Studying the cutaneous microcirculatory response during upper-limb exercise in healthy, older, sedentary people

This study investigated changes incurred in cutaneous skin blood flux (SKBF) in the superficial veins of the lower limb by upper limb exercise training in the form of arm-cranking in 14 healthy participants over the age of 50 years. Changes in cutaneous microvascular function of the lower leg were assessed using laser Doppler Flowmetry (LDF) during a 30-minute exercise session undertaken over 4-exercise periods. Both SKBF and Time to reach Peak Perfusion (Tmax) were improved significantly during the 2nd (e.g. 121 (±107.2) vs 280 (±269.1) and 171 (±34.4) vs. 247 (±38.3) respectively) when compared to the first exercise period, while values approaching initial levels in the following stages. The results indicate that the thermoregulatory and vasodilation mechanisms observed during exercise in middle-aged and older healthy people are different to the one appearing in younger age groups, suggesting a more extensive effect of the age-related structural changes than it was previously thought

Physiological effects of a short-term, lifestyle intervention based on the Mediterranean diet - comparison between older and younger healthy, sedentary adults

Objective: To determine whether short-term adherence to the Mediterranean Diet (MD) is associated with improved physiological function. Research Methods and Procedures: This was a single-centre, cohort pilot study. Twenty-four healthy, sedentary younger (18-35 years) and older (55-75 years) adults took part. Participants were advised and supported to follow the Mediterranean diet for 4 weeks. We took baseline and post-intervention measurements of weight, height, waist and hip circumference, blood pressure, heart rate, as well as microvascular physiological assessments using laser Doppler Fluximetry (LDF) at rest as well as transcutaneous oxygen pressure (TcPO2) during a sub-maximal exercise assessment. Results: We identified statistically-significant improvements in axon-mediated microvascular vasodilation (2.24 (±0.56) to 3.14 (±0.84), P =0.03) and endothelial-mediated NO synthesis (2.59 (±0.67) to 3.32 (±0.87), P =0.022) in the younger group. Despite the intervention not including an exercise element, the rate of perceived exertion was reduced in both groups (p<0.001), after following the MD for a month. Conclusions: Improvements in physiological function were observed following a short-term dietary intervention based on the MD in a younger population. These were not matched in a senior group. Our findings suggest that different durations should be applied when designing dietary interventions in different age-groups, with expectations in physiological improvements differing. Keywords: Mediterranean diet, LDF, Oxygen tension, cardiovascular disease, blood pressure

Exploring the feasibility of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis.

OBJECTIVES: It is suggested that exercise can improve the vascular function and quality of life (QoL) in people with systemic sclerosis (SSc), potentially offering clinical benefits to this population. Yet the feasibility of such an intervention remains untested. Therefore, the purpose of this study is to examine the feasibility of a combined exercise protocol (aerobic and resistance training) in people with limited cutaneous SSc (lcSSc). METHODS: Thirty-two lcSSc patients (66.5 ± 12 years old) were randomly allocated in two groups (exercise and control group). The exercise group underwent a 12-week exercise programme, twice per week. All patients performed the baseline, three- and six-month follow-up measurements where functional ability, body composition and QoL were assessed. Participants' experiences were explored through interviews. RESULTS: Compliance was 92.6% with no dropouts. The individuals' confidence to participate in the study's exercise protocol for twice per week was 95%. The average value for the physical activity enjoyment scale was 103 ± 10 out of 119 (highest score). The mean values for the intention to engage in exercise twice per week were 6.4 ± 1 (likely) out of 7 (very likely). QoL for the exercise group showed to have a better life satisfaction, less anxiety and Raynaud's phenomenon-accompanied pain. CONCLUSIONS: Our results suggest that a combined exercise protocol was feasible for people with lcSSc, with no adverse events, resulting in high adherence and low attrition rates, high enjoyment levels and intentions for future engagement to this exercise. Thus, the specific protocol is a safe adjunct therapy for people with lcSSc. TRIAL REGISTRATION: ClinicalTrials.gov (NCT number): NCT03058887, February 23, 2017, https://clinicaltrials.gov/ct2/show/NCT03058887?term=NCT03058887&rank=1Key Points• High-intensity interval training in combination with resistance training constitutes a feasible exercise protocol for people with lcSSc.• Overall, the exercise programme demonstrated high adherence and enjoyment levels and low attrition rates.• The exercise protocol was proved to be safe with no adverse events for people with lcSSc

Commentary on: "Implementing a Mediterranean-Style Diet Outside the Mediterranean Region".

Letter to the editor

Supervised exercise training and increased physical activity to reduce cardiovascular disease risk in women with polycystic ovary syndrome: Study protocol for a randomized controlled feasibility trial

Background: Polycystic ovary syndrome (PCOS) affects up to 20% of women and is characterised by higher amounts of visceral fat, obesity, insulin resistance, dyslipidemia and reproductive and cardiometabolic complications. Increased oxidised low-density lipoprotein (LDL) concentrations have been associated with an increased risk of cardiovascular disease (CVD)-related events. Oxidised LDL is rarely used as a marker for CVD risk in PCOS-related studies despite its widely accepted role in atherogenesis and the increased risk factors associated with PCOS. Additionally, prolonged periods of sedentary behaviour can negatively affect metabolic health. No studies have specifically examined the effects of reducing sedentary behaviour on CVD risk in PCOS with a lifestyle physical activity intervention. The aim of the current study is to measure the feasibility of a randomised controlled trial (RCT) examining the effects of supervised exercise and reducing sedentary behaviour in women with PCOS on CVD risk. Methods/design: A feasibility, exploratory RCT will be conducted. Fifty-one pre-menopausal females will be randomly allocated between an exercise group (EG), a lifestyle physical activity group (LPAG) and a control group. Participants in the EG will undertake a 12-week supervised aerobic exercise programme. The LPAG will aim to increase daily physical activity and reduce sedentary behaviour for 12 weeks. The control group will not take part in any intervention. Primary outcomes are feasibility and acceptability of the intervention and procedures. Secondary outcomes are oxidised LDL, aerobic fitness, blood lipid profile, fasting glucose and insulin, testosterone and inflammatory markers. Discussion: PCOS is associated with various increased risk factors for CVD, including hypertension, dyslipidemia, abdominal obesity, insulin resistance, and inflammation. Whether oxidised LDL has a role in this increased risk is not yet known. The present study aims to measure the feasibility of implementing structured exercise training and/or increased lifestyle physical activity in women with PCOS, so that a subsequent adequately powered RCT can be designed. The results from the study will be used to refine the interventions and determine the acceptability of the study design. A limitation is that some self-monitoring in the lifestyle physical activity group may not be reliable or replicable, for example inputting information about time spent cleaning/gardening

Validation of an arm crank ergometer test for use in sedentary adults

The maximal oxygen uptake (V̇O2peak) test is an approved pre-operative examination tool, in a clinical setting: Both V̇O2peak and anaerobic threshold indicate a patient's physiological tolerance for major surgery and post-operative mortality, with cycle ergometry being routinely used for V̇O2peak tests in clinical settings, in many European countries. Nevertheless, the opportunities to assess populations with restricted mobility of the lower limbs are limited, as alternative methods (such as an arm-crank test protocol) to assess V̇O2peak are yet to be established. Twelve sedentary middle-aged adults (55.1 ± 5.0 years) performed two incremental protocols on an arm crank and cycle ergometer on separate occasions. During exercise, gas exchange was collected and analysed by an online breath-by-breath analysis system. Regression analysis showed that the model with dependent variable cycle ergometer V̇O2peak (CEV̇O2peak) in ml·kg-1·min-1 and independent variables arm crank V̇O2peak (ACEV̇O2peak) in ml·kg-1·min-1, lean body mass lower limbs (LBMLL) and total lean body mass (TLBM) fitted the population the best, with r2 = 0.87, adj. r2 = 0.82 and SEE = 3.14. The equation estimated with this model is: CE V̇O2peak = 11.776 + 1.418 X ACE V̇O2peak(ml·kg-1·min-) – 1.454 x TLBM + 3.967 X LLLBM. Our study suggests that arm cranking could be an alternative mode of exercise for sedentary middle-aged adults (and potentially in clinical settings) to assess the cardiorespiratory fitness of people with restricted lower-limb mobility. Key words: Cardiopulmonary test, arm exercise, physiological responses, upper limbs

Assessing the effects of a short-term green tea intervention in skin microvascular and oxygen tension in older and younger adults

Green tea consumption has been associated with a reduction in cardiovascular disease risk factors. However, there is little evidence examining its potential differing effect between younger and older populations, while little is known on its effect on the circulatory system when oxygen demand is higher. Therefore the aim of this study was to evaluate the short-term effects of green tea consumption on microvascular functioning in both an older and younger population. Fifteen young [24 (4.0)] and fifteen older [61 (4.0)] participants, consumed two cups of green tea daily for 14 days. We used Laser Doppler Flowmetry to assess cutaneous microvascular function and Transcutaneous Oxygen Pressure to assess skin oxygen tension. Systolic and diastolic blood pressure were also assessed on both visits. We observed significant improvements in axon-mediated microvascular vasodilation for the younger group [1.6 (0.59) vs 2.05 (0.72), p<0.05] and the older group [1.25 (0.58) vs 1.65 (0.5) p<0.05]. Improvements in skin oxygen tension were also noted for both groups in both noted TcPO2 measures (i.e. 1.25 (0.58) vs 1.65 (0.5) (p<0.05), for ΔTcPO2max for the older group, between visits) respectively. Improvements were also observed for systolic blood pressure in both the younger [120 (10) vs 112 (10), p<0.05] and older group [129 (12) v 124 (11), p<0.001]. In conclusion, we observed statistically-significant improvements in microvascular function and skin oxygen tension. Our results suggest that green tea may prove beneficial as a dietary element in lifestyle interventions aiming to lower cardiovascular disease risk, in both older and younger populations

Encouraging effects of a short-term, adapted Nordic diet intervention on skin microvascular function and skin oxygen tension in younger and older adults

Objective: Microvascular benefits of regional diets are appearing in the literature however little is known about Nordic-type diets. We investigated the effects of short-term adapted Nordic diet on microvascular function in younger and older individuals at rest and during activity. Research Method & Procedures: Thirteen young [Mean: 28, SD: (5)] and fifteen older participants [Mean: 68, SD: (6)] consumed a modified Nordic diet for four weeks. Laser Doppler Flowmetry and Transcutaneous oxygen monitoring assessed cutaneous microvascular function and oxygen tension pre and post-intervention; blood pressure, body mass, body-fat%, ratings of perceived exertion and peak heart rate during activity were examined concurrently. Results: Axon-mediated vasodilation improved in older participants [1.17 (0.30) to 1.30 (0.30); P < 0.05]. Improvements in endothelium-dependent vasodilation were noted in young [1.67 (0.50) to 2.03 (0.62); P < 0.05] and older participants [1.49 (0.37) to 1.63 (0.39); P < 0.05]. Reduced peak heart rate during activity was noted in older participants only [36.5(8.9) to 35.3(8.5); P < 0.05] and reduced body-fat % in young participants only [young = 27.2 (8.3) to 25.2 (8.8); P < 0.05]. No other variables reached statistical significance however trends were observed. Conclusions: We observed statistically-significant improvements in microvascular function, peak heart rate and body composition. Following an adapted Nordic diet might improve microvascular health. Keywords Nordic Diet; Laser Doppler Flowmetry; Oxygen Tensio

Exploring the microcirculatory effects of an exercise programme including aerobic and resistance training in people with limited cutaneous systemic sclerosis.

Purpose of the study High intensity interval training (HIIT) is able to improve the endothelial-dependent microvascular function is people with limited cutaneous systemic sclerosis (lcSSc). Resistance training (RT) alone has shown significant improvements in the function of the vasculature; moreover, a combination of aerobic and RT have shown both in the past and recently to significantly improve the vascular function and the microcirculation. Therefore, the purpose of this study is to explore the effectiveness of a combined exercise protocol (aerobic and resistance training) on microvascular function in people with lcSSc. Methods Thirty-two lcSSc patients (66.5 ± 12 years old) were randomly allocated in two groups (exercise and control group). The exercise group underwent a 12-week exercise programme twice per week. All patients performed the baseline, three- and six-month follow up measurements where microvascular function, transcutaneous oxygen tension (ΔTcpO2) and body composition were assessed. Results The time to peak endothelial-dependent reactivity was significantly improved (91 ± 42 s, d = 1.06, p = 0.007) when compared to control group after the exercise intervention. Endothelial-independent function was also significantly improved (3.16 ± 2, d = 1.17, p = 0.005) when compared to the control group. Baseline (5.71 ± 4.4, p < 0.05)) and peak (15.4 ± 7.5, p < 0.05) transcutaneous oxygen pressure were also significantly improved compared to the control group. Conclusions Our results suggest that a combined exercise protocol (aerobic and RT) was effective in improving endothelial-dependent reactivity in people with lcSSc. The next step would be to explore its clinical- and cost- effectiveness. Therefore, we recommend a large, community-based intervention against standard pharmacotherapy only, which would assess these important factors and support a change in therapeutic protocols and guidelines for this clinical population