Abstract 13599: Combined Aerobic and Resistance Exercise Training Decrease Oxidative Stress by Augmenting Antioxidant Potential in Patients with Cardiovascular Disease

Objective: To compare the long-term effects of two community-based exercise programs on fall risk factors, such as balance, postural control, mobility and leg strength, in community-dwelling older men. Design: Single-blinded randomized controlled trial, comparing three groups, with follow-ups at eight, 16, 24 and 32 weeks. Setting: Older men independent-living residing in Maia city, Portugal. Participants: A total of 66 older men (aged 69.0 ±4.9 years) were randomly assigned to an aerobic exercise group (n = 22), a combined aerobic and resistance exercise group (n = 22) or a control group (n = 22). Interventions: Both community-based exercise programs consisted of three sessions each week for 32 consecutive weeks and were planned for moderate-to-vigorous intensity. The control group had no exercise intervention. Measurements: Main outcomes were measured by the Timed Up and Go Test, functional reach test, 30-second chair stand test and 6-minute walk test, on five different occasions. Results: Repeated measures of analysis of covariance revealed significant main effects between time × group interaction in all outcomes over time (Timed Up and Go Test: p < 0.001; functional reach test: p = 0.002; 30–second chair stand: p = 0.001; 6-minute walk test: p < 0.001). Both exercise groups reported improvements; however, better performance was identified in the combined aerobic and resistance exercise group compared with the aerobic exercise group (–20.3% vs. –9.1% on the Timed Up and Go Test, +27.5% vs. +10.9% on the functional reach test, +20.8% vs. +7.3% on 30-second chair stand, +10.9% vs. +3.5% on 6-minute walk test). Conclusions: Adding resistance exercise to aerobic exercise improves factors associated with an increased risk of falls. However, both exercise regimes, combined or aerobic alone, are more effective than no exercise in the reduction of fall risk factors. ClinicalTrials.org #NCT01874132

The purpose of this study is to investigate the effects of sequence of aerobic and resistance exercise on free fatty acids, epinephrine, testosterone, and IGF-1. 7 healthy adult males, the subjects of this research, performed both resistance exercise after aerobic exercise and aerobic exercise after resistance exercise. V?O2max of all the subjects was measured through treadmil test, and they performed aerobic exercise for 30 minutes using treadmil at the intensity of 65% of V?O2max. They also performed resistance exercise using weight machine. They did 80%1RM × 8~10 rep × 3set with one-minute rest between each set. Resistance after aerobic subjects had their blood sample all 4 times: before aerobic exercise, after aerobic exercise, after resistance exercise, and at 30-minute in the recovery; The aerobic after resistance subjects did their blood sample all 4 times: before resistance exercise, after resistance exercise, after aerobic exercise, and at 30-minute in the recovering period. Data were analyzed using SPSS PC 20.0. The Data were analyzed by One-way repeated ANOVA. Scheffe were used as a Post-Hoc test. Statistical significance level was a=.05. As a result of this study are as follows. First, the FFA are significant for resistance exercise after aerobic exercise group(p=.028). That is, FFA significantly increased after aerobic exercise and then decreased during 30-minute in the recovering stage; the coefficients on FFA are not significant for aerobic exercise after resistance exercise group(p=.415). Second, the coefficients of epinephrine are significant for resistance exercise after aerobic exercise group(p=.012); increased epinephrine resistance after exercise decreased during 30-minute in the recovering stage; the coefficients of epinephrine are not statistically significant for aerobic exercise after resistance exercise group(p=.112). Third, testosterone are significant for aerobic exercise after resistance exercise group(p=.004); increased testosterone due to resistance exercise decreased after aerobic exercise during 30-minute in the recovering stage. However, we can see that the coefficients of testosterone are not statistically significant in case of resistance exercise after aerobic exercise group(p=.074). Fourth, we can find that the coefficients on IGF-1 are statistically significant for both aerobic after resistance exercise(p=.000) and resistance exercise after aerobic groups(p=.000); the coefficients on IGF-1 are not significant after aerobic exercise, but they are significantly increased after resistance exercise for both. In conclusion, resistance exercise after aerobic exercise is likely to have a significant effect on FFA and epinephrine; aerobic exercise after resistance exercise look to affect testosterone and IGF-1. Accordingly, based on the research findings we can find that it is important to decide the order of exercise between aerobic exercise and resistance exercise depending on the purposes fat metabolism or protein synthesis of exercise.

To determine the comparative efficacy of resistance, aerobic, and combined resistance plus aerobic exercise on cardiovascular disease (CVD) risk profile. This randomized controlled trial enrolled 406 adults aged 35-70 years with overweight or obesity and elevated blood pressure. Participants were randomly assigned to resistance (n = 102), aerobic (n = 101), combined resistance plus aerobic exercise (n = 101), or no-exercise control (n = 102). All exercise participants were prescribed 1 h of time-matched supervised exercise (the combination group with 30 min of each resistance and aerobic exercise) three times per week for 1 year. The primary outcome was the change from baseline to 1 year in the standardized composite Z-score of four well-established CVD risk factors: systolic blood pressure, low-density lipoprotein (LDL) cholesterol, fasting glucose, and per cent body fat. Among 406 participants (53% women), 381 (94%) completed 1-year follow-up. Compared with the control group, the composite Z-score decreased at 1 year, which indicates improved CVD risk profile, in the aerobic {mean difference, -0.15 [95% confidence interval (CI): -0.27 to -0.04]; P = .01} and combination [mean difference, -0.16 (95% CI: -0.27 to -0.04); P = .009] groups, but not in the resistance [mean difference, -0.02 (95% CI: -0.14 to 0.09); P = .69] group. Both aerobic and combination groups had greater reductions in the composite Z-score compared with the resistance group (both P = .03), and there was no difference between the aerobic and combination groups (P = .96). Regarding the four individual CVD risk factors, only per cent body fat decreased in all three exercise groups at 1 year, but systolic blood pressure, LDL cholesterol, and fasting glucose did not decrease in any exercise groups, compared with the control group. In adults with overweight or obesity, aerobic exercise alone or combined resistance plus aerobic exercise, but not resistance exercise alone, improved composite CVD risk profile compared with the control.

The effects of combined aerobic and resistance exercise training on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis were investigated. Twenty-six patients with chronic poststroke hemiparesis were randomly assigned to either the combined aerobic and resistance exercise group (n = 14) or the control group (n = 12). The exercise intervention group received a combined aerobic and resistance exercise training (1 hr/day, three times/week for 16 wks), whereas the control group received usual care. Central arterial stiffness was determined by pulse wave velocity and augmentation index. Gait velocity was assessed using the 6-min walk test, 10-m walk test, and the Timed Up-and-Go test. Patients in the exercise intervention group had greater improvement of mean pulse wave velocity (P < 0.001), augmentation index (P = 0.048), and gait velocity (6-min walk test, P < 0.001; 10-m walk test, P < 0.001) than did patients in the control group. Patients in the exercise intervention group also had greater improvements in physical fitness component (grip strength, P < 0.001; muscular strength of upper and lower limbs, P < 0.027; flexibility, P < 0.001) when compared with control patients. The combined aerobic and resistance exercise program significantly reduced central arterial stiffness and increased gait velocity in patients with chronic poststroke hemiparesis.

Physiological effects of aerobic and anaerobic exercises are frequently investigated. However, it is considered that combined exercises may be more effective. The aim of this study was to investigate the effect of aerobic and combined exercise program on some biochemical parameters. The study group consisted of 45 male volunteers with sedentary life. The participants were divided into three groups as control (n: 15), aerobic exercise (n: 15) and combined exercise (n: 15). The control group did not perform any exercise. Aerobic and combined exercise groups participated in the exercise program 4 days a week for 10 weeks. Blood samples were taken from the participants twice. TSH, T3, T4, AST, ALT, Uric acid and glucose levels were determined in blood samples. SPSS software was used for the analysis of the data and the significance level was accepted as p &amp;lt;0.05. As a result of analysis; no difference was observed in the control group (p&amp;gt; 0.05). In the aerobic exercise group, T3, AST, Uric acid levels of post test were found to be different according to baseline, while in the combined exercise group, there were significant differences in T3, AST, Uric acid and glucose levels between pre and post test values (p &amp;lt;0.05). As a result, it was determined that both aerobic and combined exercises had effects on biochemical parameters (thyroid hormones, liver enzymes, Uric acid and glucose). According to this study it can be said that combined exercises may be more effective than aerobic exercises.

Physical Activity and Diabetes.

Decreased levels of the neuroprotective growth factors, low-grade inflammation, and reduced neurocognitive functions during aging are associated with neurodegenerative diseases, such as Alzheimer's disease. Physical exercise modifies these disadvantageous phenomena while a sedentary lifestyle promotes them. The purposes of the present study included investigating whether both aerobic and resistance exercise produce divergent effects on the neuroprotective growth factors, inflammatory cytokines, and neurocognitive performance, and further exploring whether changes in the levels of these molecular biomarkers are associated with alterations in neurocognitive performance. Fifty-five older adults with amnestic MCI (aMCI) were recruited and randomly assigned to an aerobic exercise (AE) group, a resistance exercise (RE) group, or a control group. The assessment included neurocognitive measures [e.g., behavior and event-related potential (ERP)] during a task-switching paradigm, as well as circulating neuroprotective growth factors (e.g., BDNF, IGF-1, VEGF, and FGF-2) and inflammatory cytokine (e.g., TNF-α, IL-1β, IL-6, IL-8, and IL-15) levels at baseline and after either a 16-week aerobic or resistance exercise intervention program or a control period. Aerobic and resistance exercise could effectively partially facilitate neurocognitive performance [e.g., accuracy rates (ARs), reaction times during the heterogeneous condition, global switching cost, and ERP P3 amplitude] when the participants performed the task switching paradigm although the ERP P2 components and P3 latency could not be changed. In terms of the circulating molecular biomarkers, the 16-week exercise interventions did not change some parameters (e.g., leptin, VEGF, FGF-2, IL-1β, IL-6, and IL-8). However, the peripheral serum BDNF level was significantly increased, and the levels of insulin, TNF-α, and IL-15 levels were significantly decreased in the AE group, whereas the RE group showed significantly increased IGF-1 levels and decreased IL-15 levels. The relationships between the changes in neurocognitive performance (AR and P3 amplitudes) and the changes in the levels of neurotrophins (BDNF and IGF-1)/inflammatory cytokines (TNF-α) only approached significance. These findings suggested that in older adults with aMCI, not only aerobic but also resistance exercise is effective with regard to increasing neurotrophins, reducing some inflammatory cytokines, and facilitating neurocognitive performance. However, the aerobic and resistance exercise modes likely employed divergent molecular mechanisms on neurocognitive facilitation.

Effects of Yoga and aerobic exercise training on functional capacity, respiratory muscle strength, and quality of life in breast cancer survivors

Objective: To investigate the effect of dietary control combined with different exercise modes on plasma vaspin, irisin, and metabolic parameters in patients with non-alcoholic fatty liver disease (NAFLD) through a randomized open parallel-controlled study. Methods: The patients aged 30-65 years who visited Tianjin Third Central Hospital from January 2013 to December 2014 and were diagnosed with NAFLD by liver ultrasound and fat content determination were screening, and 474 patients were enrolled in this randomized controlled trial and divided into aerobic exercise group, resistance exercise group, and control group. All patients received dietary intervention. The three groups were compared in terms of biochemical parameters, fat content, NFS score, energy metabolic parameters, body composition index, and levels of vaspin and irisin at baseline and after 6 months of intervention. SPSS 19.0 was used for statistical analysis. The t-test, the Mann-Whitney U test, the chi-square test, and an analysis of variance were used for comparison between groups. The multiple imputation method was used for missing data, and the results were included in the intention-to-treat analysis. Results: There were no significant differences in age, sex, anthropometrical parameters, and biochemical parameters between the three groups at baseline. Compared with dietary control alone, aerobic exercise and resistance exercise helped to achieve significant reductions in waist circumference, diastolic pressure, percentage of body fat, volatile fatty acid, fasting blood glucose, homeostasis model assessment of insulin resistance, triglyceride, low-density lipoprotein cholesterol, free fatty acid, uric acid, alanine aminotransferase, and liver fat content after 6 months of intervention (P < 0.05). The aerobic exercise group had a significant increase in non-protein respiratory quotient and significant reductions in body mass index and aspartate aminotransferase after intervention, as well as a significant increase in resting energy expenditure and significant reductions in abdominal fat ratio and total cholesterol after 6 months of resistance exercise (P < 0.05). The aerobic exercise group and the resistance exercise group had a significant reduction in vaspin and a significant increase in irisin after intervention (P < 0.05), and the resistance exercise group had significantly greater changes in these two adipokines than the aerobic exercise group (P < 0.05). Conclusion: Exercise therapy is an effective method for the treatment of metabolism-associated diseases, and a combination of resistance and aerobic exercises is more reasonable and effective in clinical practice. As a relatively safe exercise mode, resistance exercise can also effectively improve the metabolic state of NAFLD patients.

BackgroundPsychological disorders are common among individuals with type 2 diabetes mellitus. The effect of exercise training on psychological disorders like anxiety and depression has not been well studied in Ethiopia. The objective of this study was to assess the effect of structured aerobic and resistance exercises on psychological domains among people with type 2 diabetes mellitus in southern Ethiopia.MethodWe began by approaching 97 type 2 diabetic patients who regularly attend follow-up clinics. The 24 study participants were randomly assigned to one of four groups: aerobic exercise (n = 6), resistance exercise (n = 6), combined aerobic and resistance exercise (n = 6), and control group (n = 6). For each arm, the interventions were a structured workout package that was completed without interrupting usual clinical follow-up. The control groups, on the other hand, were kept as follow-up clinical cases with daily routine work. A paired t-test was performed to compare the means and mean differences of each exercise group’s pretest and posttest. A Tukey’s post hoc test was performed to compare mean differences between groups. The significance level was set at P < 0.05.ResultA more significant change was obtained in the combined aerobic and resistance exercise on anxiety and depression (p = 0.006), social dysfunction (p = 0.009), loss of confidence (p = 0.012) in particular, and psychological wellbeing (p = 0.010) in general. Resistance exercise alone had a significant impact on social dysfunction (p = 0.010), anxiety and depression (p = 0.017), and psychological well-being (p = 0.012) in general. Changes in social dysfunction (p = 0.010), anxiety and depression (p = 0.030), and psychological well-being (p = 0.018) were also influenced by aerobic exercise. The study found no significant change in depression and anxiety among control groups.ConclusionAs a result, the combined effect of aerobic and resistance exercise had a greater influence on improving anxiety and depression, social dysfunction, loss of confidence in particular, and psychological well-being in general among patients with type 2 diabetes. In other words, the present evidence proves the betterment of combined aerobic and resistance exercises alone followed by resistance exercise alone and aerobic exercise alone compared with non-exercise groups seems to upgrade psychological wellbeing by setting up three main benefits named as: (1) anti-anxiety and depression effects; (2) anti-social dysfunction effects; and (3) anti-loss of confidence effects. This suggests that patients with diabetes who exercise regularly enhance their psychological well-being.

Objective To explore the effects of individual aerobic combined with resistance training on the blood glucose, blood lipid and total exercise capacity compared with simple aerobic training in the coronary artery disease(CAD)patients with type 2 diabetes mellitus(T2DM)and the possible mechanisms. Methods The total 60 patients of CAD and T2DM were randomly assigned to control group(n=20), aerobic training group(n=20)and combined training group(n=20). Three groups all adopted the routine medication management, health education and diet guide.The control group had no other intervention.The aerobic training group had some 60%-85% of target heart rate(HR)aerobic exercises which was set according to the cardiopulmonary exercise test(CPET). The combined training group adopted isokinetic muscle strength training based on the aerobic training group which set intensity in 11-13 according the RPE.All patients were evaluated with fasting blood-glucose(FBG), glycosylated hemoglobin(HBA1c), total cholesterol(TC), triglyceride(TG), low density lipoprotein(LDL), fat mass(FM), lean body mass(LBM), VO2max, lower limbs peak torque(PT)and balance ability before and after training.Each exercise time 30-60 min, 3 times a week, a total of 12 weeks. Results There was no significant difference among the physiology index in three groups before training(P>0.05). Aerobic training group and combined training group significantly improved compared with control group in blood glucose, blood lipid, FM, VO2max after training(P 0.05). Combined training group had great improvement in lower limbs peak torque and balance ability than the other two groups(P<0.05). Conclusions Individualized aerobic combined with resistance training can give better control of coronary risk factors in CAD-T2DM patients, and improve the muscle strength and balance ability. Key words: Coronary artery disease; Diabetes mellitus; Aerobic training; Resistance training

Effect of combined aerobic and resistance training on peak oxygen consumption, muscle strength and health-related quality of life in patients with heart failure with reduced left ventricular ejection fraction: a systematic review and meta-analysis

Currently, there are inconsistencies in the body of evidence for the effects of resistance and aerobic training on skeletal muscle hypertrophy. We aimed to systematically review and meta-analyze current evidence on the differences in hypertrophic adaptation to aerobic and resistance training, and to discuss potential reasons for the disparities noted in the literature. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this review. The Downs and Black checklist was used for the assessment of methodological quality of the included studies. A random-effects meta-analysis was employed. In total, three analyses were performed: (1) for whole-muscle knee extensor data; (2) for type I fiber cross-sectional area; and (3) for type II fiber cross-sectional area. The final number of included studies in the present review is 21. All studies were of good or moderate methodological quality. The meta-analysis for whole-muscle hypertrophy resulted in a significant pooled difference (p < 0.001) in responses between the aerobic training and resistance training interventions. The pooled Hedge'sg, favoring resistance over aerobic training, was 0.66 (95% confidence interval 0.41-90; I2 = 0%). The meta-analysis for type I fiber cross-sectional area data resulted in a significant pooled difference (p < 0.001) between the aerobic training and resistance training groups. The pooled Hedge'sg, favoring resistance training over aerobic training, was 0.99 (95% confidence interval 0.44-1.54; I2 = 24%). The meta-analysis of type II fiber cross-sectional area data resulted in a significant pooled difference (p < 0.001) between the aerobic training and resistance training groups. The pooled Hedge'sg, favoring resistance training over aerobic training, was 1.44 (95% confidence interval 0.93-1.95; I2 = 8%). The results of this systematic review and meta-analysis suggest that single-mode aerobic training does not promote the same skeletal muscle hypertrophy as resistance training. This finding was consistent with measurements of muscle hypertrophy both at the whole-muscle and myofiber levels. While these results are specific to the knee extensor musculature, it can be hypothesized that similar results would be seen for other muscle groups as well.

Resistance and aerobic exercises are both recommended as effective treatments for people with type 2 diabetes. However, the optimum type of exercise for the disease remains to be determined to inform clinical decision-making and facilitate personalized exercise prescription. Our objective was to investigate whether resistance exercise is comparable to aerobic exercise in terms of effectiveness and safety in people with type 2 diabetes. PubMed, EMBASE, CENTRAL, CINAHL, and SPORTdiscus were systematically searched up to March 2013. The reference lists of eligible studies and relevant reviews were also checked. We used the following criteria to select studies for inclusion in the review: (i) the study was a randomized controlled trial; (ii) the participants were people with type 2 diabetes aged 18 years or more; (iii) the trial compared resistance exercise with aerobic exercise for a duration of at least 8 weeks, with pre-determined frequency, intensity, and duration; and (iv) the trial provided relevant data on at least one of the following: glycaemic control, blood lipids, anthropometric measures, blood pressure, fitness, health status, and adverse events. The assessment of study quality was based on the Cochrane Risk of Bias tool. For effectiveness measures, differences (resistance group minus aerobic group) in the changes from baseline with the two exercises were combined, using a random-effects model wherever possible. For adverse events, the relative risks (resistance group vs. aerobic group) were combined. Twelve trials (n = 626) were included. Following the exercise interventions, there was a greater reduction of glycosylated hemoglobin with aerobic exercise than with resistance exercise (difference 0.18% (1.97 mmol/mol), 95% confidence interval (CI) 0.01, 0.36). This difference became non-significant with sensitivity analysis (p = 0.14). The differences in changes from baseline were also statistically significant for body mass index (difference 0.22, 95% CI 0.06, 0.39), peak oxygen consumption (difference -1.84 mL/kg/min, 95% CI -3.07, -0.62), and maximum heart rate (difference 3.44 beats per minute, 95% CI 2.49, 4.39). Relative risks for adverse events (all) and serious adverse events were 1.17 (95% CI 0.77, 1.79) and 0.89 (95% CI 0.18, 4.39), respectively. Most included trials were short term (8 weeks to 6 months), and seven had important methodological limitations. Additionally, the meta-analyses for some of the secondary outcomes had a small number of participants or substantial statistical heterogeneity. Although differences in some diabetic control and physical fitness measures between resistance exercise and aerobic exercise groups reached statistical significance, there is no evidence that they are of clinical importance. There is also no evidence that resistance exercise differs from aerobic exercise in impact on cardiovascular risk markers or safety. Using one or the other type of exercise for type 2 diabetes may be less important than doing some form of physical activity. Future long-term studies focusing on patient-relevant outcomes are warranted.

Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial