Type 2 Diabetes (T2DM) and hypertension (HTN) are prevalent comorbid chronic conditions in West Virginia (WV). However, patients often lack healthy lifestyle practices, have low self-efficacy and access to self-management education and support from their healthcare providers, especially in rural and medically underserved communities. The 6-Minute Walk Test (6MWT) is an objective assessment of functional exercise capacity and response to treatment in patients. PURPOSE: This study examined the impact of a 12-week, community-based, Diabetes and Hypertension Self-Management program (DHSMP) on exercise capacity among patients with T2DM and HTN. METHODS: A prospective 3-arm, parallel-group, randomized controlled study was conducted with 98 patients with T2DM and HTN. Participants were randomized to 12-week DHSMP core lifestyle (Group A; N = 32), 12-week DHSMP core plus medication therapy management (MTM, Group B; n = 33) and enhanced usual care (EUC; 3-hour educational session; N = 33) in two geographically-separated WV churches. The intervention groups were provided weekly health coaching plus 75-minute educational sessions. Participants completed lifestyle, anthropometric and clinical assessments (A1c, blood pressure, and lipids) at baseline, 3- and 6-months. Diet (4 questions) and exercise (2 questions) were assessed by the Summary of Diabetes Selfcare Activities questionnaire. RESULTS: Mean age and BMI were 63.0 ± 11.3 years and 37.3 ± 7.5, respectively. The mean 6MWT distance was 353.8 ± 81.9 meters (range 106.6 to 557.8 m). Forty percent of the participants were in the first and second quintile (i.e., < 332 m). Longitudinal repeated measures analysis showed a statistically significant improvement in 6MWT distance between the baseline and 6 months for the intervention group participants. 6MWT distance was associated with the participant’s age, BMI, duration of diabetes (years), and high-density lipoprotein (HDL) cholesterol levels (p < .05) in the multivariate model. CONCLUSION: Participation in a non-pharmacological lifestyle program led to positive improvements in 6MWT over time. Future research needs to evaluate the effectiveness of this exercise capacity on other indicators of cardiovascular health.

Using upperclassmen as success coaches for a physical activity intervention for academic probation freshmen fostered social integration, improved mood and mental well-being, and increased university retention rates.

Older men (n = 12) and women (n = 18) 65-80 years of age completed 12 weeks of exercise and took either a placebo or resveratrol (RSV) (500 mg/d) to test the hypothesis that RSV treatment combined with exercise would increase mitochondrial density, muscle fatigue resistance, and cardiovascular function more than exercise alone. Contrary to our hypothesis, aerobic and resistance exercise coupled with RSV treatment did not reduce cardiovascular risk further than exercise alone. However, exercise added to RSV treatment improved the indices of mitochondrial density, and muscle fatigue resistance more than placebo and exercise treatments. In addition, subjects that were treated with RSV had an increase in knee extensor muscle peak torque (8%), average peak torque (14%), and power (14%) after training, whereas exercise did not increase these parameters in the placebo-treated older subjects. Furthermore, exercise combined with RSV significantly improved mean fiber area and total myonuclei by 45.3% and 20%, respectively, in muscle fibers from the vastus lateralis of older subjects. Together, these data indicate a novel anabolic role of RSV in exercise-induced adaptations of older persons and this suggests that RSV combined with exercise might provide a better approach for reversing sarcopenia than exercise alone.

Arterial stiffness is a strong independent risk factor for cardiovascular disease and is elevated in individuals with metabolic syndrome (MetS). Resistance training is a popular form of exercise that has beneficial effects on muscle mass, strength, balance and glucose control. However, it is unknown whether resistance exercise training (RT) can lower arterial stiffness in patients with MetS. Thus, the aim of this study was to examine whether a progressive RT program would improve arterial stiffness in MetS.

Metabolic syndrome (MetS) is associated with an increase in cardiovascular (CV) mortality, partially due to arterial stiffening, which can be measured non‐invasively via pulse wave velocity (PWV). Arterial stiffness is a clinically relevant CV marker of mortality, an increase in PWV by only 1 SD is associated with an increase of CV risk by 15%. We tested the hypothesis that 8 weeks, 3 days per week, of deep water exercise can lower the PWV in individuals with MetS.10 women (age=58±5) were recruited to participate in the study. Carotid to femoral PWV was measured using applanation tonometry; radial artery waveforms were used for pulse wave analysis and to calculate central pressures. Aquatic exercise significantly lowered PWV by 0.53 m/s (p<0.05). Other significant changes that were observed were BMI (p=0.03) from 33.5±1.5 to 32.9±1.5, blood glucose (p=0.01, from 110±8 to 101±7), insulin (p=0.02, from 20±2 to 14±1), insulin resistance (p=0.01, from 5.39±0.81 to 3.55±0.50), augmentation index (p=0.05, from 25±2 to 22±2), and aerobic capacity (p=0.02, from 15.9±1.3 to 17.8±1.7).These findings indicate that the introduction of deep‐water exercise positively influences the PWV. This decrease in PWV portends improvements in overall CV health and it may be useful in managing other CV related diseases. Much of the data showed significant improvement in clinical measures and this shows the efficacy of deep‐water exercise. While the benefits of land based exercise have long been well known, these findings show that aquatic based exercise is also a very effective method for improving CV health.

Regular physical activity and healthy body composition are important predictors of good outcomes for breast cancer survivors, especially in overweight/obese individuals. However, individualized exercise and healthy eating programs have not focused on lifestyle changes and outcomes among women recovering from triple-negative breast cancer. Our purpose was to examine the associations between baseline levels of inflammatory cytokines and obesity-related adipokines after weight loss, diet and physical activity intervention in survivors of triple-negative breast cancer. We enrolled overweight/obese survivors (average time since diagnosis, 4 years) and randomly assigned them to a 12-week supervised exercise and low-fat diet (n=18) or a usual care group (n=10). The program consisted of supervised exercise 3 times/week, as well as 2 unsupervised sessions per week. The goal of our Get Fit for the Fight® program was to complete 150 min/week of moderate-intensity aerobic exercise. Participants completed a 3-day diet record during baseline testing and the dietitian recommended ways to cut calories from these typical eating patterns. The goal of caloric restriction was to decrease dietary fat in order for the participant to consume 200 kcal/week less. Assessments included aerobic fitness, body composition, and self-reported physical activity, mood and quality of life. Blood cytokines and obesity-related adipokines were also analyzed before and after the intervention period. The intervention group lost an average of 2% body fat compared with the control group (p Citation Format: Linda Vona-Davis, Jame Abraham, Daniel Bonner, Diana Gilleland, Gerald Hobbs, Sobha Kurian, Mary Anne Yanosik, Anne Swisher. Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-12.

PURPOSE:Regular exercise and healthy eating are routinely recommended for breast cancer survivors, and past studies show benefits in quality of life and decreased inflammation. However, this has not been tested specifically in triple-negative breast cancer survivors. Increasing physical activity and losing body fat are thought to positively affect inflammatory biomarkers that have been associated with breast cancer. Therefore, the primary purpose of this study was to determine if participation in an exercise and dietary counseling program can improve body fat, physical function, and quality of life in survivors of this aggressive breast cancer. Secondarily, we sought to determine if participation in the program had beneficial effects on obesity-related markers of the adipokine profile.METHODS:Sixty-six survivors of triple-negative breast cancer with BMI >25 were invited to participate. Twenty-eight enrolled and 23 completed the randomized, controlled trial (13 intervention, 10 control). Moderate-intensity aerobic exercise (150 min per week, for 12 weeks) and diet counseling were compared to usual care, education only. The primary outcome of interest was weight loss (body mass, BMI, % fat), and secondary outcomes included physical function (exercise capacity), quality of life (Function After Cancer Therapy-Breast (FACT-B)), cytokines (C-reactive protein (CRP), TNF-α, IL-6), and adipokine profile (leptin, adiponectin, insulin).RESULTS:Participants in the program lost more body fat (2.4 % loss vs. 0.4 % gain, p < 0.05) than the control group. The intervention group also improved quality of life (FACT-B total score +14 pts) and decreased sedentary time but did not improve peak exercise capacity. The intervention had no effect on serum cytokines and adipokines after 12 weeks in the program. However, serum leptin and adiponectin and their ratio were significantly correlated with BMI in the intervention group (p < 0.05).CONCLUSIONS:Exercise and dietary counseling led to loss of body fat and improved quality of life in survivors of triple-negative breast cancer. BMI was associated with favorable changes in leptin and adiponectin which may reflect a change in adiposity with intervention. Exercise and healthy eating may be equally effective in this high-risk population as in other breast cancer survivors and should be encouraged as a part of a cancer survivorship program.

The blood pressure response to graded exercise testing (GXT) is a predictor of cardiovascular (CV) health. A hypertensive response (HTR) to GXT in women, defined as brachial (b) systolic blood pressure (SBP) exceeding 190 mmHg, is associated with increased risk of CV mortality. It is critical to find resting measurements predictive of a HTR for the early detection of CV impairments. Baseline GXTs of 66 women were assessed and compared to resting cardiac function, arterial function [pulse wave velocity (PWV) and analysis (PWA)] arterial structure, and anthropometrics. 48% of the women had a HTR. The HTR group was older (HTR 55±2 vs. NT 48±2, p=0.05), and more obese (higher BMI, body fat %, and triglycerides, p<0.05) than the normal response group (NT). The HTR group also had elevated central (c) SBP, (HTR 121±2 vs. NT 106±2 mmHg) and pulse pressure (cPP) (HTR 44± 3 vs. NT 33± 2 mmHg), bPP (HTR 54± 3 vs. NT 42±2 mmHg) and PWV (HTR 8.3±0.4 vs. NT 7.1± 0.2 m/sec) all p<0.01. The HTN group had an elevated intima media thickness (HTR 0.72±0.03 vs. NT 0.63±0.02 mm, p<0.01). Cardiac diastolic dysfunction was also evident in the HTR with decreased mitral annular velocity and increased late ventricular filling velocity (p<0.01). Due to the positive correlation of bSBP and the measurements with significant group differences, we used max bSBP as a surrogate for HTR. Three backward elimination models (arterial: function, structure, cardiac: function) revealed age and BMI to be predictors of HTR in women along with both c&bSBP. Suggesting aging and obese women are at risk of having a HTR, and GXTs should be implemented into general care even in the absence of other CV risk factors.

Arterial stiffness, a strong independent risk factor for cardiovascular (CV) disease, is elevated in patients with metabolic syndrome. Central arterial stiffening can be non‐invasively measured by pulse wave velocity (PWV), were 1 standard deviation change is associated with a 15% increase in CV risk. Therapeutic interventions aimed at decreasing PWV and other CV risk factors are clinically important to reduce the risk of CV disease and events in metabolic syndrome. Resistance training (RT) is under investigation, but to date results have been controversial with some showing increases in PWV. This increase could be detrimental to someone with preexisting arterial stiffness, but none of these studies included subjects with metabolic syndrome. We hypothesize that 8 weeks of progressive RT would not increase PWV in subjects with metabolic syndrome. Following RT there was a non‐significant reduction in triglycerides (12%) and body fat (11%) in the RT MetS group. We found 8 weeks of progressive RT did not cause a rise in PWV in metabolic syndrome patients (Pre 7.7 ± 0.4 Post 7.6 ± 0.3 m/s). Further, we found correlations between high baseline PWV (r=‐0.7, p<0.01), carotid intima media thickness (r=‐0.5, p<0.05), and systolic blood pressure (r=‐0.5, p<0.01) with improvement in PWV pre to post. Backward elimination models showed baseline PWV (β=‐0.7, p<0.01) as the best predictor of a decrease in PWV following RT. In summary progressive RT is a safe exercise modality for individuals with metabolic syndrome to reduce CV risk factors and improve arterial function.

PURPOSE The metabolic syndrome (MetS) is associated with threefold increased risk of cardiovascular (CV) morbidity and mortality, which is partly due to a blunted CV reserve capacity, reflected by a reduced peak exercise left ventricular (LV) contractility and aerobic capacity and a blunted peak arterial-ventricular coupling. To date, no study has examined whether aerobic exercise training in MetS can reverse peak exercise CV dysfunction. Furthermore, examining how exercise training alters CV function in a group of individuals with MetS before the development of diabetes and/or overt CV disease can provide insights into whether some of the pathophysiological CV changes can be delayed/reversed, lowering their CV risk. The objective of this study was to examine the effects of 8 wk of aerobic exercise training in individuals with MetS on resting and peak exercise CV function. METHODS Twenty participants with MetS underwent either 8 wk of aerobic exercise training (MetS-ExT, n = 10) or remained sedentary (MetS-NonT, n = 10) during this period. Resting and peak exercise CV function was characterized using Doppler echocardiography and gas exchange. RESULTS Exercise training did not alter resting LV diastolic or systolic function and arterial-ventricular coupling in MetS. In contrast, at peak exercise, an increase in LV contractility (40%, P < 0.01), cardiac output (28%, P < 0.05), and aerobic capacity (20%, P < 0.01), but a reduction in vascular resistance (30%, P < 0.05) and arterial-ventricular coupling (27%, P < 0.01), were noted in the MetS-ExT but not in the MetS-NonT group. Furthermore, an improvement in lifetime risk score was also noted in the MetS-ExT group. CONCLUSIONS These findings have clinical importance because they provide insight that some of the pathophysiological changes associated with MetS can be improved and can lower the risk of CV disease.

Abstract Regular physical activity and healthy body composition are important predictors of good outcomes for breast cancer survivors, especially in overweight/obese individuals. However, individualized exercise and healthy eating programs have not focused on lifestyle changes and outcomes among women recovering from triple-negative breast cancer. Our purpose was to examine the associations between baseline levels of inflammatory cytokines and obesity-related adipokines after weight loss, diet and physical activity intervention in survivors of triple-negative breast cancer. We enrolled overweight/obese survivors (average time since diagnosis, 4 years) and randomly assigned them to a 12-week supervised exercise and low-fat diet (n=18) or a usual care group (n=10). The program consisted of supervised exercise 3 times/week, as well as 2 unsupervised sessions per week. The goal of our Get Fit for the Fight® program was to complete 150 min/week of moderate-intensity aerobic exercise. Participants completed a 3-day diet record during baseline testing and the dietitian recommended ways to cut calories from these typical eating patterns. The goal of caloric restriction was to decrease dietary fat in order for the participant to consume 200 kcal/week less. Assessments included aerobic fitness, body composition, and self-reported physical activity, mood and quality of life. Blood cytokines and obesity-related adipokines were also analyzed before and after the intervention period. The intervention group lost an average of 2% body fat compared with the control group (p<0.01). Significant (p<0.05) decreases were seen in the intervention group for body weight, BMI, and all skinfold measures except mid-axillary. Self-reported physical activity and breast-cancer specific quality of life also improved significantly in the intervention group from baseline to 12 weeks, indicating a shift from inactivity toward increasing time spent in moderate physical activity, primarily during weekends. No significant associations were observed between the intervention group and serum levels of inflammatory cytokines. However, BMI was significantly correlated (p<0.05) with serum leptin/adiponectin ratios, an indicator of insulin resistance. These findings indicate that a pragmatic lifestyle intervention with physical activity and healthy eating were consistent with improvements in body composition, functional capacity and quality of life for triple-negative breast cancer survivors. The intervention also evoked favorable changes in blood leptin/adiponectin ratios which are linked to reductions in central adiposity and improved insulin sensitivity. Citation Format: Linda Vona-Davis, Jame Abraham, Daniel Bonner, Diana Gilleland, Gerald Hobbs, Sobha Kurian, Mary Anne Yanosik, Anne Swisher. Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-12.

Individuals with metabolic syndrome (MetS) have an increased arterial stiffness which is a strong independent risk factor for cardiovascular disease. Therapeutic interventions aimed at decreasing arterial stiffness is critical. However, resistance training has been shown to increase arterial stiffness in young healthy individuals. Thus, would resistance training exacerbate the arterial stiffness in individuals with MetS? We hypothesized individuals with MetS who participated in progressive resistance training of moderate intensity will not experience an increase in carotid arterial stiffness. A total of 18 individuals (8 MetS and 10 healthy control) performed resistance training exercises for 8 weeks. Resting measurements of carotid pulse wave analysis, systolic pressures, and carotid ultrasounds were taken before and after the intervention. No changes in systolic carotid diameter were found in the MetS (pre 0.65 ±0.02; post 0.66 ±0.02, p>0.5) or control (pre 0.61 ±0.01; post 0.61 ±0.01, p>0.5) group. Carotid systolic blood pressure did not significantly change in the MetS (pre 123±6; post 120±4 mmHg p>0.5) or control (pre 112 ±3; post 111±4 p>0.5) group. Regardless of group, a non‐significant (p=0.08) 16% decrease in carotid β‐stiffness was found following resistance training. In summary, individuals with MetS may safely participate in progressive hypertrophic resistance training.

Metabolic syndrome (MetS) is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to examine comprehensively the LV and arterial responses to exercise in individuals with MetS without diabetes and/or overt cardiovascular disease in comparison to a healthy control population. Cardiovascular function was characterized using Doppler echocardiography and gas exchange in individuals with MetS (n = 27) versus healthy control subjects (n = 20) at rest and during peak exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.

The metabolic syndrome (MetS) is associated with a threefold increase risk of cardiovascular disease (CVD) mortality partly due to increased arterial stiffening. We compared the effects of aerobic exercise training on arterial stiffening/mechanics in MetS subjects without overt CVD or type 2 diabetes. MetS and healthy control (Con) subjects underwent 8 wk of exercise training (ExT; 11 MetS and 11 Con) or remained inactive (11 MetS and 10 Con). The following measures were performed pre- and postintervention: radial pulse wave analysis (applanation tonometry) was used to measure augmentation pressure and index, central pressures, and an estimate of myocardial efficiency; arterial stiffness was assessed from carotid-femoral pulse-wave velocity (cfPWV, applanation tonometry); carotid thickness was assessed from B-mode ultrasound; and peak aerobic capacity (gas exchange) was performed in the seated position. Plasma matrix metalloproteinases (MMP) and CVD risk (Framingham risk score) were also assessed. cfPWV was reduced (P < 0.05) in MetS-ExT subjects (7.9 ± 0.6 to 7.2 ± 0.4 m/s) and Con-ExT (6.6 ± 1.8 to 5.6 ± 1.6 m/s). Exercise training reduced (P < 0.05) central systolic pressure (116 ± 5 to 110 ± 4 mmHg), augmentation pressure (9 ± 1 to 7 ± 1 mmHg), augmentation index (19 ± 3 to 15 ± 4%), and improved myocardial efficiency (155 ± 8 to 168 ± 9), but only in the MetS group. Aerobic capacity increased (P < 0.05) in MetS-ExT (16.6 ± 1.0 to 19.9 ± 1.0) and Con-ExT subjects (23.8 ± 1.6 to 26.3 ± 1.6). MMP-1 and -7 were correlated with cfPWV, and both MMP-1 and -7 were reduced post-ExT in MetS subjects. These findings suggest that some of the pathophysiological changes associated with MetS can be improved after aerobic exercise training, thereby lowering their cardiovascular risk.

Metabolic Syndrome (MetS) is a cluster of cardiovascular (CV) risk factors associated with functional limitations and an increased risk of CV mortality. Resting diastolic function is thought to be altered in MetS and may contribute to increased CV risk and functional deficiency. Using echocardiography we explored the relationship between resting diastolic function and left ventricular (LV) contractile reserve capacity, assessed by the change from rest to peak exercise in end‐systolic elastance (ΔEes), in Mets (n=21) and healthy controls (n=13). MetS had resting diastolic dysfunction and a 15% decrease in ΔEes (p<0.05) vs. controls. Univariate analysis, used to examine the correlation between ΔEes and resting diastolic function revealed that ΔEes was related to LV end‐diastolic pressure (EDP), the transmitral to mitral annular early diastolic velocity ratio (E/e’), the diastolic stiffness constant (β), and the isovolumetric relaxation time constant (τ) (p<0.05). We used multivariate analysis to examine the relationship between ΔEes and diastolic function after adjusting for age and metabolic risk score (MRS: the sum of risk points selected for specific CV risk factors). After adjusting for age and MRS, ΔEes remained associated with LV EDP, E/e’, β, and τ (p<0.05), suggesting a link between resting diastolic dysfunction and altered CV reserve in metabolic disease states. AHA 11CRP7370056, 5T32HL090610–04.