Efectos del entrenamiento físico sobre la composición de las fibras musculares y actividad enzimática en pacientes con insuficiencia cardíaca: Revisión sistemática

Increased expression of fast-twitch glycolytic fibers and diminished activity of oxidative enzymes were previously cited as plausible causes of profound exercise intolerance in patients with chronic heart failure. Research from healthy populations demonstrated the potential of exercise to modify fiber type composition and increase the activity of enzymes of oxidative phosphorylation. Therefore, the primary purpose of this systematic review was to confirm whether these findings could be extrapolated to patients with heart failure. Based on the conclusions from the reviewed studies, the benefits of exercise on fiber type composition could not be confirmed. However, enzymatic activity responded well to diverse protocols ranging from moderate-intensity aerobic to resistance exercises. Notably, the increases in citrate synthase activity as a reflection of improved mitochondrial function highlight the need to consider exercise as an integral part of heart failure treatment strategies to address the underlying muscle pathology. No meta-analysis was performed as a part of the present review, which precluded the informative analysis of potential moderating variables. Future research should implement robust statistical approaches to identify variables specific to exercise prescription and individual patient characteristics that may enhance further exercise-induced adaptations.El aumento de la expresión de fibras glucolíticas de contracción rápida y la disminución de la actividad de las enzimas oxidativas se citaron previamente como posibles causas de intolerancia al ejercicio en pacientes con insuficiencia cardíaca. Los trabajos de investigación en poblaciones sanas demostraron el potencial del ejercicio para modificar la composición del tipo de fibra y aumentar la actividad de las enzimas de la fosforilación oxidativa. Por lo tanto, el objetivo principal de esta revisión sistemática fue confirmar si estos hallazgos podrían extrapolarse a pacientes con insuficiencia cardíaca. Según las conclusiones de los estudios revisados, no se pudieron confirmar los beneficios del ejercicio sobre la composición del tipo de fibra. Sin embargo, la actividad enzimática respondió a diversos protocolos que iban desde entrenamientos aeróbicos de intensidad moderada hasta entrenamientos de fuerza. En particular, los aumentos en la actividad de citrato sintasa como un reflejo de la mejora de la función mitocondrial resaltan la necesidad de considerar el ejercicio como una parte integral de las estrategias de tratamiento de la insuficiencia cardíaca para abordar la patología muscular subyacente. No se realizó un metanálisis como parte de la presente revisión, lo que impidió el análisis de las posibles variables moderadoras. La investigación futura debería implementar métodos estadísticos sólidos para identificar variables específicas de la prescripción del ejercicio y las características individuales de los pacientes que pueden modificar las adaptaciones al ejercicio

Effects of high-intensity interval training on vascular function in patients with cardiovascular disease: a systematic review and meta-analysis

Background: Exercise training improves endothelial function in patients with cardiovascular disease (CVD). However, the influence of training variables remains unclear. The aim of this study was to evaluate the effect of highintensity interval training (HIIT), compared to moderate intensity training (MIT) and other exercise modalities (i.e., resistance and combined exercise), on endothelial function, assessed by arterial flow-mediated dilation (FMD) or endothelial progenitor cells (EPCs), in patients with CVD. Secondly, we investigated the influence of other training variables (i.e., HIIT protocol). Methods: The PICOS strategy was used to identify randomised and nonrandomised studies comparing the effect of HIIT and other exercise modalities (e.g., MIT) on endothelial function in patients with CVD. Electronic searches were carried out in Pubmed, Embase, and Web of Science up to November 2022. The TESTEX scale was used to evaluate the methodological quality of the included studies. Random-effects models of between-group mean difference (MD) were estimated. A positive MD indicated an effect in favour of HIIT. Heterogeneity analyses were performed by the chi-square test and I2 index. Subgroup analyses evaluated the influence of potential moderator variables. Results: Fourteen studies (13; 92.9% randomised) were included. Most of the studies trained 3 days a week for 12 weeks and performed long HIIT. No statistically significant differences were found between HIIT and MIT for improving brachial FMD in patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) (8 studies; MD+ = 0.91% [95% confidence interval (CI) = −0.06, 1.88]). However, subgroup analyses showed that long HIIT (i.e., > 1 min) is better than MIT for enhancing FMD (5 studies; MD+ = 1.46% [95% CI = 0.35, 2.57]), while no differences were found between short HIIT (i.e., ≤ 1 min) and MIT (3 studies; MD+ = −0.41% [95% CI = −1.64, 0.82]). Insufficient data prevented pooled analysis for EPCs, and individual studies failed to find statistically significant differences (p > .050) between HIIT and other exercise modalities in increasing EPCs. Discussion: Poor methodological quality could limit the precision of the current results and increase the inconsistency. Long HIIT is superior to MIT for improving FMD in patients with CAD or HFrEF. Future studies comparing HIIT to other exercise modalities, as well as the effect on EPCs and in HF with preserved ejection fraction are required

Effects of high-intensity interval training on vascular function in patients with cardiovascular disease: a systematic review and meta-analysis

Background: Exercise training improves endothelial function in patients with cardiovascular disease (CVD). However, the influence of training variables remains unclear. The aim of this study was to evaluate the effect of high-intensity interval training (HIIT), compared to moderate intensity training (MIT) and other exercise modalities (i.e., resistance and combined exercise), on endothelial function, assessed by arterial flow-mediated dilation (FMD) or endothelial progenitor cells (EPCs), in patients with CVD. Secondly, we investigated the influence of other training variables (i.e., HIIT protocol).Methods: The PICOS strategy was used to identify randomised and non-randomised studies comparing the effect of HIIT and other exercise modalities (e.g., MIT) on endothelial function in patients with CVD. Electronic searches were carried out in Pubmed, Embase, and Web of Science up to November 2022. The TESTEX scale was used to evaluate the methodological quality of the included studies. Random-effects models of between-group mean difference (MD) were estimated. A positive MD indicated an effect in favour of HIIT. Heterogeneity analyses were performed by the chi-square test and I2 index. Subgroup analyses evaluated the influence of potential moderator variables.Results: Fourteen studies (13; 92.9% randomised) were included. Most of the studies trained 3 days a week for 12 weeks and performed long HIIT. No statistically significant differences were found between HIIT and MIT for improving brachial FMD in patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) (8 studies; MD+ = 0.91% [95% confidence interval (CI) = −0.06, 1.88]). However, subgroup analyses showed that long HIIT (i.e., > 1 min) is better than MIT for enhancing FMD (5 studies; MD+ = 1.46% [95% CI = 0.35, 2.57]), while no differences were found between short HIIT (i.e., ≤ 1 min) and MIT (3 studies; MD+ = −0.41% [95% CI = −1.64, 0.82]). Insufficient data prevented pooled analysis for EPCs, and individual studies failed to find statistically significant differences (p > .050) between HIIT and other exercise modalities in increasing EPCs.Discussion: Poor methodological quality could limit the precision of the current results and increase the inconsistency. Long HIIT is superior to MIT for improving FMD in patients with CAD or HFrEF. Future studies comparing HIIT to other exercise modalities, as well as the effect on EPCs and in HF with preserved ejection fraction are required.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42022358156

Physical Exercise and Cognitive Function

Cognitive skills are relevant predictors of academic achievement, employability, socioeconomic success, health, and longevity [...

Exploring the Impact of Web-Based vs. In-Person Exercise Training on Benefits and Adherence in Substance Use Disorder Interventions: A Pilot Study

Background: Substance use disorders pose unique challenges, affecting individuals physiologically and socially. This study addresses the fundamental question of how adherence to exercise programs impacts those with substance use disorders, examining both in-person and online interventions. Methods: A 12-week analysis involving 26 participants assessed physical fitness, strength, and quality of life. Participants were categorized into in-person and online exercise groups, with their adherence tracked through attendance and a dedicated app. Results: The in-person group exhibited higher adherence rates and significant improvements, in contrast to the challenges encountered by the online groups, particularly in substance use disorder cohorts. Statistical analyses highlighted these differences, emphasizing the pivotal role of the exercise program delivery format. Conclusions: This research advocates for hybrid models, blending professional supervision with online flexibility, recognizing the distinct challenges of substance use disorders. Insights from this study will contribute to shaping more effective, personalized interventions in the complex landscape of substance use disorders, offering guidance for advancing treatment strategies