Metabolic Health in Adult Life

Several noncommunicable diseases have their origins in early developmental phases. One factor possibly explaining the association between early growth and later health could be adipocyte function. The objective of this study was to assess the association between the adipocytokine chemerin and early growth and later health. 1074 participants from Helsinki Birth Cohort Study born 1934-1944 with information on prenatal and childhood growth participated. Metabolic outcomes include glucose tolerance, adiposity, and chemerin concentration. Mean chemerin concentrations were 5.0 ng/mL higher in women than in men (95% CI 2.7 to 7.2, < 0.001). The strongest correlate of chemerin concentration was adult waist circumference and body fat percentage ( = 0.22, < 0.001 and = 0.21, < 0.001, resp.). After adjustment for body fat percentage, chemerin concentration was 5.4 ng/mL lower in subjects with type 2 diabetes than in those with normal glucose tolerance (−0.2 to 10.9, = 0.06). It was 3.0 ng/mL higher in those with metabolic syndrome than in those without (0.6 to 5.3, = 0.01). No measure of early growth was associated with chemerin concentration. Our findings do not support a role for chemerin in linking early growth with later metabolic health

Improved Aerobic Capacity and Adipokine Profile Together with Weight Loss Improve Glycemic Control without Changes in Skeletal Muscle GLUT-4 Gene Expression in Middle-Aged Subjects with Impaired Glucose Tolerance

(1) Objective: The aim of this study was to clarify the role of adipokines in the regulation of glucose metabolism in middle-aged obese subjects with impaired glucose tolerance in response to a long-term exercise and dietary intervention. (2) Methods: Skeletal muscle, plasma and serum samples were examined in 22 subjects from an exercise-diet intervention study aiming to prevent type 2 diabetes. The subjects were further divided into two subgroups (non-responders n = 9 and responders n = 13) based on their achievement in losing at least 3 kg. (3) Results: The two-year exercise-diet intervention reduced leptin levels and increased adiponectin levels in responders; the changes in leptin levels were significantly associated with changes in their weights (r = 0.662, p 2peak) (r = 0.831, p p 2peak and oxidative capacity of skeletal muscle improved in responders, but not in non-responders. However, there were no changes between the two groups in expressions of the glucose transporter protein-4 (GLUT-4) gene or of AMP-activated protein kinase (AMPK)-alpha 1 or AMPK-alpha 2 proteins. (4) Conclusions: The exercise-diet intervention decreased serum leptin and increased serum adiponectin concentrations, improved glucose control without affecting GLUT-4 gene expression in the skeletal muscle in responders.</p

Humanin skeletal muscle protein levels increase after resistance training in men with impaired glucose metabolism

Humanin (HN) is a mitochondrially encoded and secreted peptide linked to glucose metabolism and tissue protecting mechanisms. Whether skeletal muscle HN gene or protein expression is influenced by exercise remains unknown. In this intervention study we show, for the first time, that HN protein levels increase in human skeletal muscle following 12 weeks of resistance training in persons with prediabetes. Male subjects (n = 55) with impaired glucose regulation (IGR) were recruited and randomly assigned to resistance training, Nordic walking or a control group. The exercise interventions were performed three times per week for 12 weeks with progressively increased intensity during the intervention period. Biopsies from the vastus lateralis muscle and venous blood samples were taken before and after the intervention. Skeletal muscle and serum protein levels of HN were analyzed as well as skeletal muscle gene expression of the mitochondrially encoded gene MT-RNR2, containing the open reading frame for HN. To elucidate mitochondrial training adaptation, mtDNA, and nuclear DNA as well as Citrate synthase were measured. Skeletal muscle HN protein levels increased by 35% after 12 weeks of resistance training. No change in humanin protein levels was seen in serum in any of the intervention groups. There was a significant correlation between humanin levels in serum and the improvements in the 2 h glucose loading test in the resistance training group. The increase in HN protein levels in skeletal muscle after regular resistance training in prediabetic males may suggest a role for HN in the regulation of glucose metabolism. Given the preventative effect of exercise on diabetes type 2, the role of HN as a mitochondrially derived peptide and an exercise-responsive mitokine warrants further investigation.</p

Exercise training with dietary counselling increases mitochondrial chaperone expression in middle-aged subjects with impaired glucose tolerance

<p>Abstract</p> <p>Background</p> <p>Insulin resistance and diabetes are associated with increased oxidative stress and impairment of cellular defence systems. Our purpose was to investigate the interaction between glucose metabolism, antioxidative capacity and heat shock protein (HSP) defence in different skeletal muscle phenotypes among middle-aged obese subjects during a long-term exercise and dietary intervention. As a sub-study of the Finnish Diabetes Prevention Study (DPS), 22 persons with impaired glucose tolerance (IGT) taking part in the intervention volunteered to give samples from the <it>vastus lateralis </it>muscle. Subjects were divided into two sub-groups (IGTslow and IGTfast) on the basis of their baseline myosin heavy chain profile. Glucose metabolism, oxidative stress and HSP expressions were measured before and after the 2-year intervention.</p> <p>Results</p> <p>Exercise training, combined with dietary counselling, increased the expression of mitochondrial chaperones HSP60 and glucose-regulated protein 75 (GRP75) in the <it>vastus lateralis </it>muscle in the IGTslow group and that of HSP60 in the IGTfast group. In cytoplasmic chaperones HSP72 or HSP90 no changes took place. In the IGTslow group, a significant positive correlation between the increased muscle content of HSP60 and the oxygen radical absorbing capacity values and, in the IGTfast group, between the improved VO_2maxvalue and the increased protein expression of GRP75 were found. Serum uric acid concentrations decreased in both sub-groups and serum protein carbonyl concentrations decreased in the IGTfast group.</p> <p>Conclusion</p> <p>The 2-year intervention up-regulated mitochondrial HSP expressions in middle-aged subjects with impaired glucose tolerance. These improvements, however, were not correlated directly with enhanced glucose tolerance.</p

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Effect of physical activity counselling on the number of contacts in primary healthcare, specialised healthcare and the related healthcare costs among patients with type 2 diabetes: a register-based evaluation study

Introduction This study evaluated the effect of physical activity (PA) counselling on the number of contacts and related costs in primary healthcare (PHC) and specialised healthcare (SHC) among patients with type 2 diabetes (T2D).Methods The study was carried out in North Karelia, Finland, among PHC clients with T2D in 2016–2018. Altogether, 521 patients participated in the counselling. In total, 1382 sex, age, time of diagnosis and intervention time-matched controls were used to assess the effect of the intervention. Information on outpatient nurse and physician appointments in PHC and SHC was collected from October 2016 to December 2019. The reason for the visit was identified with the recorded main diagnosis using both International Classification of Diseases-10 and International Standard Classification of Primary Care-2 diagnoses. Unit costs of SHC visits were based on average diagnosis-related group costs and for PHC unit costs for appointments for physicians, nurses and physiotherapists on the national price list.Results The number of physician and nurse appointments in the PHC related to T2D decreased in the intervention group and increased in the control group with statistically significant differences in mean annual changes between groups (p=0.010 and p&lt;0.001, respectively). In PHC, the number of physician appointments related to musculoskeletal disorders decreased in the intervention group and increased in the control group with a statistically significant difference between groups (p&lt;0.001). In the intervention group, T2D-related costs of appointments per person-year in PHC decreased, while an increase was observed in the control group (p&lt;0.001).Conclusions This study shows that PA counselling in PHC offers significant benefits in the treatment of patients with T2D by also improving the use of the resources in healthcare. The PA counselling reduced the number of other appointments and costs of appointments per person-year

The impact on physical performance, pain and psychological wellbeing of chronic low back pain patients during 12-weeks of equine- facilitated therapy intervention

Equine - Facilitated Therapy (EFT), an equine environment, and horses themselves can meet many physical and mental health needs beyond diagnostic categories. The horse's ability to produce a walk-like movement and the participant's ability to connect to non-judgemental living creatures, both of which can benefit participation and construct a positive self-image for chronic pain patients. The objective of this study is to evaluate the impact of EFT on perceived physical performance, level of pain, pain acceptance, depression and anxiety, and quality of life within a 12-week intervention for chronic low back pain (LBP) patients. Twenty-two LBP patients received EFT led by physical therapists as part of the public health services. A mixed method design combining quantitative and qualitative methods was employed to detect the outcome of the intervention. The data were collected via questionnaires, interviews, and patient data repositories. An interview was voluntary for participants and included questions of one's health, visits to the pain clinic during 6 months and an open-ended question about the intervention. The coding of the data was completed independently by two persons using thematizing. The welfare of the attending horses was taken into consideration in basic training and for the research setting. Statistical analysis and paired t-tests detected the changes during a 12-week intervention. The results suggest a significant increase in Canadian Occupational Performance Measure (COPM) levels of satisfaction with self-selected performances. The Raitasalo's version of Beck's Depression Inventory (RBDI) level of anxiety and Chronic Pain Acceptance Questionnaire (CPAQ) did not change, whereas a decline in the amount of perceived RBDI depression was found combined with increased levels of SF-36 Mental Change Scores and COPM satisfaction with performance. Only two of the 22 participants returned with reoccurring symptoms after 6 months to the pain clinic. The participant interviews revealed three important domains of experience during coding: physical-, psychological-, and social that link to the research question and suggest impact for the recovery from the human-animal interaction

Validity and Reliability of Dynamic and Functional Balance Tests in People Aged 19-54: A Systematic Review

Evaluating an impairment in an individual's capacity to maintain, achieve, or restore balance suggests a deficiency in postural control. For effective identification of individuals at risk for falls, balance assessment should exhibit reliability, validity, and ease of use. This systematic review concentrated on dynamic and functional balance assessment methods and their validity in healthy adults aged 19-54. The objective was to clarify the tools that health professionals can utilize to assess balance in this healthy population. # Methods A systematic literature search conducted in August 2019 yielded nine articles meeting predefined selection criteria. Inclusion criteria required studies featuring healthy adult participants aged 19-54, published in English, and focusing on dynamic and functional balance testing. Exclusion criteria excluded studies involving participants with chronic diseases or musculoskeletal disorders, systematic reviews, professional athletes, and those lacking specific participant age information. The quality of the studies was evaluated using a modified PEDro scale. # Results This review analyzed ten distinct postural balance tests. The Star Excursion Balance Test and Y-Balance Test exhibited moderate to high reliability, establishing them as dependable measures of dynamic balance. The Nintendo Wii Balance Board, Clever Balance Board, and Posturomed device also displayed excellent reliability for assessing dynamic postural balance. Comparing one-arm and two-arm functional reach tests, the one-arm reach test emerged as a more suitable option for evaluating dynamic balance among young adults. Moreover, an investigation comparing three dynamic balance tests (one-leg jump landing, Posturomed device, and stimulated forward fall) revealed a low correlation among these tests, indicating a measurement of different balance constructs. # Discussion In conclusion, the Y-Balance Test stands out as the most practical dynamic balance assessment for clinical use, characterized by a standardized protocol, good repeatability, affordability, and ease of application. The Nintendo Wii Balance Board also presents itself as a cost-effective and reliable tool for dynamic balance evaluation in clinical settings. It is crucial to recognize that these tests appraise discrete postural skills, preventing direct comparisons between test outcomes. This review equips healthcare professionals with valuable insights into optimal balance assessment methods for the healthy, 19 to 54 aged population. # Levels of evidence Level

Effectiveness of physical activity counselling provided for people with type 2 diabetes mellitus in primary healthcare in North Karelia, Finland: a register-based evaluation study

Objectives Physical activity (PA) plays a significant role in the treatment of type two diabetes (T2D). This study evaluated the effectiveness of PA counselling in primary healthcare (PHC) on clinical outcome measures in patients with T2D, comparing them with a registry-based controls.Setting The study was carried out in North Karelia, Finland, among PHC clients who have been diagnosed with T2D in 2016–2018.Participants The study population consisted of patients aged 19–87 years diagnosed with T2D (n=1803). Altogether 546 patients were referred to the PA educator of whom 521 participated the counselling. In totally 1382 sex, age, time of diagnosis and intervention time-matched controls were used to see the effect of intervention.Interventions Patients with T2D followed up in PHC were offered to participate in PA counselling provided by trained PA educators. The number of counselling sessions and their content were tailored according to patients needs and willingness to participate. To assess the effects of PA to management of T2D clinical outcome measures such as weight and Haemoglobin A1c (HbA1c) and lipid levels were assessed using data from electronic patient records. Each patient was followed up from records at least for a year.Results Weight and body mass index (BMI) decreased in both groups and mean yearly changes did not differ between the groups. HbA1c levels declined in the intervention and increased in the control group with statistically significant difference in the mean yearly change between the groups (p=0.001). The low-density lipoprotein declined in both groups. The decline was bigger in the intervention group, but the difference did not quite reach the statistical significance (p=0.096).Conclusions This study shows that PA counselling in PHC offers significant benefits in the treatment outcomes of T2D although no significant declines were not observed in the weight or BMI