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Want to be robust at 40-plus? Meeting minimum exercise guidelines won’t cut it

5 hours of moderate activity a week may be required to avoid midlife hypertension, UCSF-led study shows.

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Young adults must step up their exercise routines to reduce their chances of developing high blood pressure or hypertension – a condition that may lead to heart attack and stroke, as well as dementia in later life.

Current guidelines indicate that adults should have a minimum of two-and-a-half hours of moderate intensity exercise each week, but a new study led by UCSF Benioff Children’s Hospitals reveals that boosting exercise to as much as five hours a week may protect against hypertension in midlife – particularly if it is sustained in one’s thirties, forties and fifties.

In the study publishing in American Journal of Preventive Medicine on April 15, researchers followed approximately 5,000 adults ages 18 to 30 for 30 years. The participants were asked about their exercise habits, medical history, smoking status and alcohol use. Blood pressure and weight were monitored, together with cholesterol and triglycerides.

Hypertension was noted if blood pressure was 130 over 80 mmHg, the threshold established in 2017 by the American College of Cardiology/American Heart Association.

The 5,115 participants had been enrolled by the Coronary Artery Risk Development in Young Adults (CARDIA) study and came from urban sites in Birmingham, Ala., Chicago, Minneapolis and Oakland, Calif. Approximately half the participants were Black (51.6 percent) and the remainder were White. Just under half (45.5 percent) were men.

Fitness Levels Fall Fast for Black Men Leading to More Hypertension

Among the four groups, who were categorized by race and gender, Black men were found to be the most active in early adulthood, exercising slightly more than White men and significantly more than Black women and White women. But by the time Black men reached age 60, exercise intake had slumped from a peak of approximately 560 exercise units to around 300 units, the equivalent to the minimum of two-and-a-half hours a week of moderate intensity exercise recommended by the U.S. Department of Health and Human Services. This was substantially less exercise than White men (approximately 430 units) and slightly more than White women (approximately 320 units). Of the four groups, Black women had the least exercise throughout the study period and saw declines over time to approximately 200 units.

“Although Black male youth may have high engagement in sports, socio-economic factors, neighborhood environments, and work or family responsibilities may prevent continued engagement in physical activity through adulthood,” said first author Jason Nagata, MD, of the UCSF Division of Adolescent and Young Adult Medicine. Additionally, Black men reported the highest rates of smoking, which may preclude physical activity over time, he noted.

Physical activity for White men declined in their twenties and thirties and stabilized at around age 40. For White women, physical activity hovered around 380 exercise units, dipping in their thirties and remaining constant to age 60.

Rates of hypertension mirrored this declining physical activity. Approximately 80-to-90 percent of Black men and women had hypertension by age 60, compared with just below 70 percent for White men and 50 percent for White women.

“Results from randomized controlled trials and observational studies have shown that exercise lowers blood pressure, suggesting that it may be important to focus on exercise as a way to lower blood pressure in all adults as they approach middle age,” said senior author Kirsten Bibbins-Domingo, MD, PhD, of the UCSF Department of Epidemiology and Biostatistics.

“Teenagers and those in their early twenties may be physically active but these patterns change with age. Our study suggests that maintaining physical activity during young adulthood – at higher levels than previously recommended – may be particularly important.”

More Exercise from Youth to Midlife Offers Best Protection Against Hypertension

When researchers looked at the 17.9 percent of participants who had moderate exercise for at least five hours a week during early adulthood – double the recommended minimum – they found that the likelihood of developing hypertension was 18 percent lower than for those who exercised less than five hours a week. The likelihood was even lower for the 11.7 percent of participants who maintained their exercise habits until age 60.

Patients should be asked about physical activity in the same way as they are routinely checked for blood pressure, glucose and lipid profiles, obesity and smoking, Nagata said, and intervention programs should be held at schools, colleges, churches, workplaces and community organizations. Black women have high rates of obesity and smoking, and low rates of physical activity, he said, and should be an important group for targeted intervention.

“Nearly half of our participants in young adulthood had suboptimal levels of physical activity, which was significantly associated with the onset of hypertension, indicating that we need to raise the minimum standard for physical activity,” Nagata said. “This might be especially the case after high school when opportunities for physical activity diminish as young adults transition to college, the workforce and parenthood, and leisure time is eroded.”

Fitness

Postmenopausal women can dance their way to better health

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

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Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of camaraderie from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

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Stair climbing offers significant cardiovascular, muscular benefits for heart patients

While it is widely known that exercise and lifestyle changes reduce the risk of secondary cardiovascular disease, statistics suggest less than a quarter of all cardiac patients adhere to fitness programs.

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A team of McMaster University researchers who studied heart patients found that stair-climbing routines, whether vigorous or moderate, provide significant cardiovascular and muscular benefits.

The findings, published in closely related studies in the journals Medicine & Science in Sports & Exercise and Frontiers, address the most frequently cited barriers to exercise: time, equipment and access to gym facilities.

“Brief, vigorous stair-climbing and traditional moderate intensity exercise both changed fitness, which is a key predictor of mortality after a cardiac event,” says Maureen MacDonald, one of the lead researchers on both studies and a professor in McMaster’s Department of Kinesiology.

“We’ve shown stair-climbing is a safe, efficient and feasible option for cardiac rehabilitation, which is particularly relevant during the pandemic when many people don’t have the option to exercise in a gym,” she says.

While it is widely known that exercise and lifestyle changes reduce the risk of secondary cardiovascular disease, statistics suggest less than a quarter of all cardiac patients adhere to fitness programs.

Researchers worked closely with the Cardiac Health and Rehabilitation Centre at the Hamilton General Hospital to develop an exercise protocol that did not require specialized equipment or monitoring and could be easily performed outside a laboratory.

Participants with coronary artery disease who had undergone a cardiac procedure were randomly assigned either to traditional moderate-intensity exercise or vigorous stair climbing: three rounds of six flights of 12 stairs, separated by recovery periods of walking, with participants selecting their own stepping pace.

Researchers compared the results and found that individuals who had done traditional exercise and those who had done stair-climbing both increased their cardiorespiratory fitness after four weeks of supervised training and maintained those levels for an additional eight weeks of unsupervised training.

They also reported substantial muscular improvement.

“These patients who had undergone a coronary bypass or stent procedure had muscle that was compromised, compared to age-matched healthy controls,” explained Stuart Phillips, a co-author of the studies and a professor in the Department of Kinesiology at McMaster who oversaw the analysis of muscle tissue taken during the study.

Previously, there had been very few studies of the impact of exercise on cardiac patients’ muscle specifically. This analysis shows heart patients can still repair and build lost muscle.

“Even in just a short period, whether it was moderate intensity, continuous training or high-intensity stair climbing, there were beneficial adaptations in muscles after a cardiac procedure,” Phillips says. “The improvements were clear.”

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Returning to sports or exercise after recovering from COVID-19

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As COVID-19 affects everyone differently and the long-term effects are hard to predict, returning to exercise once recovered should be undertaken with great care, especially in the case of moderate to severe cases of COVID-19, says an expert from a top American hospital, Cleveland Clinic.

Sports medicine physician Marie Schaefer, MD, says: “The truth is, the disease can affect everyone differently. Anyone, including young athletes, could experience a severe case or have long-term damage, which is why it is so important to take this seriously.”

While experts know that in some people the virus can lead to damage of the heart, brain, lungs and kidneys, she says there is no way to pinpoint or predict who exactly these individuals will be. Some might also experience lingering symptoms, including shortness of breath, muscle aches, loss of stamina and exhaustion.

For many athletes and active people, Dr. Schaefer says, returning to activity will likely be a slow process and will require patience. Individuals should work with a physician to make sure they are progressing appropriately and to monitor their symptoms.

Timelines determined by severity of COVID-19

When an athlete or active individual is sick with COVID-19, they should not engage in any physical activity. During this time, they should focus on rest, good hydration, proper nutrition and following the advice of their physician or healthcare provider.

After this, the timeline of return to exercise or sport will be determined by how mild, moderate or severe the case was.

If an active individual or athlete only has a mild illness or tests positive without experiencing any symptoms, he or she can consider returning to activity after a 10-day isolation period. Once that window has passed, the athlete may consider a gradual return to physical activity, but must not have symptoms.

If an active individual or athlete had a moderate or a severe illness, or had to be hospitalized, he or she should be evaluated by a physician prior to restarting any type of exercise. Dr. Schaefer says these people may need to have additional tests, including ECGs, heart imaging or blood work before they are cleared to start a progression back into activity.

Myocarditis in athletes and active people

Dr. Schaefer points to the possibility of myocarditis, which is an inflammatory response of the heart due to a viral infection, such as COVID-19. It can cause swelling in the heart muscle making rigorous activity more difficult and sometimes, even deadly.

“Myocarditis is more likely to be found in people who had a moderate or severe case of the virus, but it can happen to anyone who was infected,” says Dr. Schaefer.

Given this increased potential risk for myocarditis, athletes or active people returning after COVID-19 infections need to be cleared by a healthcare provider who will determine if any additional testing is needed. Because of the risk of myocarditis, athletes and anyone who exercises should follow a graduated return to physical activity over the course of a week to monitor for signs and symptoms of this serious complication.

Advice for easing back into fitness

While serious athletes should follow a Return to Play (RTP) schedule supervised by a professional trainer or physician, Dr. Schaefer has three pieces of advice for anyone planning to reintroduce exercise into their routine.

1. Listen to your body. If someone is experiencing symptoms like chest pain or heart palpitations, they should stop exercising immediately and consult with a doctor. Exercise and movement are important for overall health, but for COVID-19, things can change overnight as we learn more about the virus, she says. People should keep monitoring themselves and if something feels more serious than just a consequence of being out of shape, they need to stop exercising and talk to a physician.

If individuals experience any of the follow red flag symptoms, they stop exercising immediately:

  • chest pain or heart palpitations
  • nausea
  • headache
  • high heart rate not proportional to exertion level or prolonged heart rate recovery.
  • feeling lightheaded or dizzy
  • shortness of breath, difficulty catching breath or abnormal, rapid breathing
  • excessive level of fatigue
  • swelling in the extremities
  • syncope (passing out)
  • experiencing tunnel vision or loss of vision.

2. Take it easy. Recovered patients should not try to “power through” as they did in the past. Athletes of all ages should follow a gradual progression to get back into exercise. They will need to build up the time and intensity of their workouts. Dr. Schaefer advises starting with a slow walk and if that feels alright, trying a brisk walk the next day. They will need to gradually increase the time they spend walking, building this up for about one to two weeks before returning to HIIT training or CrossFit, for example.

3. Be patient. Dr. Schaefer points out that even if someone the recovered patients were training for a marathon prior to becoming infected, they will likely discover that their body has changed a bit, which warrants extra caution. “Do not push too hard on a body that is still trying to recover,” she concludes.

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