (CKD) experience imbalance between oxygen reactive species (ROS) production and antioxidant defenses leading to cell and tissue damage. However, it remains unclear at which stage of renal insufficiency the redox imbalance becomes more profound. The aim of this systematic review was to provide an update on recent advances in our understanding of how the redox status changes in the progression of renal disease from predialysis stages 1 to 4 to end stage 5 and whether the various treatments and dialysis modalities influence the redox balance. A systematic review was conducted searching PubMed and Scopus by using the Cochrane and PRISMA guidelines. In total, thirty-nine studies met the inclusion criteria and were reviewed. Even from an early stage, imbalance in redox status is evident and as the kidney function worsens it becomes more profound. Hemodialysis therapy per se seems to negatively influence the redox status by the elevation of lipid peroxidation markers, protein carbonylation, and impairing erythrocyte antioxidant defense. However, other dialysis modalities do not so far appear to confer advantages. Supplementation with antioxidants might assist and should be considered as an early intervention to halt premature atherogenesis development at an early stage of CKD

Impact of Flavonols on Cardiometabolic Biomarkers: A Meta-Analysis of Randomized Controlled Human Trials to Explore the Role of Inter-Individual Variability

Several epidemiological studies have linked flavonols with decreased risk of cardiovascular disease (CVD). However, some heterogeneity in the individual physiological responses to the consumption of these compounds has been identified. This meta-analysis aimed to study the effect of flavonol supplementation on biomarkers of CVD risk such as, blood lipids, blood pressure and plasma glucose, as well as factors affecting their inter-individual variability. Data from 18 human randomized controlled trials were pooled and the effect was estimated using fixed or random effects meta-analysis model and reported as difference in means (DM). Variability in the response of blood lipids to supplementation with flavonols was assessed by stratifying various population subgroups: age, sex, country, and health status. Results showed significant reductions in total cholesterol (DM = -0.10 mmol/L; 95% CI: -0.20, -0.01), LDL cholesterol (DM = -0.14 mmol/L; Nutrients 2017, 9, 117 2 of 21 95% CI: -0.21, 0.07), and triacylglycerol (DM = -0.10 mmol/L; 95% CI: -0.18, 0.03), and a significant increase in HDL cholesterol (DM = 0.05 mmol/L; 95% CI: 0.02, 0.07). A significant reduction was also observed in fasting plasma glucose (DM = -0.18 mmol/L; 95%CI: -0.29, -0.08), and in blood pressure (SBP: DM = -4.84 mmHg; 95% CI: -5.64, -4.04; DBP: DM = -3.32 mmHg; 95% CI: -4.09, -2.55). Subgroup analysis showed a more pronounced effect of flavonol intake in participants from Asian countries and in participants with diagnosed disease or dyslipidemia, compared to healthy and normal baseline values. In conclusion, flavonol consumption improved biomarkers of CVD risk, however, country of origin and health status may influence the effect of flavonol intake on blood lipid levels

Functional and psychosocial effects of an exercise program with greek traditional dances in patients with cardiovascular diseases

Exercise training is recommended in patients with chronic heart failure (CHF), to improve functional capacity and quality of life and to relieve symptoms. Despite these benefits, the adherence to exercise training programs in CHF remains high mainly due to the lack of enthusiasm among participants. To stimulate patients to rehabilitation programs, alternative forms of exercise are requested. Traditional dancing is a form of exercise that combines movement, social interaction and fun. The aim of the present study was to examine whether an exercise training program with Greek traditional dances improves functional capacity and quality of life in patients with CHF, and is capable to increase the compliance of the participants. Fifty-one male patients with heart failure of NYHA class I and II and mean age 67.1±5.5 years, volunteered to participate in the 8-month study and were randomly assigned to an exercise training with Greek traditional dances group (group A, n=18), a mixed-type exercise training group (group B, n=16) or sedentary group that served as control (group C, n=17). At entry and at the end of the study all patients underwent a cardiopulmonary exercise and isokinetic strength testing and were also tested on 6-min walk test, sit to stand test and Berg Balance Scale (BBS). Moreover, health-related quality of life was assessed using two questionnaires; the 36-item short form health survey (SF-36) and Life Satisfaction Inventory (LSI). The Intrinsic Motivation Inventory (IMI) was also used to assess participants' subjective experience. At the beginning of the study all patients had similar means at all measurements without statistical significant differences. At the end of the 8-month study VO2peak increased by 34% (p<0.05) in group A and by 32.5% (p<0.05) in group B, VO2AT by 11% (p<0.05) in A and by 10.5% (p<0.05) in B, exercise time by 48.5% (p<0.05) and 46.5% (p<0.05), VE by 15% (p<0.05) and 14% (p<0.05) and O2 pulse by 30% (p<0.05) in group A and by 36.5% (p<0.05) in B, respectively. Moreover, after training VE/VCO2 slope was decreased by 18% (p<0.05) in group A and by 19.5% (p<0.05) in group B. Regarding the functional ability measurements at the end of the study, the maximum distance walk in the six-minute test significantly increased by 20.5% (p<0.05) in group A and by 18.5% (p<0.05) in B, while the time in the sit to stand test decreased by 20.5% (p<0.05) in A and by 22% (p<0.05) in B. Moreover, the BBS increased by 6% (p<0.05) in both groups and the maximal isometric force of lower limbs by 39% (p<0.05) in group A and by 43.5% (p<0.05) in B. A significant improvement was revealed in the total score of SF-36 by 8% (p<0.05) in group A and by 7% (p<0.05) in group B, as a result of the improvements observed in physical health subscale by 8% (p<0.05) in A and 6.5% (p<0.05) in B and in mental health subscale by 7.5% (p<0.05) in A and by 6.5% (p<0.05) in B. Moreover, the LSI score was found to be significant increased in group A by 18% (p<0.05) and in B by 20.5% (p<0.05). The IMI score was increased only in group A by 26.2% (p<0.05). The change in L.S.I. score in group A was correlated with changes in distance walk in the six-minute test (r=0.584, p<0.05), in exercise time (r=0.551, p<0.05) and in mental health subscale of SF-36 questionnaire (r=0.596, p<0.05). Furthermore, the improvement in VO2peak was correlated with the improvement in physical health subscale of SF-36 (r=0.602, p<0.05) and total score of I.M.I. (r=0.607, p<0.05). In conclusion, the results indicate that exercise training with Greek traditional dances is feasible and able to improve functional capacity and quality of life, similar to traditional mixed exercise training in CHF patients, and well motivate patients to complete the program. Exercise with Greek traditional dances may be considered as an alternative way to exercise CHF patients.Τα ποσοστά συμμετοχής των ασθενών με καρδιακή ανεπάρκεια σε προγράμματα επαναδραστηριοποίησης δεν είναι υψηλά και η εύρεση εναλλακτικών μορφών γύμνασης που θα είναι αποδεκτές και προσιτές από τους ασθενείς κρίνεται αναγκαία. Οι ελληνικοί παραδοσιακοί χοροί αποτελούν φυσική δραστηριότητα που έχει βρεθεί ότι μπορεί να επιφέρει ευνοϊκές προσαρμογές στα διάφορα συστήματα, κυρίως υγιών ατόμων. Σκοπός της μελέτης αυτής ήταν να διαπιστωθεί εάν ένα πρόγραμμα φυσικής αποκατάστασης με ελληνικούς παραδοσιακούς χορούς είναι ικανό να επηρεάσει τη λειτουργική ικανότητα και την ποιότητα ζωής ασθενών με καρδιακή ανεπάρκεια. Στη μελέτη συμμετείχαν συνολικά 51 ασθενείς με καρδιακή ανεπάρκεια Ι και ΙΙ βαθμού κατά NYHA, ηλικίας 67.2± 5.5 έτη, που διαιρέθηκαν τυχαία σε τρεις ομάδες: στην ομάδα Α (18 ασθενείς), η οποία συμμετείχε σε πρόγραμμα 8μηνης γύμνασης με ελληνικούς παραδοσιακούς χορούς, στην ομάδα Β (16 ασθενείς) που παρακολούθησε 8μηνο πρόγραμμα μεικτής γύμνασης και στην ομάδα Γ (17 ασθενείς) που αποτέλεσε την ομάδα ελέγχου. Σε όλους κατά την έναρξη και τη λήξη της μελέτης, πραγματοποιήθηκε κλινική εξέταση, δοκιμασία κόπωσης, εργοσπιρομέτρηση και έλεγχος της λειτουργικής ικανότητας με απλές δοκιμασίες πεδίου, όπως η 6-λεπτη δοκιμασία βαδίσματος και η δοκιμασία κάθισμα-όρθια θέση-κάθισμα. Επίσης, αξιολογήθηκε η μέγιστη ισομετρική μυϊκή δύναμη των κάτω άκρων με ισοκινητικό δυναμόμετρο και η ικανότητα ισορροπίας με την κλίμακα του Berg (B.B.S.). Παράλληλα, όλοι οι ασθενείς απάντησαν σε τρία ερωτηματολόγια: α. της κλίμακας ικανοποίησης ζωής (L.S.I.), β. της αξιολόγησης της ποιότητας ζωής (SF-36) και γ. των εσωτερικών κινήτρων (I.M.I.). Κατά την έναρξη της μελέτης οι ασθενείς παρουσίασαν σημαντικά μειωμένη λειτουργική ικανότητα και επιβαρυμένη ποιότητα ζωής συγκριτικά με υγιείς. Μετά τη λήξη των 8μηνων προγραμμάτων γύμνασης παρατηρήθηκε αύξηση της VO2peak κατά 34% (p<0.05) στην ομάδα Α και κατά 32.5% (p<0.05) στη Β, της VO2 στο αναερόβιο κατώφλι κατά 11% (p<0.05) και 10.5% (p<0.05) αντίστοιχα, του χρόνου κόπωσης κατά 48.5% (p<0.05) και 46.5% (p<0.05), του πνευμονικού αερισμού κατά 15% (p<0.05) και 14% (p<0.05) και του παλμού Ο2 κατά 30% (p<0.05) και 36.5% (p<0.05) αντίστοιχα. Επίσης, μείωση εμφάνισε ο δείκτης VE/VCO2 κατά 18% (p<0.05) στην ομάδα Α και κατά 19.5% (p<0.05) στη Β. Σημαντικά αυξημένη, μετά τη γύμναση ήταν η δυανυόμενη απόσταση στη δοκιμασία των 6 λεπτών κατά 20.5% (p<0.05) στην ομάδα Α και κατά 18.5% (p<0.05) στη Β και μειωμένος ο χρόνος στη δοκιμασία κάθισμα-όρθια θέση- κάθισμα κατά 20.5% (p<0.05) στην ομάδα Α και 22% (p<0.05) στη Β. Σημαντική αύξηση παρουσίασε η μυϊκή ισχύς των κάτω άκρων κατά 39% (p<0.05) στην ομάδα Α και 43.5% (p<0.05) στη Β, καθώς και η ικανότητα ισορροπίας κατά 6% (p<0.05), και στις δύο ομάδες. Η συνολική βαθμολογία του ερωτηματολογίου SF-36 αυξήθηκε σημαντικά κατά 8% (p<0.05) στην ομάδα Α και 7% (p<0.05) στη Β, καθώς η διάσταση της σωματικής κατάστασης βελτιώθηκε κατά 8% (p<0.05) στην ομάδα Α και 6.5% (p<0.05) στη Β και της ψυχικής κατάστασης κατά 7.5% (p<0.05) στην ομάδα Α και 6.5% (p<0.05) στη Β. Επίσης οι ασθενείς της ομάδας Α συμπλήρωσαν καλύτερη βαθμολογία στο ερωτηματολόγιο L.S.I. κατά 18% (p<0.05) και κατά 20.5%, (p<0.05) της Β. Τέλος η βαθμολογία του ερωτηματολογίου Ι.Μ.Ι. αυξήθηκε σημαντικά μόνο στην ομάδα Α κατά 26.2% (p<0.05), μετά το πέρας της μελέτης. Θετική συσχέτιση διαπιστώθηκε μεταξύ της βελτίωσης της βαθμολογίας του ερωτηματολογίου LSI και της βελτίωσης της απόστασης που δυανύθηκε στην 6-λεπτη δοκιμασία βαδίσματος (r=0.584, p<0.05), της βελτίωσης του χρόνου άσκησης (r=0.551, p<0.05) και της βελτίωσης της βαθμολογίας της διάστασης της ψυχικής κατάστασης (r=0.596, p<0.05), των ασθενών της ομάδας Α. Επίσης, η βελτίωση της VO2peak των ασθενών της ομάδας Α συσχετίστηκε θετικά με τη βελτίωση της βαθμολογίας της διάστασης της σωματικής κατάστασης του SF-36 (r=0.602, p<0.05) και με τη μεταβολή της συνολικής βαθμολογίας του ερωτηματολογίου Ι.Μ.Ι. (r=0.607, p<0.05). Συμπερασματικά προκύπτει ότι η άσκηση με ελληνικούς παραδοσιακούς χορούς σε ασθενείς με καρδιακή ανεπάρκεια, στα πλαίσια ενός προγράμματος αποκατάστασης, βελτιώνει σημαντικά τη λειτουργική ικανότητα και την ποιότητα ζωής τους, ενώ παράλληλα αυξάνει τα εσωτερικά κίνητρα ευνοώντας έτσι τη συμμετοχή τους στο πρόγραμμα

Cognitive impairment as a central cholinergic deficit in patients with Myasthenia Gravis

Background: The purpose of this study was to investigate with neurophysiological and neuropsychological methods such as pupillometry, cognitive test and Hamilton Depression Rating Scale (HAM-D) the hypothesis of Central Nervous System (CNS) cholinergic involvement in patients with Myasthenia Gravis (MG). Methods: Thirty-two patients (32) with MG and a mean age of 51.1 ± 17.2 volunteered to participate in this investigation, while thirty-three (33) healthy subjects with a mean age of 50.2 ± 14.8 served as controls. All subjects underwent pupillometric measurements and performed the Wechsler Memory Scale (WMS) and HAM-D. The pupillometric indices studied were: 1) latency for the onset of constriction (T1), 2) maximum constriction velocity (VCmax) and 3) maximum constriction acceleration (ACmax). Results: T1 was found significantly increased by 21.7% (p < 0.05) in MG patients as compared to healthy subjects. Conversely, VCmax and ACmax were significantly decreased in MG patients by 33.3% (p < 0.05) and 43.5% (p < 0.05) respectively, as opposed to healthy subjects. Additionally, MG patients showed significantly decreased score in WMS by 41.6% (p < 0.05) as compared to healthy controls. No significant difference was found for HAM-D between the two groups. Conclusions: VCmax and ACmax are governed mainly by the action of the Parasympathetic Nervous System, through acetylcholine. The results of this study demonstrate that the CNS may be affected in MG and support the hypothesis that MG has central cholinergic effects manifested by cognitive dysfunction

Intra-Renal Hemodynamic Changes After Habitual Physical Activity in Patients with Chronic Kidney Disease

Background: Chronic Kidney Disease (CKD) is considered a silent epidemic with a continuously growing prevalence around the world. Due to uremia many functional and morphological abnormalities occur in almost all systems. Mostly affected, the cardiovascular system, leads to diminished cardiac function that affects patients’ functional capacity and physical activity levels, reducing survival and increasing all-cause mortality. Systematic exercise training ameliorates uremia induced body deficits and significantly improves the survival of CKD patients. Intradialytic exercise training has been recommended as a complementary therapeutic modality equally important to hemodialysis. Methods: The aim of this systematic review is to provide an update on recent advances in our understanding of how exercise training improves functionality of the cardiovascular system through the hemodynamic changes induced by habitual or intradialytic and/or home-based exercise training programs. Results: Systematic exercise training induces beneficial adaptive responses and influences many sensitive physiological biomarkers, such as oxidative stress biomarkers that are implicated in the development of atherosclerosis. Additionally, exercise training decreases the cardiovascular risk by improving the autonomic nervous system activity and the left ventricular function and by reducing nontraditional risk factors such as epicardial adipose tissue. It seems that all these central and peripheral adaptations to exercise training significantly contribute to improvements in functional capacity and exercise tolerance among CKD patients and result in the risk reduction of CKD-associated disorders. Conclusion: Exercise training could serve as a complimentary therapeutic strategy in CKD patients while health care providers should motivate patients to engage in any type of exercise training programs

Efects of chronic physical exercise on executive functions and episodic memory in clinical and healthy older adult populations

Background Executive functions (EFs) and episodic memory are fundamental components of cognition that deteriorate with age and are crucial for independent living. While numerous reviews have explored the effect of exercise on these components in old age, these reviews screened and analyzed selected older adult populations, or specific exercise modes, thus providing only limited answers to the fundamental question on the effect of exercise on cognition in old age. This article describes the protocol for a systematic review and multilevel meta-analytic study aiming at evaluating the effectiveness of different types of chronic exercise in improving and/or maintaining EFs and long-term episodic memory in older adults. Methods and analysis The study protocol was written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Several databases will be searched. Randomized controlled trials (RCTs) conducted in older adults aged ≥ 60 years providing any kind of planned, structured, and repetitive exercise interventions, and EFs and/or episodic memory measures as outcomes, published in English in peer-reviewed journals and doctoral dissertations will be included. Two independent reviewers will screen the selected articles, while a third reviewer will resolve possible conflicts. The Cochrane risk-of-bias tool will be used to assess the quality of the studies. Finally, data will be extracted from the selected articles, and the formal method of combining individual data from the selected studies will be applied using a random effect multilevel meta-analysis. The data analysis will be conducted with the metafor package in R. Discussion and conclusion This review will synthesize the existing evidence and pinpoint gaps existing in the literature on the effects of exercise on EFs and episodic memory in healthy and unhealthy older adults. Findings from this meta-analysis will help to design effective exercise interventions for older adults to improve and/or maintain EFs and episodic memory. Its results will be useful for many researchers and professionals working with older adults and their families

Age alters cardiac autonomic modulations during and following exercise-induced heat stress in females

The aim of this study was to examine the effect of natural ageing on heart rate variability during and following exercise-induced heat stress in females. Eleven young (»24 years) and 13 older (»51 years), habitually active females completed an experimental session consisting of baseline rest, moderate intensity intermittent exercise (four 15-min bouts separated by 15-min recovery) and 1-hour of final recovery in a hot and dry (35C, 20% relative humidity) environment. Respiratory and heart rate recordings were continuously logged with 10-min periods analysed at the end of: baseline rest; each of the exercise and recovery bouts; and during the 1-hour final recovery period. Comparisons over time during exercise and recovery, and between groups were conducted via two-way repeated-measures ANCOVAs with rest values as the covariate. During baseline rest, older females exhibited lower heart rate variability compared to young females with similar levels of respiration and most (»71-79%) heart rate variability measures during repeated exercise and recovery. However, older females exhibited heart rate variability metrics suggestive of greater parasympathetic modulation (greater long axis of Poincare plot, cardiac vagal index; lower low-high frequency ratio) during repeated exercise with lower indices during the latter stage of prolonged recovery (less very low frequency component, Largest Lyapunov Exponent; greater cardiac sympathetic index). The current study documented several unique, age-dependent differences in heart rate variability, independent of respiration, during and following exercise-induced heat stress for females that may assist in the detection of normal heat-induced adaptations as well as individuals vulnerable to heat stress