Wellness Checkup: Exercise |  Medicine in 2 Minutes

Wellness Checkup: Exercise | Medicine in 2 Minutes

Aerobic and strengthening physical activity may have a dose-response association with mortality

1. In this study, compared to no aerobic physical activity (PA), a substantial reduction in mortality risk was associated with 1 hour/week of aerobic PA and stabilized at 3 hours/week .
2. Muscle strengthening exercise (MSE) conferred an additional reduction in mortality risk at 1 time/week, but was no longer beneficial at 7 times/week.

Level of evidence assessment: 2 (good)

Despite its many benefits, more than a billion adults do not meet standard World Health Organization recommendations. Although recent reviews have examined the association between physical activity and the risk of all-cause mortality, there is little evidence regarding minimum effective doses. Accordingly, the objective of the present prospective cohort study was to identify the dose-response association and minimum effective doses of aerobic PA and MSE necessary to result in a lower, clinically meaningful risk of all-cause mortality.

This study used data from the National Health Interview Survey (1997-2014) and included 416,420 adults from the United States (US). Participants were excluded if they were not permanent residents of the United States, if they were in correctional facilities, active duty military, or in long-term care facilities. Activity levels were reported using a standardized questionnaire. The study adhered to STROBE (Strengthing the Reporting of Observational Studies in Epidemiology) guidelines. Cox proportional hazards models were used to assess the association between physical activity and all-cause mortality.

The results demonstrated that, compared to no aerobic PA, a substantial reduction in mortality risk was associated with 1 hour/week of aerobic PA and stabilized at 3 hours/week. Muscle strengthening exercise (MSE) conferred an additional reduction in mortality risk at 1 time/week but was no longer beneficial at 7 times/week. Despite these findings, the study was limited by the self-reported nature of physical activity. Nevertheless, this longitudinal analysis of data from a large sample of US adults has provided insight into the relationship between PA/MSE and mortality, and may inform US healthcare providers.

Regular physical activity may confer protection against adverse effects of COVID-19

1. In this study, engaging in regular physical activity had a lower risk of infection, hospitalization, severe COVID-19-related illness, and COVID-19-related death compared to inactive peers.

2. The greatest benefit was obtained at 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity per week.

Level of evidence assessment: 1 (Excellent)

Physical activity is known to have a multitude of health benefits as well as boosting immunity. To date, the link between regular physical activity and COVID-19 outcomes has been poorly understood. Therefore, the aim of this systematic review and meta-analysis was to quantify the association between physical activity and the risk of COVID-19 infection, hospitalization, severe illness and death in adults. .

Of 4063 records identified, 16 studies were included in the systematic review (n=1,853,610) from the inception of the database through March 2022. Studies were eligible if they investigated the effects of physical activity ( questionnaires or objective measures) on COVID-19 outcomes. Studies were excluded if participants self-reported COVID-19 infection or were hospitalized. The quality of evidence was assessed using the Grading of Recommendations, Appraisal, Development and Evaluation (GRADE). Statistical analysis was performed using a random effects inverse variance model.

The results demonstrated that engaging in regular physical activity had a lower risk of infection, hospitalization, severe COVID-19-related illness, and COVID-19-related death compared to inactive peers. Additionally, the greatest benefit was obtained at 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity per week. Despite these results, the study was limited by the possibility that the pooled estimates were confounded. Nonetheless, these findings may help physicians encourage physical activity in patients to reduce the burden of health outcomes related to COVID-19.

Occupational and recreational physical activity may have varying effects on inflammation

1. Lower leisure physical activity and higher occupational physical activity were associated with increased high-sensitivity C-reactive protein (hs-CRP) levels.
2. When analyzed as continuous variables, only leisure-time physical activity was strongly associated with hs-CRP levels.

Level of evidence assessment: 2 (good)

Paradoxically, work-related physical activity has been shown in the literature to increase cardiovascular disease and mortality; an observation that does not apply to physical activity associated with leisure. Although many mechanisms have been proposed, sustained systemic inflammation (measured by hs-CRP levels) may be an important contributor. To further investigate this association, the aim of the present cross-sectional study was to determine the extent to which physical activity performed during work and leisure was associated with systemic inflammation.

The present study used data from the Copenhagen Aging and Midlife Biobank (CAMB) cohort. Of 12,656 invited participants, 5,304 underwent blood sampling, including the hs-CRP biomarker. Occupational physical activity was measured based on self-reported work history with an occupational exposure matrix. Leisure-time physical activity was self-reported using the CAMB questionnaire. The association between the two types of physical activity and hs-CRP was carried out using multivariable linear regression models as well as post-hoc analyses.

The results demonstrated that lower leisure physical activity and higher occupational physical activity were associated with increased levels of high-sensitivity C-reactive protein (hs-CRP). Moreover, when analyzed as continuous variables, only leisure-time physical activity was strongly associated with hs-CRP levels. Despite these findings, the study was limited by the risk of misclassification because physical activity was based on job title. Nevertheless, the inclusion of a large number of participants reinforced the results of the present study and the fact that systemic inflammation may in fact explain the physical activity paradox.

Lower limb osteoarthritis may be more common among retired Olympians

1. In this study, one in four retired Olympians reported physician-diagnosed osteoarthritis, with injury associated with an increased risk of osteoarthritis and knee, hip and ankle pain.
2. After adjusting for risk factors, Olympians were more likely to have knee and hip osteoarthritis after injury compared to the general population.

Level of evidence assessment: 3 (Average)

Joint damage can be a risk factor for the future development of osteoarthritis, especially for elite athletes. To date, few studies have compared the extent of OA in different body sites in elite athletes (such as Olympians) and the general population. Therefore, the objective of this cross-sectional study was to compare the prevalence of physician-diagnosed lower extremity osteoarthritis and pain among retired Olympians, and to determine contributing factors.

The current study included self-reported data from an online survey administered to Olympians (via Olympic Association platforms) and the general population (in three different phases). 3,357 retired Olympians (median age = 44.7 years) and 1,735 (median age = 40.5 years) people from the general population responded to the survey between April 2018 and June 2019. Retired Olympians had to be 16 years old or more and have participated in at least one summer/and or winter Olympic game. General population controls included people over the age of 16 who did not participate in the Olympics. For statistical analyses, independent t-tests, Mann-Whitney U-tests, chi-square tests and logistic regression were used.

The results showed that one in four retired Olympians reported physician-diagnosed osteoarthritis, and injuries were associated with an increased risk of osteoarthritis and knee, hip and ankle pain. Additionally, after adjusting for risk factors, Olympians were more likely to suffer from knee and hip osteoarthritis after injury, compared to the general population. Despite these results, the study was limited by representing only 4% of the total population of retired Olympians. Nonetheless, the present findings may help inform prevention strategies to reduce the risk of lower extremity osteoarthritis among Olympians after retirement from their sport.

Picture: PD

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