Abstract: A meta-analysis examined data from 36 studies linking physical activity to well-being in older adults without clinical disorders. The weighted mean-change effect size for treatment groups (d(C). = 0.24) was almost 3 times the mean for control groups (d(C). = 0.09). Aerobic training was most beneficial (d(C). = 0.29), and moderate intensity activity was the most beneficial activity level (d(C). = 0.34). Longer exercise duration was less beneficial for several types of well-being, though findings are inconclusive. Physical activity had the strongest effects on self-efficacy (d(C).= 0.38), and improvements in cardiovascular status, strength, and functional capacity were linked to well-being improvement overall. Social-cognitive theory is used to explain the effect of physical activity on well-being.

Abstract: background Changes in heart rate during exercise and recovery from exercise are mediated by the balance between sympathetic and vagal activity. Since alterations in the neural control of cardiac function contribute to the risk of sudden death, we tested the hypothesis that among apparently healthy persons, sudden death is more likely to occur in the presence of abnormal heart-rate profiles during exercise and recovery. methods A total of 5713 asymptomatic working men (between the ages of 42 and 53 years), none of whom had clinically detectable cardiovascular disease, underwent standardized graded exercise testing between 1967 and 1972. We examined data on the subjects’ resting heart rates, the increase in rate from the resting level to the peak exercise level, and the decrease in rate from the peak exercise level to the level one minute after the termination of exercise. results During a 23-year follow-up period, 81 subjects died suddenly. The risk of sudden death from myocardial infarction was increased in subjects with a resting heart rate that was more than 75 beats per minute (relative risk, 3.92; 95 percent confidence interval, 1.91 to 8.00); in subjects with an increase in heart rate during exercise that was less than 89 beats per minute (relative risk, 6.18; 95 percent confidence interval, 2.37 to 16.11); and in subjects with a decrease in heart rate of less than 25 beats per minute after the termination of exercise (relative risk, 2.20; 95 percent confidence interval, 1.02 to 4.74). After adjustment for potential confounding variables, these three factors remained strongly associated with an increased risk of sudden death, with a moderate but significantly increased risk of death from any cause but not of nonsudden death from myocardial infarction. conclusions The heart-rate profile during exercise and recovery is a predictor of sudden death.

Abstract: BACKGROUND: Although some patients with adult congenital heart disease (ACHD) report limitations in exercise capacity, we hypothesized that depressed exercise capacity may be more widespread than s ...

Abstract: To assess the effectiveness of dietary interventions and exercise in long-term weight loss in overweight and obese people. A systematic review with meta-analysis. Overweight and obese adults—18 years old or older with body mass index (calculated as weight divided by the square of height in meters)>25. Medline, Cochrane Library and Lilacs databases up to March 2003. Also, published reviews and all relevant studies and their reference lists were reviewed in search for other pertinent publications. No language restrictions were imposed. Randomised clinical trials comparing diet and exercise interventions vs diet alone. All trials included a follow-up of 1 y after intervention. Two reviewers independently abstracted data and evaluated the studies’ quality with criteria adapted from the Jadad Scale and the Delphi list. The estimate of the intervention's effect size was based on the differences between the comparison groups, and then the overall effect was calculated. A chi-squared test was used to assess statistical heterogeneity. A total of 33 trials evaluating diet, exercise or diet and exercise were found. Only 6 studies directly comparing diet and exercise vs diet alone were included (3 additional studies reporting repeated observations were excluded). The active intervention period ranged between 10 and 52 weeks across studies. Diet associated with exercise produced a 20% greater initial weight loss. (13 kg vs 9.9 kg; z=1.86—p=0.063, 95%CI). The combined intervention also resulted in a 20% greater sustained weight loss after 1 y (6.7 kg vs 4.5 kg; z=1.89—p=0.058, 95%CI) than diet alone. In both groups, almost half of the initial weight loss was regained after 1 y. Diet associated with exercise results in significant and clinically meaningful initial weight loss. This is partially sustained after 1 y.

Abstract: Purpose To systematically review the methodologic quality of, and summarize the evidence from trials examining the effectiveness of physical exercise in improving the level of physical functioning and psychological well-being of cancer patients during and after medical treatment Methods Thirty-four randomized clinical trials (RCTs) and controlled clinical trials were identified, reviewed for substantive results, and assessed for methodologic quality Results Four of 34 trials met all (seven of seven) methodologic criteria on the Delphi criteria list Failure to conceal the sequencing of treatment allocation before patient recruitment, failure to blind the outcome assessor, and failure to employ an intention-to-treat analysis strategy were the most prevalent methodologic shortcomings Various exercise modalities have been applied, differing in content, frequency, intensity, and duration Positive results have been observed for a diverse set of outcomes, including physiologic measures, objective performance indicators, self-reported functioning and symptoms, psychological well-being, and overall health-related quality of life Conclusion The trials reviewed were of moderate methodologic quality Together they suggest that cancer patients may benefit from physical exercise both during and after treatment However, the specific beneficial effects of physical exercise may vary as a function of the stage of disease, the nature of the medical treatment, and the current lifestyle of the patient Future RCTs should use larger samples, use appropriate comparison groups to rule out the possibility of an attention-placebo effect, use a comparable set of outcome measures, pay greater attention to issues of motivation and adherence of patients participating in exercise programs, and examine the effect of exercise on cancer survival

Abstract: The aim of the present study was to establish fat oxidation rates over a range of exercise intensities in a large group of healthy men and women. It was hypothesised that exercise intensity is of p...

Abstract: Intermittent fasting (IF; reduced meal frequency) and caloric restriction (CR) extend lifespan and increase resistance to age-related diseases in rodents and monkeys and improve the health of overweight humans. Both IF and CR enhance cardiovascular and brain functions and improve several risk factors for coronary artery disease and stroke including a reduction in blood pressure and increased insulin sensitivity. Cardiovascular stress adaptation is improved and heart rate variability is increased in rodents maintained on an IF or a CR diet. Moreover, rodents maintained on an IF regimen exhibit increased resistance of heart and brain cells to ischemic injury in experimental models of myocardial infarction and stroke. The beneficial effects of IF and CR result from at least two mechanisms — reduced oxidative damage and increased cellular stress resistance. Recent findings suggest that some of the beneficial effects of IF on both the cardiovascular system and the brain are mediated by brain-derived neurotrophic factor signaling in the brain. Interestingly, cellular and molecular effects of IF and CR on the cardiovascular system and the brain are similar to those of regular physical exercise, suggesting shared mechanisms. A better understanding of the cellular and molecular mechanisms by which IF and CR affect the blood vessels and heart and brain cells will likely lead to novel preventative and therapeutic strategies for extending health span.

Abstract: It has been recognized for some time that cardiovascular disease and type 2 diabetes are, to a major extent, inflammatory disorders associated with an environment characterized by a sedentary lifestyle together with abundant intakes of calories. Systemic low-level inflammation is suggested to be a cause as well as consequence of pathological processes with local tumor necrosis factor alpha production as an important biological driver. It is hypothesized that physical inactivity contributes to an enhanced proinflammatory burden independently of obesity, as regular muscle contractions mediate signals with myokines/cytokines as important messengers, which suppress proinflammatory activity at distant sites as well as within skeletal muscle. Muscle-derived interleukin (IL)-6 is considered to possess a central role in anti-inflammatory activities and health beneficial effects in relation to physical exercise. It is discussed how this fits the consistent observation that enhanced plasma levels of IL-6 represent a strong risk marker in chronic disorders associated with systemic low-level inflammation and all-cause mortality.

Abstract: We investigated the hemodynamic and hormonal responses to a short-term low-intensity resistance exercise (STLIRE) with the reduction of muscle blood flow. Eleven untrained men performed bilateral leg extension exercise under the reduction of muscle blood flow of the proximal end of both legs pressure-applied by a specially designed belt (a banding pressure of 1.3 times higher than resting systolic blood pressure, 160–180 mmHg), named as Kaatsu. The intensity of STLIRE was 20% of one repetition maximum. The subjects performed 30 repetitions, and after a 20-seconds rest, they performed three sets again until exhaustion. The superficial femoral arterial blood flow and hemodynamic parameters were measured by using the ultrasound and impedance cardiography. Serum concentrations of growth hormone (GH), vascular endothelial growth factor (VEGF), noradrenaline (NE), insulin-like growth factor (IGF)-1, ghrelin, and lactate were also measured. Under the conditions with Kaatsu, the arterial flow was reduced to about 30% of the control. STLIRE with Kaatsu significantly increased GH (0.11±0.03 to 8.6±1.1 ng/ml, P < 0.01), IGF-1 (210±40 to 236±56 ng/ml, P < 0.01), and VEGF (41±13 to 103±38 pg/ml, P < 0.05). The increase in GH was related to neither NE nor lactate, but the increase in VEGF was related to that in lactate (r = 0.57, P < 0.05). Ghrelin did not change during the exercise. The maximal heart rate (HR) and blood pressure (BP) in STLIRE with Kaatsu were higher than that without Kaatsu. Stroke volume (SV) was lower due to the decrease of the venous return by Kaatsu, but, total peripheral resistance (TPR) did not change significantly. These results suggest that STLIRE with Kaatsu significantly stimulates the exercise-induced GH, IGF, and VEGF responses with the reduction of cardiac preload during exercise, which may become a unique method for rehabilitation in patients with cardiovascular diseases.

Abstract: OBJECTIVE —Obesity and physical inactivity are established risk factors for type 2 diabetes and cardiovascular comorbidities. Whether adiposity or fitness level is more important to health is controversial. The objective of this research is to determine the relative associations of physical activity and BMI with the prevalence of diabetes and diabetes-related cardiovascular comorbidities in the U.S. RESEARCH DESIGN AND METHODS —The Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of the U.S. population. From 2000 to 2002, detailed information on sociodemographic characteristics and health conditions were collected for 68,500 adults. Normal weight was defined as BMI 18.5 to 2 , overweight 25 to ≤30 kg/m 2 , obese (class I and II) 30 to 2 , and obese (class III) ≥40 kg/m 2 . Physical activity was defined as moderate/vigorous activity ≥30 min ≥3 days per week. RESULTS —The likelihood of having diabetes and diabetes-related cardiovascular comorbidities increased with BMI regardless of physical activity and increased with physical inactivity regardless of BMI. Compared with normal-weight active adults, the multivariate-adjusted odds ratio (OR) for diabetes was 1.52 (95% CI 1.25–1.86) for normal-weight inactive adults and 1.65 (1.40–1.96) for overweight inactive adults; the OR for diabetes and comorbid hypertension was 1.71 (1.32–2.19) for normal-weight inactive adults and 1.84 (1.47–2.32) for overweight inactive adults. CONCLUSIONS —Both physical inactivity and obesity seem to be strongly and independently associated with diabetes and diabetes-related comorbidities. These results support continued research investigating the independent causal nature of these factors.

Abstract: BACKGROUND: Recent studies have demonstrated that exercise capacity is an independent predictor of mortality in women. Normative values of exercise capacity for age in women have not been well established. Our objectives were to construct a nomogram to permit determination of predicted exercise capacity for age in women and to assess the predictive value of the nomogram with respect to survival. METHODS: A total of 5721 asymptomatic women underwent a symptom-limited, maximal stress test. Exercise capacity was measured in metabolic equivalents (MET). Linear regression was used to estimate the mean MET achieved for age. A nomogram was established to allow the percentage of predicted exercise capacity to be estimated on the basis of age and the exercise capacity achieved. The nomogram was then used to determine the percentage of predicted exercise capacity for both the original cohort and a referral population of 4471 women with cardiovascular symptoms who underwent a symptom-limited stress test. Survival data were obtained for both cohorts, and Cox survival analysis was used to estimate the rates of death from any cause and from cardiac causes in each group. RESULTS: The linear regression equation for predicted exercise capacity (in MET) on the basis of age in the cohort of asymptomatic women was as follows: predicted MET = 14.7 - (0.13 x age). The risk of death among asymptomatic women whose exercise capacity was less than 85 percent of the predicted value for age was twice that among women whose exercise capacity was at least 85 percent of the age-predicted value (P<0.001). Results were similar in the cohort of symptomatic women. CONCLUSIONS: We have established a nomogram for predicted exercise capacity on the basis of age that is predictive of survival among both asymptomatic and symptomatic women. These findings could be incorporated into the interpretation of exercise stress tests, providing additional prognostic information for risk stratification.

Abstract: The consequences of physical inactivity are particularly detrimental in older individuals with chronic disease. Impairments resulting from chronic disease (e.g., reduced mobility, pain), in addition to the lack of accessible and appropriate community-based exercise programs could lead to further sedentary lifestyle, and additional declines in functional status.1 Physical inactivity could also contribute to secondary debilitating or life-threatening diseases. A recent study has found that approximately one third of cardiac disease and osteoporosis cases are attributable to lack of physical activity and have posed tremendous burden on the health care system.2 Stroke is one of the most common chronic conditions seen in older adults, with an incidence approximately doubling each decade after the age of 55.3 Most stroke survivors continue to live with residual physical impairments, which may promote a sedentary lifestyle and resultant secondary complications.4 One of the secondary complications commonly observed following stroke is poor cardiorespiratory fitness.5,6 Low cardiorespiratory fitness is related to poor functional performance7 and increased risk of stroke and cardiovascular disease.8,9 Indeed, cardiac events and recurrent stroke are major occurrences in stroke survivors.10,11 Other common stroke impairments are poor balance and muscle weakness,12–14 which may contribute to the higher incidence of falls in older adults with stroke than the age-matched population.15 In addition, poor mobility and decreased loading of the hemiparetic leg may also result in decline of hip bone mineral density (BMD).16,17 The increased falls and reduced bone health may in part explain the two to four time greater hip fracture risk among stroke survivors.18 These secondary conditions seen in stroke survivors are compounded by the fact that the number of older individuals with chronic stroke in the community is on the rise. Studies have shown that the incidence of stroke is increasing, particularly in older people.3 The mortality rate of stroke, however, has been declining3 and more stroke survivors are returning home instead of going into an inpatient rehabilitation program.19 These factors may translate into an increasing number of older adults living with a chronic stroke in the community, who have not attained optimal functional recovery and are at risk of developing secondary complications due to physical inactivity. There has been an increasing recognition of the importance of health promotion for people with disabilities.20 One of the key components of health promotion for people with disabilities is “the prevention of health complications (medical secondary conditions) and further disabling conditions”.20 According to the conceptual model of health promotion proposed by Rimmer20, community-based fitness programs play one important role in achieving this objective. Considering that physical inactivity in older adults with chronic stroke could lead to devastating secondary health complications, an accessible and multidimensional fitness program is urgently needed.21 Most exercise programs proposed for chronic stroke, however, are not community-based and have addressed only one or two of the impaired domains.5,6,22–24 Moreover, although it is known that stroke is a major risk factor for hip fracture,18 no study has examined the effects of exercise on hip BMD in stroke. This study aims to assess the efficacy of a multidimensional community-based fitness and mobility exercise (FAME) program for individuals with chronic stroke. This is the first study to examine the effects of exercise on hip BMD in this population. It was hypothesized that the individuals who underwent the FAME program would have significantly more improvement in cardiorespiratory fitness, mobility, leg muscle strength, balance, activity and participation, and hip BMD than those in the control group.

Abstract: Aims The aims of this study were to assess the accuracy of exercise testing in predicting symptom onset within 12 months in patients with asymptomatic aortic stenosis and to establish the criteria that define a positive test. Methods and results A total of 125 patients with aortic stenosis [effective orifice area (EOA) 0.9±0.2 cm2] were assessed by Specific Activity Scale (SAS) classification, transthoracic echocardiography, and treadmill exercise testing using the modified Bruce protocol. During follow-up, 36 patients (29%) developed spontaneous symptoms within 12 months. Of these, 26 (72%) had had symptoms revealed by exercise testing and 24 (67%) had severe stenosis (EOA≤0.8 cm2). Exercise-limiting symptoms were the only independent predictors of outcome at 12 months, and an abnormal blood pressure response or ST segment depression did not improve the accuracy of the exercise test. The positive predictive accuracy for exercise-induced symptoms was 57% in the whole population and 79% for patients aged <70 in SAS Class I. The negative predictive accuracy was 87% in the whole population and 86% in the subgroup. Conclusion A significant proportion of patients with apparently asymptomatic aortic stenosis experience limiting symptoms on treadmill exercise testing. The subsequent development of spontaneous symptoms is strongly related to the severity of stenosis and to limiting symptoms on exercise testing, but less so to an abnormal blood pressure response or ST segment depression.

Abstract: It is unclear whether chronic exercise without caloric restriction or weight loss is a useful strategy for obesity reduction in obese men with and without Type 2 diabetes (T2D). We examined the eff...

Abstract: Despite the importance of randomized, dose-response studies for proper evaluation of effective clinical interventions, there have been no dose-response studies on the effects of exercise amount on ...

Abstract: There is an inverse relationship between physical activity and weight gain. However, additional research is needed to quantify the amount of physical activity required to prevent weight gain in different populations, improve the way we convey physical activity recommendations to the public, and help the individuals increase their physical activity. Although physical activity does not appear to contribute significantly to weight loss, it is critical for maintenance of weight loss. Available data are consistent in that 60-90 min/day of moderate-intensity physical activity is required to maintain a significant weight loss. Although there is agreement about the need for high levels of physical activity to maintain weight loss, there is a need for more research to understand why physical activity is critical for weight loss maintenance. Finally, additional research is needed to determine whether there is an optimal level of physical activity below which it is difficult for most people to achieve a balance between energy intake and expenditure at a healthy body weight. The increasing prevalence of obesity may reflect the fact that the majority of the population has fallen below such a level of physical activity.

Abstract: Objective : Current guidelines are controversial regarding exercise intensity in cardiovascular prevention and rehabilitation. Although high-intensity training induces larger increases in fitness and maximal oxygen uptake ( V O2max), moderate intensity is often recommended as equally effective. Controlled preclinical studies and randomized clinical trials are required to determine whether regular exercise at moderate versus high intensity is more beneficial. We therefore assessed relative effectiveness of 10-week HIGH versus moderate (MOD) exercise intensity on integrative and cellular functions. Methods : Sprague–Dawley rats performed treadmill running intervals at either 85%–90% (HIGH) or 65%–70% (MOD) of V O2max 1 h per day, 5 days per week. Weekly V O2max-testing adjusted exercise intensity. Results : HIGH and MOD increased V O2max by 71% and 28%, respectively. This was paralleled by intensity-dependent cardiomyocyte hypertrophy, 14% and 5% in HIGH and MOD, respectively. Cardiomyocyte function (fractional shortening) increased by 45% and 23%, contraction rate decreased by 43% and 39%, and relaxation rate decreased by 20% and 10%, in HIGH and MOD, respectively. Ca2+ transient time-courses paralleled contraction/relaxation, whereas Ca2+ sensitivity increased 40% and 30% in HIGH and MOD, respectively. Carotid artery endothelial function improved similarly with both intensities. EC50 for acetylcholine-induced relaxation decreased 4.3-fold in HIGH ( p <0.05) and 2.8-fold in MOD ( p <0.20) as compared to sedentary; difference HIGH versus MOD 1.5-fold ( p =0.72). Multiple regression identified rate of systolic Ca2+ increase and diastolic myocyte relengthening as main variables associated with V O2max. Cell hypertrophy, contractility and vasorelaxation also correlated significantly with V O2max. Conclusions : The present study demonstrates that cardiovascular adaptations to training are intensity-dependent. A close correlation between V O2max, cardiomyocyte dimensions and contractile capacity suggests significantly higher benefit with high intensity, whereas endothelial function appears equivalent at moderate levels. Thus, exercise intensity emerges as an important variable in future preclinical and clinical investigations.

Abstract: Background: This randomized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors. Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk. Methods: A convenience sample of 85 recent survivors was randomized into immediate and delayed treatment groups. The immediate group trained from months 0 to 12; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12. Measures at baseline, 6 and 12 months included body weight, height, body fat, lean mass, body fat %, and waist circumference, as well as fasting glucose, insulin, insulin resistance, insulin-like growth factor-I (IGF-I), IGF-II, and IGF-binding protein-1, IGFBP-2, and IGFBP-3. Injury reporting was standardized. Results: The intervention resulted in significant increases in lean mass (0.88 versus 0.02 kg, P < 0.01), as well as significant decreases in body fat % (−1.15% versus 0.23%, P = 0.03) and IGF-II (−6.23 versus 28.28 ng/mL, P = 0.02) comparing immediate with delayed treatment from baseline to 6 months. Within-person changes experienced by delayed treatment group participants during training versus no training were similar. Only one participant experienced a study related injury that prevented continued participation. Conclusion: Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass, as well as decreased body fat % and IGF-II. The implications of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors.

Abstract: This study investigates the relationship of emotional intelligence (EI) characteristics, such as perception, control, use and understanding of emotions, with physical and psychological health. In the first study, 365 individuals filled in measures of EI and general health. It was hypothesized that EI would be negatively associated with poor general health. In the second study, 212 working adults completed the same measure of EI and another measure, which apart from the standard information regarding physical and psychological health, provided also information about other health related behaviours, such as smoking, drinking, and exercising. It was also hypothesized that EI would negatively correlate with smoking and drinking and positively correlate with exercising. The findings confirmed both hypotheses and provided further support on the claims that there is a relationship between EI and health functioning. Additionally, in a series of hierarchical regression analyses the unique contribution of each of the EI scales on the overall health score were investigated. The findings are discussed in the context of the importance of emotional competences on health and personal lifestyle, while implications for practice and directions for future research are proposed. Copyright © 2005 John Wiley & Sons, Ltd.

Abstract: Purpose: This study was designed to determine if a single bout of moderate-intensity aerobic exercise would improve mood and well-being in 40 (15 male, 25 female) individuals who were receiving treatment for major depressive disorder (MDD). Methods: All participants were randomly assigned to exercise at 60-70% of age-predicted maximal heart rate for 30 min or to a 30-min period of quiet rest. Participants completed both the Profile of Mood States (POMS) and Subjective Exercise Experiences Scale (SEES) as indicators of mood 5 min before, and 5, 30, and 60 min following their experimental condition. Results: Both groups reported similar reductions in measures of psychological distress, depression, confusion, fatigue, tension, and anger. Only the exercise group, however, reported a significant increase in positive well-being and vigor scores. Conclusion: Although 30 min of either moderate-intensity treadmill exercise or quiet rest is sufficient to improve the mood and well-being of patients with MDD, exercise appears to have a greater effect on the positively valenced states measured.

Abstract: Study Objectives: To present normative data of sleep-wake characteristics and to examine risk factors associated with extreme values (ie, in the 5 lower and upper percentiles of the distribution) in older adults. Design: Cross-sectional telephone survey Setting: The metropolitan area of Paris, France. Participants: A total of 7010 randomly selected households were contacted. Among them, 1264 households included at least 1 resident 60 years of age or older; 1,026 subjects agreed to participate (participation rate: 80.9%). Interventions: None. Measurements and Results: Subjects were interviewed with the Sleep-EVAL System about their sleeping habits and sleep and psychiatric disorders. In addition, the system administered to all the participants the Psychological General Well-Being Schedule, the Cognitive Difficulties Scale (Mac Nair-R), and an independent living scale. The median nighttime sleep duration was 7 hours without significant difference between the age groups. Factors positively associated with the 5 percentile (4 hours 30 minutes or less) of nighttime sleep duration were obesity, poor health, insomnia, and insomnia accompanied by daytime sleepiness and cognitive impairment. At the other extremity (95 th percentile), long sleep (9 hours 30 minutes or more) was associated with organic disease, lack of physical exercise, and lower education. A daytime sleep duration of 1 hour or more (95 th percentile) was associated with being a man, cognitive impairment, high blood pressure, obesity, and insomnia. Long sleep latency (95 th percentile at 80 minutes) was associated with anxiety, lower education, poor health, insomnia without excessive daytime sleepiness, and obstructive sleep apnea syndrome. Obesity and loss of autonomy in activities of daily living was associated with both early (9 PM or earlier) and late bedtime (1 AM or later) and early (≤ 5 AM) and late (≥ 9 AM) wake-up time. Conclusions: This study illustrates the usefulness of normal distributions of sleep parameters in the general population to calculate different risk factors associated with extreme values of the normal distribution.

Abstract: This study was designed to investigate the effect of exercise intensity on cardiorespiratory fitness and coronary heart disease risk factors. Maximum oxygen consumption (Vo(2 max)), lipid, lipoprotein, and fibrinogen concentrations were measured in 64 previously sedentary men before random allocation to a nonexercise control group, a moderate-intensity exercise group (three 400-kcal sessions per week at 60% of Vo(2 max)), or a high-intensity exercise group (three 400-kcal sessions per week at 80% of Vo(2 max)). Subjects were instructed to maintain their normal dietary habits, and training heart rates were represcribed after monthly fitness tests. Forty-two men finished the study. After 24 wk, Vo(2 max) increased by 0.38 +/- 0.14 l/min in the moderate-intensity group and by 0.55 +/- 0.27 l/min in the high-intensity group. Repeated-measures analysis of variance identified a significant interaction between monthly Vo(2 max) score and exercise group (F = 3.37, P < 0.05), indicating that Vo(2 max) responded differently to moderate- and high-intensity exercise. Trend analysis showed that total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and fibrinogen concentrations changed favorably across control, moderate-intensity, and high-intensity groups. However, significant changes in total cholesterol (-0.55 +/- 0.81 mmol/l), low-density lipoprotein cholesterol (-0.52 +/- 0.80 mmol/l), and non-high-density lipoprotein cholesterol (-0.54 +/- 0.86 mmol/l) were only observed in the high-intensity group (all P < 0.05 vs. controls). These data suggest that high-intensity training is more effective in improving cardiorespiratory fitness than moderate-intensity training of equal energy cost. These data also suggest that changes in coronary heart disease risk factors are influenced by exercise intensity.

Abstract: Resting pulmonary function and exercise variables are widely used to stage and monitor idiopathic interstitial pneumonia (IIP). However, the variability of exercise data (maximal exercise and the 6-minute walk test) has not been evaluated definitively. We have prospectively quantified the reproducibility of resting and exercise functional data in fibrotic IIP (idiopathic pulmonary fibrosis, fibrotic nonspecific interstitial pneumonia) and have evaluated interrelationships between variables. Thirty consecutive patients with fibrotic IIP underwent serial resting pulmonary function tests, 6-minute walk (n = 29), and maximal exercise (n = 24) at an interval of 1 week, with all testing performed in accordance with American Thoracic Society standards. Within-subject reproducibility was excellent for 6-minute walk distance (SD/mean = 4.2%) and clinically acceptable for resting pulmonary function indices and VO(2)max on maximal exercise testing. However, the amplitude of oxygen desaturation at the end of exercise was poorly reproducible in both 6-minute walk and maximal exercise testing (SD/mean > 25%). There was a highly significant relationship between VO2max on maximal exercise testing and 6-minute walk distance (r(s) = 0.78, p < 0.0001). In fibrotic IIP, the excellent reproducibility of the 6-minute walk distance is a major advantage in routine staging and monitoring, whereas maximal exercise variables are poorly reproducible.