Open Access
Revisiting skeletal myopathy and exercise training in heart failure: emerging role of myokines
(Elsevier, 2023) Ramírez Vélez, Robinson; González, Arantxa; García Hermoso, Antonio; Latasa Amézqueta, Íñigo; Izquierdo Redín, Mikel; Díez, Javier; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Exercise intolerance remains a major unmet medical need in patients with heart failure (HF). Skeletal myopathy is currently considered as the major limiting factor for exercise capacity in HF patients. On the other hand, emerging evidence suggest that physical exercise can decrease morbidity and mortality in HF patients. Therefore, mechanistic insights into skeletal myopathy may uncover critical aspects for therapeutic interventions to improve exercise performance in HF. Emerging data reviewed in this article suggest that the assessment of circulating myokines (molecules synthesized and secreted by skeletal muscle in response to contraction that display autocrine, paracrine and endocrine actions) may provide new insights into the pathophysiology, phenotyping and prognostic stratification of HF-related skeletal myopathy. Further studies are required to determine whether myokines may also serve as biomarkers to personalize the modality and dose of physical training prescribed for patients with HF and exercise intolerance. In addition, the production and secretion of myokines in patients with HF may interact with systemic alterations (e.g., inflammation and metabolic disturbances), frequently present in patients with HF. Furthermore, myokines may exert beneficial or detrimental effects on cardiac structure and function, which may influence adverse cardiac remodelling and clinical outcomes in HF patients. Collectively, these data suggest that a deeper knowledge on myokines regulation and actions may lead to the identification of novel physical exercise-based therapeutic approaches for HF patients.
Open Access
Changes in muscle power after usual care or early structured exercise intervention in acutely hospitalized older adults
(Wiley, 2020) López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; Ramírez Vélez, Robinson; García Hermoso, Antonio; Lusa Cadore, Eduardo; Casas Herrero, Álvaro; Galbete Jiménez, Arkaitz; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Background: A classic consequence of short-term bed rest in older adults is the significant loss in skeletal muscle mass and muscle strength that underlies the accelerated physical performance deficits. Structured exercise programmes applied during acute hospitalization can prevent muscle function deterioration. Methods: A single-blind randomized clinical trial conducted in an acute care for elders unit in a tertiary public hospital in Navarre (Spain). Three hundred seventy hospitalized patients [56.5% female patients; mean age (standard deviation) 87.3 (4.9) years] were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training programme performed during 5–7 consecutive days (2 sessions/day). The usual-care group received habitual hospital care, which included physical rehabilitation when needed. The main endpoints were change in maximal dynamic strength (i.e. leg-press, chest-press, and knee extension exercises) and maximal isometric knee extensors and hip flexors strength from baseline to discharge. Changes in muscle power output at submaximal and maximal loads were also measured after the intervention. Results: The physical exercise programme provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 19.6 kg [95% confidence interval (CI), 16.0, 23.2; P < 0.001] on the one-repetition maximum (1RM) in the leg-press exercise, 5.7 kg (95% CI, 4.7, 6.8; P < 0.001) on the 1RM in the chest-press exercise, and 9.4 kg (95% CI, 7.3, 11.5; P < 0.001) on the 1RM in the knee extension exercise over usual-care group. There were improvements in the intervention group also in the isometric maximal knee extension strength [14.8 Newtons (N); 95% CI, 11.2, 18.5 vs. −7.8 N; 95% CI, −11.0, −3.5 in the control group; P < 0.001] and the hip flexion strength (13.6 N; 95% CI, 10.7, 16.5 vs. −7.2 N; 95% CI, −10.1, −4.3; P < 0.001). Significant benefits were also observed in the exercise group for the muscle power output at submaximal loads (i.e. 30% 1RM, 45% 1RM, 60% 1RM, and 75% 1RM; all P < 0.001) over usual-care group. Conclusions: An individualized, multicomponent exercise training programme, with special emphasis on muscle power training, proved to be an effective therapy for improving muscle power output of lower limbs at submaximal loads and maximal muscle strength in older patients during acute hospitalization.
Open Access
Effects of exercise intervention on health-related physical fitness and blood pressure in preschool children: a systematic review and meta-analysis of randomized controlled trials
(Springer, 2020) García Hermoso, Antonio; Alonso Martínez, Alicia; Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background: No previous systematic review has quantitatively examined the effect of physical exercise interventions on health-related physical fitness and blood pressure in children younger than 6 years old. Objective: To evaluate the effects of exercise interventions on health-related physical fitness (i.e., physical fitness components and body composition) and blood pressure in preschoolers. Methods: We searched four databases. Only randomized controlled trials (RCTs), evaluating the effectiveness of exercise intervention on weight-related outcomes, blood pressure, and physical fitness components in preschoolers (1–5.99 years old) were included. The effect sizes were reported as Hedges’ g using random-effects models. Results: A total of 19 RCTs were included. Exercise interventions favored reductions in body mass index (g = − 0.17; 95% confidence interval [CI], − 0.31 to − 0.03), waist circumference (g = − 0.25; 95% CI − 0.47 to − 0.03), and body fat percentage (g = − 0.31; 95% CI − 0.60 to − 0.23); as well as improvement in cardiorespiratory fitness (g = 0.25; 95% CI 0.08–0.42), muscular strength (g = 0.25; 95% CI 0.09–0.40), and speed–agility (g = − 0.51; 95% CI − 0.78 to − 0.24). Blood pressure was not reduced. The subgroup analysis revealed that physical exercise alone favored larger reductions in body mass index and waist circumference compared with physical exercise combined with another intervention. Also, changes in cardiorespiratory fitness, lower-body muscular strength and speed–agility were associated with larger decreases in body composition. Conclusion: Physical exercise whether combined or not with additional intervention has a small effect on both body weight and physical fitness in preschoolers. Also, it seems that interventions to prevent obesity should be directed towards improving physical fitness of preschoolers.
Open Access
Safety and effectiveness of long-term exercise interventions in older adults: a systematic review and meta-analysis of randomized controlled trials
(Springer, 2020-02-04) García Hermoso, Antonio; Ramírez Vélez, Robinson; López Sáez de Asteasu, Mikel; Martínez Velilla, Nicolás; Zambom Ferraresi, Fabrício; Valenzuela, Pedro L.; Lucía, Alejandro; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background Physical exercise is benefcial to reduce the risk of several conditions associated with advanced age, but to our knowledge, no previous study has examined the association of long-term exercise interventions (≥1 year) with the occurrence of dropouts due to health issues and mortality, or the efectiveness of physical exercise versus usual primary care interventions on health-related outcomes in older adults (≥ 65 years old). Objective To analyze the safety and efectiveness of long-term exercise interventions in older adults. Methods We conducted a systematic review with meta-analysis examining the association of long-term exercise interventions (≥1 year) with dropouts from the corresponding study due to health issues and mortality (primary endpoint), and the efects of these interventions on health-related outcomes (falls and fall-associated injuries, fractures, physical function, quality of life, and cognition) (secondary endpoints). Results Ninety-three RCTs and six secondary studies met the inclusion criteria and were included in the analyses (n=28,523 participants, mean age 74.2 years). No diferences were found between the exercise and control groups for the risk of dropouts due to health issues (RR=1.05, 95% CI 0.95–1.17) or mortality (RR=0.93, 95% CI 0.83–1.04), although a lower mortality risk was observed in the former group when separately analyzing clinical populations (RR=0.67, 95% CI 0.48–0.95). Exercise signifcantly reduced the number of falls and fall-associated injuries, and improved physical function and cognition. These results seemed independent of participants’ baseline characteristics (age, physical function, and cognitive status) and exercise frequency. Conclusions Long-term exercise training does not overall infuence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations. Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.

Ramírez Vélez, Robinson

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