Background: When assessing health status, physicians may focus on objective symptoms and diagnoses, whereas individuals may focus more on subjective symptoms, functional limitations and quality of ...life.
Methods: In the Zutphen Elderly Study, 710 community-living men (aged 64-84 years) were followed until death for 15 years. Self-rated health was assessed through a single-item question. Physician-rated health was estimated on a Likert scale by physicians after medical history assessment and physical examination. Both health ratings were categorised into three groups. All-cause, cardiovascular and cancer mortality rates were analysed in Cox proportional-hazards models.
Results: There were 352 (49.6%) men who felt healthy and 225 (31.7%) men with a good physician-rated health. During 15 years of follow-up 503 of 710 men (70.8%) died, of whom 229 (45.5%) from cardiovascular causes and 144 (28.6%) from cancer. Self-rated and physician-rated health both predicted independently all-cause mortality (hazard ratios HR for worst vs. best health category: 1.72; 95% confidence interval CI: 1.26-2.33, and 1.77; 95% CI: 1.36-2.29; respectively; P-values of <0.005). When self-rated and physician-rated health were discordant, mortality risk was highest when physicians had a less favourable view on the health status than the participant. Self-rated health predicted independently cancer mortality (HR 2.41), whereas physician-rated health cardiovascular mortality (HR 2.13).
Conclusion: Self-rated and physician-rated health status predicted both all-cause mortality, and showed a differential pattern for cancer and cardiovascular diseases mortality.
A low maximal oxygen consumption (VO2max) is a strong risk factor for premature mortality. Supervised endurance exercise training increases VO2max with a very wide range of effectiveness in humans. ...Discovering the DNA variants that contribute to this heterogeneity typically requires substantial sample sizes. In the present study, we first use RNA expression profiling to produce a molecular classifier that predicts VO2max training response. We then hypothesized that the classifier genes would harbor DNA variants that contributed to the heterogeneous VO2max response. Two independent preintervention RNA expression data sets were generated (n=41 gene chips) from subjects that underwent supervised endurance training: one identified and the second blindly validated an RNA expression signature that predicted change in VO2max ("predictor" genes). The HERITAGE Family Study (n=473) was used for genotyping. We discovered a 29-RNA signature that predicted VO2max training response on a continuous scale; these genes contained approximately 6 new single-nucleotide polymorphisms associated with gains in VO2max in the HERITAGE Family Study. Three of four novel candidate genes from the HERITAGE Family Study were confirmed as RNA predictor genes (i.e., "reciprocal" RNA validation of a quantitative trait locus genotype), enhancing the performance of the 29-RNA-based predictor. Notably, RNA abundance for the predictor genes was unchanged by exercise training, supporting the idea that expression was preset by genetic variation. Regression analysis yielded a model where 11 single-nucleotide polymorphisms explained 23% of the variance in gains in VO2max, corresponding to approximately 50% of the estimated genetic variance for VO2max. In conclusion, combining RNA profiling with single-gene DNA marker association analysis yields a strongly validated molecular predictor with meaningful explanatory power. VO2max responses to endurance training can be predicted by measuring a approximately 30-gene RNA expression signature in muscle prior to training. The general approach taken could accelerate the discovery of genetic biomarkers, sufficiently discrete for diagnostic purposes, for a range of physiological and pharmacological phenotypes in humans.
Reduced-exertion high-intensity interval training (REHIT) is a genuinely time-efficient intervention that can improve aerobic capacity and insulin sensitivity in sedentary individuals. The present ...study compared the effects of REHIT and moderate-intensity walking on health markers in patients with type 2 diabetes (T2D) in a counter-balanced crossover study. Sixteen men with T2D (mean ± SD age: 55 ± 5 years, body mass index: 30.6 ± 2.8 kg·m
−2
, maximal aerobic capacity: 27 ± 4 mL·kg
−1
·min
−1
) completed 8 weeks of REHIT (three 10-min low-intensity cycling sessions/week with two “all-out” 10–20-s sprints) and 8 weeks of moderate-intensity walking (five 30-min sessions/week at an intensity corresponding to 40%–55% of heart-rate reserve), with a 2-month wash-out period between interventions. Before and after each intervention, participants underwent an incremental fitness test, an oral glucose tolerance test (OGTT), a whole-body dual-energy X-ray absorptiometry scan, and continuous glucose monitoring. REHIT was associated with a significantly larger increase in maximal aerobic capacity compared with walking (7% vs. 1%; time × intervention interaction effect: p < 0.05). Both REHIT and walking decreased resting mean arterial pressure (−4%; main effect of time: p < 0.05) and plasma fructosamine (−5%; main effect of time: p < 0.05). Neither intervention significantly improved OGTT-derived measures of insulin sensitivity, glycaemic control measured using continuous glucose monitors, blood lipid profile, or body composition. We conclude that REHIT is superior to a 5-fold larger volume of moderate-intensity walking in improving aerobic fitness, but similar to walking REHIT is not an effective intervention for improving insulin sensitivity or glycaemic control in T2D patients in the short term.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Bacterial infections such as febrile urinary tract infection (fUTI) may run a complicated course that is difficult to foretell on clinical evaluation only. Because the conventional biomarkers ...erythrocyte sedimentation rate (ESR), leucocyte count, C-reactive protein (CRP) and procalcitonin (PCT) have a limited role in the prediction of a complicated course of disease, a new biomarker—plasma midregional pro-adrenomedullin (MR-proADM)—was evaluated in patients with f UTI. We conducted a prospective multicentre cohort study including consecutive patients with f UTI at 35 primary-care centres and eight emergency departments. Clinical and microbiological data were collected and plasma biomarker levels were measured at presentation to the physician. Survival was assessed after 30 days. Of 494 fUTI patients, median age was 67 (interquartile range 49-78) years, 40% were male; two-thirds of them had significant co-existing medical conditions. Median MR-proADM level was 1.42 (interquartile range 0.67-1.57) nM; significantly elevated MR-proADM levels were measured in patients with bacteraemia, those admitted to the intensive care unit, and in 30-day and 90-day non-survivors, compared with patients without these characteristics. The diagnostic accuracy for predicting 30-day mortality in fUTI, reflected by the area-under-the-curve of receiver operating characteristics were: MR-proADM 0.83 (95% CI 0.71-0.94), PCT 0.71 (95% CI 0.56-0.85); whereas CRP, ESR and leucocyte count lacked diagnostic value in this respect. This study shows that MR-proADM assessed on first contact predicts a complicated course of disease and 30-day mortality in patients with fUTI and in this respect has a higher discriminating accuracy than the currently available biomarkers ESR, CRP, PCT and leucocyte count.
Summary
Host genetic factors may contribute to susceptibility to and outcome in infectious diseases. Recently polymorphisms in PARK2/PACRG, a gene cluster linked to ubiquitination and ...proteasome‐mediated protein degradation, were found to be associated with manifest infection by M. leprae. Here, we address whether these polymorphisms are associated with susceptibility to infection with Salmonella typhi and S. paratyphi A, intracellular pathogens that upon infection of humans share with mycobacteria aspects of the hosts’ immune response. The polymorphisms of PARK_e01(−697), PARK2_e01(−2599), rs1333955 and rs1040079 were analysed by polymerase chain reaction and restriction fragment length polymorphism in a case‐control study of typhoid and paratyphoid fever patients in an endemic area in Jakarta, Indonesia. For this study, samples were obtained from patients with blood culture‐confirmed typhoid fever (n = 90), paratyphoid fever (n = 26) and fever controls (n = 337) in a passive, community‐based surveillance and compared to those of randomly selected community controls (n = 322) from the same city area. The PARK2_e01(−2599) allele T was significantly associated with typhoid and paratyphoid fever (OR: 1·51, 95%CI: 1·02–2·23) but the other polymorphisms, PARK2_e01(−697), rs1333955 and rs1040079, were not associated. Although within the PARK2/PACRG gene cluster the PARK2_e01(−2599) allele T was most strongly associated with leprosy (OR∼ 3–5), the association with typhoid is much less strong. Our findings suggest that this polymorphism in PARK2/PACRG plays a small but significant role in susceptibility to the intracellular pathogens S. typhi and S. paratyphi.
The efficacy of high-intensity interval training (HIT) as a time-efficient exercise strategy for beneficially modifying risk factors for cardiovascular disease has repeatedly been demonstrated in ...controlled laboratory settings. However, the effectiveness of HIT in an unsupervised workplace setting has not been investigated. The objective of this study was to use mixed methods to investigate the feasibility, acceptability and effectiveness of a short-duration, high-intensity exercise intervention (REHIT) when applied unsupervised in a workplace setting.
Twenty-five office-workers (mean ± SD age: 47 ± 9 y, BMI: 27.5 ± 4.4 kg·m
, V̇O
max: 28 ± 7 mL·kg
·min
) completed a 6-week REHIT intervention unsupervised in their workplace (n = 13, 6 men), or acted as a no-intervention control (n = 12, 6 men). The intervention consisted of 2 sessions/week of low-intensity (~ 25 W) cycling interspersed with 2 'all-out' sprints, increasing in duration from 10 to 20 s per sprint over the 6 weeks (total time-commitment: 8:40 min per session). V̇O
max was assessed pre- and post-training, whilst questionnaire-based measures of exercise enjoyment, self-efficacy, and acceptability were completed post-training. Eight participants also completed post-intervention semi-structured interviews.
V̇O
max significantly improved in the exercise group (2.25 ± 0.75 L·min
vs. 2.42 ± 0.82 L·min
; + 7.4%) compared to the control group (2.22 ± 0.72 L·min
vs. 2.17 ± 0.74 L·min
; - 2.3%; time*intervention interaction effect: p < 0.01). Participants considered the REHIT intervention acceptable and enjoyable (PACES: 89 ± 17 out of 119) and were confident in their ability to continue to perform REHIT (7.8 ± 1.2 out of 9). Qualitative data revealed that REHIT offered a time-efficient opportunity to exercise, that was perceived as achievable, and which encouraged highly valued post-exercise outcomes (e.g. progress towards health/fitness benefits).
REHIT could be implemented as a feasible, effective and acceptable exercise intervention in a workplace setting, with a total time-commitment of < 20 min/week. Consideration of certain psycho-social factors and behaviour-change techniques may ensure adherence to the REHIT programme in the long term.
The study was registered on ClinicalTrials.gov on 07/05/2019 (registration: NCT03941145).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Traditional high volume aerobic exercise training reduces cardiovascular and metabolic disease risk but involves a substantial time commitment. Extremely low volume high-intensity interval training ...(HIT) has recently been demonstrated to produce improvements to aerobic function, but it is unknown whether HIT has the capacity to improve insulin action and hence glycemic control.
Sixteen young men (age: 21 +/- 2 y; BMI: 23.7 +/- 3.1 kg x m-2; VO2peak: 48 +/- 9 ml x kg-1 x min-1) performed 2 weeks of supervised HIT comprising of a total of 15 min of exercise (6 sessions; 4-6 x 30-s cycle sprints per session). Aerobic performance (250-kJ self-paced cycling time trial), and glucose, insulin and NEFA responses to a 75-g oral glucose load (oral glucose tolerance test; OGTT) were determined before and after training.
Following 2 weeks of HIT, the area under the plasma glucose, insulin and NEFA concentration-time curves were all reduced (12%, 37%, 26% respectively, all P < 0.001). Fasting plasma insulin and glucose concentrations remained unchanged, but there was a tendency for reduced fasting plasma NEFA concentrations post-training (pre: 350 +/- 36 v post: 290 +/- 39 micromol x l-1, P = 0.058). Insulin sensitivity, as measured by the Cederholm index, was improved by 23% (P < 0.01), while aerobic cycling performance improved by approximately 6% (P < 0.01).
The efficacy of a high intensity exercise protocol, involving only ~250 kcal of work each week, to substantially improve insulin action in young sedentary subjects is remarkable. This novel time-efficient training paradigm can be used as a strategy to reduce metabolic risk factors in young and middle aged sedentary populations who otherwise would not adhere to time consuming traditional aerobic exercise regimes.
Regular physical activity (PA) can reduce the risk of developing type 2 diabetes, but adherence to time-orientated (150 min week
or more) PA guidelines is very poor. A practical and time-efficient PA ...regime that was equally efficacious at controlling risk factors for cardio-metabolic disease is one solution to this problem. Herein, we evaluate a new time-efficient and genuinely practical high-intensity interval training (HIT) protocol in men and women with pre-existing risk factors for type 2 diabetes.
One hundred eighty-nine sedentary women (
= 101) and men (
= 88) with impaired glucose tolerance and/or a body mass index >27 kg m
mean (range) age: 36 (18-53) years participated in this multi-center study. Each completed a fully supervised 6-week HIT protocol at work-loads equivalent to ~100 or ~125% Formula: see text. Change in Formula: see text was used to monitor protocol efficacy, while Actiheart™ monitors were used to determine PA during four, weeklong, periods. Mean arterial (blood) pressure (MAP) and fasting insulin resistance homeostatic model assessment (HOMA)-IR represent key health biomarker outcomes.
The higher intensity bouts (~125% Formula: see text) used during a 5-by-1 min HIT protocol resulted in a robust increase in Formula: see text (136 participants, +10.0%,
< 0.001; large size effect). 5-by-1 HIT reduced MAP (~3%;
< 0.001) and HOMA-IR (~16%;
< 0.01). Physiological responses were similar in men and women while a sizeable proportion of the training-induced changes in Formula: see text, MAP, and HOMA-IR was retained 3 weeks after cessation of training. The supervised HIT sessions accounted for the entire quantifiable increase in PA, and this equated to 400 metabolic equivalent (MET) min week
. Meta-analysis indicated that 5-by-1 HIT matched the efficacy and variability of a time-consuming 30-week PA program on Formula: see text, MAP, and HOMA-IR.
With a total time-commitment of <15 min per session and reliance on a practical ergometer protocol, 5-by-1 HIT offers a new solution to modulate cardio-metabolic risk factors in adults with pre-existing risk factors for type 2 diabetes while approximately meeting the MET min week
PA guidelines. Long-term randomized controlled studies will be required to quantify the ability for 5-by-1 HIT to reduce the incidence of type 2 diabetes, while strategies are required to harmonize the adaptations to exercise across individuals.
Finding effective intervention strategies to combat rising obesity levels could significantly reduce the burden that obesity and associated non-communicable diseases places on both individuals and ...the National Health Service.
In this parallel randomised-controlled trial, 76 participants who are overweight or obese (50 female) were given free access to a fitness centre for the duration of the 12-week intervention and randomised to one of three interventions. The commercial intervention, the Healthy Weight Programme, (HWP, n = 25, 10/15 men/women) consisted of twelve 1-h nutrition coaching sessions with a nutritionist delivered as a mixture of group and 1 to 1 sessions. In addition, twice-weekly exercise sessions (24 in total) were delivered by personal trainers for 12 weeks. The NHS intervention (n = 25, 8/17 men/women) consisted of following an entirely self-managed 12-week online NHS resource. The GYM intervention (n = 26, 8/18 men/women) received no guidance or formal intervention. All participants were provided with a gym induction for safety and both the NHS and GYM participants were familiarised with ACSM physical activity guidelines by way of a hand-out.
The overall follow-up rate was 83%. Body mass was significantly reduced at post-intervention in all groups (HWP: N = 18, - 5.17 ± 4.22 kg, NHS: N = 21-4.19 ± 5.49 kg; GYM: N = 24-1.17 ± 3.00 kg; p < 0.001) with greater reductions observed in HWP and NHS groups compared to GYM (p < 0.05). Out with body mass and BMI, there were no additional statistically significant time x intervention interaction effects.
This is the first study to evaluate the efficacy of both a free online NHS self-help weight-loss tool and a commercial weight loss programme that provides face-to-face nutritional support and supervised exercise. The findings suggest that both interventions are superior to an active control condition with regard to eliciting short-term weight-loss.
ISRCTN Registry - ISRCTN31489026. Prospectively registered: 27/07/16.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
Sprint interval training (SIT) provides a potent stimulus for improving maximal aerobic capacity (
V
˙
O
2
max
), which is among the strongest markers for future cardiovascular health and ...premature mortality. Cycling-based SIT protocols involving six or more ‘all-out’ 30-s Wingate sprints per training session improve
V
˙
O
2
max
, but we have recently demonstrated that similar improvements in
V
˙
O
2
max
can be achieved with as few as two 20-s sprints. This suggests that the volume of sprint exercise has limited influence on subsequent training adaptations. Therefore, the aim of the present study was to examine whether a single 20-s cycle sprint per training session can provide a sufficient stimulus for improving
V
˙
O
2
max
.
Methods
Thirty sedentary or recreationally active participants (10 men/20 women; mean ± SD age: 24 ± 6 years, BMI: 22.6 ± 4.0 kg m
−2
,
V
˙
O
2
max
: 33 ± 7 mL kg
−1
min
−1
) were randomised to a training group or a no-intervention control group. Training involved three exercise sessions per week for 4 weeks, consisting of a single 20-s Wingate sprint (no warm-up or cool-down).
V
˙
O
2
max
was determined prior to training and 3 days following the final training session.
Results
Mean
V
˙
O
2
max
did not significantly change in the training group (2.15 ± 0.62 vs. 2.22 ± 0.64 L min
−1
) or the control group (2.07 ± 0.69 vs. 2.08 ± 0.68 L min
−1
; effect of time:
P
= 0.17; group × time interaction effect:
P
= 0.26).
Conclusion
Although we have previously demonstrated that regularly performing two repeated 20-s ‘all-out’ cycle sprints provides a sufficient training stimulus for a robust increase in
V
˙
O
2
max
, our present study suggests that this is not the case when training sessions are limited to a single sprint.
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