It is unclear if cutaneous microvascular dysfunction associated with diabetes and obesity can be ameliorated with exercise. We investigated the effect of 12-weeks of exercise training on cutaneous microvascular reactivity in the foot. Thirty-three inactive adults with type 2 diabetes and obesity (55% male, 56.1 ± 7.9 years, BMI: 35.8 ± 5, diabetes duration: 7.9 ± 6.3 years) were randomly allocated to 12-weeks of either (i) moderate-intensity continuous training [50–60% peak oxygen consumption (VO2peak), 30–45 min, 3 d/week], (ii) low-volume high-intensity interval training (90% VO2peak, 1–4 min, 3 d/week) or (iii) sham exercise placebo. Post-occlusive reactive hyperaemia at the hallux was determined by laser-Doppler fluxmetry. Though time to peak flux post-occlusion almost halved following moderate intensity exercise, no outcome measure reached statistical significance (p > 0.05). These secondary findings from a randomised controlled trial are the first data reporting the effect of exercise interventions on cutaneous microvascular reactivity in the foot in people with diabetes. A period of 12 weeks of moderate-intensity or low-volume high-intensity exercise may not be enough to elicit functional improvements in foot microvascular reactivity in adults with type 2 diabetes and obesity. Larger, sufficiently powered, prospective studies are necessary to determine if additional weight loss and/or higher exercise volume is required.

We sought to determine the effects of 12 months of power training on cognition, and whether improvements in body composition, muscle strength, and/or aerobic capacity (VO2peak) were associated with improvements in cognition in older adults with type 2 diabetes (T2D). Participants with T2D were randomized to power training or low-intensity sham exercise control condition, 3 days per week for 12 months. Cognitive outcomes included memory, attention/speed, executive function, and global cognition. Other relevant outcomes included VO2peak, strength, and whole body and regional body composition. One hundred and three adults with T2D (mean age 67.9 years; standard deviation [SD] 5.9; 50.5% women) were enrolled and analyzed. Unexpectedly, there was a nearly significant improvement in global cognition (p = .05) in the sham group relative to power training, although both groups improved over time (p < .01). There were significant interactions between group allocation and body composition or muscle strength in the models predicting cognitive changes. Therefore, after stratifying by group allocation, improvements in immediate memory were associated with increases in relative skeletal muscle mass (r = 0.38, p = .03), reductions in relative body fat (r = -0.40, p = .02), and increases in knee extension strength were directly related to changes in executive function (r = -0.41, p = .02) within the power training group. None of these relationships were present in the sham group (p > .05). Although power training did not significantly improve cognition compared to low-intensity exercise control, improvements in cognitive function in older adults were associated with hypothesized improvements in body composition and strength after power training.

Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0–6 (p = 0.16) or 0–6–12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changes in any PA measures over time and changes in metabolic profile. Conclusion: Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort.

Backgrounds and aims: Obesity and diabetes independently contribute to cutaneous microvascular dysfunction via pathological processes that are not fully understood. We sought to determine if obesity severity is associated with cutaneous microvascular dysfunction and measures of peripheral arterial disease in adults with type 2 diabetes in cross-sectional observational study design. Methods and results: Primary outcomes were post-occlusive reactive hyperaemia as determined by laser-Doppler fluxmetry (peak flux post-occlusion, time to peak flux post-occlusion, peak as a percentage of baseline, and area under the curve [AuC] index post-occlusion to pre-occlusion). Secondary outcomes were ankle- and toe-brachial indices (ABI and TBI) and systolic toe pressure. Thirty-six participants (20 men, 16 women) with mean age 55 +/- 8 years, BMI of 36 +/- 5 kg/m2 and duration of diabetes 8 +/- 6 years underwent measurements. After adjusting for age and duration of diabetes, SAT and total percentage body fat were able to explain 29% (p = 0.001) and 20% (p = 0.01) of variance of AuC index models, as well as 29% (p = 0.02) and 18% (p = 0.02) of peak as a percentage of baseline models, respectively. Though TBI demonstrated moderate, significant correlations with SAT (r:0.37, p = 0.04) and total percentage body fat (r:0.39, p = 0.03), these were not upheld by regression analyses. Neither ABI nor systolic toe pressure significantly correlated with any measure of adiposity or obesity. Conclusion: These findings demonstrate impairment in cutaneous microvascular function related to adiposity and obesity severity in adults with type 2 diabetes, suggesting that obesity may pathologically effect cutaneous microvascular function in the absence of overt macrovascular disease, warranting further investigation.

BACKGROUND:Low-volume high-intensity interval training (HIIT) may be a time-efficient strategy that leads to similar or superior improvements in cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) risk factors when compared with moderate-intensity continuous training (MICT). Our study investigated the effect of low-volume HIIT or MICT versus sham placebo-control (PLA) on central arterial stiffness, hemodynamic responses, and CVD risk factors in adults with obesity and type 2 diabetes (T2D). METHODS:Eligible participants were previously inactive adults with obesity and T2D. Individuals were randomly allocated to: i) HIIT (1 × 4 min cycling at 90% peak oxygen consumption [V̇O2peak]); ii) MICT (45 min of cycling at 60% VO2peak); or PLA. Training groups exercised thrice weekly for 12 weeks. Central arterial stiffness, hemodynamics and CVD risk factors were assessed at baseline and post-intervention. Analysis of covariance (ANCOVA) was used to examine changes following HIIT, MICT and PLA. RESULTS:Thirty-five participants (age: 55.1 ± 1.4 years, BMI: 36.1 ± 0.8 kg/m2) completed the study. A significant intervention effect was found for changes in pulse wave velocity (PWV) (p = .03), which reduced with HIIT (-0.3 ± 0.9 m/s) and MICT (-0.1 ± 1.1 m/s) but increased with PLA (0.8 ± 1.6 m/s). There was a significant intervention effect for changes in V̇O2peak (p < .01), glycosylated hemoglobin (p = .03), systolic blood pressure (p < .01), and waist circumference (p = .03), which all improved following MICT or HIIT but not PLA; there was no difference between MICT and HIIT. CONCLUSIONS:Twelve minutes of low-volume HIIT per week leads to improvements in central arterial stiffness and cardiovascular health in inactive individuals with obesity and T2D.

PURPOSE: We examined the effect of power training on long-term changes in physical activity (PA) in older adults with type 2 diabetes (T2D) during a 5-year follow-up of the GREAT2DO randomized control trial. METHODS: 103 participants with T2D and metabolic syndrome (51% male, 67.9 ±5.5 yrs) were randomized to receive power or sham exercise training, 3 times/week for 12 months and followed for another 5 years. During follow-up, the power group was supported to continue, and controls were crossed over to training, but neither group exercised under direct supervision. Total PA was assessed using the Physical Activity Scale for the Elderly and the Homeostasis model assessment: insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c) were used as indices of IR and glucose homeostasis, respectively. RESULTS: Total PA decreased significantly during the follow-up period (p=0.0001), driven by reductions between 12 and 24 months when full supervision of exercise was withdrawn, followed by relative stability over the next 4 years. Engagement in resistance training (PRT) declined from 76% at 12 months in the original power training group to 43% of those assessed at the 6-year follow-up. Notably, 43% of the original sham group also reported engaging in PRT at 6 years. HbA1c, adjusted for total PA level over the 5 years, and diabetes medication usage were significantly lower at 72 vs. 12 months (p= 0.04), without any effect of original group assignment. However, there was no significant change over the follow-up period for HOMA2-IR, adjusted for PA and medication usage (p= 0.23). CONCLUSION: 5 years after withdrawal of fully supervised power training or sham exercise in initially inactive older adults with T2D, 43% of both groups were engaged in minimally-supervised resistance training in community sites. Although both groups reduced participation in structured exercise after withdrawal of direct supervision at 12 months, stability in Total PA level from 24-72 months along with persistence of PRT in 43% of older adults with diabetes and many progressive co-morbidities is notable and unexpected. We are unaware of any other study of unsupervised PRT in an older clinical cohort in which adherence rates of 43% have been achieved 6 years after initial randomization, accompanied by significant improvements in glucose control.

Background Growing evidence suggests that men exposed to androgen deprivation therapy (ADT) have an increased risk of cardiovascular disease. While exercise has shown to attenuate some adverse effects of ADT, the effects on cardiometabolic health have not been systematically evaluated. Objective To evaluate the effect of exercise on cardiometabolic health in men with prostate cancer (PCa) receiving ADT. Methods A systematic literature search of MEDLINE, EMBASE, CINHAL, SCOPUS, WEB OF SCIENCE and SPORTSDICUS from database inception to April 2020 was performed. A quantitative synthesis using Cohens d effect size and a meta-analysis using random-effects models were conducted. Results Overall, fourteen randomised controlled trials (RCTs) and four non-randomised studies were included. Eleven RCTs ( n = 939 patients) were included in the meta-analysis. Exercise training improved the 400-m-walk test (MD −10.11 s, 95% CI [−14.34, −5.88]; p < 0·00001), diastolic blood pressure (−2.22 mmHg, [−3.82, −0.61]; p = 0.007), fasting blood glucose (−0.38 mmol/L, [−0.65, −0.11]; p = 0.006), C-reactive protein (−1.16 mg/L, [−2.11, −0.20]; p = 0.02), whole-body lean mass (0.70 kg, [0.39, 1.01]; p < 0.0001), appendicular lean mass (0.59 kg, [0.43, 0.76]; p < 0.00001), whole-body fat mass (−0.67 kg, [−1.08, −0.27]; p = 0.001), whole-body fat percentage (−0.79%, [−1.16, −0.42]; p < 0.0001), and trunk fat mass (−0.49 kg, [−0.87, −0.12]; p = 0.01), compared to usual care. No significant effects on systolic blood pressure or blood lipid metabolism were detected. Conclusions In a small subset of evaluated studies, exercise may favourably improve some but not all markers of cardiometabolic health. Future exercise intervention trials with cardiometabolic outcomes as primary endpoints are needed to confirm these initial findings.

Objective: The aim of this study was toexamine the effect of a novel low-volume high-intensity interval training (HIIT), moderate-intensity continuous training (MICT) or placebo (PLA)intervention on liver fat, glycaemia, and cardiorespiratory fitness using arandomised placebo-controlled design. Research design and methods: Thirty-five inactiveadults (54.6±1.4 years, 54% male; BMI 35.9±0.9kg/m2) with obesity and type 2diabetes were randomised to 12 weeks of supervised: MICT (n=12) at 60% VO2peakfor 45 minutes, 3 days/week, HIIT (n=12) at 90% VO2peakfor 4 minutes, 3 days/week, orPLA (n=11). Liver fat % was quantified via proton magneticresonance spectroscopy.Results: Liver fat reduced in MICT (-0.9±0.7%)and HIIT (-1.7±1.1%) but increased in PLA (1.2±0.5%) (p = 0.046). HbA1c improvedin MICT (-0.3±0.3%) and in HIIT (-0.3±0.3%) but not in PLA (0.5±0.2%) (p=0.014).Cardiorespiratory fitness improved in MICT (2.3±1.2 ml/kg/min) andHIIT (1.1±0.5 ml/kg/min) but not in PLA (-1.5±0.9 ml/kg/min) (p=0.006).Conclusions: MICT or a low-volume HIITapproach involving 12 minutes of weekly high-intensity exercise may improveliver fat, glycaemia, and cardiorespiratory fitness in type 2 diabetes in theabsence of weight loss. Further studies are required to elucidate therelationship between exercise-induced reductions in liver fat and improvements inglycaemia.

Hypertension is a cardiovascular disease risk factor which can be modified by exercise. The effect of high intensity power training on ambulatory blood pressure (ABP) in older adults with type 2 diabetes (T2D) has never been studied. PURPOSE: To determine if high intensity power training (PRT) can reduce ABP in older adults with T2D. METHODS: One hundred three participants (51% male, 67.9 ±5.5 yrs, 100% T2D, 24hr SBP: 132 ± 13 mmHg, 24hr DBP: 73 ± 7 mmHg, 55% ABP hypertensive (141/83 mmHg)) were randomized into 3 times/week of PRT or low-intensity, non-progressive sham exercise (SHAM) for 12 months. Ambulatory blood pressure monitors were fitted to the non-dominant arm and worn continuously for 24 hours at baseline, 6- and 12-month timepoints. Sleep and waking times were logged by participants and used for analyses. Systolic (SBP) and diastolic (DBP) blood pressures during awake, asleep and overall 24-hr period were similar for both groups. RESULTS: There was no significant effect of time or group on any measure of ABP in older adults with T2D over 12 months. However, a fully adjusted model including baseline ABP hypertensive status (defined as baseline 24hr ABP of SBP > 130 or DBP > 80) revealed significant reductions in ABP domains over time in hypertensive vs. normotensive participants regardless of group assignment [mean difference (p-value): 24hr SBP, -4.1 vs 4.2 (p<0.01); 24hr DBP, -5.0 vs 0.9 (p<0.01); Awake SBP, -7.9 vs 5.8 (p<0.001); Awake DBP, -5.8 vs 1.3 (p<0.01); Sleep SBP, -3.5 vs 6.2 (p<0.05); Sleep DBP, -2.6 vs 2.5 (p=0.09)]. CONCLUSION: Overall, there was no change in ABP following 12 months of high or low intensity exercise training in older adults with T2D. However, in those with hypertension at baseline, both PRT and SHAM exercise were associated with clinically meaningful and significant reductions in ABP domains over 12 months. The mean difference of -8 mmHg in Awake SBP after 12 months of exercise in hypertensive individuals with T2D is particularly noteworthy. Extrapolating from meta-analyses of anti-hypertensive medication effects, a difference of this magnitude may be associated with major cardiovascular disease risk reduction.

ABSTRACTBackgroundIndividuals with Mild Cognitive Impairment (MCI) have more gait variability under dual-task conditions than cognitively healthy adults. However, characteristics associated with this susceptibility of gait to dual-task stress are unknown.MethodsTesting was performed at baseline in the Study of Mental And Resistance Training (SMART). Ninety-three adults with MCI (age 70±6.8 years; 66.6% female) performed a single- and dual-task walk (cognitive distractor=letter fluency), in random order. Linear and non-linear gait variability were measured using force-sensitive insoles. Cognitive performance during dual-tasking was assessed by the number of correct words vocalized. Cognitive function, brain Magnetic Resonance Imaging (MRI), muscle strength, aerobic capacity, body composition, physical and psychosocial function were also assessed as potential correlates of gait dynamics.ResultsGait dynamics worsened during dual-tasking, with decrements in both stride time variability (p<0.001) and detrended fluctuation analysis (DFA) (p=0.001). Lower aerobic capacity and thinner posterior cingulate cortex were associated with greater decrements in DFA (p<0.05). Smaller hippocampal volume, worse psychological well-being and poorer static balance were associated with greater decrements in stride time variability (p<0.05). By contrast, cognitive performance did not change under dual-task conditions compared to seated testing (p=0.13).ConclusionsUnder dual-task conditions, participants with MCI preserved their cognitive performance at the expense of gait stability. Decrements in dual-tasking gait were associated with lower aerobic fitness, balance, psychological well-being, and brain volume in cognitively-relevant areas of the posterior cingulate and hippocampus, all potentially modifiable characteristics. Trials of targeted interventions are needed to determine the potential plasticity of gait variability in high-risk cohorts.

Abstract Objectives Greater arterial stiffness and poor 24 h blood pressure (BP) are recognized as indicators of poor cardiovascular health. Evidence has shown that high intensity interval training (HIIT) may be a superior alternative to moderate intensity continuous training (MICT) for improving cardiovascular disease risk factors such as cardiorespiratory fitness and vascular function. However, there are limited data comparing the effect of HIIT to MICT on central arterial stiffness and/or 24 h BP response. The purpose of this study was to compare HIIT versus MICT on central arterial stiffness and 24 h BP outcomes by systematic review and meta-analysis. Design A systematic review and meta-analysis was conducted. Methods Eligible studies were exercise training interventions (≥4 weeks) that included both HIIT and MICT and reported central arterial stiffness, as measured by pulse wave velocity and augmentation index and/or 24 h BP outcome measures. Results HIIT was found to be superior to MICT for reducing night-time diastolic BP (ES: −0.456, 95% CI: −0.826 to −0.086 mmHg; P = 0.016). A near-significant greater reduction in daytime systolic (ES: −0.349, 95% CI: −0.740 to 0.041 mmHg; p = 0.079) and diastolic BP was observed with HIIT compared to MICT (ES: −0.349, 95% CI: −0.717 to 0.020 mmHg; p = 0.063). No significant difference was found for other BP responses or arterial stiffness outcomes. Conclusions HIIT leads to a superior reduction in night-time diastolic BP compared to MICT. Furthermore, a near-significant greater reduction in daytime BP was found with HIIT compared to MICT. No significant difference was observed for changes to central arterial stiffness between HIIT and MICT.

Background: Neoadjuvant chemoradiation treatment (CRT) in rectal cancer patients is associated with a reduction in physical capacity, lean mass and increased fatigue. As a countermeasure to these treatment-related adverse effects, we examined the feasibility and preliminary efficacy of a 10-week exercise program during CRT. Methods: Ten rectal cancer patients (7 men, aged 27-70 years, body mass index = 26.4 ± 3.8 kg/m 2 ) receiving CRT undertook supervised resistance and aerobic exercise twice weekly. Assessments were undertaken pre- and post-intervention for upper and lower body muscle strength by 1-RM, muscle endurance, physical performance tests, body composition by dual X-ray absorptiometry, quality of life, and fatigue. Results: There was a significant loss in appendicular skeletal muscle (−1.1 kg, P = .012), and fat mass (−0.8 kg, P = .029) following CRT. Despite the loss in skeletal muscle, leg press ( P = .030) and leg extension ( P = .046) strength improved by 27.2% and 22.7%, respectively, and leg press endurance by 76.7% ( P = .007). Changes in strength were accompanied by improved performance ( P < .05) in 6-m fast walking speed (6.9%) and dynamic balance as determined by the 6-m backwards walk (15.5%). There was minimal change in quality of life and fatigue, and no adverse events related to training. Conclusions: Exercise during neoadjuvant CRT appears to be feasible and well tolerated in rectal cancer patients and may enhance physical function while minimizing adverse changes in body composition and cancer-related fatigue. These initial findings need to be confirmed in randomized controlled trials.

Introduction: Women with breast cancer are often prescribed aromatase inhibitors, which can cause rapid loss of bone mass leading to significant potential for morbidity. Vibration training has been shown to be helpful in reducing bone turnover in postmenopausal women without cancer. Aim: To examine the effect of vibration stimulus on markers of bone turnover in breast cancer patients receiving aromatase inhibitors. Methods: Thirty-one breast cancer survivors undergoing treatment with aromatase inhibitors were randomized to vibration stimulus (n = 14) or usual care control (n = 17). Low-frequency and low-magnitude vibration stimulus (27-32 Hz, 0.3g) was delivered in supervised sessions via standing on a vibration platform for 20 minutes, 3 times per week for 12 weeks. The primary outcome was blood markers of bone resorption (serum N-telopeptide X/creatine) and formation (serum type 1 procollagen N-terminal propeptide; P1NP). Other study outcomes body composition as well as measures of physical functioning. Outcomes were compared between groups using analysis of covariance adjusted for baseline values as well as time on aromatase inhibitors. Outcomes: On average, participants were 61.5 years old and overweight (ie, body mass index = 28.5 kg/m2). Following vibration training, there was no significant difference between groups for bone resorption (adjusted group difference 0.5, P = .929) or formation (adjusted group difference 5.3, P = .286). There were also no changes in any measure of physical functioning body composition. Conclusions: Short-term low-magnitude vibration stimulus does not appear to be useful for reducing markers of bone turnover secondary to aromatase inhibitors in breast cancer patients; nor is it useful in improving physical function or symptoms. However, further investigations with larger samples and higher doses of vibration are warranted. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12611001094965).

PURPOSE:The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases. METHODS:Between 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention. RESULTS:There was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4-6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6-12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507). CONCLUSIONS:Multimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain. TRIAL REGISTRATION:ACTRN12611001158954.

Dementia is a leading cause of morbidity and mortality without pharmacologic prevention or cure. Mounting evidence suggests that adherence to a Mediterranean dietary pattern may slow cognitive decline, and is important to characterise in at-risk cohorts. Thus, we determined the reliability and validity of the Mediterranean Diet and Culinary Index (MediCul), a new tool, among community-dwelling individuals with mild cognitive impairment (MCI). A total of sixty-eight participants (66 % female) aged 75·9 (sd 6·6) years, from the Study of Mental and Resistance Training study MCI cohort, completed the fifty-item MediCul at two time points, followed by a 3-d food record (FR). MediCul test-retest reliability was assessed using intra-class correlation coefficients (ICC), Bland-Altman plots and κ agreement within seventeen dietary element categories. Validity was assessed against the FR using the Bland-Altman method and nutrient trends across MediCul score tertiles. The mean MediCul score was 54·6/100·0, with few participants reaching thresholds for key Mediterranean foods. MediCul had very good test-retest reliability (ICC=0·93, 95 % CI 0·884, 0·954, P<0·0001) with fair-to-almost-perfect agreement for classifying elements within the same category. Validity was moderate with no systematic bias between methods of measurement, according to the regression coefficient (y=-2·30+0·17x) (95 % CI -0·027, 0·358; P=0·091). MediCul over-estimated the mean FR score by 6 %, with limits of agreement being under- and over-estimated by 11 and 23 %, respectively. Nutrient trends were significantly associated with increased MediCul scoring, consistent with a Mediterranean pattern. MediCul provides reliable and moderately valid information about Mediterranean diet adherence among older individuals with MCI, with potential application in future studies assessing relationships between diet and cognitive function.

Cognitive and physical exercise may reduce risk of dementia in mild cognitive impairment (MCI) but the underlying mechanisms are poorly understood. The SMART is a longitudinal randomised controlled trial that compares the benefits of isolated and combined progressive resistance and computerised cognitive training in MCI. Previously, we revealed therapeutically relevant structural and functional brain changes immediately after training cessation1, however, no effects were found on hippocampal structure. Here, for the first time, we investigate the ongoing impact of training on hippocampal anatomy 12-months after cessation using linear mixed effects (LME) models to account for imperfect timing and missing data. Eighty six community-dwelling participants aged ≥55 with MCI were randomised into 4 training groups; 1- Combined computerised cognitive and progressive resistance training (CT+PRT), 2- PRT and Sham CT (PRT), 3- Sham PRT and CT (CT), 4- Double Sham (DS). Training consisted of 2x1.5hours/week for 6-months. Cognitive and MRI assessments were carried out at baseline (BL), 6-months (F1) (directly after training) and 18-months (F2) from BL. Whole-brain T13DTFE MR images were automatically processed with the longitudinal FreeSurfer analysis pipeline. Longitudinal hippocampal volume was analysed with a freely available LME Matlab tool, modelled as % of BL volume. A linear time x group interaction was selected as the main contrast of interest in a comprehensive model controlling for covariates (sex, education, age). Five alternate hypotheses tested for group x time interactions between BL->F1 and BL->F1->F2 (Table 1). LME models showed significant differences in left (but not right) hippocampal atrophy rates for either training intervention compared to DS across the entire 18-month follow-up period. There were no differences in hippocampal trajectories between PRT or CT, nor between combined training and the DS. Meta-analysis in MCI and Alzheimer's confirm a faster rate of atrophy in the left hippocampus compared to the right2. Our findings of preserved left but not right hippocampal volume due to training may therefore have implications for combating neurodegeneration. Further work is needed to determine if such training-related benefits are linked to improved memory and cognitive outcomes long term. References: 1-C. Suo, et al. Molecular Psychiatry. 2016.21:1633–1642 2-F. Shi et al. Hippocampus. 2009. 19:1055–1064. Render of hippocampi from FreeSurfer segmentation (left). Lowess plot of left hippocampal volume as a percentage of ICV (right). The lowess plot shows predicted values of left hippocampal volume from LME model. Sliding window data fraction was set to 0.9.

Cognitive and physical exercise may reduce risk of dementia in mild cognitive impairment (MCI) but the underlying mechanisms are poorly understood. The SMART is a longitudinal randomised controlled trial that compares the benefits of isolated and combined progressive resistance and computerised cognitive training in MCI. Previously, we revealed therapeutically relevant structural and functional brain changes immediately after training cessation1, however, no effects were found on hippocampal structure. Here, for the first time, we investigate the ongoing impact of training on hippocampal anatomy 12-months after cessation using linear mixed effects (LME) models to account for imperfect timing and missing data. Eighty six community-dwelling participants aged ≥55 with MCI were randomised into 4 training groups; 1- Combined computerised cognitive and progressive resistance training (CT+PRT), 2- PRT and Sham CT (PRT), 3- Sham PRT and CT (CT), 4- Double Sham (DS). Training consisted of 2x1.5hours/week for 6-months. Cognitive and MRI assessments were carried out at baseline (BL), 6-months (F1) (directly after training) and 18-months (F2) from BL. Whole-brain T13DTFE MR images were automatically processed with the longitudinal FreeSurfer analysis pipeline. Longitudinal hippocampal volume was analysed with a freely available LME Matlab tool, modelled as % of BL volume. A linear time x group interaction was selected as the main contrast of interest in a comprehensive model controlling for covariates (sex, education, age). Five alternate hypotheses tested for group x time interactions between BL->F1 and BL->F1->F2 (Table1). LME models showed significant differences in left (but not right) hippocampal atrophy rates for either training intervention compared to DS across the entire 18-month follow-up period. There were no differences in hippocampal trajectories between PRT or CT, nor between combined training and the DS. Meta-analysis in MCI and Alzheimer's confirm a faster rate of atrophy in the left hippocampus compared to the right2. Our findings of preserved left but not right hippocampal volume due to training may therefore have implications for combating neurodegeneration. Further work is needed to determine if such training-related benefits are linked to improved memory and cognitive outcomes long term. References 1-C. Suo, et al. Molecular Psychiatry. 2016.21,1633–1642 2-F. Shi et al. Hippocampus, 2009. 19:1055–1064. Render of hippocampi from FreeSurfer segmentation (left). Lowess plot of left hippocampal volume as a percentage of ICV (right). The lowess plot shows predicted values of left hippocampal volume from LME model. Sliding window data fraction was set to 0.9.

OBJECTIVES:This study aimed to review the efficacy of exercise training for improving cutaneous microvascular reactivity in response to local stimulus in human adults. DESIGN:Systematic review with meta-analysis. METHODS:A systematic search of Medline, Cinahl, AMED, Web of Science, Scopus, and Embase was conducted up to June 2015. Included studies were controlled trials assessing the effect of an exercise training intervention on cutaneous microvascular reactivity as instigated by local stimulus such as local heating, iontophoresis and post-occlusive reactive hyperaemia. Studies where the control was only measured at baseline or which included participants with vasospastic disorders were excluded. Two authors independently reviewed and selected relevant controlled trials and extracted data. Quality was assessed using the Downs and Black checklist. RESULTS:Seven trials were included, with six showing a benefit of exercise training but only two reaching statistical significance with effect size ranging from -0.14 to 1.03. The meta-analysis revealed that aerobic exercise had a moderate statistically significant effect on improving cutaneous microvascular reactivity (effect size (ES)=0.43, 95% CI: 0.08-0.78, p=0.015). CONCLUSIONS:Individual studies employing an exercise training intervention have tended to have small sample sizes and hence lacked sufficient power to detect clinically meaningful benefits to cutaneous microvascular reactivity. Pooled analysis revealed a clear benefit of exercise training on improving cutaneous microvascular reactivity in older and previously inactive adult cohorts. Exercise training may provide a cost-effective option for improving cutaneous microvascular reactivity in adults and may be of benefit to those with cardiovascular disease and metabolic disorders such as diabetes.