Effects Of Community-Based Exercise Training Among Older Individuals With Metabolic Disease, Cardiovascular Disease, Or Muscle Atrophy

Exercise training is associated with increased health benefits such as improved quality of life, mental health, and physical functioning. PURPOSE: The purpose of this study is to quantify the effects of structured aerobic and resistance exercise training on body composition, functional tests, and quality of life in older individuals in a community-based facility. We hypothesized that at least moderate participation in the program would decrease fat mass, improve outcomes on grip and timed movement tests, and increase quality of life. METHODS: Twenty subjects who were members from a community-based institute participated in the study (7M:13F; 69.10 ± 6.40 yrs [mean ± sd]; 166.88 ± 10.52 cm; 76.40 ± 16.42 kg) and had metabolic or cardiovascular disease, or muscle atrophy. Subjects were expected to participate in 3, 30-min sessions/week for 8 weeks. The program was 30 min aerobic conditioning of intervals and 6–7 full-body resistance exercises and basic stretches. We measured height (cm), weight (kg), fat mass (kg), lean mass (kg), grip strength (kg), timed-up-go (TUG, s), 10-meter walk forwards (s), 10-meter walk backwards (a novel movement) (s), 6-minute walk tests (m), the Health-Related Quality of Life (CDC HRQOL-4) survey, and 36-Item Short-Form Health (SF-36), before and after the completion of exercise training. We performed paired t-tests on testing variables and the 8 subsections of the SF-36 and one-sample t-tests on the delta of questions on the HRQOL-4. Alpha \u3c0.05. RESULTS: There were no significant differences in any of the SF-36 subsections or testing variables (p \u3e 0.05) except for increased right-hand grip strength (2.02 ± 4.35 kg, p = 0.05) and decreased time in the backwards 10-meter walk (0.52 ± 0.88 s, p = 0.02). Concerning the HRQOL-4, no members had fair to poor self-rated health before or after the program, more members experienced fewer but non-significant physically unhealthy days (delta = -3.61 ± 8.67 days, p = 0.10), and a similar number of mentally unhealthy days and days when poor mental/physical health kept them from usual activities (p \u3e 0.05). CONCLUSION: These preliminary findings suggest that there may be clinically meaningful improvements in strength and novel movement in these older individuals after an 8-week prescribed and training program in the community setting. Different measurements of quality of life in this population should be explored

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline