title: Raisins and additional walking have distinct effects on plasma lipids and inflammatory cytokines Recommending Self-Paced Exercise among Overweight and Obese Adults: a Randomized Pilot Study Optimum frequency of exercise for bone health: randomised controlled trial of a high-impact unilateral intervention. The effects of aerobic exercise training at two different intensities in obesity and type 2 diabetes: implications for oxidative stress, low-grade inflammation and nitric oxide production High-Intensity Interval Training as an Efficacious Alternative to Moderate-Intensity Continuous Training for Adults with Prediabetes The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Home-based exercise for middle-aged Chinese at diabetic risk: a randomized controlled trial. A randomised controlled trial of the effects of implementation intentions on women's walking behaviour Improving body image one step at a time: greater pedometer step counts produce greater body image improvements. Self-guided brisk walking training with or without poles: a randomized-controlled trial in middle-aged women. Reliability of the PEDro scale for rating quality of randomized controlled trials. Effectiveness of long and short bout walking on increasing physical activity in women. Effects of Nordic walking on cardiovascular risk factors in overweight individuals with type 2 diabetes, impaired or normal glucose tolerance. Mechanisms behind the superior effects of interval vs continuous training on glycaemic control in individuals with type 2 diabetes: a randomised controlled trial An internet-delivered exercise intervention for workplace health promotion in overweight sedentary employees: a randomized trial. Exercise-Induced Weight Loss is More Effective than Dieting for Improving Adipokine Profile, Insulin Resistance, and Inflammation in Obese Men. High-Intensity Interval Training on an Aquatic Treadmill in Adults With Osteoarthritis: Effect on Pain, Balance, Function, and Mobility Accumulated brisk walking reduces arterial stiffness in overweight adults: evidence from a randomized control trial.
abstract: Background Raisins are a significant source of dietary fiber and polyphenols , which may reduce cardiovascular disease ( CVD ) risk by affecting lipoprotein metabolism and inflammation . Walking represents a low intensity exercise intervention that may also reduce CVD risk . The purpose of this study was to determine the effects of consuming raisins , increasing steps walked , or a combination of these interventions on blood pressure , plasma lipids , glucose , insulin and inflammatory cytokines . Results Thirty-four men and postmenopausal women were matched for weight and gender and r and omly assigned to consume 1 cup raisins/d ( RAISIN ) , increase the amount of steps walked/d ( WALK ) or a combination of both interventions ( RAISINS + WALK ) . The subjects completed a 2 wk run-in period , followed by a 6 wk intervention . Systolic blood pressure was reduced for all subjects ( P = 0.008 ) . Plasma total cholesterol was decreased by 9.4 % for all subjects ( P < 0.005 ) , which was explained by a 13.7 % reduction in plasma LDL cholesterol ( LDL-C ) ( P < 0.001 ) . Plasma triglycerides ( TG ) concentrations were decreased by 19.5 % for WALK ( P < 0.05 for group effect ) . Plasma TNF-α was decreased from 3.5 ng/L to 2.1 ng/L for RAISIN ( P < 0.025 for time and group × time effect ) . All subjects had a reduction in plasma sICAM-1 ( P < 0.01 ) . Conclusion This research shows that simple lifestyle modifications such as adding raisins to the diet or increasing steps walked have distinct beneficial effects on CVD risk Background National guidelines call for exercise of at least moderate intensity ; however , recommending self-paced exercise may lead to better adherence , particularly among overweight and obese adults . Purpose The purpose of this study was to test proof-of-concept for recommending self-paced exercise among overweight adults . Methods Fifty-nine healthy , low-active ( exercise < 60 min/week ) , overweight ( body mass index 25.0–39.9 ) adults ( 18–65 ) received a 6-month print-based exercise promotion program with the goal of walking 30–60 min/day . Participants were surreptitiously r and omly assigned to receive a recommendation for either self-paced ( n = 30 ) or moderate ( 64–76 % maximum heart rate ; n = 29 ) intensity exercise . All participants used electronic diaries and heart rate monitors to track exercise frequency , duration , and intensity . Results The self-paced condition reported more minutes/week of walking ( f2 = 0.17 , p = 0.045 ) and a trend toward greater exercise-related energy expenditure/week ( f2 = 0.12 , p = 0.243 ) , corresponding to approximately 26 additional minutes/week and 83 additional kilocalories/week over 6 months . Conclusions Explicit recommendation for self-paced exercise may improve adherence to exercise programs among overweight and obese adults INTRODUCTION Exercise can increase bone strength , but to be effective in reducing fracture risk , exercise must be feasible enough to be adopted into daily life and influence potentially vulnerable skeletal sites such as the superolateral cortex of the femoral neck , where thinning is associated with increased fracture risk . Brief , high-impact exercise increases femoral neck bone density but the optimal frequency of such exercise and the location of bone accrual is unknown . This study thus examined ( 1 ) the effectiveness of different weekly frequencies of exercise on femoral neck BMD and ( 2 ) whether BMD change differed between hip sites using a high-impact , unilateral intervention . METHODS Healthy premenopausal women were r and omly assigned to exercise 0 , 2 , 4 , or 7 days/week for 6 months . The exercise intervention incorporated 50 multidirectional hops on one r and omly selected leg . BMD was measured by DXA at baseline and after 6 months of exercise . Changes in the exercise leg were compared between groups using ANCOVA , with change in the control leg and baseline BMD as covariates . RM-MANOVA was conducted to determine whether bone changes from  exercise  differed between hip sites . RESULTS 61 women ( age 33.6+/-11.1 years ) completed the intervention .  Compliance amongst exercisers was 86.7+/-10.6 % . Peak ground reaction forces during exercise increased from 2.5 to 2.8 times body weight . The change in femoral neck BMD in the exercise limb ( adjusted for change in the control limb and baseline BMD ) differed between groups ( p=0.015 ) , being -0.3 % ( -1.2 to 0.6 ) , 0.0 % ( -1.0 to 1.0 ) , 0.9 % ( -0.1 to 2.0 ) and 1.8 % ( 0.8 to 2.8 ) in those exercising 0 , 2 , 4 and 7 days per week , respectively . When BMD changes at upper neck , lower neck and trochanter were compared using RM-MANOVA , a significant exercise effect was observed ( p=0.048 ) , but this did not differ significantly between sites ( p=0.439 ) despite greatest mean increases at the upper femoral neck . CONCLUSIONS Brief , daily hopping exercises increased femoral neck BMD in premenopausal women but less frequent exercise was not effective . Brief high-impact exercise may have a role in reducing hip fragility , but may need to be performed frequently for optimal response Aims To investigate the effect of 16 weeks of aerobic training performed at two different intensities on nitric oxide ( tNOx ) availability and iNOS/nNOS expression , oxidative stress ( OS ) and inflammation in obese humans with or without type 2 diabetes mellitus ( T2DM ) . Methods Twenty-five sedentary , obese ( BMI > 30 kg/m2 ) males ( 52.8 ± 7.2 years ) ; 12 controls versus 13 T2DM were r and omly allocated to four groups that exercised for 30 min , three times per week either at low ( Fat-Max ; 30–40 % VO2max ) or moderate ( Tvent ; 55–65 % VO2max ) intensity . Before and after training , blood and muscle sample s ( v. lateralis ) were collected . Results Baseline erythrocyte glutathione was lower ( 21.8 ± 2.8 vs. 32.7 ± 4.4 nmol/ml ) and plasma protein oxidative damage and IL-6 were higher in T2DM ( 141.7 ± 52.1 vs. 75.5 ± 41.6 nmol/ml ) . Plasma catalase increased in T2DM after Tvent training ( from 0.98 ± 0.22 to 1.96 ± 0.3 nmol/min/ml ) . T2DM groups demonstrated evidence of oxidative damage in response to training ( elevated protein carbonyls ) . Baseline serum tNOx were higher in controls than T2DM ( 18.68 ± 2.78 vs. 12.34 ± 3.56 μmol/l ) . Training at Tvent increased muscle nNOS and tNOx in the control group only . Pre-training muscle nNOS was higher in controls than in T2DMs , while the opposite was found for iNOS . No differences were found after training for plasma inflammatory markers . Conclusion Exercise training did not change body composition or aerobic fitness , but improved OS markers , especially when performed at Tvent . Non-diabetics responded to Tvent training by increasing muscle nNOS expression and tNOx levels in skeletal muscle while these parameters did not change in T2DM , perhaps due to higher insulin resistance ( unchanged after intervention ) Aims . High-intensity interval training ( HIIT ) leads to improvements in various markers of cardiometabolic health but adherence to HIIT following a supervised laboratory intervention has yet to be tested . We compared self-report and objective measures of physical activity after one month of independent exercise in individuals with prediabetes who were r and omized to HIIT ( n = 15 ) or traditional moderate-intensity continuous training ( MICT , n = 17 ) . Method . After completing 10 sessions of supervised training  participants were asked to perform HIIT or MICT three times per week for four weeks . Results . Individuals in HIIT ( 89 ± 11 % ) adhered to their prescribed protocol to a greater extent than individuals in MICT ( 71 ± 31 % ) as determined by training logs completed over one-month follow-up ( P = 0.05 , Cohen 's d = 0.75 ) . Minutes spent in vigorous physical activity per week measured by accelerometer were higher in HIIT ( 24 ± 18 ) as compared to MICT ( 11 ± 10 ) at one-month follow-up ( P = 0.049 , Cohen 's d = 0.92 ) . Cardiorespiratory fitness and systolic blood pressure assessed at one-month follow-up were equally improved ( P 's < 0.05 ) . Conclusions . This study provides preliminary evidence that individuals with prediabetes can adhere to HIIT over the short-term and do so at a level that is greater than MICT QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis OBJECTIVE To evaluate short- ( 3 months ) and long-term ( 9 months ) effects of home-based exercise on adiponectin , exercise behavior and metabolic risk factors in middle-aged adults at diabetic risk . METHODS One hundred and thirty-five middle-aged adults ( 38 men , 97 women ) with at least one diabetic risk factor were r and omly assigned to either a home-based exercise group ( Ex-group ) or a usual care group ( C-group ) . Outcome measures included plasma adiponectin , exercise self-efficacy , physical activity , and metabolic risk factors , as follows : insulin levels , insulin resistance by homeostasis model assessment ( HOMA-IR ) , physical fitness , and components of metabolic syndrome . This study was conducted in metropolitan Taipei from 2004 to 2005 . RESULTS The Ex-group had improvements in exercise self-efficacy ( + 2.5 , p = 0.01 ) , body mass index ( BMI ) ( -0.6 kg/m2 , p < 0.001 ) and flexibility ( + 2.4 cm , p < 0.001 ) at 3-month follow-up and maintained BMI and flexibility at 9-month follow-up . The Ex-group exhibited significantly increased physical activity while the C-group exhibited decreased physical activity at 9-month follow-up ( p < 0.001 ) . No intervention effect was found on adiponectin ( p = 0.64 ) or other outcome measures over time . CONCLUSIONS Home-based exercise did not improve adiponectin levels , but significantly improved exercise behavior , and certain metabolic risk factors , with the effects maintained for 9-months in subjects with type 2 diabetic risk The combination of low physical activity rates and increased cardiovascular deaths indicate the overwhelming need for behaviour change interventions that can effectively promote physical activity among sedentary women . This 11-week r and omised controlled trial examined the effects of an implementation intentions intervention on sedentary women 's walking behaviour . Seventy-five women ( M age = 48.17 ) were r and omly assigned to either a control group where they were required to self-monitor their daily pedometer-determined step count or to an experimental group where they were asked to form specific walking plans ( i.e. implementation intentions ) every 6 weeks and to self-monitor their daily pedometer-determined step count .  Measures of  exercise intentions , perceived behavioural control , scheduling and barrier self-efficacy were administered at baseline , week 6 and week 11 . Analyses indicated higher step counts over the first 6 weeks for women in the experimental condition ( p < 0.02 ) . Furthermore , higher self-efficacy to schedule ( p < 0.01 ) and overcome walking barriers ( p < 0.03 ) , as well as higher perceptions of behavioural control ( p < 0.02 ) were found at week 11 for women in the experimental versus control condition . However , none of the control beliefs were found to mediate the effects of the intervention on the women 's walking behaviour . Furthermore , the intervention did not have any effect on the strength of the goal intention – behaviour relationship . The findings suggest implementation intentions are an effective strategy for initiating leisure-time walking within sedentary women This r and omized controlled trial examined whether the number of steps walked during an 11-week action planning intervention would mediate changes in sedentary women 's body image . Seventy-five healthy , sedentary women were r and omly assigned to either a control group , where they were required to self-monitor their daily pedometer-determined step count , or to an experimental group , where they were asked to self-monitor and form specific action plans for walking . Of the 75 participants r and omized , 41 were included in the efficacy analyses . Measured outcomes were satisfaction with physical functioning and physical appearance , and daily pedometer-determined step counts . Greater satisfaction with physical functioning and higher step counts were found for the experimental group . Moreover , the total number of steps walked over Weeks 2 - 11 was shown to partially mediate the effect of the intervention on satisfaction with physical functioning . These findings suggest that walking greater distances is associated with greater improvement in at least one aspect of women 's body images Walking with poles ( Nordic walking , NW ) has become popular . We compared training responses of brisk walking ( W ) or NW on  cardiorespiratory and neuromuscular fitness .  We r and omized 121 non-obese sedentary women ( aged 50 - 60 ) to an NW or W group ( NWG , WG ) , to train 40 min four times weekly for 13 weeks . Intensity was based on subjective perception of exertion . Cardiorespiratory performance was assessed in four levels corresponding to 50 % , 65 % , 80 % and 100 % of peak VO(2 ) . Fifty-four NWG and 53 WG subjects completed the study . The mean intensity was about 50 % of heart rate ( HR ) reserve . The baseline peak VO(2 ) was 25.8 ( SD 3.9 ) mL/min/kg . Both groups improved peak VO(2 ) similarly ( NWG 2.5 mL/min/kg , 95 % confidence interval ( CI ) 1.9 - 3.3 ; WG 2.6 , CI 1.9 - 3.3 ) . In the submaximal stages while walking with or without poles , HR and lactate decreased after training in both groups , but the changes were not statistically significantly different between the groups . Of the neuromuscular tests after training , the only significant difference between the groups was in the leg strength in the one-leg squat , favoring WG . In conclusion , both training modes improved similarly health-enhancing physical fitness , and they were feasible and safe BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . BACKGROUND The accumulation of physical activity ( PA ) throughout the day has been suggested as a means to increase PA behavior . It is not known , however , if accumulated PA results in equivalent increases in PA behavior compared with one continuous session . The purpose of this investigation was to compare changes in  PA  between participants assigned to walk daily in accumulated shorter bouts vs. one continuous session . METHODS In this 8-week r and omized controlled trial , 60 inactive women were r and omly assigned to one of the following : ( 1 ) control group , ( 2 ) 30 minutes a day of walking 5 days a week in one continuous long bout ( LB ) , or ( 3 ) three short 10-minute bouts ( SB ) of walking a day , all at a prescribed heart rate intensity . Walking was assessed by pedometer and self-reported walking log . Before and after measures were taken of average steps/day , resting systolic and diastolic blood pressure ( SBP , DBP ) , resting heart rate ( RHR ) , six-minute walk test ( 6MWT ) distance , height , weight , body mass index ( BMI ) , and hip and waist circumference . RESULTS Both walking groups significantly increased PA measured as steps/day compared to controls ( p < 0.001 ) , and no significant differences were found between LB and SB groups . The LB group demonstrated significant decreases in hip circumference and significant increases in 6MWT distance compared to the control group . CONCLUSIONS Both walking groups significantly increased PA participation . LB group participants completed more walking at a higher intensity than the SB and control groups , which result ed in significant increases in health benefits BACKGROUND Physical activity remains a valuable prevention for metabolic disease . The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation . METHODS We included 213 individuals , aged 60 ± 5.3 years and with body mass index ( BMI ) of 30.2 ± 3.8 kg/m(2 ) ; of these , 128 had normal glucose tolerance ( NGT ) , 35 had impaired glucose tolerance ( IGT ) and 50 had type 2 diabetes mellitus ( T2DM ) . Participants were r and omized to unaltered physical activity or to 5 h per week of Nordic walking with poles , for a 4-month period . Dietary habits were unaltered . BMI , waist circumference , blood pressure , glucose tolerance , clinical chemistry , maximal oxygen uptake ( peak VO(2 ) ) and self-reported physical activity ( question naire ) were assessed at the time of inclusion and after 4 months . The participants in the exercise-intervention group kept a walking diary . RESULTS In the NGT exercise group , self-reported physical activity increased markedly , and body weight ( -2.0 ± 3.8 kg ) , BMI ( -0.8 ± 1.4 kg/m(2 ) ) and waist circumference ( -4.9 ± 4.4 cm ) ( mean ± SD ) decreased . Exercise power output ( 12.9 ± 9.9 W ) and peak VO(2 ) ( 2.7 ± 2.8 mL/kg/min ) increased in the IGT exercise group . More cardiovascular risk factors were improved after exercise intervention in people with NGT compared with those with IGT or T2DM . Exercise capacity improved significantly in all three groups of participants who reported at least 80 % compliance with the scheduled exercise . CONCLUSIONS Nordic walking  improved anthropometric measurements and exercise capacity . However , unsupervised Nordic walking may not provide a sufficient increase in exercise intensity to achieve ultimate health-promoting benefits on the cardiovascular parameters assessed in this study , particularly for those with disturbed glucose regulation Abstract Aims /hypothesisBy use of a parallel and partly crossover r and omised , controlled trial design we sought to eluci date the underlying mechanisms behind the advantageous effects of interval walking training ( IWT ) compared with continuous walking training ( CWT ) on glycaemic control in individuals with type 2 diabetes . We hypothesised that IWT , more than CWT , would improve insulin sensitivity including skeletal muscle insulin signalling , insulin secretion and disposition index ( DI ) . Methods By simple r and omisation ( sequentially numbered , opaque sealed envelopes ) , eligible individuals ( diagnosed with type 2 diabetes , no exogenous insulin treatment ) were allocated to three groups : a control group ( CON , n = 8) , an IWT group ( n = 12 ) and an energy expenditure-matched CWT group ( n = 12 ) . Training groups were prescribed free-living training , five sessions per week ( 60 min/session ) . A three-stage hyperglycaemic clamp , including glucose isotope tracers and skeletal muscle biopsies , was performed before and after a 4 month intervention in a hospitalised setting . No blinding was performed . Results The improved glycaemic control , which was only seen in the IWT group , was consistent with IWT-induced increases in insulin sensitivity index ( 49.8 ± 14.6 % ; p < 0.001 ) , peripheral glucose disposal ( 14.5 ± 4.9 % ; p < 0.05 ) and DI ( 66.2 ± 21.8 % ; p < 0.001 ) , with no changes in the CWT or CON group . Moreover , only IWT  improved insulin signalling in skeletal muscle via increased insulin-stimulated phosphorylation of AS160 ( 29.0 ± 10.8 % ; p < 0.05 ) . No changes were seen in insulin secretion during hyperglycaemia alone , hyperglycaemia + glucagon-like peptide 1 infusion or arginine injection . Conclusions /interpretationIWT maintains insulin secretion and improves insulin sensitivity and DI , in contrast to energy expenditure-matched CWT . These results suggest that training with alternating intensity , and not just training volume and mean intensity , is a key determinant of changes in whole body glucose disposal in individuals with type 2 diabetes . Trial registration : Clinical Trials ( NCT01234155 ) OBJECTIVE To evaluate the effect of structured vs. non-structured internet-delivered exercise recommendations on aerobic exercise capacity and cardiovascular risk profile in overweight sedentary employees . METHODS 140 employees of an automobile company ( 11 % female , median age 48 years ( range 25 - 60 ) , BMI 29.0 kg/m(2 ) ( 25.0 - 34.8 ) ) were r and omized in a 3:2 ratio to an intervention group receiving structured exercise schedules or a control group choosing workouts individually via an interactive website . The 12-week intervention took place in Munich , Germany , during summer 2008 . Main outcome measure was performance at the lactate anaerobic threshold ( P(AT)/kg ) during ergometry . RESULTS 77 participants completed the study . The intervention group ( n=50 ) improved significantly in P(AT)/kg ( ( mean ( SD ) ) 1.68 ( 0.31 ) vs. 1.81 ( 0.33 ) W/kg ; p=0.002 ) , VO(2)peak ( 3.21 ( 0.63 ) vs. 3.35 ( 0.74 ) L/min ; p=0.04 ) , and waist circumference ( 100.5 ( 7.9 ) vs. 98.0 ( 7.8 ) cm ; p=0.001 ) . The control group ( n=27 ) improved significantly in P(AT)/kg ( 1.59 ( 0.38 ) vs. 1.80 ( 0.49 ) ; p<0.001 ) and waist circumference ( 101.9 ( 8.7 ) vs. 98.3 ( 8.5 ) cm ; p<0.001 ) , but not in VO(2)peak . No significant between group differences in these outcome measures were noted . CONCLUSION Structured , internet-delivered exercise recommendations are not superior to internet-delivered non-structured exercise recommendations in a workplace setting . Both lifestyle intervention strategies are , however , limited by high dropout rates The adipokines chemerin and adiponectin are reciprocally related in the pathogenesis of insulin resistance and inflammation in obesity . Weight loss increases adiponectin and reduces chemerin , insulin resistance , and inflammation , but the effects of caloric restriction and physical activity are difficult to separate in combined lifestyle modification . We compared effects of diet- or exercise-induced weight loss on chemerin , adiponectin , insulin resistance , and inflammation in obese men . Eighty abdominally obese Asian men ( body mass index [ BMI ] ≥ 30 kg/m(2 ) , waist circumference [ WC ] ≥ 90 cm , mean age 42.6 years ) were r and omized  to reduce daily intake by ~500 kilocalories ( n = 40 ) or perform moderate-intensity aerobic and resistance exercise ( 200 - 300 min/week ) ( n = 40 ) to increase energy expenditure by a similar amount for 24 weeks . The diet and exercise groups had similar decreases in energy deficit ( -456 ± 338 vs. -455 ± 315 kcal/day ) , weight ( -3.6 ± 3.4 vs. -3.3 ± 4.6 kg ) , and WC ( -3.4 ± 4.4 vs. -3.6 ± 3.2 cm ) . The exercise group demonstrated greater reductions in fat mass ( -3.9 ± 3.5 vs. -2.7 ± 5.3 kg ) , serum chemerin ( -9.7 ± 11.1 vs. -4.3 ± 12.4 ng/ml ) , the inflammatory marker high-sensitivity C-reactive protein ( -2.11 ± 3.13 vs. -1.49 ± 3.08 mg/L ) , and insulin resistance as measured by homeostatic model assessment ( -2.45 ± 1.88 vs. -1.38 ± 3.77 ) . Serum adiponectin increased only in the exercise group . Exercise-induced fat mass loss was more effective than dieting for improving adipokine profile , insulin resistance , and systemic inflammation in obese men , underscoring metabolic benefits of increased physical activity Abstract Bressel , E , Wing , JE , Miller , AI , and Dolny , DG . High-intensity interval training on an aquatic treadmill in adults with osteoarthritis :  effect on pain , balance , function , and mobility . J Strength Cond Res 28(8 ) : 2088–2096 , 2014—Although aquatic exercise is considered a potentially effective treatment intervention for people with osteoarthritis ( OA ) , previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity . The purpose of this study was to quantify the efficacy of a 6-week aquatic treadmill exercise program on measures of pain , balance , function , and mobility .  Eighteen participants ( age = 64.5 ± 10.2 years ) with knee OA completed a non-exercise control period followed by a 6-week exercise period . Outcome measures included visual analog scales for pain , posturography for balance , sit-to-st and test for function , and a 10-m walk test for mobility . The exercise protocol included balance training and high-intensity interval training ( HIT ) in an aquatic treadmill using water jets to destabilize while st and ing and achieve high ratings of perceived exertion ( 14–19 ) while walking . In comparison with pretests , participants displayed reduced joint pain ( pre = 50.3 ± 24.8 mm vs. post = 15.8 ± 10.6 mm ) , improved balance ( equilibrium pre = 66.6 ± 11.0 vs. post = 73.5 ± 7.1 ) , function ( rising index pre = 0.49 ± 0.19 % vs. post = 0.33 ± 0.11 % ) , and mobility ( walk pre = 8.6 ± 1.4 s vs. post = 7.8 ± 1.1 s ) after participating in the exercise protocol ( p = 0.03–0.001 ) . The same benefits were not observed after the non-exercise control period . Adherence to the exercise protocol was exceptional and no participants reported adverse effects , suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by patients with OA and may be effective at managing symptoms of OA Arterial stiffness is a major contributor to the development of atherosclerosis and consequently cardiovascular disease . This study aim ed to examine whether 6 months of accumulated ( 3 × 10 minutes , 5 days/week ) brisk walking was sufficient to reduce arterial stiffness in sedentary , overweight individuals . Seventy-seven individuals ( 19 men , 58 women ; age , 30 - 55 years ) were r and omly allocated to one of three groups ; two groups completed 30 minutes of accumulated walking with either monthly or weekly telephone support ; the third group ( control ) performed stretching exercises . The walking groups were combined and telephone support included as a covariate . Anthropometry , blood pressure ( BP ) , blood lipids , pulse wave velocity ( PWV ) , and NOx ( surrogate marker for nitric oxide ) were measured at baseline , post-intervention and 4 months post-intervention . No changes were observed for anthropometry , BP , or lipids . However , at the end of the intervention , there was a decrease in PWV ( P < .001 ) accompanied by an increase in NOx ( P < .001 ) , with changes maintained 4 months post-intervention . A strong negative correlation between PWV and NOx was also observed ( P < .001 ; r = -0.65 ) . A lifestyle approach to meeting current physical activity guidelines results in favorable alterations in arterial function in overweight individuals
target: This review summarised in detail the effects  SD exercise interventions had on sedentary middle-aged individuals alongside the adherence to the prescriptions .
  SD exercise was seen to be beneficial for improving metabolic outcomes physical characteristics , cardiorespiratory fitness and functional measures
background: Many chronic diseases and illnesses are caused by the lifestyle , including the physical activity habits , of an individual .
  As such , consistent high levels of exercise should be encouraged across the lifespan , to limit the risk of developing one of these conditions and allowing for healthy aging to occur .
  Exercise prescriptions that encourage high completion and adherence rates in an independent manner and improve health related outcomes should be provided to individuals .
  To date , no review has identified optimal prescriptions of exercise to achieve this in sedentary middle-aged adults and this is important , given the higher risk of developing illnesses in this population as they age .
  This review examines the effects prescriptions of self-directed ( SD ) exercise has on adherence and health related outcomes in sedentary middle-aged individuals in good general health currently and aims to identify the most suitable forms of planned SD exercise that can be carried out independently .