Effects of physical activity on vascular function in autoimmune rheumatic diseases: A systematic review and meta-analysis

Objectives: To summarize existing evidence and quantify the effects of physical activity on vascular function and structure in autoimmune rheumatic diseases (ARDs). Methods: Databases were searched (through March 2020) for clinical trials evaluating the effects of physical activity interventions on markers of micro- and macrovascular function and macrovascular structure in ARDs. Studies were combined using random effects meta-analysis, which was conducted using Hedges' g. Meta-analyses were performed on each of the following outcomes: microvascular function [i.e. skin blood flow or vascular conductance responses to acetylcholine (ACh) or sodium nitropusside (SNP) administration]; macrovascular function [i.e. brachial flow-mediated dilation (FMD%) or brachial responses to glyceryl trinitrate (GTN%); and macrovascular structure [i.e. aortic pulse wave velocity (PWV)]. Results: Ten studies (11 trials) with a total of 355 participants were included in this review. Physical activity promoted significant improvements in microvascular [skin blood flow responses to ACh, g = 0.92 (95% CI 0.42, 1.42)] and macrovascular function [FMD%, g = 0.94 (95% CI 0.56, 1.02); GTN%, g = 0.53 (95% CI 0.09, 0.98)]. Conversely, there was no evidence for beneficial effects of physical activity on macrovascular structure [PWV, g = -0.41 (95% CI -1.13, 0.32)]. Conclusions: Overall, the available clinical trials demonstrated a beneficial effect of physical activity on markers of micro- and macrovascular function but not on macrovascular structure in patients with ARDs. The broad beneficial impact of physical activity across the vasculature identified in this review support its role as an effective non-pharmacological management strategy for patients with ARDs

Adherence to unsupervised exercise in sedentary individuals: A randomised feasibility trial of two mobile health interventions

Introduction: Adherence to unsupervised exercise is poor, yet unsupervised exercise interventions are utilised in most healthcare settings. Thus, investigating novel ways to enhance adherence to unsupervised exercise is essential. This study aimed to examine the feasibility of two mobile health (mHealth) technology–supported exercise and physical activity (PA) interventions to increase adherence to unsupervised exercise. Methods: Eighty-six participants were randomised to online resources ( n =  44, females n =  29) or MOTIVATE ( n =  42, females n =  28). The online resources group had access to booklets and videos to assist in performing a progressive exercise programme. MOTIVATE participants received exercise counselling sessions supported via mHealth biometrics which allowed instant participant feedback on exercise intensity, and communication with an exercise specialist. Heart rate (HR) monitoring, survey-reported exercise behaviour and accelerometer-derived PA were used to quantify adherence. Remote measurement techniques were used to assess anthropometrics, blood pressure, HbA1c and lipid profiles. Results: HR–derived adherence rates were 22  ±  34% and 113  ±  68% in the online resources and MOTIVATE groups, respectively. Self-reported exercise behaviour demonstrated moderate (Cohen's d =  0.63, CI  =  0.27 to 0.99) and large effects (Cohen's d =  0.88, CI  =  0.49 to 1.26) in favour of online resources and MOTIVATE groups, respectively. When dropouts were included, 84% of remotely gathered data were available, with dropouts removed data availability was 94%. Conclusion: Data suggest both interventions have a positive impact on adherence to unsupervised exercise but MOTIVATE enables participants to meet recommended exercise guidelines. Nevertheless, to maximise adherence to unsupervised exercise, future appropriately powered trials should explore the effectiveness of the MOTIVATE intervention

Impact of handgrip exercise and ischemic preconditioning on local and remote protection against endothelial reperfusion injury in young men.

Aims/Hypothesis: Ischemic preconditioning (IPC), cyclical bouts of non-lethal ischemia, provides immediate protection against ischemic injury, which is evident both locally and remotely. Given the similarities in protective effects of exercise with ischemic preconditioning, we examined whether handgrip exercise also offers protection against endothelial ischemia-reperfusion (IR)-injury, and whether this protection is equally present in the local (exercised) and remote (contralateral, non-exercised) arm. Methods: Fifteen healthy males (age 24±3 years; BMI 25±2 kg/m2) attended the laboratory on 3 occasions. Bilateral brachial artery flow-mediated dilation (FMD) was examined at rest and following a temporary IR-injury in the upper arm. Prior to the IR-injury, in the dominant (local) arm participants performed (randomised, counterbalanced); i. 4x5 minutes unilateral handgrip exercise (50% maximal voluntary contraction), ii. 4x5 minutes unilateral IPC (220 mmHg), or iii. 4x5 minutes rest (control). Data were analysed using repeated measures general linear models. Results: Allometrically scaled FMD declined after IR in the control condition (4.6 ± 1.3% to 2.2 ± 1.7%, P<0.001), as well as following handgrip exercise (4.6 ± 1.6% to 3.4 ± 1.9%, P=0.01), however was significantly attenuated with IPC (4.5 ± 1.4% to 3.8 ± 3.5%, P=0.14). There were no differences between the local and remote arm. Conclusion: Our findings reinforce the established protective effects of IPC in young, healthy males, and also highlight a novel strategy to protect against IR injury with handgrip exercise, which warrants further study