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5-minute workout lowers blood pressure as much as exercise, drugs

The ultra-time-efficient maneuver known as High-Resistance Inspiratory Muscle Strength Training (IMST) could play a key role in helping aging adults fend off cardiovascular disease.

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Photo by Meghan Holmes from Unsplash.com

Working out just five minutes daily via a practice described as “strength training for your breathing muscles” lowers blood pressure and improves some measures of vascular health as well as, or even more than, aerobic exercise or medication, new CU Boulder research shows.

The study, published in the Journal of the American Heart Association, provides the strongest evidence yet that the ultra-time-efficient maneuver known as High-Resistance Inspiratory Muscle Strength Training (IMST) could play a key role in helping aging adults fend off cardiovascular disease.

In the United States alone, 65% of adults over age 50 have above-normal blood pressure – putting them at greater risk of heart attack or stroke. Yet fewer than 40% meet recommended aerobic exercise guidelines.

“There are a lot of lifestyle strategies that we know can help people maintain cardiovascular health as they age. But the reality is, they take a lot of time and effort and can be expensive and hard for some people to access,” said lead author Daniel Craighead, an assistant research professor in the Department of Integrative Physiology. “IMST can be done in five minutes in your own home while you watch TV.”

Developed in the 1980s as a way to help critically ill respiratory disease patients strengthen their diaphragm and other inspiratory (breathing) muscles, IMST involves inhaling vigorously through a hand-held device which provides resistance. Imagine sucking hard through a tube that sucks back.

Initially, when prescribing it for breathing disorders, doctors recommended a 30-minute-per-day regimen at low resistance. But in recent years, Craighead and colleagues have been testing whether a more time-efficient protocol–30 inhalations per day at high resistance, six days per week–could also reap cardiovascular, cognitive and sports performance improvements.

For the new study, they recruited 36 otherwise healthy adults ages 50 to 79 with above normal systolic blood pressure (120 millimeters of mercury or higher). Half did High-Resistance IMST for six weeks and half did a placebo protocol in which the resistance was much lower.

After six weeks, the IMST group saw their systolic blood pressure (the top number) dip nine points on average, a reduction which generally exceeds that achieved by walking 30 minutes a day five days a week. That decline is also equal to the effects of some blood pressure-lowering drug regimens.

Even six weeks after they quit doing IMST, the IMST group maintained most of that improvement.

“We found that not only is it more time-efficient than traditional exercise programs, the benefits may be longer lasting,” Craighead said.

The treatment group also saw a 45% improvement in vascular endothelial function, or the ability for arteries to expand upon stimulation, and a significant increase in levels of nitric oxide, a molecule key for dilating arteries and preventing plaque buildup. Nitric oxide levels naturally decline with age.

Markers of inflammation and oxidative stress, which can also boost heart attack risk, were significantly lower after people did IMST.

And, remarkably, those in the IMST group completed 95% of the sessions.

“We have identified a novel form of therapy that lowers blood pressure without giving people pharmacological compounds and with much higher adherence than aerobic exercise,” said senior author Doug Seals, a Distinguished Professor of Integrative Physiology. “That’s noteworthy.”

The practice may be particularly helpful for postmenopausal women.

In previous research, Seals’ lab showed that postmenopausal women who are not taking supplemental estrogen don’t reap as much benefit from aerobic exercise programs as men do when it comes to vascular endothelial function. IMST, the new study showed, improved it just as much in these women as in men.

“If aerobic exercise won’t improve this key measure of cardiovascular health for postmenopausal women, they need another lifestyle intervention that will,” said Craighead. “This could be it.”

Preliminary results suggest MST also improved some measures of brain function and physical fitness. And previous studies from other researchers have shown it can be useful for improving sports performance.

“If you’re running a marathon, your respiratory muscles get tired and begin to steal blood from your skeletal muscles,” said Craighead, who uses IMST in his own marathon training. “The idea is that if you build up endurance of those respiratory muscles, that won’t happen and your legs won’t get as fatigued.”

Seals said they’re uncertain exactly how a maneuver to strengthen breathing muscles ends up lowering blood pressure, but they suspect it prompts the cells lining blood vessels to produce more nitric oxide, enabling them to relax.

The National Institutes of Health recently awarded Seals $4 million to launch a larger follow-up study of about 100 people, comparing a 12-week IMST protocol head-to-head with an aerobic exercise program.

Meanwhile, the research group is developing a smartphone app to enable people to do the protocol at home using already commercially available devices.

Those considering IMST should consult with their doctor first. But thus far, IMST has proven remarkably safe, they said.

“It’s easy to do, it doesn’t take long, and we think it has a lot of potential to help a lot of people,” said Craighead.

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Aerobic exercise can help fight liver diseases

he Mfn-2 protein would regulate the curve of the mitochondrial membrane in promoting the oxidation of fat in a specific population of mitochondria, through its interaction and ability to form specific domains with membrane phospholipids.

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Aerobic exercise could help fight the non-alcoholic fatty liver disease, the most common liver disease worldwide: it affects nearly 24% of the global population and it usually causes a certain stigma among the affected people.

This is according to a study – “Mitofusin-2 induced by exercise modifies lipid droplet-mitochondria communication, promoting fatty acid oxidation in male mice with NAFLD” that appeared in the journal Metabolism. The study was led by Professor María Isabel Heràndez-Alvarez, in collaboration with Rodrigo Troncoso, and Víctor Cortés.  

When the liver accumulates large amounts of fat

One of the features of the fatty liver disease or non-alcoholic steatohepatitis (NAFLD) is the large concentration of lipid droplets (LD) that accumulate in the liver cells. “Our findings reveal that aerobic exercise, that is, moderate physical activity over time, helps metabolize the fats because it reduces the size of lipid droplets, and therefore, the severity of the disease”, notes the author. 

“Therefore, the energy demands induced by the exercise determine regulated changes in physical and functional relationships between fat droplets and mitochondria, the cell organelles that provide energy for the metabolism.”

This interaction may take place in a specific population of mitochondria known as peridroplet mitochondria (PDM). “As a result, there is a higher oxidation of lipids in this specific population of mitochondria, a process that helps prevent the progress of the disease”.

Discovering a previously unknown connection

“The interaction between the lipid droplets (LD) and the mitochondria is functionally important for the homeostasis of the fat metabolism. Exercise improves fatty liver disease, but to date, it was unknown whether the disease had a direct impact on the interactions between hepatic LDs and mitochondria,” noted María Isabel Hernàndez-Alvarez, Ramón y Cajal postdoctoral researcher at the UB’s Department of Biochemistry and Molecular Biomedicine.

The study also stresses that mitofusin 2 (Mfn-2) — a protein located in the external membrane of mitochondria — plays a decisive role in this process, since it modifies the communication between lipid droplets and the specific population of mitochondria.

“We found a decrease in the content related to saturated fatty acids in the hepatic mitochondrial membranes of animals that had done physical activity. This suggests that membrane fluidity increases in the mitochondria,” noted the researcher. “In the case of the mice without the Mfn-2 gene, exposed to physical activity, we did not observe changes in the saturation and the metabolism of fatty acids. These results show that the Mfn-2 protein takes part in the regulation of the composition of fatty acids of the mitochondrial membranes in response to exercise”.

According to the authors, the Mfn-2 protein would regulate the curve of the mitochondrial membrane in promoting the oxidation of fat in a specific population of mitochondria, through its interaction and ability to form specific domains with membrane phospholipids.

The study is a step forward to boosting research on mediators and molecular mechanisms that could promote new strategies to prevent the progression of NAFLD. “Considering the Mfn-2 functions in mitochondrial morphology and in the liver, the therapeutic manipulations of the levels and the activity of Mfn-2 could contribute to the improvement of the NAFLD-related inflammation and the fibrosis”, concluded the researcher.

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Fitness

Treatment options to help overcome knee pain for sports enthusiasts

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

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Millions of people experience chronic pain, with knee pain among the most common. Athletes and active adults know the impact activities like running and skiing can have on their knees, but when chronic knee pain makes it difficult to do those activities, or even day-to-day tasks like walking up the stairs, people may often face challenges.

According to the journal “Cartilage,” unlike other tissues, cartilage does not repair itself and, without proper treatment, can worsen over time and become more difficult to treat. However, options like FDA-approved knee cartilage repair surgery MACI (autologous cultured chondrocytes on porcine collagen membrane) uses a patient’s cells to help repair cartilage defects and may help alleviate knee pain.

“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

Justin Keys, a former patient of Meininger and avid skier, knows that the long-term outcomes of knee cartilage surgery can be worth the short-term sacrifices. After several injuries, including an ACL injury, Keys struggled with most activities except walking on flat, paved surfaces. After consulting with Meininger, Keys chose knee cartilage repair to help get back to his active lifestyle.

Keys considered whether to manage the injury as-is or choose MACI and undergo rehabilitation to potentially get back to his favorite activities in the future. He knew he could no longer use short-term relief methods and had to address his pain with a treatment to help provide lasting relief.

For athletes like Keys who want to fix knee pain, it’s important to consider these steps:

Discuss Options with Your Doctor

Patients should talk to their doctors and undergo an MRI to help assess the internal structures of the knee. Meininger recommends patients and their doctors discuss options for long-term knee restoration health, preserving function for future decades and recognizing the short-term sacrifice.

Set Yourself Up for Success

Experts like Meininger suggest patients take steps ahead of surgery to help their recovery.

“The important thing is to be as fit as possible and use the preseason months to undergo surgery and rehab,” Meininger said.

Patients can take steps to prep their home for recovery, which may include:

  • Bringing necessities down from hard-to-reach shelves
  • Moving furniture to ensure clear pathways
  • Installing shower safety handles to minimize potential falls

The Road to Rehab and Recovery

Rehabilitation takes time and everyone’s experience is unique. It can be as much of a mental challenge as it is physical. Committing to a physical therapy regime, staying hydrated and eating well are important aspects to support recovery. Patients should talk to their doctors with questions and before starting any exercises.

IMPORTANT SAFETY INFORMATION

Do not use if you are allergic to antibiotics such as gentamicin or materials from cow or pig; have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue or blood clotting conditions; had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant; or cannot follow a rehabilitation program post-surgery.

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Wellness

Whether you exercise regularly or one-to-two days a week, weight loss is possible

Whether you engage in physical activity on a regular basis or one-to-two days a week, both options produce weight loss suggests a new study published in the journal Obesity.

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Whether you engage in physical activity on a regular basis or one-to-two days a week, both options produce weight loss suggests a new study published in the journal Obesity, The Obesity Society’s (TOS) flagship journal. The study is the first of its kind to examine the association between physical activity patterns and objectively-measured fat tissue mass.

Guidelines from the World Health Organization recommend that adults perform at least 150 minutes per week of moderate physical activity, 75 minutes per week of vigorous physical activity or an equivalent combination of both intensities. However, many individuals find it challenging to meet this recommendation due to physical activity being time consuming in a fast-paced society. The new study found that people defined by researchers as “weekend warriors”—individuals who condense their exercise into one-to-two days a week—can also lose weight similar to individuals who exercise on a regular basis as long as they achieved the recommended goals.

“The weekend warrior pattern is worth promoting in individuals who cannot meet the recommended frequency in current guidelines,” said Lihua Zhang, health care scientist, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Zhang is one of the corresponding authors of the study.

Zhang suggested that office workers, bus drivers and other employees who have to sit for many hours during the work day care about the research. “Those people are struggling to catch up in their exercise plan in daily life to offset the hazard of a sedentary lifestyle but have less free time to get to the gym,” she said. “Our study could offer them an alternative choice to keep fit,” said Zhang, who added that there are suitable activities for weekend warriors such as climbing, hiking, cycling or running.

Researchers extracted data from more than 9,600 participants in the National Health and Nutrition Examination Survey from 2011 to 2018. Participants ranged in age from 20- to 59-years-old.

Abdominal and general adiposity were assessed by dual-energy x-ray absorptiometry (DXA)—a non-invasive and easily accessible body composition scan—and anthropometric measures. Physical activity levels were collected from the Global Physical Activity Questionnaire and classified as inactive, weekend warrior and regularly active. Survey linear regression models were used to assess associations between physical activity patterns and adiposity indicators.

Results showed that 772 participants reported the weekend warrior pattern and 3,277 reported the regularly active pattern. Compared to the 5,580 inactive participants, both the weekend warrior and regular active groups had lower DXA-measured abdominal adiposity, waist circumference, whole-body fat mass and body mass index. These two groups were also younger, more likely to be non-Hispanic White, have higher educational backgrounds, and less likely to be unemployed or to have hypertension or diabetes.

“On a high level, this study reaffirms the old adage about physical activity and health: any activity is better than no activity. Notably, the weekend warriors’ workout was of higher intensity and longer duration, and more intensity and longer duration correlated with even lower abdominal fat. The main takeaway, though, is that people should be active in any manner that suits their lifestyle,” said Assistant Professor of Clinical Medicine Beverly Tchang, MD, DABOM, Comprehensive Weight Control Center, Weill Cornell Medicine in New York. Tchang was not associated with the research study.

Steven B. Heymsfield, MD, professor, Pennington Biomedical Research Center, Baton Rouge, La., who was also not associated with the study added, “Findings in a cross-sectional sample such as reported by the study’s researchers need confirmation in prospective longitudinal studies.”

Other authors of the study include Lubi Lei, Jingkuo Li, Wei Wang, Yanwu Yu, Boxuan Pu and Yue Peng, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Another corresponding author, Zhenyan Zhao, is from the Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

The authors declared no conflicts of interest.

The study, titled “The Associations of ‘Weekend Warrior’ and Regularly Active Physical Activity with Abdominal and General Adiposity in U.S. Adults,” will be published in the April 2024 issue of Obesity.

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