Exercise May Reduce Sleep Apnea and Improve Brain Health

Laura Williamson wrote . . . . . . . . .

Exercise may help reduce symptoms of a common sleep disorder and improve brain function, a small study finds.

Exercise training could be a useful supplemental treatment for people with moderate to severe obstructive sleep apnea, the research showed. The condition is characterized by loud snoring and disrupted breathing and can raise the risk for heart disease, stroke and cognitive decline. It is typically treated with continuous positive airway pressure, or CPAP, a machine that pushes air through a mask into the airway to keep it open while a person sleeps.

“Exercise training appears to be an attractive and adjunctive (add-on) non-pharmacological treatment,” said lead investigator Linda Massako Ueno-Pardi, an associate professor at the School of Arts, Science and Humanities at the University of São Paulo in Brazil. She also is a research collaborator at the university’s Heart Institute and Institute of Psychiatry, Faculty of Medicine.

Estimates show obstructive sleep apnea affects roughly 9% to 38% of U.S. adults, though many cases are thought to be undiagnosed. It is more common in men than women and becomes more prevalent as people age.

According to a scientific statement by the American Heart Association published in June, between 40% and 80% of people with cardiovascular disease have sleep apnea.

The condition often is associated with obesity, which can narrow the airway at the back of the throat, making it harder to breathe while lying down. Cigarette smoking, family history, nasal congestion, back sleeping, drinking alcohol, having a thicker neck or narrow throat and some hormone abnormalities also can contribute to the condition. Some medical conditions, such as Type 2 diabetes, also raise the risk for sleep apnea.

Previous studies have shown people with sleep apnea experience a decrease in brain glucose metabolism, or the brain’s ability to upload and properly use glucose, its main source of fuel. This can impair cognitive function. Ueno-Pardi and her team explored whether exercise could help correct that.

The new work builds upon a small 2019 study in the journal Brain Plasticity that concluded increased aerobic activity improved brain glucose metabolism and executive function in older, middle-aged adults at risk for Alzheimer’s disease.

The new research included 47 Brazilian adults with moderate to severe obstructive sleep apnea. Half took part in 60 minutes of supervised exercise three times per week for six months. The other half did not. The supervised exercise included five minutes of warming up; 25-40 minutes riding a stationary bicycle, 10 minutes of muscle strengthening and five minutes of cooling down.

Participants in both groups were given a series of tests to measure exercise capacity, brain glucose metabolism and cognitive function, including attention and executive function – the ability to plan and carry out tasks. Researchers also measured the severity of obstructive sleep apnea symptoms, such as disruptions to breathing and reductions in the body’s oxygen levels, or hypoxia, which has been shown to impact attention and executive function skills.

At the end of six months, those in the exercise group showed an increased capacity for exercise; improvements in the brain’s ability to use glucose; reductions in sleep apnea symptoms; and a boost in cognitive function, including a 32% improvement in attention and executive function. Those who did not exercise experienced no changes except a decline in brain glucose metabolism.

The findings, reported this week at the AHA’s Hypertension Scientific Sessions virtual conference, are considered preliminary until published in a peer-reviewed journal.

The research makes a good case as to why exercise should be added to the treatment strategy for sleep apnea, said Michael Grandner, director of the Sleep and Health Research Program and associate professor of psychiatry at the University of Arizona College of Medicine in Tucson. He was not involved in the study.

The findings are important because they show exercise could benefit brain health in people with sleep disorders, he said.

“Our current treatments largely involve pushing air down people’s airways, which is great, and it works. But it is kind of a blunt instrument. Exercise training is one option that could add benefit and maybe even be curative. This is especially important with a disease where our gold standard treatment is not curative.”

CPAP machines do little to address obesity, the largest cause of obstructive sleep apnea. Exercise training may be effective in reducing the excess fat around the airways that makes it harder for people to breathe at night, Grandner said.

That’s one of the outcomes Ueno-Pardi believes happened in her study. While she and her team didn’t measure weight loss or muscle tone, they did measure percentage of body fat and found a “significant reduction” in the exercise group, she said. The exercise may have improved sleep apnea severity by decreasing body fat, especially around the airways.

“There’s a lot of research out there that weight loss is a really powerful strategy for treating sleep apnea,” Grandner said.

Source: American Heart Association

Healthy Changes in Diet, Activity Improved Treatment-resistant High Blood Pressure

People with treatment-resistant hypertension successfully reduced their blood pressure by adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan, losing weight and improving their aerobic fitness by participating in a structured diet and exercise program at a certified cardiac rehabilitation facility, according to new research published today in the American Heart Association’s flagship journal Circulation.

Uncontrolled high blood pressure (130/80 mm Hg or higher) despite the use of three or more medications of different classes including a diuretic to reduce blood pressure is a condition known as resistant hypertension. Although estimates vary, resistant hypertension likely affects about 5% of the general global population and may affect 20% to 30% of adults with high blood pressure. Resistant hypertension is also associated with end-organ damage and a 50% greater risk of adverse cardiovascular events, including stroke, heart attack and death.

Diet and exercise are well-established treatments for high blood pressure. In June 2021, the American Heart Association advised that physical activity is the optimal first treatment choice for adults with mild to moderately elevated blood pressure and blood cholesterol who otherwise have low heart disease risk.

This new study, Treating Resistant Hypertension Using Lifestyle Modification to Promote Health (TRIUMPH), is the first to evaluate the impact of lifestyle modifications in people with resistant hypertension. Researchers found that behavioral changes, including regular aerobic exercise, adoption of the DASH (Dietary Approaches to Stop Hypertension) diet, reducing salt consumption and losing weight, can lower blood pressure significantly and improve cardiovascular health in people with resistant hypertension. The DASH eating plan is rich in fruits, vegetables, low-fat dairy products and limited salt, and aligns with the American Heart Association’s nutrition recommendations.

The four-month clinical trial involved 140 adults with resistant hypertension (average age 63; 48% women; 59% Black adults; 31% with type 2 diabetes; and 21% with chronic kidney disease). Participants were randomly divided into two groups – 90 participants received weekly dietary counseling and exercise training in an intensive, supervised cardiac rehabilitation setting three times a week. The other 50 participants received a single informational session from a health educator and written guidelines on exercise, weight loss and nutritional goals to follow on their own.

Researchers found:

  • The participants in the supervised program had about a 12-point drop in systolic blood pressure, compared to 7 points in the self-guided group. Systolic blood pressure (the first number in a blood pressure reading) indicates how much pressure blood is exerting against artery walls when the heart beats and is recognized as a major risk factor for cardiovascular disease for adults ages 50 and older.
  • Blood pressure measures captured through 24 hours of ambulatory monitoring during a typical day revealed that the group in the supervised lifestyle program had a 7-point reduction in systolic blood pressure, while the self-guided group had no change in blood pressure.
  • Participants in the supervised program also had greater improvements in other key indicators of heart health, suggesting that they had a lower risk of a heart event in the future.

“Our findings showed lifestyle modifications among people with resistant hypertension can help them successfully lose weight and increase their physical activity, and as a result, lower blood pressure and potentially reduce their risk of heart attack or stroke,” said James A. Blumenthal, Ph.D., first and senior author of the study, and J.P. Gibbons Professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina. “While some people can make lifestyle changes on their own, a structured program of supervised exercise and dietary modifications conducted by a multidisciplinary team of health care professionals in cardiac rehabilitation programs is likely more effective.”

Blumenthal noted that the success of the supervised program doesn’t mean people with resistant hypertension can stop taking their medications; however, it suggests that they may want to talk with their physicians about possibly reducing the dosages or altering their medications based upon their lowered blood pressure values.

The study was conducted at a single institution – Duke University School of Medicine – so findings may not be generalizable to broader groups of people. However, the intensive, structured, supervised part of the study occurred at several representative cardiac rehabilitation centers in central North Carolina, with educational and cultural diversity well represented. Researchers believe the program could be implemented with success at similar cardiac rehabilitation centers throughout the county. Also, the study’s impact beyond the four months of monitoring is limited by whether participants who made significant lifestyle changes will maintain them. “The benefits of the lifestyle modifications may be reduced unless the healthy lifestyle habits can be maintained,” Blumenthal said.

“The most important point is that it is not too late to lower blood pressure by making healthy lifestyle choices,” he said. “Adopting a healthy lifestyle pays huge dividends, even for people whose blood pressure remains elevated despite being on three or more antihypertensive medications.”

American Heart Association volunteer expert Bethany Barone Gibbs, Ph.D., FAHA, noted that this data gives clinicians another evidence-based tool for helping patients with resistant hypertension.

“Though we usually think about recommending lifestyle changes like losing weight and getting more physical activity before starting medications, this study provides important reinforcement that adding lifestyle changes in conjunction with medications – and when medications alone are not doing the job – is an effective strategy,” said Gibbs, an associate professor in the department of health and human development and clinical and translational sciences at the University of Pittsburgh. “Also exciting is that Blumenthal, et. al., used a cardiac rehab model, which can be duplicated in many settings.”

Gibbs, chair of the statement writing group of the Association’s June 2021 scientific statement on lifestyle treatment for hypertension, urged patients to commit to lifestyle changes – losing 5% to 10% of their bodyweight, greater adherence to the DASH-style diet, and increasing steps by at least 1,000 per day can yield health benefits.

Source: American Heart Association

A Year of Committed Exercise in Middle Age Reversed Worrisome Heart Stiffness

Karen Schmidt wrote . . . . . . . . .

A year of exercise training helped to preserve or increase the youthful elasticity of the heart muscle among people showing early signs of heart failure, a small study shows.

The new research, published in the American Heart Association journal Circulation, bolsters the idea that “exercise is medicine,” an important shift in approach, the researchers wrote.

The study focused on a condition called heart failure with preserved ejection fraction, which affects about half of the 6 million people in the United States with heart failure. Characterized by increasing stiffness of the heart muscle and high pressures inside the heart during exercise, the condition is largely untreatable once established and causes fatigue, excess fluid in the lungs and legs, and shortness of breath.

“It is considered by some to be one of the most important virtually untreatable diseases in cardiovascular medicine,” said Dr. Benjamin Levine, the study’s senior author. He is a professor of internal medicine at UT Southwestern and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Dallas. “So, of course, if there are no therapies, then the most important thing to do is to figure out how to prevent it from happening in the first place.”

Previous studies show prolonged exercise training could improve heart elasticity in younger people, but that it had no effect on heart stiffness in people 65 and older. So, the researchers wondered if committed exercise could improve heart stiffness in healthy, sedentary men and women ages 45 to 64.

The study, funded in part by the AHA, included 31 people who showed some thickening of the heart muscle and an increase in blood biomarkers associated with heart failure, even though they had no symptoms such as shortness of breath.

Eleven were randomly assigned to a control group and prescribed a program of yoga, balance and strength training three times a week. The rest were assigned to an individually tailored exercise regimen of walking, cycling or swimming that built gradually until the participants were doing intensive aerobic interval training for at least 30 minutes at least twice a week, plus two to three moderate-intensity training sessions and one to two strength training sessions each week. Everyone had a personal trainer or exercise physiologist to monitor their training.

After a year, the people doing the vigorous exercise training showed a physiologically and statistically significant improvement in measures of cardiac stiffness and cardiorespiratory fitness, compared to no change in the control group.

The results suggest late middle age may be a “sweet spot” for using exercise to prevent heart failure with preserved ejection fraction, before the heart gets too stiff, Levine said. He compared the heart muscle to a rubber band. A new one stretches easily and snaps right back.

“That’s a youthful cardiovascular system,” he said. “Now, stick it in a drawer and come back 30 years later – it doesn’t stretch, and it doesn’t snap back. And that’s one of the things that happens to the circulation, both the heart and the blood vessels as we age, particularly with sedentary aging.”

Researchers can’t determine from the new study whether these people will go on to develop heart failure; larger studies will be needed for that. In addition, it isn’t easy for people to stick to an exercise program, and the intensive intervention studied may be difficult and expensive to replicate on a large scale.

“That may be a challenge, but I think this study is a good first step,” said Dr. Shannon M. Dunlay, an advanced heart failure and transplant cardiologist who was not involved in the study. She is a professor of medicine at Mayo Clinic in Rochester, Minnesota. “Heart failure is a tough thing to live with, and if we’re able to prevent it with exercise – if additional studies also show that – that’s really useful information.”

Since this type of heart failure can be so hard to treat, the new results could help clinicians in counseling their patients, she said. “This gives us more information to say to a patient, you already have these early findings that you are at risk for heart failure, and exercise could help your heart to become less stiff.”

Levine said physical activity, with its profound health benefits, should be woven into our everyday lives.

“I tell my patients, you brush your teeth every day, take a shower, change your underwear, have dinner,” he said. “These are things you do for your health and your personal hygiene. Exercise needs to be part of that process. And that’s how we can stay as healthy as possible throughout the lifespan.”

Source: American Heart Association

Fruit, Vegetables and Exercise Can Make You Happier

Olivia Miller wrote . . . . . . . . .

New research led by the University of Kent and University of Reading has found that fruit and vegetable consumption and exercise can increase levels of happiness.

While the link between lifestyle and wellbeing has been previously documented and often used in public health campaigns to encourage healthier diets and exercise, new findings published by the Journal of Happiness Studies show that there is also a positive causation from lifestyle to life satisfaction.

This research is the first of its kind to unravel the causation of how happiness, the consumption of fruit and vegetables and exercising are related, rather than generalising a correlation. The researchers, Dr Adelina Gschwandtner (Kent’s School of Economics), Dr Sarah Jewell and Professor Uma Kambhampati (both from the University of Reading’s School of Economics), used an instrumental variable approach to filter out any effect from happiness to lifestyle. It showed that it is rather the consumption of fruit and vegetables and exercising that makes people happy and not the other way round.

Findings demonstrate that the ability of individuals to delay gratification and apply self-control plays a major role in influencing lifestyle decisions, which in turn has a positive impact on wellbeing. The research also shows that men appear to exercise more, and women eat more fruit and vegetables.

With it being well known that lifestyle diseases are a leading cause of ill health and mortality worldwide, and the UK having one of the highest obesity rates in Europe, these findings could have significant implications for public health policy.

Dr Gschwandtner said: ‘Behavioural nudges that help the planning self to reinforce long-term objectives are likely to be especially helpful in maintaining a healthy lifestyle. If a better lifestyle not only makes us healthier but also happier, then it is a clear win-win situation.’

Professor Kambhampati said: ‘There has been a bigger shift in recent years for healthier lifestyle choices. To establish that eating more fruit and vegetables and exercising can increase happiness as well as offer health benefits is a major development. This may also prove useful for policy campaigns around environment and sustainability.’

Their research paper titled ‘Lifestyle and Life Satisfaction: The Role of Delayed Gratification’ is published by the Journal of Happiness Studies.

Source: University of Kent

Anxious? Maybe You Can Exercise It Away

Alan Mozes wrote . . . . . . . . .

Anxiety prevention may be just a snowy trail away.

New research suggests cross-country skiers — and perhaps others who also exercise vigorously — are less prone to develop anxiety disorders than less active folks.

Researchers in Sweden spent roughly two decades tracking anxiety risk among more than 395,000 Swedes. Nearly half the participants were skiers with a history of competing in long-distance cross-country ski races. The others were similarly aged non-skiers deemed to be less active.

“We found that the group with a more physically active lifestyle had an almost 60% lower risk of developing anxiety disorders,” noted study lead author Martina Svensson, an associate researcher with the Experimental Neuroinflammation Laboratory at Lund University.

Anxiety disorders are common, she and her colleagues noted. About 1 in every 10 people is at risk, with women generally twice as vulnerable as men.

To explore whether physical activity might somehow protect against anxiety, the team focused on men and women who had participated in the Vasaloppet ski race at some point between 1989 and 2010.

The annual Swedish event is billed as the world’s largest long-distance cross-country ski race, covering distances of 19 to 56 miles. About half the study participants had done the race; the other half had not.

In the Frontiers in Psychiatry, the researchers point out that the ski group — at an average age of 36 — had healthier eating habits, smoked less, engaged in more leisure-time exercise, and were better educated, compared with the general Swedish population.

Study participants were tracked for an average of 10 years, during which time just under 1,650 participants developed some form of anxiety disorder.

Among both men and women, significantly lower risk was seen among skiers. However, Svensson stressed that while the finding illustrated a link between activity and lower anxiety risk, it did not prove cause and effect.

Digging deeper, investigators identified a notable gender gap. After analyzing race finishing times, skiers were divided into three groups according to performance: those who had clocked the fastest, second-fastest, and third-fastest times.

After analyzing all three groups according to gender, the team found that among men anxiety risk remained equally low — and lower than non-skiers– regardless of skiing speed. But that was not the case among women.

“We were surprised to see that physically high-performing women had almost a doubled risk of developing anxiety compared to lower-performing women,” Svensson acknowledged.

She stressed that even so, “the total risk of getting anxiety among these high-performing women was still lower compared to the more physically inactive women in the general population. So it seems like both sexes benefit from being physically active, even though the optimal level may differ between men and women.”

Svensson said her study didn’t analyze potential underlying causes for gender differences. Nor did the researchers investigate precisely why exercise might help cut down on anxiety. Both need further study, she said.

Still, Svensson pointed to “the ability of physical activity to preoccupy the mind and offer distraction from other potentially anxious thoughts.” And she noted that “exercise may also fine-tune your body’s stress system to better cope with other stressful situations.”

James Maddux, a professor emeritus of psychology at George Mason University in Fairfax, Va., expressed little surprise with the findings.

“There is considerable research indicating that exercise of almost any kind — even a 10-minute walk — can help people manage anxiety,” said Maddux, who is also a senior scholar with GMU’s Center for the Advancement of Well-Being.

“Many cognitive-behavioral therapists, in fact, ‘prescribe’ exercise as an important component of their interventions with clients dealing with anxiety or depression or both,” he pointed out.

As to why, Maddux echoed the points raised by Svensson, adding that research has found that engaging in exercise can lead to a sense of accomplishment and greater self-confidence that can result in lower anxiety.

“I think that anyone dealing with anxiety, stress or depression should seriously consider using regular exercise as a strategy for better managing their emotions,” Maddux said. “I say this not based on the findings of just this particular study, but on the cumulative research on this issue. You don’t have to join a gym or take up cross-country skiing. Just start walking a few minutes every day.”

Source: HealthDay