Exercise

Posted on Exercise, Mental health

Weight training improves symptoms of anxiety and depression in old people, study confirms

Brazilian researchers analyzed more than 200 articles on the subject and identified the types of training most indicated for these cases.

Weight training can help reduce body fat and increase muscle strength and mass in older people, contributing to functional autonomy and avoiding falls and injury. Furthermore, recent studies have shown that it can also benefit the mental health of older people, especially those who suffer from anxiety and depression.

These benefits were confirmed by a study reported in the journal Psychiatry Research. The study involved a systematic review and meta-analysis of more than 200 articles. The analysis was conducted by Paolo Cunha, a postdoctoral fellow with a scholarship from FAPESP at the Albert Einstein Jewish-Brazilian Institute of Education and Research (IIEPAE) in São Paulo, Brazil. 

“Resistance training has been shown to be one of the most effective non-pharmacological strategies for healthy aging. It promotes countless health benefits, including improvements to mental health,” Cunha said.

The findings of the study are highly promising, he continued. Besides improvements to symptoms of anxiety and depression in the general population, weight training appears to have a more significant effect on people with a confirmed diagnosis of anxiety or depression disorder.

“Epidemiological studies have shown that the decrease in muscle strength and mass that occurs naturally as we age may be associated with an increase in mental health problems, given the existence of various physiological mechanisms that bring about functional and structural changes and that are controlled by the brain,” Cunha said.

Another important mental health benefit, he added, is that when weight training is done in a group, it contributes to more social interaction among those involved.

Recommended exercises

The investigation also pointed to the best ways of structuring one’s training to improve mental health. “How the training is done appears to influence the results achieved. The information obtained so far suggests that older people should ideally do weight training exercises three times a week, with three sets of each exercise and sessions that are not too long – six exercises would seem to be sufficient. Do less, but do it well: a short set produces better results. This is meaningful information, as we lack guidelines with specific recommendations for resistance training that focuses on mental health parameters,” Cunha said.

While there are many possible ways to prescribe resistance training programs designed to improve the health, autonomy and quality of life for older people, most result directly or indirectly in improvements to symptoms of anxiety and depression, regardless of the intensity and volume of the exercises involved, according to Edilson Cyrino, last author of the article and principal investigator for the study. He is a professor at the State University of Londrina (UEL) and coordinates the Active Aging Longitudinal Study, a project begun in 2012 to analyze the impact of resistance training on parameters relating to the health of older women.

Another point observed by the researchers was that the use of training machines and free weights appears to be more beneficial for mental health than exercises that involve elastic bands or calisthenics (using the weight of the person’s body), for example. 

“We don’t have statistics comparing the two kinds of training, but the analysis showed that resistance training with weights and other gear is more effective in terms of improving the mental health of older people, largely because the intensity and volume of the exercises can be more precisely controlled,” Cunha explained.

Posted on Exercise

Does the time of day you move your body make a difference to your health?

Physical activity in the evening linked to greater health benefits for people with obesity

Undertaking the majority of daily physical activity in the evening is linked to the greatest health benefits for people living with obesity, according to researchers from the University of Sydney, Australia who followed the trajectory of 30,000 people over almost 8 years.

Using wearable device data to categorise participant’s physical activity by morning, afternoon or evening, the researchers uncovered that those who did the majority of their aerobic moderate to vigorous physical activity– the kind that raises our heartrate and gets us out of breath– between 6pm and midnight had the lowest risk of premature death and death from cardiovascular disease.

The frequency with which people undertook moderate to vigorous physical activity (MVPA) in the evening, measured in short bouts up to or exceeding three minutes, also appeared to be more important than their total daily physical activity.

The study, led by researchers from the University’s Charles Perkins Centre is published in the journal Diabetes Care today.

“Due to a number of complex societal factors, around two in three Australians have excess weight or obesity which puts them at a much greater risk of major cardiovascular conditions such as heart attacks and stroke, and premature death,” said Dr Angelo Sabag, Lecturer in Exercise Physiology at the University of Sydney.

“Exercise is by no means the only solution to the obesity crisis, but this research does suggest that people who can plan their activity into certain times of the day may best offset some of these health risks.”

Smaller clinical trials have shown similar results, however the large scale of participant data in this study, the use of objective measures of physical activity and hard outcomes, such as premature death, makes these findings significant.

Joint first author Dr Matthew Ahmadi also stressed that the study did not just track structured exercise. Rather researchers focused on tracking continuous aerobic MVPA in bouts of 3 minutes or more as previous research shows a strong association between this type of activity, glucose control and lowered cardiovascular disease risk compared with shorter (non-aerobic) bouts.

“We didn’t discriminate on the kind of activity we tracked, it could be anything from power walking to climbing the stairs, but could also include structured exercise such as running, occupational labour or even vigorously cleaning the house,” said Dr Ahmadi, National Heart Foundation postdoctoral research fellow at the Charles Perkins Centre, University of Sydney.

While observational, the findings of the study support the authors original hypothesis, which is the idea – based on previous research – that people living with diabetes or obesity, who are already glucose intolerant in the late evening, may be able to offset some of that intolerance and associated complications, by doing physical activity in the evening.

How was the study conducted?

The researchers used data from UK Biobank and included 29,836 adults aged over 40 years of age living with obesity, of whom 2,995 participants were also diagnosed with Type 2 diabetes.

Participants were categorised into morning, afternoon of evening MVPA based on when they undertook the majority of their aerobic MVPA as measured by a wrist accelerometer worn continuously for 24 hours a day over 7 days at study onset.

The team then linked health data (from the National Health Services and National Records of Scotland) to follow participants health trajectory for 7.9 years. Over this period they recorded 1,425 deaths, 3,980 cardiovascular events and 2,162 microvascular disfunction events.

To limit bias, the researchers accounted for differences such as age, sex, smoking, alcohol intake, fruit and vegetable consumption, sedentary time, total MVPA, education, medication use and sleep duration. They also excluded participants with pre-existing cardiovascular disease and cancer.

The researchers say the length of the study follow-up and additional sensitivity analysis bolster the strength of their findings however, due to the observational design, they cannot completely rule out potential reverse causation. This is the possibility that some participants had lower aerobic MVPA levels due to underlying or undiagnosed disease.

Posted on Exercise, Patient Talk

A daily step count of 9,000 to 10,000 may counteract the risk of death and cardiovascular disease in highly sedentary people.

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Increased step count linked to lower risk regardless of time spent sedentary
Increased step count is linked to lower risk regardless of sedentary time.

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In good news for office workers, a new study from the University of Sydney’s Charles Perkins Centre (Australia) has found increasing your step count may counteract the health consequences of too much sedentary time each day.

The study of over 72,000 people, published in the British Journal of Sports Medicine, found every additional step up to around 10,000 steps a day was linked to reduced risk of death (39 per cent) and cardiovascular disease (21 per cent) regardless of how much remaining time was spent sedentary.

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Previous studies have shown an association between greater daily step count and lower levels of death and CVD, and separate studies have linked high levels of sedentary behaviour with increased risks of CVD and death. However, this is the first to measure objectively, via wrist-worn wearables, if daily steps could offset the health risks of high sedentary behaviour.

Lead author and research fellow Dr Matthew Ahmadi said: “This is by no means a get-out-of-jail card for sedentary people for excessive periods. However, it does hold an important public health message that all movement matters and that people can and should try to offset the health consequences of unavoidable sedentary time by upping their daily step count.”

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Senior author Professor Emmanuel Stamatakis, Director of the Mackenzie Wearables Research Hub at the Charles Perkins Centre, said this growing body of physical activity research using device-based measurement provided huge opportunities for public health.

“Step count is a tangible and easily understood measure of physical activity that can help people in the community, and indeed health professionals, accurately monitor physical activity. We hope this evidence will inform the first generation of device-based physical activity and sedentary behaviour guidelines, which should include key recommendations on daily stepping,” said Professor Stamatakis.

How was the study conducted?

Researchers used data on 72,174 individuals (average age 61; 58% female) from the UK Biobank study – a major biomedical database – who had worn an accelerometer device on their wrist for seven days to measure their physical activity. The accelerometer data were used to estimate daily step count and time spent sedentary: sitting or lying down while awake.

The research team then followed the health trajectory of the participants by linking hospitalisation data and death records.

The median daily step count for participants was 6222 steps/day, and 2200 steps/day (the lowest 5 percent of daily steps among all participants) was taken as the comparator for assessing the impact of increasing step count on death and CVD events.

The median time spent sedentary was 10.6 hours/day, so study participants who spent 10.5 hours/day or more sedentary were considered to have high sedentary time, while those who spent less than 10.5 hours/day sedentary were classified as having low sedentary time.

Adjustments were made to eliminate biases, such as excluding participants with poor health who were underweight or had a health event within two years of follow-up. Researchers also took into account factors such as age, sex, ethnicity, education, smoking status, alcohol consumption, diet and parental history of CVD and cancer.

What did they find?

Over an average 6.9 years follow up, 1633 deaths and 6190 CVD events occurred.

After taking into account other potential influences, the authors calculated that the optimal number of steps per day to counteract high sedentary time was between 9000 and 10000 steps/day, which lowered mortality risk by 39 per cent and incident CVD risk by 21 per cent.

In both cases, 50 per cent of the benefit was achieved between 4000 and 4500 steps daily.

Study limitations

This is an observational study, so it can’t establish direct cause and effect. Although the large sample size and long follow-up allowed the risk of bias to be reduced, the authors acknowledge the possibility that other unmeasured factors could affect results. They add that steps and sedentary time were obtained in a single time point, which could also lead to bias.

Nevertheless, they conclude, “Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing between 9000 and 10,000 steps a day optimally lowered the risk of mortality and incident CVD among highly sedentary participants.”

Posted on Exercise

Are ChatGPT exercise recommendations just what the doctor ordered?

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Pescatello

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Linda Pescatello from UConn’s College of Agriculture, Health and Natural Resources. CREDIT Jason Sheldon/UConn Photo

According to a new UConn study, ChatGPT’s output provided only 41% of the content expected in a gold-standard exercise recommendation

Since its debut in late 2022, people have experimented with using the AI (artificial intelligence) chat bot ChatGPT for everything from recipe planning to answering trivia to helping with homework. But ChatGPT has been mired in issues concerning its accuracy.

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Regular physical activity is critical for health and disease prevention, yet only 25% of U.S. adults meet national physical activity guidelines. Since the public premiere of ChatGPT, people have been using the tool to generate physical activity plans.

A team composed of researchers from UConn’s College of Agriculture, Health and Natural Resources and Hartford Hospital recently investigated the accuracy of ChatGPT’s exercise recommendations. They published these findings in the Journal of Medical Internet Research Medical Education in a special issue dedicated to ChatGPT and Generative Language Models in Medical Education. The team was led by Amanda Zaleski ’08, ’14, ’18 (CAHNR), a senior scientist in the Department of Preventive Cardiology at Hartford Hospital.

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“It’s a big topic and nobody knows what to do with it,” says Distinguished Professor of Kinesiology Linda Pescatello.

The research team developed a formal grading rubric to score the AI-generated exercise recommendations. The rubric included ten categories that comprise a “gold-standard” exercise recommendation according to the American College of Sports Medicine (ACSM) Guidelines for Exercise Testing and Prescription. Pescatello was already very familiar with these recommendations. She was a member of the 2018 Physical Activity Guidelines Advisory which established them.

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he AI chatbot was then prompted to provide individualized exercise recommendations for all 26 clinical populations for which there exists an evidence base in the ACSM Guidelines. The team then compared AI-generated exercise recommendations to the gold-standard reference and evaluated their comprehensiveness, accuracy, and readability.

The researchers found that ChatGPT’s output provided only 41% of the content expected in a gold-standard exercise recommendation indicating poor comprehensiveness.

The chat bot was able to provide general recommendations, such as getting 150 minutes of exercise per week, but failed to provide guidance on other key elements such as the frequency, intensity, time, and type, also known as the FITT principle of physical activity.

However, of the content provided, ChatGPT output demonstrated high accuracy, around 91%.

The most common source of misinformation was the recommendation to seek medical clearance prior to engaging in any exercise, which is generally not necessary except when a person is having signs and symptoms of disease.

The AI chatbot also failed to account for special considerations such as how the medications a person is taking may interact with a new exercise regime.

In addition, the ChatGPT output was written at the college-level. This is well above the American Medical Association’s recommendation that health-related educational material be written at a level a sixth grader could understand.

The researchers recommend being cautious with following exercise recommendations from ChatGPT, understanding it does not provide a complete physical activity program.

Compounding these findings is another paper by Pescatello’s team led by Shiqi Chen, a master’s student, which analyzed existing mobile apps for exercise recommendations. This work was published in the Journal of Cardiovascular Development and Disease.

They determined that there was no app currently on the market that offered evidence-based exercise recommendations for people with cardiovascular disease risk factors in line with ACSM’s and American Heart Association guidelines.

“We did not find a single app on the market that did that,” Pescatello says.

The 219 apps they studied were highly rated with more than 1,000 reviews, free to download, and not gender specific. A mere 0.5% of the apps were evidence-based. Only 3.7% included a preparticipation screening and less than a third built cardiovascular disease risk profiles.

A majority of the apps (64.8%) focused on body image and/or athletic performance rather than health.

Within this environment of uncertainty and shortcomings, Pescatello has developed her own tool, P3-EX LLC, which offers evidence-based personalized exercise recommendations for those with cardiovascular disease risk factors.

Clinicians can use the tool to generate an exercise recommendation in less than five minutes. This is a critical resource as most doctors do not receive training on generating exercise prescriptions in medical school.

“Our research shows that  we’re touching on something and identifying an unmet clinical need,” Pescatello says.

While the tool is currently only available to clinicians, Pescatello hopes to scale P3-EX so that one day it may be available to the public.

The tool is used in the exercise prescription program at UConn.

“Our mission is to get people to realize the value of exercise and provide that value with tools that can make exercise more accessible and increase adherence,” Pescatello says.

Posted on Exercise, Women's Health

Women get the same exercise benefits as men, but with less effort.

Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men
Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men

A new study from the Smidt Heart Institute at Cedars-Sinai shows there is a gender gap between women and men when it comes to exercise.

The findings, published in the Journal of the American College of Cardiology (JACC), show that women can exercise less often than men, yet receive greater cardiovascular gains.   

“Women have historically and statistically lagged behind men in engaging in meaningful exercise,” said Martha Gulati, MD, director of Preventive Cardiology in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research and co-lead author of the study. “The beauty of this study is learning that women can get more out of each minute of moderate to vigorous activity than men do. It’s an incentivizing notion that we hope women will take to heart.”

Investigators analyzed data from 412,413 U.S. adults utilizing the National Health Interview Survey database. Participants between the time frame of 1997 to 2019—55% of whom were female—provided survey data on leisure-time physical activity. Investigators examined gender-specific outcomes in relation to frequency, duration, intensity and type of physical activity.

“For all adults engaging in any regular physical activity, compared to being inactive, mortality risk was expectedly lower,” said Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, director of the Institute for Research on Healthy Aging in the Department of Cardiology in the Smidt Heart Institute, and senior author of the study. “Intriguingly, though, mortality risk was reduced by 24% in women and 15% in men.”

The research team then studied moderate to vigorous aerobic physical activity, such as brisk walking or cycling, and found that men reached their maximal survival benefit from doing this level of exercise for about five hours per week, whereas women achieved the same degree of survival benefit from exercising just under about 2 ½ hours per week.

Similarly, when it came to muscle-strengthening activity, such as weightlifting or core body exercises, men reached their peak benefit from doing three sessions per week and women gained the same amount of benefit from about one session per week.

Cheng said that women had even greater gains if they engaged in more than 2 ½ hours per week of moderate to vigorous aerobic activity, or in two or more sessions per week of muscle-strengthening activities. The investigators note their findings help to translate a longstanding recognition of sex-specific physiology seen in the exercise lab to a now-expanded view of sex differences in exercise-related clinical outcomes.

With all types of exercise and variables accounted for, Gulati says there’s power in recommendations based on the study’s findings. “Men get a maximal survival benefit when performing 300 minutes of moderate to vigorous activity per week, whereas women get the same benefit from 140 minutes per week,” Gulati said. “Nonetheless, women continue to get further benefit for up to 300 minutes a week.”

Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, says concrete, novel studies like this don’t happen often.

“I am hopeful that this pioneering research will motivate women who are not currently engaged in regular physical activity to understand that they are in a position to gain tremendous benefit for each increment of regular exercise they are able to invest in their longer-term health,” said Albert, professor of Cardiology.