Search Weight Loss Topics:

Page 18«..10..17181920..3040..»

Home » Exercise Programs » Page 18

By Editorial Team | on February 23, 2023

The Towns spring co-ed recreational programs have consistently proven to be one of the most popular programs the Town offers each year, as they provide a terrific outlet for our residents to exercise and stay in shape, said Town Councilwoman Laura Maier. The Towns Parks Department has done an amazing job offering residents the opportunity to take advantage of these classes and stay physically active, creating an optimal environment for fitness and forging new friendships!

This April, residents can participate in a variety of fitness classes that will be held at the Hicksville Athletic Center:

Online registration begins Monday, March 6 at 5 p.m. at http://www.oysterbaytown.com/portal. You must upload proof of residency (tax or utility bill) and a valid identification card such as a drivers license.

In-person registration will be available at the Hicksville Athletic Center, located at 167 S. Broadway in Hicksville, on Tuesday, March 7, from 5 p.m. to 9 p.m. The schedule is subject to change. If a session is cancelled, make-up day(s) will be attempted. Class fees are $60 for residents and $70 for non-residents (checks or money orders only). Proof of residency/age required when registering, with TOB residents given first preference. Participants must bring their own mat to yoga and Pilates. For more information, call(516) 797-7945 or email tobparks@oysterbay-ny.gov.

Here is the original post:
Town offers fitness classes for spring - The Mid Island Times

Swimming is one of the activities that people of all ages enjoy. Apart from being a popular sport in many countries, it is also a great way to bond with families and friends during summer. Swimming is not only enjoyable, but it can help you to stay fit and healthy!

Since it is a low-impact activity, many older adults and young children prefer this type of exercise to promote both physical and mental health.

Competitive swimming is for people who want to take this sport to a competitive level. During the Olympics, swimming remains one of the marquee events, with many people watching the games and rooting for their favourite swimmer.

Competitive swimming requires numerous hours of training over prolonged periods. Olympians start very young and spend most of their time training for specific swimming events. As elite athletes, Olympian swimmers show the power and benefits of this sport. These swimmers demonstrate how swimming is a vigorous workout while introducing fans to the thrill of competitive sports.

During competitive swimming, the main strokes used are:

All people of all ages can enjoy swimming as a recreation. This type of swimming provides people with a low-impact workout. Further, it is also an excellent way to feel good and relax with friends and family.

Similar to competitive swimming, there are also four common swimming styles:

Swimming is an essential full-body exercise workout as you swim against the resistance of the water.

Any type of exercise is better than no exercise at all. One of the most common forms of exercise is walking, which is feasible for many people as it is a low-impact activity and can be done anytime indoors or outdoors. Running is another common exercise since it is an extension of walking. Next to these two exercises is swimming. Considered an all-body workout, swimming also dramatically improves cardiovascular fitness.

In a study published in the International Journal of Aquatic Research and Education [1], investigators examined the association between swimming, running, and walking on all-cause mortality of 40 547 men aged 20 to 90. All the participants completed a health examination from 1971 to 2003 for 32 years. The investigators observed 543,330 person-years and recorded 3 386 deaths. After adjusting for body-mass index, age, alcohol intake, smoking, and family history of cardiovascular disease, the researchers found out that the swimmers had the lowest all-cause mortality risk compared with walkers, runners or those with a sedentary lifestyle.

Results showed that swimmers had 53% lower all-cause mortality risk than sedentary people. When compared with walkers or runners, swimmers had a 50% and 49% lower risk of all-cause mortality, respectively. The investigators, who are faculty members of the Exercise Science Department of the University of South Carolina, Columbia, concluded that swimmers had lower mortality rates than sedentary people, runners and walkers. After the longitudinal study, all participants were followed-up for an additional 13 years. At the end of the follow-up period, only 2% of the swimmers died compared with 8% of runners. Meanwhile, 9% of the walkers and 11% of non-exercisers died during the follow-up period.

Swimming is a crucial all-over workout since it works both the lungs and the heart. This workout trains the body to use oxygen more efficiently. As a result, the breathing and resting heart rates reduce following years of a swimming workout. For instance, the resting heart rate for non-athletes is 60-70 beats per minute. In contrast, swimmers have a resting heart rate of 40-60 beats per minute, demonstrating oxygen efficiency. Non-athletes have a normal breathing rate of 12-20 breaths per minute. However, the fitter you are, the lower your breathing rate. For competitive swimmers, the breath rate may be as low as eight breaths/per minute.

Since swimming uses both arms and legs and other muscle groups, it improves flexibility and muscle strength.

Regular swimming can improve physical strength and composition in middle-aged women and reduce blood lipid levels. A study [2] published in the Journal of Exercise Rehabilitation recruited a total of 24 middle-aged women who were assigned to the swimming group and a control group. The average age in the swimming group was 45.5 years, and 47.2 in the control group. There were no significant differences in each groups height, weight and BMI.

Women in the swimming group performed exercises for 60 minutes thrice a week for a total of 180 minutes. The exercise sessions lasted for 12 weeks. The control group did not engage in any exercise during the duration of the study.

Results indicated significant differences in physical composition between the swimming and control groups at the end of the study. There were also substantial differences in physical strength, cardiovascular endurance and flexibility between groups. There were significant differences in total cholesterol between the groups.

Although the study had a relatively small sample size, the findings are significant since it adds to evidence of the effectiveness of swimming in reducing body fats, increasing a persons physical strength and reducing the risk of cardiovascular disorders.

Results are also essential when promoting longevity among middle-aged women. This study showed that swimming is an excellent exercise in improving strength and flexibility, reducing body fats and reducing the risk of cardiovascular disease in older women. Since swimming minimizes the stress in joints, it would help middle-aged women with pain in their knee joints engage in exercise that does not negatively impact their joints.

People with osteoarthritis and associated joint pain would find it difficult to perform exercises such as walking and running. However, the good news is they can exercise through swimming. Swimming is known to be an ideal form of exercise for patients with joint pain and arthritis.

Osteoarthritis is the most common form of arthritis and a significant cause of pain and physical disability. The knee is recognized as the most commonly affected joint. Risk factors associated with knee osteoarthritis include increased age and body-mass index, female gender, prior ACL tears, prior history of trauma, and meniscal damage or surgery [3].

A randomized trial [4] published in the Journal of Rheumatology enrolled a total of 48 middle-aged and older adults who did not engage in any exercise. All participants were diagnosed with osteoarthritis. The participants were randomly assigned to a cycling exercise training and swimming group. Exercise training was performed three times a week, 45 minutes per day, at 60-70% heart rate reserve for three months or 12 weeks.

Results of the study showed significant reductions in stiffness and pain in the joints and physical limitation in both groups. Further, all also reported significantly increased quality of life. Both groups also increased their functional capacity and distance covered during the six-minute walk. There were no significant differences in the magnitude of improvements between cycling and swimming training.

It should be noted that the most frequently prescribed exercise for those with osteoarthritis is cycling training. However, joint pain and stiffness due to osteoarthritis can be reduced while functional capacity and muscle strength improve with swimming exercise programs. Since swimming is a low-impact activity, it is ideal for middle-aged to older adults with osteoarthritis.

Meanwhile, a retrospective longitudinal study [5] published in the Physical Medicine and Rehabilitation journal evaluated the relationship between knee pain, symptomatic knee osteoarthritis, radiographic knee osteoarthritis and history of swimming. Investigators included a total of 2,637 participants who have a mean age of 64.3 years. The participants mean BMI was 28.4 kg/m2. There were 44.2% males and 55.8% females.

The studys findings revealed that the prevalence of frequent knee pain was 36.4% for those with a history of swimming compared with 39.9% for those with no history of swimming. Only 54.3% in the swimming group had radiographic knee osteoarthritis compared with 61.1% in the non-swimming group. Symptomatic knee osteoarthritis prevalence was also lower in the swimming group (21.9%) compared with the non-swimming group (27.0%).

Since the study was population-based, it was the first to indicate that swimming could potentially improve knee health, especially when swimming is done before age 35 and continues throughout life. Although more prospective studies are needed to examine the relationship between swimming and knee osteoarthritis in older age groups, the findings are reassuring since they showed that swimming could benefit knee health.

Chronic stress is recognized as one of the significant mental health issues worldwide. Unsurprisingly, exposure to chronic stress can lead to other physical and mental health conditions. Specifically, chronic stress can affect our cognition and brain functioning. Recent studies [6] suggest that chronic stress is linked to psychiatric disorders such as anxiety and major depressive disorders. To treat anxiety and depression, a variety of medications and nonpharmacologic methods have been proposed. One of the nonpharmacologic methods includes exercise.

Animal studies show that exercise releases hormones that moderate stress and anxiety. In human and non-human studies, swimming can reduce anxiety symptoms, cortisol levels, and inflammatory markers.

An animal study [7] published in the International Journal of Environmental Research and Public Health examined the effects of swimming on corticosterone and anxiety-like behaviours in unstressed and stressed rats.

Findings indicated that self-paced swimming training could lessen anxiety parameters and concentrations of corticosterone, a hormone associated with stress. Interestingly, exercise can reduce stress-related hormones in both stressed and unstressed rats. In stressed rats, apart from swimming, they needed a recovery period to minimize corticosterone levels. Overall, this animal study demonstrated the effectiveness of swimming exercises in lowering hormone levels associated with stress and reducing anxiety.

A YouGov poll [8], which Swim England commissioned, examined if swimming can reduce anxiety symptoms amongst 1.4 million adults in Britain. Findings showed that 492,000 participants with mental health conditions reported that swimming reduced the number of their mental health visits to their medical professionals. In addition, more than 490,000 of those surveyed said their healthcare practitioners had advised them to reduce or stop medications for their mental health conditions. They attributed swimming as the reason why they had better mental health and were no longer required to take medications for their mental health conditions.

The benefits of swimming were also examined during the survey. About 43% of the participants in the YouGov poll who are regular swimmers stated that swimming made them feel happier. Another 26 per cent indicated that swimming helped them feel motivated to complete their daily tasks. Another 15% believed that swimming helped them feel that life is more manageable.

UKs chair of the Swimming and Health Commission, Ian Cumming [8], stated, Physical activity in any form can have a positive impact on a persons mental health, but swimming is unique because the buoyancy of water ensures everyone can take part at a pace that suits them. It is perfect for people with restricted movement.

Research shows that simply being in water can be restorative, particularly swimming outside. People relax in many ways some set a target and aim to beat their time, while others prefer a more leisurely swim on their own or with friends. Swimming provides that choice, and if it is regularly prescribed alongside other support forms, swimming could impact wider society.

Swimming is a sport or exercise that you can continue until age. However, research shows that other forms of exercise benefit the heart and muscles of the body while also improving mood. Hence, you can take up swimming along with another exercise regimen such as dancing, walking, cycling or running.

Although swimming is an excellent exercise programme and improves your health and mood, it does not do much for your bone health. Hence, many doctors advise those who take up swimming as a hobby and sport to supplement this with strength training and activities such as climbing stairs, gardening, or strength training. Other forms of weight-bearing exercises are also highly recommended to improve bone health.

It is easy to get started in swimming. As a recreational and competitive sport, it can be done by young children to older adults. Hence, it fits all age groups, fitness and skill levels.

You can contact your local public swimming pools and aquatic centres offering swimming lessons for all age groups and fitness levels. Public pools have minimal entry fees and can help you start swimming.

When planning to swim, it is vital to ensure your safety and the safety of your children and others:

Swimming is best known for improving cardiovascular health and improve mood. It can be done by anyone of all ages and at different fitness levels.

To reap the benefits of exercise, you do not need to swim long distances or several laps. You can walk through the water since it is safe for your joints and does not have the same impact on your knees as land-based activities such as running and walking.

You can also tread in water, a fun way to bond with your families and friends while challenging your cardiovascular system. In addition, there are classes such as aqua aerobics and aqua Zumba that increase the resistance of moving in the water.

For those who are more adventurous, you can start plyometric exercises in the pool. These exercises increase the bodys power and strength without the risk of overtraining your body. Some examples of plyometric exercises include running underwater with weights.

A body of evidence from published studies well supports the benefits of swimming. However, recent studies suggest swimming lessons could significantly impact their cognitive and motor development, especially among babies and young children.

Investigators from the University of Romes Department of Movement, Human and Health Sciences [9] conducted a pilot trial on the effects of swimming on babies motor and cognitive development. Investigators recruited 27 babies and randomly assigned them to a 10-week swimming intervention and a control group.

Results showed that infants in the experimental group demonstrated significant improvements in fine, gross and total motor skills compared with the control group. Likewise, there were also significant improvements in the cognition of the experimental group. Although the study had a very small sample size and would require further validation in more extensive trials, the results are promising since they showed that early swimming training could improve babies motor and cognitive skills.

The benefits of swimming on cognition may also be seen amongst older people. An animal study published in the Physiological Reports journal [10] reported that swimming exercise improves long-term and short-term memories in animal model studies. The animals in the study were subjected to training exercises of 60 minutes per day for five days a week. The animals exercised for a month. Results indicated that both short and long-term memory significantly improved even at seven days of training but plateaued in the following days until 28 days of training.

The findings of this animal model study could form a basis for the future use of exercise in healthy individuals.

Swimming is a vital exercise that you can enjoy at any age and fitness level. Start reaping its benefits now by consulting your doctor to determine if it is safe for you to take swimming lessons or engage in swimming activities.

The many benefits of swimming are well supported in high-quality studies. These include improvements in cardiovascular health, mood, and overall mental health and well-being. Since it is a low-impact activity, it is safe for both young and old and middle-aged people. This type of exercise is highly beneficial for those with osteoarthritis since it does not put weight on the knee joints.

In young children and babies, it is also reported that swimming can improve both motor skills and cognition. In middle-aged to older adults, swimming can improve short- and long-term memory.

Finally, swimming improves mood and well-being by reducing hormones related to stress and anxiety.

[1] https://ndpa.org/directory-drowning_lit/listing/swimming-and-all-cause-mortality-risk-compared-with-running-walking-and-sedentary-habits-in-men/|[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625655/%5B3%5D https://pubmed.ncbi.nlm.nih.gov/18759314/%5B4%5D https://pubmed.ncbi.nlm.nih.gov/26773104/%5B5%5D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166141/%5B6%5D https://pubmed.ncbi.nlm.nih.gov/31039481/%5B7%5D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558513/%5B8%5D https://www.swimming.org/swimengland/new-study-says-swimming-benefits-mental-health/%5B9%5D https://journals.sagepub.com/doi/abs/10.1177/00315125221090203%5B10%5D https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191402/

The information included in this article is for informational purposes only. The purpose of this webpage is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

See the rest here:
Swimming: types, benefits, importance and research - Longevity.Technology

Name something that COVID didnt ruin. OK, so maybe its responsible for an uptick in remote work, which isnt all bad, but for the most part that useless virus has given society a real gut punch and its just now finally starting to recover.

Thats why the focus of this years TEDxCharleston event the grassroots initiative featuring local speakers speaking passionately about topics ranging from health to social issues, technology and more is a celebration of our culture coming out of a tough stretch, tougher and smarter for the experience.

According to organizers, the past two-plus years have created a world fraught with new challenges and risks but new opportunities as well.

Creativity, innovation and thoughtfulness are all needed to deal with this new reality, the events website states. An exciting lineup of speakers and performers will explore many important and inspiring ideas at the event, appropriately themed Re-Emerge.

TEDxCharleston draws nearly 1,000 in-person participants each year, not including an extensive online following. This year marks the 10thyear of the event, which will be held at Charleston Music Hall on March 29.

Three of the 20 scheduled speakers/performers are MUSCs very own: surgical oncologist Andrea Marie Abbott, M.D.; trauma surgeon Ashley Hink, M.D.; and neurosurgeon Alejandro Spiotta, M.D.

Abbott, who serves as director of MUSC Healths Melanoma Program, specializes in the treatment of breast and skin cancers. Communication is something the surgeon really values. Her talk will focus on how all people, not just in health care, can better achieve their goals through communication that is calm, concise and honest.

Hink, who is passionate about eliminating gun violence in our community, not just treating those who have been hurt, has been instrumental in establishing several new programs and initiatives in and around the Charleston area. Hink plans to speak about how health care systems can work with survivors and communities to break cycles of violence by addressing its root causes.

Spiotta, a professor of neurosurgery and neuroendovascular surgery and vice chair of the Department of Neurosurgery at MUSC, has devoted much of his professional career to studying and treating cerebrovascular disease. During his career, hes performed thousands of complex, high-stakes brain surgeries in record time through deep focus and mindfulness. During his TEDx talk, he will get into how those same techniques can help with everything from exercise to finding success in the workplace.

For more information, visit http://www.tedxcharleston.org.

Read the original post:
'Re-emerging' from most uncertain times | MUSC | Charleston, SC - Medical University of South Carolina

Patients in cardiac rehab program go from wheelchair to walking track in 12 weeks

Betty Berendzen works with a patient in the cardiac rehab program, taking his blood presure. (KRCG 13)

Capital Region Medical Center's cardiac and pulmonary rehabilitation programs at the Sam B. Cook Healthplex are designedto help the patient live their life with all their heart.

And Betty Berendzen, a registered nurse and cardiac rehab supervisor with the program, said the progress she sees is incredible.

Focus on Your Health

"They come in in a wheelchair, they come in on a walker, they come in on oxygen and they graduate walking. And that is rewarding," Berendzen said.

Patients in the program have had heart attacks, undergone heart surgery or lung transplants, or experience regular chest pain.

The program requires a physician referral and is highly specialized.

"Each patient has an individualized treatment plan so their first day they do a 6-minute walk and then we base an exercise program on that," Berendzen said.

"You know we start slow and build up. We want them to graduate and be able to do 150 minutes of cardiovascular activity each week," she said.

The team of nurses and exercise specialists works side by side with the patients during the 12-week, EKG monitored program while they do exercises, stretches, and lots of walking.

"We do use the track at the Healthplex or the treadmills because we want people to walk. If you can't walk then we feel like you can't have your independence," Berendzen said.

"We have different stepping machines, just moving the legs working the leg muscles and then the arms, people think it's just the arm work but not really it opens up the cardiothoracic area and helps with breathing and helps with healing and that too," she said.

The general goal of the program is better heart health, but Berendzen said every patient has their own motivation to graduate.

"Whether it's to walk a 5K with family or to get down and do stuff with their grandkids and that sort of thing, or to get back to work. When they achieve that and see the light in their eyes it's just pretty rewarding," she said.

For more information about the program visit the Capital Region Medical Center website, crmc.org.

The rest is here:
Patients in cardiac rehab program go from wheelchair to walking track in 12 weeks - krcgtv.com

Introduction

Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. It is usually caused by significant exposure to noxious particles among which tobacco smoking is the main factor in France.1 Despite being preventable and treatable, COPD prevalence is still increasing and represents a major source of morbidity, mortality and a significant economic burden.2 Progression of the disease is associated with increased respiratory disability and health-related quality of life (HRQoL) alteration.

Pulmonary rehabilitation (PR) is an effective and comprehensive treatment for COPD patients combining retraining exercises, therapeutic education, nutritional and psychological supports but remains underused.3 Therefore, new models have emerge last years to improve access to PR such as home-based PR programs, which are useful for patients living far from PR centers and were also shown interesting for limiting contact during the SARS-CoV2 epidemic.4 However, impact of comorbidities on PR outcomes, particularly with these new PR modalities, is not well known.

Cardiovascular diseases such as ischemic heart disease, arrhythmia, heart failure, peripheral arterial diseases and metabolic disorders such as arterial hypertension and diabetes mellitus are frequently associated with COPD.5 These associations may be related to common underlying molecular mechanisms, but also to common risk factors such as smoking and decreased physical activity.6,7 These comorbidities were reported to be associated with higher symptoms burden and lower HRQoL in COPD.8 Moreover, cardiovascular diseases are associated with prolonged hospital length of stay after acute exacerbation of COPD and with increased mortality.9,10 However, it is proven that cardiac rehabilitation is effective in improving exercise capacity and HRQoL in patients with cardiovascular diseases.11 Only a few studies have evaluated the impact of cardiovascular comorbidities on PR-related outcomes in COPD patients and reported contrasting results.1216 Furthermore, all of these studies were center-based and none evaluated benefits up to a year after the end of the PR program.

The aim of our study was to determine whether established cardiovascular diseases and metabolic comorbidities impacted long-term effects of a home-based PR program on exercise capacity, HRQoL and anxiety-depression in COPD patients.

Data of all consecutive COPD patients addressed for the FormAction home-based PR program between January 2010 and June 2016 were prospectively collected in the computerized medical record CARE ITOU and retrospectively analyzed. All patients were addressed by a respiratory physician who confirmed the diagnosis of COPD according to GOLD definition and checked for absence of PR contraindications, ie active lung cancer, unstable cardiovascular disease, significant cognitive disorders, uncontrolled psychiatric illness, neurological sequelae or major osteoarticular restrictions.17 The choice of home-based vs center-based PR was determined according to patients wishes and/or lack of PR center close to their home. Adverse events and reasons for withdrawals were recorded with a systematic assessment of their relationship to the program. The study protocol was conducted in accordance with the Declaration of Helsinki and approved by the Observational Research Protocol Evaluation Committee of the French Society of Respiratory Disease (CEPRO 2017007). All participants signed a written informed consent prior to the start of the program which included their approval to use the collected data for research purposes and the computerized medical record declared to the National Commission for Informatics and Liberties.

Comorbidities were self-reported by patients and then completed and corrected from medical reports provided by the patient and their respiratory physician. Comorbidities were then registered in the computerized medical record when patients entered the PR program. Patients with a diagnosis of ischemic heart disease, chronic heart failure, cardiac arrhythmias, pulmonary hypertension or peripheral arterial disease were classified as having at least one established cardiovascular disease (Cardiovascular group). Patients without previous cardiovascular comorbidities but with at least one comorbidity used to diagnose a metabolic syndrome, ie hypertension, hypercholesterolemia, diabetes mellitus, or obesity (defined by a body mass index [BMI] 30 kg/m2) were classified as having metabolic comorbidities (Metabolic group). Patients having both metabolic and cardiovascular comorbidities were classified in the Cardiovascular group. Finally, patients who were not classified in these two groups were considered with no cardiovascular and metabolic comorbidities and considered as the Reference group. Underweight was defined by a BMI 21 kg/m2.18

Our home-based PR program was described in previous studies.19 Briefly, this 8-week program included exercise training and physical activities, therapeutic education, nutritional support and behavioral and motivational approaches. Patients were supervised in-person by a member of the PR team during a weekly 90-min session and encouraged to continue exercises the rest of the week in autonomy and after the end of the PR program. Patients started with individual endurance exercises on a cycle ergometer at the target heart rate in 10-min sequences, at least 5 days per week, with the goal of reaching 3045 min per sequence in one or several sessions. After the end of the program, the PR team performed home-visits at 6 and 12 months to assess encountered difficulties, find solutions and strengthen patients and caregivers motivation.

Assessments were performed at baseline before the PR program (M0), immediately at the end of the program (M2), and at 6 and 12 months after its end (M8 and M14, respectively). Exercise capacity was assessed using the 6-min stepper test (6MST) that measures the number of steps performed in 6 min on a stepper with a minimal clinically significant difference (MCID) of 40 steps.20,21 Health-related quality of life (HRQoL) was assessed using the visual simplified respiratory questionnaire (VSRQ) ranging for 0 (worse) to 80 (better) with a MCID of 3.4 points.22 Finally, anxiety and depression were assessed using the hospital anxiety and depression scale (HAD) distinguishing overall score, and anxiety and depression sub-scores. These scores increase with anxiety and depression with a MCID of 1.5 points for each score and sub-scores.23

Quantitative variables are expressed as means standard deviation (SD) and categorical variables are expressed as frequencies (percentage). Among patients who initiated PR, differences in baseline characteristics between patients evaluated and those not evaluated at 12 months after end of PR (due to death or loss to follow-up) were assessed by calculating the absolute standardized difference (ASD); an ASD >20% was interpreted as a meaningful difference. Comparisons in baseline characteristics between the three groups were performed using one-way analysis of variance (ANOVA) for quantitative variables or chi-squared tests for categorical variables. Evolution of outcomes (HRQoL, exercise capacity, anxiety, and depression) from baseline (M0) to M2, M8 and M14 were analyzed using linear mixed models for repeated measures (an unstructured covariance pattern model to account the correlation between repeated measures) by including time as fixed effect. Comparisons in evolution of outcomes from baseline (M0) to M2, M8 and M14 between the three groups were also performed using linear mixed models including groups, time, interaction time*groups, baseline outcome values and predetermined confounding factors (age, sex, BMI, FEV1, and long-term oxygen therapy (LTOT) status) as fixed effects;24 post hoc comparisons of 2-, 8- and 14-month changes were done using linear contrasts. Comparisons in evolution of outcomes between the three groups were also done after excluding underweight patients as a sensitivity analysis. Normality of residuals of linear mixed models were checked using quantile-quantile (Q-Q) plots. All statistical tests were done at the two-tailed level of 0.05 without correction for multiple comparisons. Data were analyzed using SAS software version 9.4 (SAS Institute, Cary, NC, USA).

Four hundred and nineteen consecutive COPD patients were addressed to the home-based PR program, among which 413 started the program and 380, 333, and 303 were evaluated at M2, M8 and M14, respectively (Figure 1). None of them had any contraindication to PR and no incident related to the PR program was reported. The population included 67% men. The mean age was 64.111.2 years. Most patients had severe COPD (mean FEV1 39.217% predicted, 66.3% GOLD stages III and IV) and were ex-smokers (80.9%) with cumulative smoking estimated at 4830 pack-years (Table 1). Only 23.6% did not receive LTOT, noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP). The most prevalent reported comorbidities were hypertension (40.8%), obesity (30.7%), underweight (22.8%), hypercholesterolemia (22.4%), ischemic heart disease (22.2%) and diabetes (21.7%) (Tables 1 and 2). Other self-reported comorbidities are detailed in Supplementary Table 1. One hundred and twenty-two patients (29.1%) were classified as having metabolic comorbidities without an established cardiovascular disease (Metabolic group) and 102 patients (24.3%) as having no cardiovascular nor metabolic comorbidities (Reference group). Therefore, 195 patients (46.5%) were classified as having at least one established cardiovascular disease (Cardiovascular group). Altogether, 83% had at least three reported comorbidities. The 110 patients who initiated the program and were lost to follow-up during the 14 months were more likely to have an established cardiovascular comorbidity, to be underweight, to present a very severe airflow limitation and to require LTOT or NIV (Supplementary Table 2).

Table 1 Baseline Description of the Population

Table 2 Patients Reported Cardiovascular and Metabolic Comorbidities

Figure 1 Flowchart of the whole population.

Abbreviation: PR, pulmonary rehabilitation.

At baseline, patients performed 3099 steps during the 6MST and had an altered HRQoL reflected by a low VSRQ score (31.10.8) (Supplementary Table 3). They exhibited elevated anxiety and depression scores (9.70.2 and 8.00.2, respectively) with 52% and 34% of them showing anxiety and depression scores greater than or equal to 11, respectively. Patients from the Cardiovascular group were more often men (73.8%), were older (mean age 68.59.6 years) and more frequently treated with LTOT and NIV (Table 1). Patients from Metabolic and Cardiovascular groups had a higher BMI (30.56.7 and 28.18.1 kg/m2, respectively, vs 21.23.8 kg/m2 for the Reference group) and were more often treated with CPAP (13.1 and 8.7%, respectively, vs 1% for the Reference group). Proportion of GOLD stage IV COPD was higher in Reference group (45.6% vs 23.6% and 37.5% in Metabolic and Cardiovascular groups, respectively) while GOLD stages I and II COPD were more frequent in Metabolic group (29.2% vs 17.8% and 19.9% for Reference and Cardiovascular groups, respectively). At baseline, patients from Cardiovascular group performed significantly fewer steps on the 6MST (272141 steps vs 343161 and 339164 for Reference and Metabolic groups, respectively), while VSRQ and HAD scores were similar between the three groups (Supplementary Table 4). Taking into account only patients evaluated at M2 and after adjustment to age, sex, BMI, FEV1 and LTOT status, the three groups were similar for all baseline assessments (Table 3).

Table 3 Absolute Variations of Exercise Capacity, Quality of Life and Anxiety-depression for each Group of Patients

In the whole population, all outcomes significantly improved between baseline and the end of the program (M2), 6 months (M8) and 12 months after PR completion (M14) (Table 4). After adjustment on age, sex, BMI, FEV1, and LTOT status, changes in all outcomes remained significant for all three groups for all three assessments (M2, M8 and M14), except for the 6MST at M8 and M14 in Reference group (Table 5). The proportion of patients exceeding the MCID for at least one of the outcomes, ie HRQoL, anxiety-depression or exercise capacity, was 69.8%, 56.7%, and 50.7% at M2, M8 and M14, respectively (Figure 2). When comparing groups to each other, mean HAD global score was significantly more improved at M14 in patients from Metabolic group versus the two other groups and depression subscore at M14 between Metabolic and Cardiovascular groups (Table 3). There were no significant differences between groups for other time point and outcomes. Results were similar after exclusion of underweight patients (Supplementary Table 5).

Table 4 Absolute Variations of Exercise Capacity, Quality of Life and Anxiety-depression for the Whole Population

Table 5 Comparisons to Baseline of Exercise Capacity, Quality of Life and Anxiety-depression Assessed at the End of the Rehabilitation Program and after 6 and 12 Months for each Group of Patients

Figure 2 Proportion of patients exceeding the MCID for exercise capacity, quality of life and anxiety-depression score according to the group.

Abbreviations: 6MST, 6-min stepper test; HAD, hospital anxiety and depression scale; MCID, minimal clinically significant difference; VSRQ, visual simplified respiratory questionnaire.

Notes: Proportion of patients exceeding the MCID for exercise tolerance assessed by (A) the 6-min stepper test (6MST MCID 40 steps), (B) quality of life assessed by the visual simplified respiratory questionnaire (VSRQ MCID 3.4 points) and (C) anxiety-depression assessed by the hospital anxiety and depression scale global score (HAD MCID 1.5 points). Group 1, Reference Group; Group 2, Metabolic Group; Group 3, Cardiovascular Group.

This retrospective observational study evaluated the impact of cardiovascular and metabolic comorbidities on the outcomes of a home-based PR program in COPD patients over 1 year after the end of this program. COPD patients with metabolic comorbidities but no established cardiovascular disease exhibited a significant greater improvement in depression at 12 months after PR achievement compared to control group. No other outcome was significantly different between the three groups. To our knowledge, this is the first real-life study to evaluate impact of cardiovascular and metabolic comorbidities after 6 and 12 months of a home-based PR program.

Cardiovascular comorbidities are frequently associated with COPD and remain the most common causes of mortality in these patients.25 We confirm this strong association with only 24.3% of patients who had no cardiovascular disease nor cardiovascular risk-factors excluding smoking and by the observation that 81% of patients who died during the 14 month follow-up had at least one cardiovascular comorbidity. Moreover, at baseline, patients with established cardiovascular disease exhibited significant lower exercise capacity. Although in our study this group of patient was older than others, this is concordant with previous studies reporting decreased physical activity in COPD patients with concomitant cardiovascular disease, a diminished capacity partly mediated by deleterious cardiorespiratory interactions.26 Comprehensive care integrating all comorbidities is therefore essential to improve the prognosis of these patients.

We chose to group patients with established cardiovascular comorbidity regardless of metabolic comorbidity because only 24% of those patients did not have metabolic comorbidity and those cardiovascular comorbidity are associated with a significant exercise capacity limitation.2729 The choice to categorize hypertension as a metabolic comorbidity and not as a cardiovascular comorbidity is questionable. However, definitions of metabolic syndrome consider hypertension as one of their diagnostic criteria and hypertension is clearly identified as a risk factor for adverse cardiovascular outcomes.30 In a cohort of healthy adults who underwent a cardiac health check-up, Kim et al reported that exercise capacity was more reduced, the level of coronary calcification more increased and the cardiac structure on echocardiography more altered when patients had more components of the metabolic syndrome including hypertension.31 This suggests that the impact of comorbidities defining the metabolic syndrome have a cumulative effect. Conversely these comorbidities are also improved and may be reversed to some extent by physical activity.32 Therefore, we chose to group these comorbidities including hypertension for their intermediate impact on exercise tolerance and their recovery potential.

Benefits of pulmonary rehabilitation for COPD patients are well described and our home-based PR program, as center-based programs, exhibit benefits on exercise capacity, quality of life and anxiety-depression, not only at the end of the program, but up to one year after its achievement in the whole population.19,33 Ninety percent of patients completed our home-based PR program. Compared to the British Thoracic Society objectives of achieving a 70% completion rate, this suggests that this modality would remove some of the obstacles to finalizing the PR program for some patients.34 Other effective PR models including telerehabilitation have emerged in recent years to improve access and uptake to PR and address issues related to the distance to rehabilitation centers or to constraints of the SARS-CoV2 epidemic.35 Cardiovascular comorbidities may be perceived as an obstacle to out-of-center PR, but our study demonstrates that home-based PR is feasible and effective for referred patients, provided that the prescriber first assesses the stability of these comorbidities.

Specific influence of cardiovascular and metabolic comorbidities on PR and results was evaluated by some studies immediately at the end of the PR program with contrasting effects. The association between having cardiovascular comorbidities and exhibiting a greater improvement of dyspnea after PR was not observed in all studies and only one retrospective study report an association between having cardiovascular comorbidities and exhibiting greater 6MWD improvements.12,1416 In a retrospective study, Crisafulli et al reported a weaker improvement of SGRQ score in patients with cardiovascular comorbidities, but this negative association was not observed in their later prospective study nor in the Mesquita et al or Butler et al studies.1315 Conversely, Tunsupon et al reported greater improvement of quality of life assessed with the chronic respiratory disease questionnaire in patients with cardiovascular diseases.12 None of these studies have evaluated the impact on anxiety-depression nor the persistence of benefits after the end of the PR. Considering metabolic comorbidities, to our knowledge no study reported an association between having a metabolic disorder and reporting a greater dyspnea improvement after PR.12,1416 The impact of metabolic comorbidities on exercise capacity improvement after PR is more controversial. Thus, Walsh et al have reported a greater improvement associated with these metabolic comorbidities, as observed in our study, but there were no association in three other studies.13,15,16,36 Moreover, in two other studies, exercise capacity improvement was weaker in patients with metabolic comorbidities.12,14 Finally, as observed in our study, none reported an association between having metabolic comorbidities and exhibiting greater quality of life improvement. Altogether, these discrepancies may suggest that comorbidities did not impact PR outcomes per se except when they participate in the symptomatology and the impact of the disease. A more precise phenotyping of the mechanisms involved in patients symptoms may help to clarify condition when patients will benefit the most from a PR.

Our study is limited by its design as we included only patients addressed to our home-based PR program by their physicians who may have made the choice to address their patients to our home-based program based on criteria unknown to us. As our study included only patients managed in our home-based PR program, our results may not be extrapolated to a center-based program despite the fact that studies have reported that these two modalities could produce similar results and that characteristics of patients choosing one or the other of these modalities would not differ.4,37 As comorbidities were self-reported by patients, we cannot exclude that some comorbidities were misdiagnosed. While underdiagnosis of cardiovascular diseases was shown to be unlikely, overestimation is possible as hypertension or hypercholesterolemia underdiagnosis.38,39 Therefore, there is still a risk of misclassifying patients despite we systematically corrected self-reported comorbidities from medical reports provided by patients. Moreover, due to the retrospective design of our study, some information was not available including precise dyspnea evaluation, exacerbations rate, detailed evaluation of nutritional and muscular status, emphysema severity, distention level, and quantification of physical activity after PR discharge. A significant proportion of underweight patients were present in the reference group and their characteristics have similarities with the cachectic cluster described by Vanfleteren et al, a phenotype associated with poorer HRQoL, more frequent exacerbations and higher mortality.40 However, the sensitivity analysis performed after exclusion of these patients showed similar results to main analysis performed with adjustment for BMI demonstrating the modest impact of this heterogeneity in weight profile.

Stable cardiovascular and metabolic comorbidities are frequently associated with COPD and do not limit short- and long-term improvement of exercise capacity, quality of life and anxiety-depression after a home-based pulmonary rehabilitation. Whether specific personalization of the PR program is required to improve benefits for all patients according to their comorbidities remains to be determined.

6MST, 6-min stepper test; 6MWD, distance in the 6-min walking test; BMI, body mass index; COPD, chronic obstructive pulmonary disease; CPAP, continuous positive airway pressure; FEV1, forced expiratory volume in one second; FVC, forced vital capacity; GOLD, global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease; HAD, hospital anxiety and depression scale; HRQoL, health-related quality of life; LTOT, long-term oxygen therapy; MCID, minimal clinically significant difference; NIV, noninvasive ventilation; PR, pulmonary rehabilitation; SGRQ, St Georges respiratory questionnaire; VSRQ, visual simplified respiratory questionnaire.

The authors would like to thank the rehabilitation team who managed the patients: G. Tywoniuk, S. Duriez, M Grosbois, V Opsomer, F. Urbain, V. Wauquier, and M. Lambinet. The authors would also like to thank Adair, Aeris Sant, Bastide, France Oxygne, Homeperf, LVL, Medopale, NorOx, Santlys, SOS Oxygne, Sysmed, VitalAire, and ARS Hauts-de-France for their support of the home-based PR program. They also thank Emeline Cailliau and Julien Labreuche who performed the new statistical analyses in response to reviewers comments.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

There is no funding to report.

JMG received financial support from Adair, Aeris Sant, Bastide, Elivie, France Oxygne, Homeperf, LVL, Medopale, NorOx, Santlys, Santo, SOS Oxygne, Sysmed, VentilHome, VitalAire, and ARS Hauts-de-France for the home-based PR program. JMG reports personal fees and nonfinancial support unrelated to the submitted work from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GlaxoSmithKlein, Novartis, Vitalaire, and Roche, unrelated to the submitted work. AD reports nonfinancial support from ALK-Abello, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, LEO Pharma, Menarini, MSD, Novartis, Novo Nordisk, Pfizer, Resmed and Vitalaire, unrelated to the submitted work. AP reports no conflicts of interest related to the submitted work. NB reports personal fees from AstraZeneca, and nonfinancial support from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Novartis, Santelys association, SOS Oxygne and TEVA, unrelated to the submitted work. TP reports grants from AstraZeneca, personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein and Novartis, and congress support from AstraZeneca, GlaxoSmithKlein, Novartis and Chiesi, unrelated to the submitted work. BW reports personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Roche and TEVA, and nonfinancial support from ALK-Abello, Aptalis pharma, AstraZeneca, Boehringer Ingelheim, Chiesi, Chugai pharma, France Oxygne, Kyowa Kirin, GlaxoSmithKlein, Mayoli, Mundipharma, Mylan, Novartis, Pfizer, Preciphar, Roche, SEFAM, SOS Oxygne, SYSMED, Vertex and Vitalaire, unrelated to the submitted work. CC reports grants from AstraZeneca and Santelys, personal fees from ALK-Abello, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKlein, Novartis, Sanofi-Regeneron and TEVA, and congress support from ALK-Abello, AstraZeneca, GlaxoSmithKlein, Novartis, Pierre Fabre, Pfizer, Roche and TEVA, unrelated to the submitted work. OLR reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Novartis, and nonfinancial supports from AstraZeneca, Boehringer Ingelheim, Chiesi, Correvio, GlaxoSmithKlein, Mayoli, MSD, Mylan, Novartis, Pfizer, PulmonX, Santelys Association, Vertex, Vitalaire and Zambon, unrelated to the submitted work. OLR is the principal investigator in studies for Vertex and CSL Behring.

1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2022 report. Available from: https://goldcopd.org/2022-gold-reports-2/#. Accessed April 29, 2022.

2. Khakban A, Sin DD, FitzGerald JM, et al. The projected epidemic of chronic obstructive pulmonary disease hospitalizations over the next 15 years. A population-based perspective. Am J Respir Crit Care Med. 2016;195(3):287291. doi:10.1164/rccm.201606-1162PP

3. Holland AE, Cox NS, Houchen-Wolloff L, et al. Defining modern pulmonary rehabilitation. an official American thoracic society workshop report. Ann Am Thorac Soc. 2021;18(5):e12e29. doi:10.1513/AnnalsATS.202102-146ST

4. Stafinski T, Nagase FI, Avdagovska M, Stickland MK, Menon D. Effectiveness of home-based pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease (COPD): systematic review. BMC Health Serv Res. 2022;22(1):557. doi:10.1186/s12913-022-07779-9

5. Gonalves JMF, Bello MG, Martnez MDM, et al. The COPD comorbidome in the light of the degree of dyspnea and risk of exacerbation. J Chron Obstruct Pulmon Dis. 2019;16(1):104107. doi:10.1080/15412555.2019.1592144

6. Faner R, Agust A. Network analysis: a way forward for understanding COPD multimorbidity. Eur Respir J. 2015;46(3):591592. doi:10.1183/09031936.00054815

7. Van Remoortel H, Hornikx M, Langer D, et al. Risk factors and comorbidities in the preclinical stages of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2014;189(1):3038. doi:10.1164/rccm.201307-1240OC

8. Giezeman M, Hasselgren M, Lisspers K, et al. Influence of comorbid heart disease on dyspnea and health status in patients with COPD a cohort study. Int J Chron Obstruct Pulmon Dis. 2018;13:38573865. doi:10.2147/COPD.S175641

9. Laforest L, Roche N, Devouassoux G, et al. Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: a population-based cohort study. Respir Med. 2016;117:3339. doi:10.1016/j.rmed.2016.05.019

10. Wang Y, Stavem K, Dahl FA, Humerfelt S, Haugen T. Factors associated with a prolonged length of stay after acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Int J Chron Obstruct Pulmon Dis. 2014;9:99105. doi:10.2147/COPD.S51467

11. Palmer K, Bowles KA, Paton M, Jepson M, Lane R. Chronic heart failure and exercise rehabilitation: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2018;99(12):25702582. doi:10.1016/j.apmr.2018.03.015

12. Tunsupon P, Lal A, Abo Khamis M, Mador MJ. Comorbidities in patients with chronic obstructive pulmonary disease and pulmonary rehabilitation outcomes. J Cardiopulm Rehabil Prev. 2017;37(4):283289. doi:10.1097/HCR.0000000000000236

13. Mesquita R, Vanfleteren LEGW, Franssen FME, et al. Objectively identified comorbidities in COPD: impact on pulmonary rehabilitation outcomes. Eur Respir J. 2015;46(2):545548. doi:10.1183/09031936.00026215

14. Crisafulli E, Costi S, Luppi F, et al. Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation. Thorax. 2008;63(6):487492. doi:10.1136/thx.2007.086371

15. Crisafulli E, Gorgone P, Vagaggini B, et al. Efficacy of standard rehabilitation in COPD outpatients with comorbidities. Eur Respir J. 2010;36(5):10421048. doi:10.1183/09031936.00203809

16. Butler SJ, Li LSK, Ellerton L, Gershon AS, Goldstein RS, Brooks D. Prevalence of comorbidities and impact on pulmonary rehabilitation outcomes. ERJ Open Res. 2019;5(4):0026402019. doi:10.1183/23120541.00264-2019

17. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017;49(3):1700214. doi:10.1183/13993003.00214-2017

18. Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):10051012. doi:10.1056/NEJMoa021322

19. Grosbois JM, Gicquello A, Langlois C, et al. Long-term evaluation of home-based pulmonary rehabilitation in patients with COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:20372044. doi:10.2147/COPD.S90534

20. Grosbois JM, Riquier C, Chehere B, et al. Six-minute stepper test: a valid clinical exercise tolerance test for COPD patients. Int J Chron Obstruct Pulmon Dis. 2016;11:657663. doi:10.2147/COPD.S98635

21. Pichon R, Couturaud F, Mialon P, et al. Responsiveness and minimally important difference of the 6-minute stepper test in patients with chronic obstructive pulmonary disease. Respiration. 2016;91(5):367373. doi:10.1159/000446517

22. Perez T, Arnould B, Grosbois JM, et al. Validity, reliability, and responsiveness of a new short Visual Simplified Respiratory Questionnaire (VSRQ) for health-related quality of life assessment in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2009;4:918.

23. Puhan MA, Frey M, Bchi S, Schnemann HJ. The minimal important difference of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2008;6:46. doi:10.1186/1477-7525-6-46

24. Lederer DJ, Bell SC, Branson RD, et al. Control of confounding and reporting of results in causal inference studies. Guidance for authors from editors of respiratory, sleep, and critical care journals. Ann ATS. 2019;16(1):2228. doi:10.1513/AnnalsATS.201808-564PS

25. Agarwal S, Rokadia H, Senn T, Menon V. Burden of cardiovascular disease in chronic obstructive pulmonary disease. Am J Prev Med. 2014;47(2):105114. doi:10.1016/j.amepre.2014.03.014

26. Mantoani LC, DellEra S, MacNee W, Rabinovich RA. Physical activity in patients with COPD: the impact of comorbidities. Expert Rev Respir Med. 2017;11(9):685698. doi:10.1080/17476348.2017.1354699

27. Baloch ZQ, Abbas SA, Marone L, Ali A. Cardiopulmonary exercise testing limitation in peripheral arterial disease. Ann Vasc Surg. 2018;52:108115. doi:10.1016/j.avsg.2018.03.014

28. Zweerink A, van der Lingen ALCJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic incompetence in chronic heart failure. Circ Heart Fail. 2018;11(8):e004969. doi:10.1161/CIRCHEARTFAILURE.118.004969

29. Paolillo S, Farina S, Bussotti M, et al. Exercise testing in the clinical management of patients affected by pulmonary arterial hypertension. Eur J Prev Cardiol. 2012;19(5):960971. doi:10.1177/1741826711426635

30. Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):16401645. doi:10.1161/CIRCULATIONAHA.109.192644

31. Kim HJ, Kim JH, Joo MC. Association of exercise capacity, cardiac function, and coronary artery calcification with components for metabolic syndrome. Biomed Res Int. 2018;2018:4619867. doi:10.1155/2018/4619867

32. Thompson PD, Buchner D, Pia IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation. 2003;107(24):31093116. doi:10.1161/01.CIR.0000075572.40158.77

33. Grosbois JM, Le Rouzic O, Monge E, Bart F, Wallaert B. Comparison of home-based and outpatient, hospital-based, pulmonary rehabilitation in patients with chronic respiratory diseases. Rev Pneumol Clin. 2013;69(1):1017. doi:10.1016/j.pneumo.2012.11.003

34. RCP London. Pulmonary rehabilitation: an exercise in improvement combined clinical and organisational audit 2017; 2018. Available from: https://www.rcplondon.ac.uk/projects/outputs/pulmonary-rehabilitation-exercise-improvement-combined-clinical-and-organisational. Accessed July 7, 2022.

35. Cox NS, Dal Corso S, Hansen H, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021;2021(1):CD013040. doi:10.1002/14651858.CD013040.pub2

36. Walsh JR, McKeough ZJ, Morris NR, et al. Metabolic disease and participant age are independent predictors of response to pulmonary rehabilitation. J Cardiopulm Rehabil Prev. 2013;33(4):249256. doi:10.1097/HCR.0b013e31829501b7

37. Nolan CM, Kaliaraju D, Jones SE, et al. Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study. Thorax. 2019;74(10):996998. doi:10.1136/thoraxjnl-2018-212765

38. Barr ELM, Tonkin AM, Welborn TA, Shaw JE. Validity of self-reported cardiovascular disease events in comparison to medical record adjudication and a statewide hospital morbidity database: the AusDiab study. Intern Med J. 2009;39(1):4953. doi:10.1111/j.1445-5994.2008.01864.x

39. Burvill AJ, Murray K, Knuiman MW, Hung J. Comparing self-reported and measured hypertension and hypercholesterolaemia at standard and more stringent diagnostic thresholds: the cross-sectional 20102015 Busselton Healthy Ageing study. Clin Hypertens. 2022;28(1):16. doi:10.1186/s40885-022-00199-1

40. Vanfleteren LEGW, Spruit MA, Groenen M, et al. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(7):728735. doi:10.1164/rccm.201209-1665OC

See the article here:
Impact of Cardiovascular and Metabolic Comorbidities on Long-term ... - Dove Medical Press

This story first appeared in the Forward. To get the Forwards free email newsletters delivered to your inbox, go to forward.com/newsletter-signup.

Growing up in a suburb of Cleveland, Ohio, I never thought of the JCC as much more than a gym. While many of my Jewish friends who lived near the JCC would spend hours there after school working out, my family and I lived a 20-minute drive away and thus chose to join a gym that was cheaper and closer to home.

The Conservative synagogue we belonged to was where we made our Jewish connections, celebrated Jewish occasions and ate Jewish food. For years, it didnt occur to me that maybe there were other Jews in the Cleveland community I could interact with outside of a denominational wall.

Get The Jewish Chronicle Weekly Edition by email and never miss our top storiesFree Sign Up

So when I visited the JCC in Warsaw, Poland, in 2018, while interning at the American Jewish Committee Central Europe office, I had no idea what to expect.

I was swept away by their incredible weekly kosher all-you-can-eat Sunday Boker Tov Brunch. Polish Jews of all ages gathered at JCC Warsaw to form community. I loved the way this JCC and others were playing a large role in the revival of Jewish life in Europe. I was inspired by the communities the JCC and its members helped build. From that point on, for the rest of that summer, and wherever else I traveled, including to Barcelona, London and Helsinki, I made it a point to visit a JCC.

European JCCs were places to explore Jewish culture across boundaries, without the limitations of official affiliations. It was powerful to meet people from backgrounds different than my own whom I otherwise may never have met. These interactions allowed all of us to discover new perspectives and ideas about Jewish life without feeling pressured to adhere to any specific practice.

JCCs can provide an alternative connection to Judaism beyond the religious aspect. And yet, American JCCs often seem to fall short when it comes to this Jewish community connection.

In Europe, the JCC is the first place many individuals go when they discover that they may have potential Jewish ancestry. After speaking with a rabbi or JCC director, they often want to explore what it means to be Jewish. Many JCCs in Europe are also opening Jewish community preschools and often they are the first Jewish preschool many cities have had since before the Holocaust. European JCCs frequently serve as the headquarters for Jewish student groups and Jewish senior citizen clubs.

I was so in awe of the way JCCs in Europe served as a hub for the whole Jewish community that I wanted to be part of the JCC movement back home. A few years after my summer living in Warsaw, I began working full time as the Jewish life and culture program associate at the JCC in Cleveland. Yet I couldnt help but notice that the majority of the people who entered the building made a beeline for the workout facility. Most people who came through the doors never connected with someone new, or with something specifically Jewish. I observed this same pattern at JCCs in other American cities where I have lived like Binghamton, New York, and Pittsburgh.

Frequently, the high cost of membership at JCCs keeps the community apart when JCCs should bring people together. In fact, the JCC movement started in 1854 in Baltimore specifically to help ensure Jewish continuity and provide a place for celebration outside of the synagogue environment. To truly bring a community together, that would mean people of many different backgrounds: young and old, employed and unemployed, students and retirees, and Jews from all denominations. But not everyone can afford the high membership rates, and I struggle to understand why JCCs cant provide greater financial assistance or subsidize those marginalized individuals who would benefit the most from Jewish community.

Joining an American JCC is often not only expensive, it also is not all-encompassing. On top of a membership fee, there are typically additional charges for attending group exercise classes or certain Jewish culture programs and events. In my hometown, the 2011 Greater Cleveland Jewish Population Study found significant economic vulnerability, with 36% of Greater Cleveland Jewish households just managing. For single-parent households, that rose to a staggering 58%. Just managing does not usually leave room for a JCC membership.

The community development coordinator at JCC Krakow, Joanna Fabijaczuk, told me that their membership dues are symbolic. Even without membership, any Jewish individual who lives in Krakow can attend the JCCs weekly Shabbat dinners and other activities, including yoga, Polish classes and choir. If you want to go to an activity at JCC Krakow, theyll find a way to make it work.

As with other JCCs outside the U.S., the JCC Krakow has a small gym and sauna, but no one joins it for the gym, said Fabijaczuk. They join for the community.

JCCs in the United States can learn something from that. One idea could be for JCCs to host more Shabbat meals that are open to all. Sharing food, sitting together, relaxing and talking builds community in ways that rushing in to work out and leave does not.

Another idea from the JCC in Budapest, Hungary, is a mentorship program for young adults, who are sometimes left out of conventional outreach efforts. In exchange for volunteering for the Jewish community, young adults received free access to all aspects of the JCC (though beginning in 2023, the program started charging a small amount to participate).

JCCs in America are doing great work hosting Jewish book and film festivals, summer camps and preschools. I only wish that all Jews, regardless of financial status, were able to participate in what they have to offer.

What is the point of calling it a community center, if much of the community is left out? PJC

Madison Jackson is an MFA student in creative nonfiction writing, with a concentration in travel writing, at Chatham University. She is passionate about global Jewish life and lives in Pittsburgh.

More here:
American JCCs are failing to nurture connections between Jews ... - thejewishchronicle.net

For most healthy adults, the Department of Health and Human Services recommends these exercise guidelines:

Moderate aerobic exercise includes activities such as brisk walking, biking, swimming and mowing the lawn. Vigorous aerobic exercise includes activities such as running, heavy yard work and aerobic dancing. Strength training can include use of weight machines, your own body weight, heavy bags, resistance tubing or resistance paddles in the water, or activities such as rock climbing.

As a general goal, aim for at least 30 minutes of moderate physical activity every day. If you want to lose weight, maintain weight loss or meet specific fitness goals, you may need to exercise more.

Reducing sitting time is important, too. The more hours you sit each day, the higher your risk of metabolic problems. Sitting too much can negatively impact your health and longevity, even if you get the recommended amount of daily physical activity. And some research has found that people who've lost weight may be more likely to keep off the lost weight by sitting less during the day.

Short on long chunks of time? Even brief bouts of activity offer benefits. For instance, if you can't fit in one 30-minute walk during the day, try a few five-minute walks instead. Any activity is better than none at all. What's most important is making regular physical activity part of your lifestyle.

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Subscribe!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Please, try again in a couple of minutes

Retry

.

Originally posted here:
Exercise: How much do I need every day? - Mayo Clinic

Exercise involves engaging in physical activity and increasing the heart rate beyond resting levels. It is an important part of preserving physical and mental health.

Whether people engage in light exercise, such as going for a walk, or high intensity activities, for example, uphill cycling or weight training, regular exercise provides a huge range of benefits for the body and mind.

Taking part in exercise of any intensity every day is essential for preventing a range of diseases and other health issues.

In this article, we explain the different types of exercise and their benefits, as well as the considerations for designing a fitness regime.

People divide exercise into three broad categories:

We describe each of these categories below.

Aerobic exercise aims to improve how the body uses oxygen. Most aerobic exercise takes place at average levels of intensity over longer periods.

An aerobic exercise session involves warming up, exercising for at least 20 minutes, and then cooling down. Aerobic exercise mostly uses large muscle groups.

Aerobic exercise provides the following benefits:

Anaerobic exercise does not use oxygen for energy. People use this type of exercise to build power, strength, and muscle mass.

These exercises are high-intensity activities that should last no longer than around 2 minutes. Anaerobic exercises include:

While all exercise benefits the heart and lungs, anaerobic exercise provides fewer benefits for cardiovascular health than aerobic exercise and uses fewer calories. However, it is more effective than aerobic exercise for building muscle and improving strength.

Increasing muscle mass causes the body to burn more fat, even when resting. Muscle is the most efficient tissue for burning fat in the body.

Agility training aims to improve a persons ability to maintain control while speeding up, slowing down, and changing direction.

In tennis, for example, agility training helps a player maintain control over their court positioning through good recovery after each shot.

People who take part in sports that heavily rely on positioning, coordination, speed, and balance need to engage in agility training regularly.

The following sports are examples of ones that require agility:

Some exercises combine stretching, muscle conditioning, and balance training. A popular and effective example is yoga.

Yoga movements improve balance, flexibility, posture, and circulation.

The practice originated in India thousands of years ago and aims to unify the mind, body, and spirit. Modern yoga uses a combination of meditation, posture, and breathing exercises to achieve the same goals.

A yoga practitioner can tailor a course for individual needs.

A person looking to manage arthritis might need gentle stretches to improve mobility and function. Someone with depression, on the other hand, may need more emphasis on the relaxation and deep breathing elements of yoga.

Pilates is another stretching option that promotes flexibility and core strength. Tai chi is also an effective option for exercise that promotes calm stretching rather than intensity.

Here, learn more about yoga.

A sedentary lifestyle can increase the risk of the following health problems:

It can also contribute to an increased risk of premature death from all causes, including the complications of being overweight and obesity.

In many parts of the world, including the United States, the number of overweight and obese people continues to increase rapidly.

According to the most recent National Health and Nutrition Examination Survey, that researchers did in 20132014 across the U.S., more than 2 in 3 adults are overweight or obesity.

The same survey found that around 1 in 13 adults have extreme obesity and face an increased risk of severe health complications.

Discover how to prevent cardiovascular disease.

Fitting exercise into a busy schedule can be a roadblock to a successful regime. However, people do not need to dedicate large amounts of extra time to exercise to see the benefits.

Here are some tips for fitting physical activity in a busy schedule:

People will likely gain the most benefit from exercises they enjoy that fit their lifestyle.

Exercise is sometimes a gradual learning curve. A person should spread sessions across the week and scale up the intensity slowly.

It is important for people to ensure they drink plenty of water during and after exercise. Checking with a doctor is a good precaution to take if someone has a health condition or injury that could impact exercise levels, or that exercise could make worse.

While a combination of aerobic and anaerobic exercise provides the most benefit, any exercise is better than none for people who currently have an inactive lifestyle.

Current U.S. guidelines recommend that people do one of the following:

Toward these goals, it is worth remembering that even 10-minute bursts of physical activity during the day provide health benefits.

Exercise may be difficult to maintain for some people. Consider the following tips to achieve long-term success:

The benefits of regular physical activity are wide-reaching and should form a part of every persons day to help them remain healthy.

Read the original post:
Exercise: Health benefits, types, and how it works - Medical News Today

Exercise is defined as any movement that makes your muscles work and requires your body to burn calories.

There are many types of physical activity, including swimming, running, jogging, walking, and dancing, to name a few.

Being active has been shown to have many health benefits, both physically and mentally. It may even help you live longer (1).

Here are the top 10 ways regular exercise benefits your body and brain.

Exercise has been shown to improve your mood and decrease feelings of depression, anxiety, and stress (2).

It produces changes in the parts of the brain that regulate stress and anxiety. It can also increase brain sensitivity to the hormones serotonin and norepinephrine, which relieve feelings of depression (3).

Additionally, exercise can increase the production of endorphins, which are known to help produce positive feelings and reduce the perception of pain (3).

Interestingly, it doesnt matter how intense your workout is. It seems that exercise can benefit your mood no matter the intensity of the physical activity.

In fact, in a study in 24 women diagnosed with depression, exercise of any intensity significantly decreased feelings of depression (4).

The effects of exercise on mood are so powerful that choosing to exercise (or not) even makes a difference over short periods of time.

One review of 19 studies found that active people who stopped exercising regularly experienced significant increases in symptoms of depression and anxiety, even after only a few weeks (5).

Exercising regularly can improve your mood and reduce feelings of anxiety and depression.

Some studies have shown that inactivity is a major factor in weight gain and obesity (6, 7).

To understand the effect of exercise on weight reduction, it is important to understand the relationship between exercise and energy expenditure (spending).

Your body spends energy in three ways:

While dieting, a reduced calorie intake will lower your metabolic rate, which can temporarily delay weight loss. On the contrary, regular exercise has been shown to increase your metabolic rate, which can burn more calories to help you lose weight (6, 7, 8).

Additionally, studies have shown that combining aerobic exercise with resistance training can maximize fat loss and muscle mass maintenance, which is essential for keeping the weight off and maintaining lean muscle mass (9, 10, 11).

Exercise is crucial to supporting a healthy metabolism and burning more calories per day. It also helps you maintain your muscle mass and weight loss.

Exercise plays a vital role in building and maintaining strong muscles and bones.

Activities like weightlifting can stimulate muscle building when paired with adequate protein intake.

This is because exercise helps release hormones that promote your muscles ability to absorb amino acids. This helps them grow and reduces their breakdown (12, 13).

As people age, they tend to lose muscle mass and function, which can lead to an increased risk of injury. Practicing regular physical activity is essential to reducing muscle loss and maintaining strength as you age (14).

Exercise also helps build bone density when youre younger, in addition to helping prevent osteoporosis later in life (15).

Some research suggests that high impact exercise (such as gymnastics or running) or odd impact sports (such as soccer and basketball) may help promote a higher bone density than no impact sports like swimming and cycling (16).

Physical activity helps you build muscles and strong bones. It may also help prevent osteoporosis.

Exercise can be a real energy booster for many people, including those with various medical conditions (17, 18).

One older study found that 6 weeks of regular exercise reduced feelings of fatigue for 36 people who had reported persistent fatigue (19).

And lets not forget the fantastic heart and lung health benefits of exercise. Aerobic exercise boosts the cardiovascular system and improves lung health, which can significantly help with energy levels.

As you move more, your heart pumps more blood, delivering more oxygen to your working muscles. With regular exercise, your heart becomes more efficient and adept at moving oxygen into your blood, making your muscles more efficient (20).

Over time, this aerobic training results in less demand on your lungs, and it requires less energy to perform the same activities one of the reasons youre less likely to get short of breath during vigorous activity (21).

Additionally, exercise has been shown to increase energy levels in people with other conditions, such as cancer (22).

Engaging in regular physical activity can increase your energy levels.

Lack of regular physical activity is a primary cause of chronic disease (23).

Regular exercise has been shown to improve insulin sensitivity, heart health, and body composition. It can also decrease blood pressure and cholesterol levels (24, 25, 26, 27).

More specifically, exercise can help reduce or prevent the following chronic health conditions.

In contrast, a lack of regular exercise even in the short term can lead to significant increases in belly fat, which may increase the risk of type 2 diabetes and heart disease (23).

Thats why regular physical activity is recommended to reduce belly fat and decrease the risk of developing these conditions (33).

Daily physical activity is essential to maintaining a healthy weight and reducing the risk of chronic disease.

Your skin can be affected by the amount of oxidative stress in your body.

Oxidative stress occurs when the bodys antioxidant defenses cannot completely repair the cell damage caused by compounds known as free radicals. This can damage the structure of the cells and negatively impact your skin.

Even though intense and exhaustive physical activity can contribute to oxidative damage, regular moderate exercise can actually increase your bodys production of natural antioxidants, which help protect cells (34, 35).

In the same way, exercise can stimulate blood flow and induce skin cell adaptations that can help delay the appearance of skin aging (36).

Moderate exercise can provide antioxidant protection and promote blood flow, which can protect your skin and delay signs of aging.

Exercise can improve brain function and protect memory and thinking skills.

To begin with, it increases your heart rate, which promotes the flow of blood and oxygen to your brain. It can also stimulate the production of hormones that enhance the growth of brain cells.

Plus, the ability of exercise to prevent chronic disease can translate into benefits for your brain, since its function can be affected by these conditions (37).

Regular physical activity is especially important in older adults since aging combined with oxidative stress and inflammation promotes changes in brain structure and function (38, 39).

Exercise has been shown to cause the hippocampus, a part of the brain thats vital for memory and learning, to grow in size, which may help improve mental function in older adults (38, 39, 40).

Lastly, exercise has been shown to reduce changes in the brain that can contribute to conditions like Alzheimers disease and dementia (41).

Regular exercise improves blood flow to the brain and helps brain health and memory. Among older adults, it can help protect mental function.

Regular exercise can help you relax and sleep better (42, 43).

With regard to sleep quality, the energy depletion (loss) that occurs during exercise stimulates restorative processes during sleep (44).

Moreover, the increase in body temperature that occurs during exercise is thought to improve sleep quality by helping body temperature drop during sleep (45).

Many studies on the effects of exercise on sleep have reached similar conclusions.

One review of six studies found that participating in an exercise training program helped improve self-reported sleep quality and reduced sleep latency, which is the amount of time it takes to fall asleep (46).

One study conducted over 4 months found that both stretching and resistance exercise led to improvements in sleep for people with chronic insomnia (47).

Getting back to sleep after waking, sleep duration, and sleep quality improved after both stretching and resistance exercise. Anxiety was also reduced in the stretching group (47).

Whats more, engaging in regular exercise seems to benefit older adults, who are often affected by sleep disorders (48, 49).

You can be flexible with the kind of exercise you choose. It appears that either aerobic exercise alone or aerobic exercise combined with resistance training can both improve sleep quality (50).

Regular physical activity, regardless of whether it is aerobic or a combination of aerobic and resistance training, can help you sleep better and feel more energized during the day.

Although chronic pain can be debilitating, exercise can actually help reduce it (51).

In fact, for many years, the recommendation for treating chronic pain was rest and inactivity. However, recent studies show that exercise helps relieve chronic pain (52).

In fact, one review of several studies found that exercise can help those with chronic pain reduce their pain and improve their quality of life (52).

Several studies also show that exercise can help control pain associated with various health conditions, including chronic low back pain, fibromyalgia, and chronic soft tissue shoulder disorder, to name a few (52).

Additionally, physical activity can also raise pain tolerance and decrease pain perception (53, 54).

Exercise has favorable effects on the pain associated with various conditions. It can also increase pain tolerance.

Exercise has been proven to boost sex drive (55, 56, 57).

Engaging in regular exercise can strengthen the heart, improve blood circulation, tone muscles, and enhance flexibility, all of which can improve your sex life (56).

Physical activity can also improve sexual performance and sexual pleasure while increasing the frequency of sexual activity (56, 58).

Interestingly enough, one study showed that regular exercise was associated with increased sexual function and desire in 405 postmenopausal women (59).

A review of 10 studies also found that exercising for at least 160 minutes per week over a 6-month period could help significantly improve erectile function in men (57).

Whats more, another study found that a simple routine of a 6-minute walk around the house helped 41 men reduce their erectile dysfunction symptoms by 71% (60).

Yet another study demonstrated that women with polycystic ovary syndrome, which can reduce sex drive, increased their sex drive with regular resistance training for 16 weeks (61).

Exercise can help improve sexual desire, function, and performance in men and women. It can also help decrease the risk of erectile dysfunction in men.

Exercise offers incredible benefits that can improve nearly every aspect of your health. Regular physical activity can increase the production of hormones that make you feel happier and help you sleep better.

It can also:

And it doesnt take much movement to make a big difference in your health.

If you aim for 150 to 300 minutes of moderate intensity aerobic activity each week or 75 minutes of vigorous physical activity spread throughout the week, youll meet the Department of Health and Human Services activity guidelines for adults (62).

Moderate intensity aerobic activity is anything that gets your heart beating faster, like walking, cycling, or swimming. Activities like running or participating in a strenuous fitness class count for vigorous intensity.

Throw in at least 2 days of muscle-strengthening activities involving all major muscle groups (legs, hips, back abdomen, chest, shoulders, and arms), and youll exceed the recommendations.

You can use weights, resistance bands, or your bodyweight to perform muscle-strengthening exercises. These include squats, push-ups, shoulder press, chest, press, and planks.

Whether you practice a specific sport or follow the guideline of 150 minutes of activity per week, you can inevitably improve your health in many ways (55).

Go here to read the rest:
The Top 10 Benefits of Regular Exercise - Healthline

Bodily activity that assists health

Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness.[1]

It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic skills, weight loss or maintenance, improve health,[2] or simply for enjoyment. Many individuals choose to exercise outdoors where they can congregate in groups, socialize, and improve well-being as well as mental health.[3][4]

In terms of health benefits, the amount of recommended exercise depends upon the goal, the type of exercise, and the age of the person. Even doing a small amount of exercise is healthier than doing none.[5]

Physical exercises are generally grouped into three types, depending on the overall effect they have on the human body:[6]

Physical exercise can also include training that focuses on accuracy, agility, power, and speed.[10]

Types of exercise can also be classified as dynamic or static. 'Dynamic' exercises such as steady running, tend to produce a lowering of the diastolic blood pressure during exercise, due to the improved blood flow. Conversely, static exercise (such as weight-lifting) can cause the systolic pressure to rise significantly, albeit transiently, during the performance of the exercise.[11]

Physical exercise is important for maintaining physical fitness and can contribute to maintaining a healthy weight, regulating the digestive system, building and maintaining healthy bone density, muscle strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and strengthening the immune system. Some studies indicate that exercise may increase life expectancy and the overall quality of life.[12] People who participate in moderate to high levels of physical exercise have a lower mortality rate compared to individuals who by comparison are not physically active.[13] Moderate levels of exercise have been correlated with preventing aging by reducing inflammatory potential.[14] The majority of the benefits from exercise are achieved with around 3500 metabolic equivalent (MET) minutes per week, with diminishing returns at higher levels of activity.[15] For example, climbing stairs 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or bicycling for transportation 25 minutes on a daily basis would together achieve about 3000 MET minutes a week.[15] A lack of physical activity causes approximately 6% of the burden of disease from coronary heart disease, 7% of type 2 diabetes, 10% of breast cancer and 10% of colon cancer worldwide.[16] Overall, physical inactivity causes 9% of premature mortality worldwide.[16]

Most people can increase fitness by increasing physical activity levels.[17] Increases in muscle size from resistance training are primarily determined by diet and testosterone.[18] This genetic variation in improvement from training is one of the key physiological differences between elite athletes and the larger population.[19][20] There is evidence that exercising in middle age may lead to better physical ability later in life.[21]

Early motor skills and development is also related to physical activity and performance later in life. Children who are more proficient with motor skills early on are more inclined to be physically active, and thus tend to perform well in sports and have better fitness levels. Early motor proficiency has a positive correlation to childhood physical activity and fitness levels, while less proficiency in motor skills results in a more sedentary lifestyle.[22]

The type and intensity of physical activity performed may have an effect on a person's fitness level. There is some weak evidence that high-intensity interval training may improve a person's VO2 max slightly more than lower intensity endurance training.[23] However, unscientific fitness methods could lead to sports injuries.[24]

The beneficial effect of exercise on the cardiovascular system is well documented. There is a direct correlation between physical inactivity and cardiovascular disease, and physical inactivity is an independent risk factor for the development of coronary artery disease. Low levels of physical exercise increase the risk of cardiovascular diseases mortality.[25][26]

Children who participate in physical exercise experience greater loss of body fat and increased cardiovascular fitness.[27] Studies have shown that academic stress in youth increases the risk of cardiovascular disease in later years; however, these risks can be greatly decreased with regular physical exercise.[28]

There is a dose-response relationship between the amount of exercise performed from approximately 7002000kcal of energy expenditure per week and all-cause mortality and cardiovascular disease mortality in middle-aged and elderly men. The greatest potential for reduced mortality is seen in sedentary individuals who become moderately active.

Studies have shown that since heart disease is the leading cause of death in women, regular exercise in aging women leads to healthier cardiovascular profiles.

Most beneficial effects of physical activity on cardiovascular disease mortality can be attained through moderate-intensity activity (4060% of maximal oxygen uptake, depending on age). Persons who modify their behavior after myocardial infarction to include regular exercise have improved rates of survival. Persons who remain sedentary have the highest risk for all-cause and cardiovascular disease mortality.[29] According to the American Heart Association, exercise reduces the risk of cardiovascular diseases, including heart attack and stroke.[26]

Some have suggested that increases in physical exercise might decrease healthcare costs, increase the rate of job attendance, as well as increase the amount of effort women put into their jobs.[30]

Although there have been hundreds of studies on physical exercise and the immune system, there is little direct evidence on its connection to illness.[31] Epidemiological evidence suggests that moderate exercise has a beneficial effect on the human immune system; an effect which is modeled in a J curve. Moderate exercise has been associated with a 29% decreased incidence of upper respiratory tract infections (URTI), but studies of marathon runners found that their prolonged high-intensity exercise was associated with an increased risk of infection occurrence.[31] However, another study did not find the effect. Immune cell functions are impaired following acute sessions of prolonged, high-intensity exercise, and some studies have found that athletes are at a higher risk for infections. Studies have shown that strenuous stress for long durations, such as training for a marathon, can suppress the immune system by decreasing the concentration of lymphocytes.[32] The immune systems of athletes and nonathletes are generally similar. Athletes may have a slightly elevated natural killer cell count and cytolytic action, but these are unlikely to be clinically significant.[31]

Vitamin C supplementation has been associated with a lower incidence of upper respiratory tract infections in marathon runners.[31]

Biomarkers of inflammation such as C-reactive protein, which are associated with chronic diseases, are reduced in active individuals relative to sedentary individuals, and the positive effects of exercise may be due to its anti-inflammatory effects. In individuals with heart disease, exercise interventions lower blood levels of fibrinogen and C-reactive protein, an important cardiovascular risk marker.[33] The depression in the immune system following acute bouts of exercise may be one of the mechanisms for this anti-inflammatory effect.[31]

A systematic review evaluated 45 studies that examined the relationship between physical activity and cancer survival rates. According to the review, "[there] was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancerspecific, and colon cancerspecific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers."[34] Evidence suggests that exercise may positively affect the quality of life in cancer survivors, including factors such as anxiety, self-esteem and emotional well-being.[35] For people with cancer undergoing active treatment, exercise may also have positive effects on health-related quality of life, such as fatigue and physical functioning.[36] This is likely to be more pronounced with higher intensity exercise.[36]

Exercise may contribute to a reduction of cancer-related fatigue in survivors of breast cancer.[37] Although there is only limited scientific evidence on the subject, people with cancer cachexia are encouraged to engage in physical exercise.[38] Due to various factors, some individuals with cancer cachexia have a limited capacity for physical exercise.[39][40] Compliance with prescribed exercise is low in individuals with cachexia and clinical trials of exercise in this population often have high drop-out rates.[39][40]

There is low-quality evidence for an effect of aerobic physical exercises on anxiety and serious adverse events in adults with hematological malignancies.[41] Aerobic physical exercise may result in little to no difference in the mortality, quality of life, or physical functioning.[41] These exercises may result in a slight reduction in depression and reduction in fatigue.[41]

The neurobiological effects of physical exercise are numerous and involve a wide range of interrelated effects on brain structure,[42] brain function, and cognition.[43][44][45][46] A large body of research in humans has demonstrated that consistent aerobic exercise (e.g., 30minutes every day) induces persistent improvements in certain cognitive functions, healthy alterations in gene expression in the brain, and beneficial forms of neuroplasticity and behavioral plasticity; some of these long-term effects include: increased neuron growth, increased neurological activity (e.g., c-Fos and BDNF signaling), improved stress coping, enhanced cognitive control of behavior, improved declarative, spatial, and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory.[43][44][45][46][47][48][49][50][51][52][excessive citations] The effects of exercise on cognition have important implications for improving academic performance in children and college students, improving adult productivity, preserving cognitive function in old age, preventing or treating certain neurological disorders, and improving overall quality of life.[43][53][54][55]

In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a single exercise session and persistent effects on cognition following regular exercise over the course of several months.[43][52][56] People who regularly perform an aerobic exercise (e.g., running, jogging, brisk walking, swimming, and cycling) have greater scores on neuropsychological function and performance tests that measure certain cognitive functions, such as attentional control, inhibitory control, cognitive flexibility, working memory updating and capacity, declarative memory, spatial memory, and information processing speed.[43][47][49][51][52][56][57][58][excessive citations] The transient effects of exercise on cognition include improvements in most executive functions (e.g., attention, working memory, cognitive flexibility, inhibitory control, problem solving, and decision making) and information processing speed for a period of up to 2hours after exercising.[56]

Aerobic exercise induces short- and long-term effects on mood and emotional states by promoting positive affect, inhibiting negative affect, and decreasing the biological response to acute psychological stress.[56] Over the short-term, aerobic exercise functions as both an antidepressant and euphoriant,[59][60][61][62] whereas consistent exercise produces general improvements in mood and self-esteem.[63][64]

A number of medical reviews have indicated that exercise has a marked and persistent antidepressant effect in humans,[47][61][62][65][82][83] an effect believed to be mediated through enhanced BDNF signaling in the brain.[50][65] Several systematic reviews have analyzed the potential for physical exercise in the treatment of depressive disorders. The 2013 Cochrane Collaboration review on physical exercise for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies.[82] Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that physical exercise is effective as an adjunct treatment (i.e., treatments that are used together) with antidepressant medication;[65] the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mildmoderate depression and mental illness in general.[61][62] One systematic review noted that yoga may be effective in alleviating symptoms of prenatal depression.[84] Another review asserted that evidence from clinical trials supports the efficacy of physical exercise as a treatment for depression over a 24month period.[47] These benefits have also been noted in old age, with a review conducted in 2019 finding that exercise is an effective treatment for clinically diagnosed depression in older adults.[85]

Continuous aerobic exercise can induce a transient state of euphoria, colloquially known as a "runner's high" in distance running or a "rower's high" in crew, through the increased biosynthesis of at least three euphoriant neurochemicals: anandamide (an endocannabinoid),[87] -endorphin (an endogenous opioid),[88] and phenethylamine (a trace amine and amphetamine analog).[89][90][91]

Preliminary evidence from a 2012 review indicated that physical training for up to four months may increase sleep quality in adults over 40 years of age.[92] A 2010 review suggested that exercise generally improved sleep for most people, and may help with insomnia, but there is insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep.[93] A 2018 systematic review and meta-analysis suggested that exercise can improve sleep quality in people with insomnia.[94]

One 2013 study found that exercising improved sexual arousal problems related to antidepressant use.[95]

People who participate in physical exercise experience increased cardiovascular fitness.[medical citation needed]There is some level of concern about additional exposure to air pollution when exercising outdoors, especially near traffic.[96]

Resistance training and subsequent consumption of a protein-rich meal promotes muscle hypertrophy and gains in muscle strength by stimulating myofibrillar muscle protein synthesis (MPS) and inhibiting muscle protein breakdown (MPB).[97][98] The stimulation of muscle protein synthesis by resistance training occurs via phosphorylation of the mechanistic target of rapamycin (mTOR) and subsequent activation of mTORC1, which leads to protein biosynthesis in cellular ribosomes via phosphorylation of mTORC1's immediate targets (the p70S6 kinase and the translation repressor protein 4EBP1).[97][99] The suppression of muscle protein breakdown following food consumption occurs primarily via increases in plasma insulin.[97][100][101] Similarly, increased muscle protein synthesis (via activation of mTORC1) and suppressed muscle protein breakdown (via insulin-independent mechanisms) has also been shown to occur following ingestion of -hydroxy -methylbutyric acid.[97][100][101][102]

Aerobic exercise induces mitochondrial biogenesis and an increased capacity for oxidative phosphorylation in the mitochondria of skeletal muscle, which is one mechanism by which aerobic exercise enhances submaximal endurance performance.[103][97][104] These effects occur via an exercise-induced increase in the intracellular AMP:ATP ratio, thereby triggering the activation of AMP-activated protein kinase (AMPK) which subsequently phosphorylates peroxisome proliferator-activated receptor gamma coactivator-1 (PGC-1), the master regulator of mitochondrial biogenesis.[97][104][105]

Developing research has demonstrated that many of the benefits of exercise are mediated through the role of skeletal muscle as an endocrine organ. That is, contracting muscles release multiple substances known as myokines which promote the growth of new tissue, tissue repair, and multiple anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases.[119] Exercise reduces levels of cortisol, which causes many health problems, both physical and mental.[120] Endurance exercise before meals lowers blood glucose more than the same exercise after meals.[121] There is evidence that vigorous exercise (9095% of VO2 max) induces a greater degree of physiological cardiac hypertrophy than moderate exercise (40 to 70% of VO2 max), but it is unknown whether this has any effects on overall morbidity and/or mortality.[122] Both aerobic and anaerobic exercise work to increase the mechanical efficiency of the heart by increasing cardiac volume (aerobic exercise), or myocardial thickness (strength training). Ventricular hypertrophy, the thickening of the ventricular walls, is generally beneficial and healthy if it occurs in response to exercise.

The effects of physical exercise on the central nervous system are mediated in part by specific neurotrophic factor hormones that are released into the blood stream by muscles, including BDNF, IGF-1, and VEGF.[123][124][125][126][127][128]

Community-wide and school campaigns are often used in an attempt to increase a population's level of physical activity. Studies to determine the effectiveness of these types of programs need to be interpreted cautiously as the results vary.[17] There is some evidence that certain types of exercise programmes for older adults, such as those involving gait, balance, co-ordination and functional tasks, can improve balance.[129] Following progressive resistance training, older adults also respond with improved physical function.[130] Brief interventions promoting physical activity may be cost-effective, however this evidence is weak and there are variations between studies.[131]

Environmental approaches appear promising: signs that encourage the use of stairs, as well as community campaigns, may increase exercise levels.[132] The city of Bogot, Colombia, for example, blocks off 113 kilometers (70mi) of roads on Sundays and holidays to make it easier for its citizens to get exercise. Such pedestrian zones are part of an effort to combat chronic diseases and to maintain a healthy BMI.[133][134]

Parents can promote physical activity by modelling healthy levels of physical activity or by encouraging physical activity.[135] According to the Centers for Disease Control and Prevention in the United States, children and adolescents should do 60 minutes or more of physical activity each day.[136] Implementing physical exercise in the school system and ensuring an environment in which children can reduce barriers to maintain a healthy lifestyle is essential.

The European Commission's Directorate-General for Education and Culture (DG EAC) has dedicated programs and funds for Health Enhancing Physical Activity (HEPA) projects[137] within its Horizon 2020 and Erasmus+ program, as research showed that too many Europeans are not physically active enough. Financing is available for increased collaboration between players active in this field across the EU and around the world, the promotion of HEPA in the EU and its partner countries, and the European Sports Week. The DG EAC regularly publishes a Eurobarometer on sport and physical activity.

Worldwide there has been a large shift toward less physically demanding work.[138] This has been accompanied by increasing use of mechanized transportation, a greater prevalence of labor-saving technology in the home, and fewer active recreational pursuits.[138] Personal lifestyle changes, however, can correct the lack of physical exercise.[medical citation needed]

Research published in 2015 suggests that incorporating mindfulness into physical exercise interventions increases exercise adherence and self-efficacy, and also has positive effects both psychologically and physiologically.[139]

Exercising looks different in every country, as do the motivations behind exercising.[3] In some countries, people exercise primarily indoors (such as at home or health clubs), while in others, people primarily exercise outdoors. People may exercise for personal enjoyment, health and well-being, social interactions, competition or training, etc. These differences could potentially be attributed to a variety of reasons including geographic location and social tendencies.

In Colombia, for example, citizens value and celebrate the outdoor environments of their country. In many instances, they use outdoor activities as social gatherings to enjoy nature and their communities. In Bogot, Colombia, a 70-mile stretch of road known as the Ciclova is shut down each Sunday for bicyclists, runners, rollerbladers, skateboarders and other exercisers to work out and enjoy their surroundings.[143]

Similarly to Colombia, citizens of Cambodia tend to exercise socially outside. In this country, public gyms have become quite popular. People will congregate at these outdoor gyms not only to use the public facilities, but also to organize aerobics and dance sessions, which are open to the public.[144]

Sweden has also begun developing outdoor gyms, called utegym. These gyms are free to the public and are often placed in beautiful, picturesque environments. People will swim in rivers, use boats, and run through forests to stay healthy and enjoy the natural world around them. This works particularly well in Sweden due to its geographical location.[145]

Exercise in some areas of China, particularly among those who are retired, seems to be socially grounded. In the mornings, square dances are held in public parks; these gatherings may include Latin dancing, ballroom dancing, tango, or even the jitterbug. Dancing in public allows people to interact with those with whom they would not normally interact, allowing for both health and social benefits.[146]

These sociocultural variations in physical exercise show how people in different geographic locations and social climates have varying motivations and methods of exercising. Physical exercise can improve health and well-being, as well as enhance community ties and appreciation of natural beauty.[3]

Proper nutrition is as important to health as exercise. When exercising, it becomes even more important to have a good diet to ensure that the body has the correct ratio of macronutrients while providing ample micronutrients, in order to aid the body with the recovery process following strenuous exercise.[147]

Active recovery is recommended after participating in physical exercise because it removes lactate from the blood more quickly than inactive recovery. Removing lactate from circulation allows for an easy decline in body temperature, which can also benefit the immune system, as an individual may be vulnerable to minor illnesses if the body temperature drops too abruptly after physical exercise.[148]

Exercise has an effect on appetite, but whether it increases or decreases appetite varies from individual to individual, and is affected by the intensity and duration of the exercise.[149]

Excessive exercise or overtraining occurs when a person exceeds their body's ability to recover from strenuous exercise.[150]

The benefits of exercise have been known since antiquity. Dating back to 65 BCE, it was Marcus Cicero, Roman politician and lawyer, who stated: "It is exercise alone that supports the spirits, and keeps the mind in vigor."[151] Exercise was also seen to be valued later in history during the Early Middle Ages as a means of survival by the Germanic peoples of Northern Europe.[152]

More recently, exercise was regarded as a beneficial force in the 19th century. In 1858 Archibald MacLaren opened a gymnasium at the University of Oxford and instituted a training regimen for Major Frederick Hammersley and 12 non-commissioned officers.[153] This regimen was assimilated into the training of the British Army, which formed the Army Gymnastic Staff in 1860 and made sport an important part of military life.[154][155][156] Several mass exercise movements were started in the early twentieth century as well. The first and most significant of these in the UK was the Women's League of Health and Beauty, founded in 1930 by Mary Bagot Stack, that had 166,000 members in 1937.[157]

The link between physical health and exercise (or lack of it) was further established in 1949 and reported in 1953 by a team led by Jerry Morris.[158][159] Dr. Morris noted that men of similar social class and occupation (bus conductors versus bus drivers) had markedly different rates of heart attacks, depending on the level of exercise they got: bus drivers had a sedentary occupation and a higher incidence of heart disease, while bus conductors were forced to move continually and had a lower incidence of heart disease.[159]

Studies of animals indicate that physical activity may be more adaptable than changes in food intake to regulate energy balance.[160]

Mice having access to activity wheels engaged in voluntary exercise and increased their propensity to run as adults.[161] Artificial selection of mice exhibited significant heritability in voluntary exercise levels,[162] with "high-runner" breeds having enhanced aerobic capacity,[163] hippocampal neurogenesis,[164] and skeletal muscle morphology.[165]

The effects of exercise training appear to be heterogeneous across non-mammalian species. As examples, exercise training of salmon showed minor improvements of endurance,[166] and a forced swimming regimen of yellowtail amberjack and rainbow trout accelerated their growth rates and altered muscle morphology favorable for sustained swimming.[167][168] Crocodiles, alligators, and ducks showed elevated aerobic capacity following exercise training.[169][170][171] No effect of endurance training was found in most studies of lizards,[169][172] although one study did report a training effect.[173] In lizards, sprint training had no effect on maximal exercise capacity,[173] and muscular damage from over-training occurred following weeks of forced treadmill exercise.[172]

More here:
Exercise - Wikipedia

Page 18«..10..17181920..3040..»

Home » Exercise Programs » Page 18