Phyiscal Activity and Pregnancy

First article looked at today concludes:

This meta-analysis suggests that higher leisure-time activity is associated with reduced risk of preterm birth. 

So, there is a possibility that a certain degree of physical activity reduces the chances that the mother will have  a preterm birth.  

What about gestational diabetes?  See here, abstract:

Physical activity has been inconsistently associated with risk of gestational diabetes mellitus in epidemiological studies, and questions remain about the strength and shape of the dose-response relationship between the two. We therefore conducted a systematic review and meta-analysis of cohort studies and randomized trials on physical activity and gestational diabetes mellitus. PubMed, Embase and Ovid databases were searched for cohort studies, and randomized controlled trials of physical activity and risk of gestational diabetes mellitus, up to August 5th 2015. Summary relative risks (RRs) were estimated using a random effects model. Twenty-five studies (26 publications) were included. For total physical activity the summary RR for high versus low activity was 0.62 (95 % CI 0.41-0.94, I2 = 0 %, n = 4) before pregnancy, and 0.66 (95 % CI 0.36-1.21, I2 = 0 %, n = 3) during pregnancy. For leisure-time physical activity the respective summary RRs for high versus low activity was 0.78 (95 % CI 0.61-1.00, I2 = 47 %, n = 8) before pregnancy, and it was 0.80 (95 % CI 0.64-1.00, I2 = 17 %, n = 17) during pregnancy. The summary RR for pre-pregnancy activity was 0.70 (95 % CI 0.49-1.01, I2 = 72.6 %, n = 3) per increment of 5 h/week and for activity during pregnancy was 0.98 (95 % CI 0.87-1.09, I2 = 0 %, n = 3) per 5 h/week. There was evidence of a nonlinear association between physical activity before pregnancy and the risk of gestational diabetes mellitus, pnonlinearity = 0.005, with a slightly steeper association at lower levels of activity although further reductions in risk were observed up to 10 h/week. There was also evidence of nonlinearity for physical activity in early pregnancy, pnonlinearity = 0.008, with no further reduction in risk above 8 h/week. There was some indication of inverse associations between walking (before and during pregnancy) and vigorous activity (before pregnancy) and the risk of gestational diabetes mellitus. This meta-analysis suggests that there is a significant inverse association between physical activity before pregnancy and in early pregnancy and the risk of gestational diabetes mellitus. Further studies are needed to clarify the association between specific types and intensities of activity and gestational diabetes mellitus.

So it seems physical activity can be helpful there as well. Of course, for both articles, this is for the general population; there may be individual cases where physical activity is restricted during pregnancy for health reasons.  

High Intensity Exercise And Age

There is the popular misconception that high intensity exercise is for the young, and the aging should just shuffle around a little bit and call it a day.

This paper from several years ago says otherwise.  This doesn't mean an elderly person needs to be doing a "Heavy Duty Mike Mentzer" bodybuilding workout, but there needs to be sufficient stimulus for the exercise to be effective.  Thus, the authors talk about the benefits of "low volume, high-intensity aerobic and/or resistance training" to achieve a variety of health benefits.

Of course, at any age, consult your physician before starting any exercise program, but we see a clear indication that high volume, low intensity does not need to be the way to go for the aging.  High intensity can do a better job.

Melatonin For Resistance-Training Athletes

Can melatonin have beneficial effects for athletes other than on circadian rhythms?  This paper says yes.  Abstract:

Previous data showed that the administration of high doses of melatonin improved the circadian system in athletes. Here, we investigated in the same experimental paradigm whether the antioxidant properties of melatonin has also beneficial effects against exercise-induced oxidative stress and muscle damage in athletes. Twenty-four athletes were treated with 100 mg.day-1 of melatonin or placebo 30 min before bedtime during four weeks in a randomized double-blind scheme. Exercise intensity was higher during the study that before starting it. Blood samples were collected before and after treatment, and plasma was used for oxygen radical absorption capacity (ORAC), lipid peroxidation (LPO), nitrite plus nitrate (NOx), and advanced oxidation protein products (AOPP) determinations. Glutathione (GSH), glutathione disulphide (GSSG) levels, and glutathione peroxidase (GPx) and reductase (GRd) activities, were measured in erythrocytes. Melatonin intake increased ORAC, reduced LPO and NOx levels, and prevented the increase of AOPP, compared to placebo group. Melatonin was also more efficient than placebo in reducing GSSG.GSH-1 and GPx.GRd-1 ratios. Melatonin, but not placebo, reduced creatine kinase, lactate dehydrogenase, creatinine, and total cholesterol levels. Overall, the data reflect a beneficial effect of melatonin treatment in resistance-training athletes, preventing extra- and intracellular oxidative stress induced by exercise, and yielding further skeletal muscle protection against exercise-induced oxidative damage.

This, melatonin seems to protect skeletal muscle from oxidative stress damage as it prevents extracellular and intracellular oxidative stress. Interestingly, total cholesterol was reduced as well.

Overuse Injuries In Endurance Athletes

Of interest is this paper on overuse injuries in endurance athletes, abstract:

AIM:

The purpose of this study was to clarify training-related risk factors for overuse injuries.

METHODS:

This was twelve-month retrospective study which was done by self-reported postal questionnaire. The study group consisted of 446 men and women top-level Finnish athletes representing three different endurance sports (cross-country skiing, swimming, long-distance running) between the ages of 15-35. Self-reported anthropometric and training-related variables (such as starting age of training, years of active training, hours trained yearly, competition hours and weekly resting days) and occurrence of overuse injuries.

RESULTS:

Athletes with less than 2 rest days per week during the training season had 5.2-fold risk (95% confidence intervals [CI] 1.89-14.06, P=0.001) for an overuse injury, and athletes who trained more than 700 hours during a year had 2.1-fold risk (95% CI 1.21-3.61, P=0.008) for an overuse injury compared to the others. Athletes who reported a tendon injury were on average two years older than athletes without such an injury (P<0.001).

CONCLUSION:

We found that low number of recovery days and a high amount of training are training-related risk factors for overuse injuries in top-level endurance athletes. The higher number of tendon overuse injuries in older than younger athletes may indicate that age-related degeneration plays an important role in the etiology of tendon injuries. These findings should be taken into account when planning exercise programs for endurance athletes.

The conclusions seem to be relevant for the more casual athlete and average person exercising as well, when one considers that insufficient recovery and excessive training are risk factors for overuse injuries in elite athletes.  The age factor is also very likely relevant as well. If we assume relevance for athletes at all levels of ability and experience, one should plan their exercise programs to incorporate sufficient recovery time, avoid excess training - and these recommendations would be especially important for the older athlete.

Exercise, DKK1, SFRP1, And Cancer

Here is a study on breast cancer patients suggesting that physical activity/exercise can reduce blood levels of cell signaling factors, one of which is associated with a poor prognosis for patients with various forms of cancer.  Abstract:

Wingless and integration site growth factor (Wnt) signaling is a tumorigenesis-related signaling pathway. Dickkpof-1 (DKK1) and secreted frizzled-related protein-1 (SFRP1) are endogenous negative regulators of Wnt/β-catenin signaling. Accumulating evidence indicates that higher serum levels of DKK1 are correlated with poor prognosis of various types of cancer. Here, we investigated whether exercise training causes changes in the serum levels of DKK1 and SFRP1 in patients with breast cancer.

METHODS:

Twenty-four breast cancer survivors, after chemo- or radiotherapy, participated in this single-blind randomized, controlled pilot study. Subjects were randomized to either an exercise program or a control group for 12 weeks and completed pre- and post-training tests for health-related fitness and body composition as well as blood biomarkers. The serum levels of DKK1 and SFRP1 were measured using enzyme-linked immunosorbent assay as the primary outcome.

RESULTS:

Exercise training for 12 weeks remarkably increased muscle strength, endurance, and flexibility and decreased body fat percentage, waist circumference, and visceral fat area (all p < 0.05). Exercise training lowered serum insulin levels and leptin/adiponectin ratios (all p < 0.05). The levels of DKK1 and SFRP1 were also significantly decreased by exercise training in breast cancer survivors (all p < 0.01).

CONCLUSIONS:

Our results indicate that DKK1 and SFRP1 may be potentially useful biomarkers for evaluating the beneficial effects of long-term exercise on physical fitness and metabolism as well as the prognosis of patients with cancer.

The benefits of exercise are many and the list of positive effects continues to grow.

Exercise Non-Responders?

Are any people real “non-responders” to exercise?  This paper says “no” – those people just need a “higher dose” of exercise in order to see a response. In this case, the exercise was aimed at “cardiorespiratory fitness,“ but presumably the same applies to muscle-building as well. This does not mean, of course, that with a sufficiently high dose everyone will ultimately obtain the same results. Some people are indeed “hard gainers.” But they should be able to achieve some reasonable gains, albeit not at the level of all those “easy gainers.” 

Exercise For Hip Osteoarthritis

Can a specific exercise program enhance hip muscle strength and therefore be of benefit to patients suffering from hip osteoarthritis?  Here is a paper that says yes, abstract:

PURPOSE: To evaluate the effect of an exercise therapy concept (the Tübingen exercise therapy approach THüKo) for increasing hip muscle strength (HMS) in patients with hip osteoarthritis (OA), and to investigate whether patients do adhere to the intervention and if there are any adverse events related to the intervention.
METHODS: A total of 210 hip OA patients (89 females, 121 males) were randomized into a 12-week exercise intervention (THüKo) including group sessions (1/week) and home exercising (2/week), a placebo ultrasound group (1/week) or a control group (no treatment). HMS was measured as isometric peak torque of hip abduction, adduction, flexion, and extension. Adherence to exercise and safety aspects were monitored as additional outcomes.
RESULTS: Baseline adjusted post intervention HMS of the THüKo group were higher compared to the control group (differences of 0.11-0.27 Nm/kg, p < 0.01) and to the placebo ultrasound group (differences of 0.09-0.19 Nm/kg, p < 0.01). Adherence to exercise was high (about 90%). No subject had to refuse from training because of an exercise related adverse event and exercise related pain was only of intermittent nature without sustainable adverse effects.
CONCLUSIONS: The Tübingen exercise therapy approach has shown to have a significant positive effect on HMS. Its implementation has shown to be feasible and safe according to the percentage of exercise participation and the absence of sustainable adverse events.

More details about the exercise program can be found in this paper here.  If you have hip osteoarthritis, this may be something you can discuss with your physician.

Dietary Supplements For The Athlete

A review of dietary supplements for the athlete can be found here. Abstract:

Some dietary supplements are recommended to athletes based on data that supports improved exercise performance. Other dietary supplements are not ergogenic per se, but may improve health, adaptation to exercise, or recovery from injury, and so could help athletes to train and/or compete more effectively. In this review, we describe several dietary supplements that may improve health, exercise adaptation, or recovery. Creatine monohydrate may improve: recovery from and adaptation to intense training, recovery from periods of injury with extreme inactivity, cognitive processing, and reduce severity of or enhance recovery from mild traumatic brain injury (mTBI). Omega 3-fatty acid supplementation may also reduce severity of or enhance recovery from mTBI. Replenishment of vitamin D insufficiency or deficiency will likely improve some aspects of immune, bone, and muscle health. Probiotic supplementation can reduce the incidence, duration, and severity of upper respiratory tract infection, which may indirectly improve training or competitive performance. Preliminary data show that gelatin and/or collagen may improve connective tissue health. Some anti-inflammatory supplements, such as curcumin or tart cherry juice, may reduce inflammation and possibly delayed onset muscle soreness (DOMS). Beta-hydroxy beta-methyl butyrate (HMB) does not consistently increase strength and/or lean mass or reduce markers of muscle damage, but more research on recovery from injury that includes periods of extreme inactivity is needed. Several dietary supplements, including creatine monohydrate, omega 3-fatty acids, vitamin D, probiotics, gelatin, and curcumin/tart cherry juice could help athletes train and/or compete more effectively.

About Iliotibial Band Syndrome

An interesting analysis on a common overuse injury in runners and cyclists. Abstract:

Iliotibial band (ITB) syndrome is regarded as an overuse injury, common in runners and cyclists. It is believed to be associated with excessive friction between the tract and the lateral femoral epicondyle-friction which 'inflames' the tract or a bursa. This article highlights evidence which challenges these views. Basic anatomical principles of the ITB have been overlooked: (a) it is not a discrete structure, but a thickened part of the fascia lata which envelops the thigh, (b) it is connected to the linea aspera by an intermuscular septum and to the supracondylar region of the femur (including the epicondyle) by coarse, fibrous bands (which are not pathological adhesions) that are clearly visible by dissection or MRI and (c) a bursa is rarely present-but may be mistaken for the lateral recess of the knee. We would thus suggest that the ITB cannot create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee. The perception of movement of the ITB across the epicondyle is an illusion because of changing tension in its anterior and posterior fibres. Nevertheless, slight medial-lateral movement is possible and we propose that ITB syndrome is caused by increased compression of a highly vascularised and innervated layer of fat and loose connective tissue that separates the ITB from the epicondyle. Our view is that ITB syndrome is related to impaired function of the hip musculature and that its resolution can only be properly achieved when the biomechanics of hip muscle function are properly addressed.

Individuals with this disorder should discuss this article with their physician and/or physical therapist to see if something can be done to address the biomechanical deficiencies leading to the problem. Perhaps a change in technique? Strengthening certain muscles?

Exercise Type And Neuromuscular Adaptions

Can the type of exercise influence what kind of neuromuscular adaptions result?  Does high intensity training cause different types of adaptions than does lower-intensity endurance training, as the “gym gurus: tell us?  The answer seems to be yes.  Abstract:

PURPOSE:
Using a novel technique of high-density surface electromyography (HDEMG) decomposition and motor unit (MU) tracking, we compared changes in the properties of vastus medialis (VM) and vastus lateralis (VL) MUs following endurance (END) and high-intensity interval training (HIIT).
METHODS:
Sixteen men were assigned to an END or HIIT group (n=8 each) and performed six training sessions over 14 days. Each session consisted of 8-12×60s intervals at 100% peak power output (PPO) separated by 75s of recovery (HIIT) or 90-120min continuous cycling at ~65% VO2peak (END). Pre and post intervention, participants performed: 1) incremental cycling to determine VO2peak and PPO and 2) maximal (MVC), submaximal (10, 30, 50 and 70% MVC) and sustained (until task failure at 30% MVC) isometric knee extensions while HDEMG signals were recorded from the VM and VL. EMG signals were decomposed (submaximal contractions) into individual MUs by convolutive blind source separation. Finally, MUs were tracked across sessions by semi-blind source separation.
RESULTS:
After training, END and HIIT improved VO2peak similarly (by 5.0 and 6.7%, respectively). The HIIT group showed enhanced maximal knee extension torque by ~7% (p=0.02) and was accompanied by an increase in discharge rate for high-threshold MUs (≥50% knee extension MVC) (p<0.05). In contrast, the END group increased their time to task failure by ~17%, but showed no change in MU discharge rates (p>0.05).
CONCLUSIONS:
HIIT and END induce different adjustments in MU discharge rate despite similar improvements in cardiopulmonary fitness. Moreover, the changes induced by HIIT are specific for high-threshold motor units. For the first time we show that HIIT and END induce specific neuromuscular adaptations, possibly related to differences in exercise load intensity and training volume.

Therefore, the findings of this study show that high-intensity HIIT and endurance-oriented END result in exercise type-specific neuromuscular adaptions, which is completely consistent with the “gym info” popular conception that different types of exercise can induce specific types of nervous system and muscular adaptions and therefore one can tailor exercise type for the desired effect.

Resistance Training For COPD

Aerobic exercise seems to be helpful for chronic obstructive pulmonary disease (COPD). Does resistance training also help? Here is a study, abstract:

OBJECTIVE: Emerging research suggests that aerobic-based physical activity may help to promote survival among chronic obstructive pulmonary disease patients. However, the extent to which engagement in resistance training on survival among chronic obstructive pulmonary disease patients is relatively unknown. Therefore, the purpose of this study was to examine the independent associations of muscle strengthening activities on all-cause mortality among a national sample of U.S. adults with chronic obstructive pulmonary disease. We hypothesize that muscle strengthening activities will be inversely associated with all-cause mortality.
METHODS: Data from the 2003-2006 NHANES were employed, with follow-up through 2011. Aerobic-based physical activity was objectively measured via accelerometry, muscle strengthening activities engagement was assessed via self-report, and chronic obstructive pulmonary disease was assessed via physician-diagnosis.
RESULTS: Analysis included 385 adults (20 + yrs) with chronic obstructive pulmonary disease, who represent 13.3 million chronic obstructive pulmonary disease patients in the USA. The median follow-up period was 78 months (IQR=64-90), with 82 chronic obstructive pulmonary disease patients dying during this period. For a two muscle strengthening activity sessions/week increase (consistent with national guidelines), chronic obstructive pulmonary disease patients had a 29% reduced risk of all-cause mortality (HR=0.71; 95% CI: 0.51-0.99; P = 0.04).
CONCLUSION: Participation in muscle strengthening activities, independent of aerobic-based physical activity and other potential confounders, is associated with greater survival among chronic obstructive pulmonary disease patients.

So, yes, it seems like resistance training is helpful. COPD patients, when discussing treatment plans with their physicians, should ask about resistance training if the physician does not bring it up themselves. One possibility is that a combination of aerobic and resistance training is best. Generally speaking, over the past few decades, increasing evidence is accumulating that resistance training is helpful for many aspects of health. I can remember “the old days” in which medical authorities recommended aerobic exercise only, and resistance training was viewed as something for “weird bodybuilders,” but today more informed medical professionals and other experts promote the benefits of resistance training.

The "Serratus Punch"

Disorders of the shoulder and neck seem to be linked to problems with the serratus anterior (SA) muscle. Exercises for that muscle may help in rehabilitation; the question is what movement optimally targets the serratus anterior, and what exercise does so while minimally involving other muscles, such as the pectoralis major (PM), that synergize with the serratus anterior in its function. A study has been performed, conclusion from the abstract:

CONCLUSIONS: All exercises activated the PM between 15 and 29% Maximum Voluntary Isometric Contraction and the SA between 15 and 43%. The Modified Push-Up Plus exercise against the wall and the floor activated the SA and PM to a similar degree. When maximum activation of the SA with minimal activation of the PM is desired in healthy subjects, the "Serratus punch" seems to be the optimal exercise.

The "Serratus punch" exercise is shown in this YouTube video. As always, consult your physician before doing any rehabilitation. Do not self-diagnose and start doing such activities without knowing whether it is appropriate for you; you may make your specific condition worse.

Chocolate Milk For Exercise Recovery?

There’s an exercise paradigm suggesting that chocolate milk (CM) is an ideal post-exercise recovery drink.  Someone actually evaluated this, and the outcome was not extremely supportive of the paradigm, but did not refute it either: “CM provides either similar or superior results when compared to placebo or other recovery drinks.”  At best, CM seems marginally better than placebo or other recovery drinks, but more studies, with larger sample sizes, are required.  Abstract:

BACKGROUND/OBJECTIVES:Chocolate milk (CM) contains carbohydrates, proteins, and fat, as well as water and electrolytes, which may be ideal for post-exercise recovery. We systematically reviewed the evidence regarding the efficacy of CM compared to either water or other "sport drinks" on post-exercise recovery markers.SUBJECTS/METHODS:PubMed, Scopus, and Google scholar were explored up to April 2017 for controlled trials investigating the effect of CM on markers of recovery in trained athletes.RESULTS:Twelve studies were included in the systematic review (2, 9, and 1 with high, fair and low quality, respectively) and 11 had extractable data on at least one performance/recovery marker [7 on ratings of perceived exertion (RPE), 6 on time to exhaustion (TTE) and heart rate (HR), 4 on serum lactate, and serum creatine kinase (CK)]. The meta-analyses revealed that CM consumption had no effect on TTE, RPE, HR, serum lactate, and CK (P > 0.05) compared to placebo or other sport drinks. Subgroup analysis revealed that TTE significantly increases after consumption of CM compared to placebo [mean difference (MD) = 0.78 min, 95% confidence interval (CI): 0.27, 1.29, P = 0.003] and carbohydrate, protein, and fat-containing beverages (MD = 6.13 min, 95% CI: 0.11, 12.15, P = 0.046). Furthermore, a significant attenuation on serum lactate was observed when CM was compared with placebo (MD = -1.2 mmol/L, 95% CI: -2.06,-0.34, P = 0.006).CONCLUSION:CM provides either similar or superior results when compared to placebo or other recovery drinks. Overall, the evidence is limited and high-quality clinical trials with more well-controlled methodology and larger sample sizes are warranted.

Diaphragm Fatigue And Lower Pack Pain

A thought-provoking study, abstract:

The diaphragm plays an important role in spinal control. Increased respiratory demand compromises spinal control, especially in individuals with low back pain (LBP). The objective was to determine whether individuals with LBP exhibit greater diaphragm fatigability compared to healthy controls. Transdiaphragmatic twitch pressures (TwPdi) were recorded in 10 LBP patients and 10 controls, before and 20 and 45 min after inspiratory muscle loading (IML). Individuals with LBP showed a significantly decreased potentiated TwPdi, 20 min (-20%) (p=0.002) and 45 min (-17%) (p=0.006) after IML. No significant decline was observed in healthy individuals, 20 min (-9%) (p=0.662) and 45 min (-5%) (p=0.972) after IML. Diaphragm fatigue (TwPdi fall ≥ 10%) was present in 80% (20 min after IML) and 70% (45 min after IML) of the LBP patients compared to 40% (p=0.010) and 30% (p=0.005) of the controls, respectively. Individuals with LBP exhibit propensity for diaphragm fatigue, which was not observed in controls. An association with reduced spinal control warrants further study.

Further study can, among other things, look at cause and effect.  Does diaphragm fatigue lead to spinal problems and lower back pain?  Or is it the reverse?  Or is spinal problems and back pain not directly related, but that one leads to the other through the intermediate step of diaphragm  fatigue?  Is there some way to make the diaphragm less "fatigable" - perhaps by increasing ease of breathing through weight loss of conditioning through exercise?

Health Benefits Of Swimming

By Jmex60 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=4611001

Swimming has been studied and has been shown to be effective for cardiovascular fitness and for enhancing body composition.  I’m not into swing myself, and get exercise through other approaches, but for those who do it, it’s obviously beneficial.  Always be safety-aware in the water, and don’t start a swimming program without first consulting with your physician.  Abstract:

BACKGROUND:Swimming is a popular and potentially health-enhancing exercise, but has received less scientific attention compared with other exercise modes.OBJECTIVE:The objective of the study was to determine the chronic (long-term) effect of pool swim training on physiological outcomes in non-elite or non-competitive swimming participants.DESIGN:This study was a systematic review with a meta-analysis.DATA SOURCES:We searched the electronic databases PubMed, EMBASE and CENTRAL from inception to March 2017.ELIGIBILITY CRITERIA:The eligibility criteria included randomised controlled trials, quasi-randomised controlled trials and controlled trials of chronic (long-term) swimming interventions in non-elite or non-competitive swimming participants, with a physiological outcome measure.RESULTS:Our search of 6712 records revealed 29 eligible studies. Swimming had a significant and clinically meaningful effect on maximal oxygen uptake compared with the control in an analysis including multiple populations (mean difference 6.32 mL/kg/min; 95% confidence interval 4.33-8.31), and subgroup analyses of healthy children/adolescents (mean difference 7.93 mL/kg/min; 95% confidence interval 3.31-12.55) and those with asthma (mean difference 9.67 mL/kg/min; 95% confidence interval 5.84-13.51) and healthy adults (mean difference 5.87 mL/kg/min; 95% confidence interval 2.93-8.81). Swimming also resulted in significant improvements in other cardiorespiratory fitness-related outcomes such as maximal minute ventilation (mean difference 0.61 L/min; 95% confidence interval 0.17-1.05), submaximal exercise performance (standardised mean difference 0.64; 95% confidence interval 0.14-1.13) and total exercise test time (mean difference 4.27 min; 95% confidence interval 2.11-6.42). Compared with the control, swimming had significant favourable effects on body mass (mean difference - 2.90 kg, 95% confidence interval - 5.02 to - 0.78), body fat percentage in multiple populations (mean difference - 1.92%; 95% confidence interval - 3.25 to - 0.60) and healthy children/adolescents (mean difference - 1.92%; 95% confidence interval - 4.64 to - 0.80) and lean mass (mean difference 1.96 kg; 95% confidence interval 0.21-3.71), but negative effects on waist circumference in a pooled analysis of two studies involving adults with hypertension (mean difference 4.03 cm; 95% confidence interval 2.58-5.49). Regarding lung function, significant effects of swimming vs. the control were found only for peak expiratory volume in analyses including children/adolescents combined with healthy adults (mean difference 58.74 L/min; 95% confidence interval 29.70-87.78) and children/adolescents with asthma alone (mean difference 63.49 L/min; 95% confidence interval 25.01-101.97). Based on limited data, swimming had similar effects to other exercise modes, except for higher post-intervention body mass index values with swimming vs. running in healthy adults (mean difference 1.18 kg/m2; 95% confidence interval 0.54-1.81).CONCLUSIONS:Swimming may offer robust beneficial effects on cardiorespiratory fitness and body composition across multiple populations and effects may be comparable to other exercise modes. Future randomised controlled trials are required to establish the effectiveness of swimming on physiological outcomes in healthy populations and those with non-communicable disease.

Muscle Damage Not Required For Muscle Growth In Resistance Training?

Muscle growth die to resistance may not be dependent on muscle damage (and subsequent repair of that damage) induced by training. If true, this is contrary to the paradigm of bodybuilding.  Abstract:

Resistance training (RT)-induced skeletal muscle hypertrophy is a highly intricate process. Despite substantial advances, we are far from understanding exactly how muscle hypertrophy develops during RT. The aim of the present review is to discuss new insights related to the role of skeletal muscle damage and muscle protein synthesis (MPS) in mediating RT-induced hypertrophy. Specifically, the thesis that in the early phase of RT (≤ 4 previous RT sessions) increases in muscle cross-sectional area are mostly attributable to muscle damage-induced muscle swelling; then (after ~ 10 sessions), a modest magnitude of muscle hypertrophy ensues; but only during a latter phase of RT (after ~ 18 sessions) is true muscle hypertrophy observed. We argue that the initial increases in MPS post-RT are likely directed to muscle repair and remodelling due to damage, and do not correlate with eventual muscle hypertrophy induced by several RT weeks. Increases in MPS post-RT session only contribute to muscle hypertrophy after a progressive attenuation of muscle damage, and even more significantly when damage is minimal. Furthermore, RT protocols that do not promote significant muscle damage still induce similar muscle hypertrophy and strength gains compared to conditions that do promote initial muscle damage. Thus, we conclude that muscle damage is not the process that mediates or potentiates RT-induced muscle hypertrophy.

Cancer Immunotherapy: The Systemic Response

An article  on cancer immunotherapy; the abstract:

Immune responses involve coordination across cell types and tissues. However, studies in cancer immunotherapy have focused heavily on local immune responses in the tumor microenvironment. To investigate immune activity more broadly, we performed an organism-wide study in genetically engineered cancer models using mass cytometry. We analyzed immune responses in several tissues after immunotherapy by developing intuitive models for visualizing single-cell data with statistical inference. Immune activation was evident in the tumor and systemically shortly after effective therapy was administered. However, during tumor rejection, only peripheral immune cells sustained their proliferation. This systemic response was coordinated across tissues and required for tumor eradication in several immunotherapy models. An emergent population of peripheral CD4 T cells conferred protection against new tumors and was significantly expanded in patients responding to immunotherapy. These studies demonstrate the critical impact of systemic immune responses that drive tumor rejection.

In other words, a local response at the tumor by the immune system is sufficient for sustained proliferation of the immune response required for tumor rejection.  A (body-wide) systemic immune response is required, a set of responses that, as the article states "involve coordination across cell types and tissues."

It would stand to reason, as my hypothesis, that those things that would enhance the overall function of the immune system - diet, exercise, proper sleep,  less stress, and possibly the gut microbiota - would assist the body in generating the systemic responses required for tumor rejection.  More studies are required to evaluate my hypothesis.

Selling Exercise

Unfortunately, some people need to be prescribed exercise by their physicians rather than incorporating it into their lives on their own; further, even this prescription can meet resistance and has to be "sold" to the patient:

Exercise is Medicine (EIM) and physical activity as a vital sign are based on health-focused research and reflect ideal frames and messages for clinicians. However, they are nonoptimal for patients because they do not address what drives patients' decision-making and motivation. With the growing national emphasis on patient-centered and value-based care, it is the perfect time for EIM to evolve and advance a second-level consumer-oriented exercise prescription and communication strategy. Through research on decision-making, motivation, consumer behavior, and meaningful goal pursuit, this article features six evidence-based issues to help clinicians make physical activity more relevant and compelling for patients to sustain in ways that concurrently support patient-centered care. Physical activity prescriptions and counseling can evolve to reflect affective and behavioral science and sell exercise so patients want to buy it.

Exercise And Brown fat

More inert white adipose tissue (WAT) is linked to a variety of obesity-related disorders, as opposed to the more metabolically active brown fat.  It's possible to "remodel" WAT to make it more active, a process called "browning." Not surprisingly, exercise training has been shown to promote "browning" as discussed here. abstract:

Exercise training increases the thermogenic capacity of white adipose tissue (WAT), an effect known as "browning" of the WAT. Here, we discuss how this affects whole-body energy homeostasis. We put forth the hypothesis that browning of the subcutaneous WAT allows the organism to adjust its metabolic rate according to energy availability while coping with increased heat production through exercise.

Yet another benefit of physical activity/exercise.

Exercise As An Anti-Depressant

Regular exercise can reduce depressive symptoms to an extent that can mimic chronic antidepressant treatment (of course, one likely won’t hear about this from most doctors or from the pharmaceutical companies pushing their samples onto those doctors), and there are molecular mechanisms for this, apparently involving the Wnt signaling pathway. Abstract:

Regular exercise reduces depressive-like behavior activation. In this study, we look for exact roles of exercise on molecular and neuronal mechanisms for antidepressant action by studying the hippocampal neuroplasticity and proliferation. Increased hippocampal neurogenesis with exercise has potential significance for depression. Exercise promotes brain health in the molecular levels in the hippocampus and also affects behavior in a similar way to chronic antidepressant treatment. Wingless (Wnt) and frizzled signaling system plays an important role in cell proliferation, growth, and differentiation during development. Our results demonstrate complicated, differential effects of antidepressants on Wnt signaling system, and assume a role for selected signaling molecules in the neurogenic activity of antidepressant care. Our review suggests that exercise may preserve brain function by increasing neurogenesis through activating Wnt signaling pathway in the psychiatric disorders, such as depression.

Maybe exercise rather than popping pills should be the first line treatment for many mental, as well as more directly physical, disorders?  First, ask you doctor about it - an informed doctor - and follow his or her advice.  Everyone is different.  Some people may require medication, others may only need exercise.  Get the medical consultation you require to figure out which category you may be in, if you require such help.