Publications by authors named "Felix Morales-Palomo"

23 Publications

  • Page 1 of 1

Endurance Exercise Training reduces Blood Pressure according to the Wilder's Principle.

Int J Sports Med 2021 Sep 24. Epub 2021 Sep 24.

Universidad de Castilla-La Mancha, Sport Sciences, Toledo, Spain.

The effect of antihypertensive medicine (AHM) is larger the higher the pre-treatment blood pressure level. It is unknown whether this Wilder's principle, also applies for the exercise-training blood pressure (BP) lowering effect. One hundred seventy-eight (n=178) middle-aged individuals (55±8 y) with metabolic syndrome (MetS), underwent high intensity interval training (3 days·week) for 16 weeks. Participants were divided into medicated (Med; n=103) or not medicated (No Med; n=75) with AHM. Office BP was evaluated before and after the exercise-training. Correlations and stepwise regression analysis were used to determine which variable better predicted the reductions in systolic BP (SBP) with training. After training, participants with hypertension lowered SBP by a similar magnitude regardless of if they were in the Med (-15 mmHg, 95% CI-12,-19; <0.001) or No Med group (-13 mmHg, 95% CI-9,-16; <0.001). However, SBP did not decrease among normotensive groups (=0.847 for Med and =0.937 for No Med). Pre-treatment SBP levels was the best predictor of exercise-training lowering effect (r=-0.650; β=-0.642; <0.001). For each 10 mmHg higher pre-training SBP there were a 5 mmHg deeper SBP reduction (Wilder principle). Furthermore, AHM does not interfere with exercise-training BP-lowering effect.
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http://dx.doi.org/10.1055/a-1548-6985DOI Listing
September 2021

Concurrent endurance and resistance training enhances muscular adaptations in individuals with metabolic syndrome.

Scand J Med Sci Sports 2021 Jul 27;31(7):1440-1449. Epub 2021 Mar 27.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain.

The purpose of the study was to determine if concurrent training (endurance and resistance in a single session) elicits leg muscular adaptations beyond the ones obtained by endurance training alone in sedentary individuals with metabolic syndrome (MetS). Sixty-six MetS individuals (37% women, age 56 ± 7 years, BMI 32 ± 5 kg m and 3.8 ± 0.8 MetS factors) were randomized to undergo one of the following 16-week isocaloric exercise programs: (i) 4 + 1 bouts of 4 min at 90% of HR of intense aerobic cycling (IAC + IAC group; n = 33), (ii) 4 IAC bouts followed by 3 sets of 12 repetitions of 3 lower-limb free-weight exercises (IAC + RT group; n = 33). We measured the effects of training on maximal cycling power, leg press maximum strength (1RM), countermovement jump height (CMJ), and mean propulsive velocity (MPV) at workloads ranging from 10% to 100% of baseline 1RM leg press. After intervention, MetS components (Z-score) improved similarly in both groups (p = 0.002). Likewise, maximal cycling power during a ramp test improved similarly in both groups (time effect p < 0.001). However, leg press 1RM improved more in IAC + RT than in IAC + IAC (47 ± 5 vs 13 ± 5 kg, respectively, interaction p < 0.001). CMJ only improved with IAC + RT (0.8 ± 0.2 cm, p = 0.001). Leg press MPV at heavy loads (ie, 80%-100% 1RM) improved more with concurrent training (0.12 ± 0.01 vs 0.06 ± 0.02 m s , interaction p = 0.013). In conclusion, in unconditioned MetS individuals, intense aerobic cycling alone improves leg muscle performance. However, substituting 20% of intense aerobic cycling by resistance training further improves 1RM leg press, MPV at high loads, and jumping ability while providing similar improvement in MetS components.
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http://dx.doi.org/10.1111/sms.13950DOI Listing
July 2021

Effects of antihypertensive medication and high-intensity interval training in hypertensive metabolic syndrome individuals.

Scand J Med Sci Sports 2021 Jul 15;31(7):1411-1419. Epub 2021 Mar 15.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain.

Pharmacological and non-pharmacological therapies are simultaneously prescribed when treating hypertensive individuals with elevated cardiovascular risk (ie, metabolic syndrome individuals). However, it is unknown if the interactions between antihypertensive medication (AHM) and lifestyle interventions (ie, exercise training) may result in a better ambulatory blood pressure (ABP) control. To test this hypothesis, 36 hypertensive individuals with metabolic syndrome (MetS) under long-term prescription with AHM targeting the renin-angiotensin-aldosterone system (RAAS) were recruited. Before and after 4 months of high-intensity interval training (HIIT), participants completed two trials in a double-blind, randomized order: (a) placebo trial consisting of AHM withdrawal for 3 days and (b) AHM trial where individuals held their habitual dose of AHM. In each trial, 24-h mean arterial pressure (MAP) was monitored and considered the primary study outcome. Secondary outcomes included plasma renin activity (PRA) and aldosterone concentration to confirm withdrawal effects on RAAS, along with the analysis of urine albumin-to-creatinine ratio (UACR) to assess kidney function. The results showed main effects from AHM and HIIT reducing 24-h MAP (-5.7 mmHg, p < 0.001 and -2.3 mmHg, p = 0.007, respectively). However, there was not interaction between AHM and HIIT on 24-h MAP (p = 0.240). There was a main effect of AHM increasing PRA (p < 0.001) but no effect on plasma aldosterone concentration (p = 0.368). HIIT did not significantly improve RAAS hormones or the UACR. In conclusion, AHM and HIIT have independent and additive effects in lowering ABP. These findings support the combination of habitual AHM with exercise training with the goal to reduce ABP in hypertensive MetS individuals.
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http://dx.doi.org/10.1111/sms.13949DOI Listing
July 2021

Exercise Reduces Medication for Metabolic Syndrome Management: A 5-Year Follow-up Study.

Med Sci Sports Exerc 2021 07;53(7):1319-1325

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, SPAIN.

Purpose: This study aimed to determine the effects of a 5-yr exercise intervention on metabolic syndrome (MetS) and health-related variables and medication use for MetS management.

Methods: Participants were randomly assigned to an exercise intervention (n = 25, 54 ± 2 yr, 20% women) or control group (n = 26, 54 ± 2 yr, 38% women). The intervention lasted 4 months per year and consisted of high-intensity interval training on a cycloergometer thrice a week. Outcomes were MetS z-score and medication use score, MetS-related variables (including blood pressure, blood glucose homeostasis, and lipid profile), and cardiorespiratory fitness (CRF, as determined by maximal oxygen uptake).

Results: MetS z-score was similarly reduced over time in both groups (P = 0.244 for group-time interaction). A quasi-significant and significant group-time interaction was found for MetS number of factors (P = 0.004) and CRF (P < 0.001), respectively. Thus, MetS factors tended to decrease over time only in the exercise group with no change in the control group, whereas CRF increased from baseline to 5-yr assessment in the exercise group (by 1.1 MET, P < 0.001) but decreased in the control group (-0.5 MET, P = 0.025). Medicine use score increased twofold from baseline to 5-yr follow-up in the control group (P < 0.001) but did not significantly change (10%, P = 0.52) in the exercise group (P < 0.001 for group-time interaction). The proportion of medicated patients who had to increase antihypertensive (P < 0.001), glucose-lowering (P = 0.036), or total medication (P < 0.0001) over the 5-yr period was lower in the exercise than that in the control group.

Conclusions: Exercise training can attenuate the increase in medication that would be otherwise required to manage MetS over a 5-yr period.
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http://dx.doi.org/10.1249/MSS.0000000000002591DOI Listing
July 2021

The use of a graded exercise test may be insufficient to quantify true changes in V̇o following exercise training in unfit individuals with metabolic syndrome.

J Appl Physiol (1985) 2020 10 3;129(4):760-767. Epub 2020 Sep 3.

Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, Spain.

We studied the accuracy of graded exercise testing (GXT) to assess improvements in maximal oxygen uptake (V̇o) with exercise training in unfit individuals with metabolic syndrome (MetS). Forty-four adults with MetS (58 ± 7 yr, 36% women, BMI 31.8 ± 4.8 kg/m) underwent 4 mo of supervised high-intensity interval exercise training. V̇o was assessed using GXT, followed by a constant-load verification test (VerT) at 110% of the maximal work rate achieved during GXT. V̇o data from GXT and VerT were compared using repeated-measures ANOVA. The mean improvement in V̇o following exercise training was similar when using GXT only or VerT. However, before training, 18 subjects achieved a higher V̇o during the verification test that was (+159 mLO/min) higher than the GXT ( < 0.001). After training, the underestimation of V̇o by GXT was reduced but still present (+64 mLO/min). As a result, improvements in V̇o following exercise training as assessed using GXT only almost doubled the "real" increase in V̇o as measured by VerT in these 18 individuals. In the remaining 26 subjects, GXT scored below VerT only after training (+54 mLO/min, = 0.046). As a consequence, GXT underestimated the actual V̇o increases (-49 mLO/min, = 0.013) in these individuals. Assessment of changes in V̇o following exercise training using only GXT over- or underestimates V̇o gains in unfit individuals with MetS. Thus, a verification test may be required to ) identify the highest V̇o during a maximal exercise test on a cycle ergometer and ) accurately quantify the true changes in cardiorespiratory fitness following exercise training in unfit individuals with MetS. It is unclear whether the traditional GXT is suitable to assess V̇o changes in unfit individuals with metabolic syndrome. Mean changes in V̇o following exercise training were similar using GXT or VerT. However, we showed that the GXT overestimated V̇o improvements in 41% and underestimated V̇o improvements in 59% of subjects. Our data suggest the need for a verification test to appropriately determine training-induced improvements in V̇o in unfit individuals with metabolic syndrome.
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http://dx.doi.org/10.1152/japplphysiol.00455.2020DOI Listing
October 2020

Substitution of parts of aerobic training by resistance training lowers fasting hyperglycemia in individuals with metabolic syndrome.

Appl Physiol Nutr Metab 2021 Jan 13;46(1):69-76. Epub 2020 Jul 13.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo 45071, Spain.

We sought to determine the effects of substituting parts of aerobic training (AT) by resistance training (RT) on metabolic syndrome (MetS) factors. MetS patients (aged 56 ± 7 years; body mass index 33 ± 5 kg·m and 3.9 ± 0.8 MetS factors) were randomized to undergo 1 of the following isocaloric, 16-week long exercise programs: () cycling 4 bouts of 4-min at 90% of maximal heart rate (HR) followed by 3 sets of 12 repetitions of 3 lower limb free-weight exercises (high-intensity interval training (HIIT)+RT group; = 33), () cycling 5 bouts of 4 min at 90% of HR (HIIT+HIIT group; = 33), or () no exercise control group ( = 21). We measured the evolution of all 5 MetS components ( score), cardiorespiratory fitness (maximal oxygen uptake), leg strength and power (leg press 1-repetition maximum (1RM) and countermovement jump (CMJ)), fasting blood glucose (FG), fasting insulin, and insulin resistance (homeostasis model assessment 2). Both training groups improved maximal oxygen uptake similarly (170 ± 310 and 190 ± 210 mL O·min;  < 0.001) and score (-0.12 ± 0.29 and -0.12 ± 0.31 for HIIT+RT and HIIT+HIIT, respectively;  < 0.02). However, only HIIT+RT improved CMJ ( = 0.002) and leg press 1RM above the HIIT+HIIT group (21% vs 6%;  < 0.001). Furthermore, FG only decreased in the HIIT+RT group (5%;  = 0.026, time × group). Our findings suggest that substitution of part of HIIT by leg RT improves glucose control in MetS individuals. Most studies addressing the efficacy of endurance versus resistance training are not matched by energy expenditure. We found that substituting 20% of AT with RT reduces hyperglycemia in MetS individuals. Training recommendations to regain glycemic control in MetS individuals should include resistance training.
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http://dx.doi.org/10.1139/apnm-2020-0281DOI Listing
January 2021

Effects of Exercise Training during Christmas on Body Weight and Cardiometabolic Health in Overweight Individuals.

Int J Environ Res Public Health 2020 07 1;17(13). Epub 2020 Jul 1.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, 45071 Toledo, Spain.

Individuals with abdominal obesity and metabolic syndrome (MetS) have augmented risk of all-cause mortality. Lifestyle interventions are effective to treat MetS, however, there are periods during the year in which exercise programs are discontinued and improper dietary habits reappear (e.g., Christmas holidays). We aimed to analyze if exercise-training during Christmas holidays would avoid body-weight gains and cardiometabolic deterioration in MetS individuals, using a randomized control trial. Thirty-eight men with MetS undergoing exercise training were randomly allocated to either continue (TRAIN group, n = 16) or discontinue (HOLID group, n = 22) training, during the three weeks of Christmas. Anthropometrics (body weight, fat, and waist circumference), fasting blood metabolites (glucose, insulin, triglycerides, and cholesterol concentrations) and exercise maximal fat oxidation (FO) and oxygen uptake (VO) were determined before and after Christmas. Both groups were similar at baseline in all parameters ( > 0.05). HOLID group increased body weight (91.3 ± 13.0 to 92.0 ± 13.4 kg, = 0.004), mean arterial pressure (94.0 ± 10.6 to 97.1 ± 8.9 mmHg, = 0.026), blood insulin (10.2 ± 3.8 to 12.5 ± 5.4 µIU·mL, = 0.003) and HOMA (3.2 ± 1.3 to 4.1 ± 2.3, = 0.003). In contrast, TRAIN prevented those disarrangements and reduced total (170.6 ± 30.6 to 161.3 ± 31.3 mg·dL, = 0.026) and low-density lipoprotein cholesterol (i.e., LDL-, 104.8 ± 26.1 to 95.6 ± 21.7 mg·dL, = 0.013). TRAIN also prevented the reductions in exercise FO and VO that was observed in the HOLID group ( = 0.002). In conclusion, exercise training during Christmas, prevents body weight gains and the associated cardiovascular (increase in blood pressure and LDL) and metabolic (reduced insulin sensitivity) health risks are an optimal non-pharmacological therapy for that period of the year.
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http://dx.doi.org/10.3390/ijerph17134732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369896PMC
July 2020

Effects of statins and exercise on postprandial lipoproteins in metabolic syndrome vs metabolically healthy individuals.

Br J Clin Pharmacol 2021 03 12;87(3):955-964. Epub 2020 Jul 12.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Spain.

Aims: To determine if the combination of exercise and statin could normalize postprandial triglyceridaemia (PPTG) in hypercholesteraemic individuals.

Methods: Eight hypercholesteraemic (blood cholesterol 182 ± 38 mg dL ; low-density lipoprotein-cholesterol [LDL-c] 102 ± 32 mg dL ) overweight (body mass index 30 ± 4 kg m ) individuals with metabolic syndrome (MetS) were compared to a group of 8 metabolically healthy (MetH) controls (blood cholesterol 149 ± 23 mg dL ; LDL-c 77 ± 23 mg dL , and body mass index 23 ± 2 kg m ). Each group underwent 2 PPTG tests, either 14 hours after a bout of intense exercise or without previous exercise. Additionally, MetS individuals were tested 96 hours after withdrawal of their habitual statin medication to study medication effects.

Results: A bout of exercise before the test meal did not reduce PPTG in MetS (P = .347), but reduced PPTG by 46% in MetH (413 ± 267 to 224 ± 142 mg dL for 5 h incremental area under the curve; P = .02). In both trials (i.e., either after a bout of intense exercise or without previous exercise), statin withdrawal in MetS greatly increased PPTG (average 65%; P < .01), mean LDL-c (average 25%; P < .01), total cholesterol (average 16%; P < .01) and apolipoprotein (Apo) B48 (24%; P < .01), without interference from exercise. However, Apo B100 was not affected by statin withdrawal.

Conclusion: Hypercholesteraemic MetS individuals (compared to MetH controls) fail to show an effect of exercise on reducing PPTG. However, chronic statin medication blunts the elevations in triglyceride after a fat meal (i.e., incremental area under the curve of PPTG) reducing their cardiovascular risk associated with their atherogenic dyslipidaemia. Statin decreases PPTG by reducing the secretion or accelerating the catabolism of intestinal Apo B48.
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http://dx.doi.org/10.1111/bcp.14447DOI Listing
March 2021

Effects of statin therapy and exercise on postprandial triglycerides in overweight individuals with hypercholesterolaemia.

Br J Clin Pharmacol 2020 06 18;86(6):1089-1099. Epub 2020 Feb 18.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Spain.

Aims: To determine the effects of statins on postprandial lipaemia (PPL) and to study if exercise could enhance statin actions.

Methods: Ten hypercholesteraemic (blood cholesterol 204 ± 36 mg dL ; low-density lipoprotein-cholesterol 129 ± 32 36 mg dL ) overweight (body mass index 30 ± 4 kg m ), metabolic syndrome individuals chronically medicated with statins (>6 months) underwent 5-hour PPL tests in 4 occasions in a randomized order: (i) substituting their habitual statin medication by placebo for 96 hours (PLAC trial); (ii) taking their habitual statin medicine (STA trial); (iii) placebo combined with a bout of intense aerobic exercise (EXER+PLAC trial); and (iv) combining exercise and statin medicine (EXER+STA trial).

Results: Before the fat meal, statin withdrawal (i.e. PLAC and EXER+PLAC) increased blood triglycerides (TG; 24%), low-density lipoprotein-cholesterol (31%) and total cholesterol (19%; all P < .05) evidencing treatment compliance. After the meal, statin withdrawal increased 5-hour postprandial TG (PPTG) compared to its matched trials (94% higher PLAC vs STA and 45% higher EXER+PLAC vs EXER+STA; P < .05). EXER+PLAC trial did not lower PPTG below PLAC (i.e. incremental AUC of 609 ± 152 vs 826 ± 190 mg dL 5 h; P = .09). Adding exercise to statin did not result in larger reductions in PPTG (i.e. EXER+STA vs STA incremental area under the curve of 421 ± 87 vs 421 ± 84 mg dL 5 h; P = .99).

Conclusion: In hypercholesteraemic metabolic syndrome individuals, chronic statin therapy blunts the elevations in TG after a fat meal (i.e. incremental area under the curve of PPTG) reducing the cardiovascular risk associated to their atherogenic dyslipidaemia. However, a single bout of intense aerobic exercise before the high fat meal, does not reduce PPTG but also does not interfere with the effects of statin treatment.
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http://dx.doi.org/10.1111/bcp.14217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256119PMC
June 2020

Exercise Training Adaptations in Metabolic Syndrome Individuals on Chronic Statin Treatment.

J Clin Endocrinol Metab 2020 04;105(4)

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain.

Background: Statins reduce atherogenic dyslipidemia and cardiovascular disease (CVD) risk in metabolic syndrome (MetS) individuals. Exercise training could also contribute to reduce CVD by improving cardiorespiratory fitness and fat oxidation. However, statin use could interfere with training adaptations.

Methods: A total of 106 MetS individuals were divided into statin users (statin group, n = 46) and statin-naïve (control group, n = 60). Groups were matched by age, weight, and MetS components. Subjects completed 16 weeks of high intensity interval training (HIIT). Before and after HIIT, muscle biopsies were collected to assess mitochondrial content (citrate synthase [CS] activity) and the activity of the rate limiting β-oxidation enzyme (3-hydroxyacyl-CoA-dehydrogenase [HAD]). Fasting plasma glucose, insulin, TG, HDL-c, and LDL-c concentrations were measured. Exercise maximal fat oxidation (FOMAX) and oxygen uptake (VO2PEAK) were determined.

Results: Training improved MetS similarly in both groups (MetS z-score -0.26 ± 0.38 vs. -0.22 ± 0.31; P < 0.001 for time and P = 0.60 for time x group). Before training, the statin group had reduced muscle HAD activity and whole body FOMAX compared to the control group. However, 16 weeks of HIIT increased HAD and FOMAX in both groups (P < 0.03, time-effect). The statin group did not prevent the increases in CS with HIIT observed in the control group (38% vs 64%, respectively; P < 0.001, time-effect). Conversely, with training VO2PEAK improved less in the statin than in the control group (12% vs. 19%, respectively; P = 0.013, time × group effect).

Conclusion: Chronic statin use in MetS does not interfere with exercise training improvements in MetS components, FOMAX, or mitochondrial muscle enzymes (ie, CS and HAD). However, the statin group attenuated the improvements in VO2PEAK with training.

Clinical Trial Information: ClinicalTrials.gov identifier no. NCT03019796, January 13, 2017.
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http://dx.doi.org/10.1210/clinem/dgz304DOI Listing
April 2020

Women with metabolic syndrome show similar health benefits from high-intensity interval training than men.

PLoS One 2019 10;14(12):e0225893. Epub 2019 Dec 10.

Exercise Physiology Laboratory, University of Castilla-La Mancha, Toledo, Spain.

High-intensity interval training (HIIT), is effective to improve cardiorespiratory fitness (CRF) and metabolic syndrome (MetS) components in adults. However, it is unclear if CRF and MetS components respond similarly in men and women after HIIT. For 16 weeks, 63 women (53±7 years) and 56 men (55±8 years) with MetS underwent a three day/week HIIT program. Bodyweight and composition, VO2MAX, surrogate parameters of CRF (Ventilatory threshold (VT), oxygen uptake efficiency slope (OUES) and VE/VCO2 slope), maximal rate of fat oxidation (MFO), and MetS components were assessed before and after training. All reported variables were analyzed by split-plot ANOVA looking for time by sex interactions. Before training men had higher absolute values of VO2MAX (58.6%), and MFO (24.6%), while lower body fat mass (10.5%) than women (all P<0.05). After normalization by fat-free mass (FFM), VO2MAX remained 16.6% higher in men (P<0.05), whereas differences in MFO disappeared (P = 0.292). After intervention VO2MAX (P<0.001), VO2 at VT (P<0.001), OUES (P<0.001), and VE/VCO2 slope (P<0.001) increased without differences by sex (P>0.05). After training MetS Z-score (P<0.001) improved without differences between men and women (P>0.05). From the MetS components, only blood pressure (P<0.001) and waist circumference (P<0.001) improved across time, without differences by sex. In both, women and men, changes in OUES (r = 0.685 and r = 0.445, respectively), and VO2 at VT (r = 0.378, and r = 0.445, respectively), correlated with VO2MAX. While only bodyweight changes correlated with MetS Z-score changes (r = 0.372, and = 0.300, respectively). Despite baseline differences, 16-weeks of HIIT similarly improved MetS, cardiorespiratory and metabolic fitness in women and men with MetS. This suggests that there are no restrictions due to sex on the benefits derived from an intense exercise program in the health of MetS participants. Trial Registration: clinicaltrials.gov NCT03019796.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225893PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903716PMC
March 2020

Importance of a verification test to accurately assess V̇O max in unfit individuals with obesity.

Scand J Med Sci Sports 2020 Mar 11;30(3):583-590. Epub 2019 Dec 11.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain.

Background: To determine the trustworthiness of graded exercise test to exhaustion (GXT) to assess maximal oxygen uptake ( ) in metabolic syndrome individuals with obesity and poor cardiorespiratory fitness.

Methods: was assessed in 100 metabolic syndrome adults (57 ± 8 years; 34% women), with obesity (BMI 32 ± 5 kg·m ) using GXT followed by supramaximal constant-load verification test (VerT) at 110% of maximal GXT work rate. data from GXT and VerT were compared using paired t test and plotted for Bland-Altman analysis. GXT sensitivity and specificity to detect were also calculated.

Results: Seventy individuals did not achieve plateau during GXT. GXT underestimated in 40 subjects. In these subjects, the magnitude of underestimation with GXT was 9% (167 mLO ·min ; P < .001). In the whole sample (n = 100), bias error differences between GXT and VerT was 63 mLO ·min (3% underestimation). This error was constant regardless of differences in fitness levels among individuals (R = -0.07; homoscedasticity). GXT results were unreliable in 62% of the sample with 16% of false-positive and 46% of false-negative results. Sensitivity and specificity of GTX to assess were low (ie, 23% and 60%, respectively).

Conclusion: Our data indicate that the magnitude (3%-9%) and prevalence (40% of subjects) of underestimation with the use of a GXT alone is high in a large sample of unfit metabolic syndrome individuals with obesity. Our data advocate for the need of using VerT after GXT to avoid significant cardiorespiratory fitness underestimation in metabolic syndrome individuals with obesity and low fitness level.
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http://dx.doi.org/10.1111/sms.13602DOI Listing
March 2020

Post-exercise Hypotension Produced by Supramaximal Interval Exercise is Potentiated by Angiotensin Receptor Blockers.

Int J Sports Med 2019 Nov 2;40(12):756-761. Epub 2019 Sep 2.

Exercise Physiology Lab, Universidad de Castilla-La Mancha, Toledo, Spain.

We studied the effects of supramaximal interval exercise (SIE) with or without antihypertensive medication (AHM) on 21-hr blood pressure (BP) response. Twelve hypertensive patients chronically medicated with AHM, underwent three trials in a randomized order: a) control trial without exercise and substituting their AHM with a placebo (PLAC); b) placebo medicine and a morning bout of SIE (PLAC+SIE), and c) combining AHM and exercise (AHM+SIE). Acute and ambulatory blood pressure responses were measured for 21-hr after treatment. 20  min after treatment, systolic blood pressure (SBP) readings were reduced, similar to readings after PLAC+SIE (-9.7±6.0 mmHg, P<0.001) and AHM+SIE (-10.4±7.9 mmHg, P=0.001). 21 h after treatment, SBP remained reduced after PLAC+SIE (125±12 mmHg, P=0.022) and AHM+SIE (122±12 mmHg, P=0.013) compared to PLAC (132±16 mmHg). The BP reduction in PLAC+SIE faded out at 4 a.m., while in AHM+SIE it continued overnight. At night, BP reduction was larger in AHM+SIE than PLAC+SIE (-5.6±4.0 mmHg, P=0.006). Our data shows that a bout of supramaximal aerobic interval exercise in combination with ARB medication in the morning elicits a sustained blood pressure reduction lasting at least 21-h. Thus, the combination of exercise and angiotensin receptor blocker medication seems superior to exercise alone for acutely decreasing blood pressure.
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http://dx.doi.org/10.1055/a-0927-6957DOI Listing
November 2019

Effectiveness of Aerobic Exercise Programs for Health Promotion in Metabolic Syndrome.

Med Sci Sports Exerc 2019 09;51(9):1876-1883

Exercise Physiology Laboratory at Toledo, University of Castilla-La Mancha, Toledo, SPAIN.

Purpose: Continuous and interval are the two types of aerobic exercise training commonly used for health promotion. We sought to determine which aerobic exercise training program results in larger health improvements in metabolic syndrome (MetS) individuals.

Methods: One hundred twenty-one MetS patients (age, 57 ± 8 yr; weight, 92 ± 15 kg; and MetS factors, 3.8 ± 0.8 components) with low initial cardiorespiratory fitness (CRF) (V˙O2peak, 24.0 ± 5.5 mL·kg·min) were randomized to undergo one of the following 16-wk exercise program: (a) 4 × 4-min high-intensity interval training at 90% of HRMAX (4HIIT group; n = 32), (b) 50-min moderate-intensity continuous training at 70% of HRMAX (MICT group; n = 35), (c) 10 × 1-min HIIT at 100% of HRMAX (1HIIT group; n = 32), or (d) no exercise control group (CONT; n = 22). We measured the evolution of all five MetS components (i.e., MetS Z Score) and CRF (assessed by V˙O2peak) before and after intervention.

Results: MetS Z score decreased 41% after 4HIIT (95% confidence interval [CI], 0.25-0.06; P < 0.01) and 52% in MICT (95% CI, 0.24-0.06; P < 0.01), whereas it did not change in 1HIIT (decreased 24%; 95% CI, -0.16 to 0.03; P = 0.21) and CONT (increased 20%; 95% CI, -0.19 to 0.04; P = 0.22). However, the three exercise groups improved similarly their V˙O2peak (4HIIT, 11%; 95% CI, 0.14-0.33; MICT, 12%; 95% CI, 0.18-0.36; and 1HIIT, 14%; 95% CI, 0.21-0.40 L·min; all P < 0.001).

Conclusions: Our findings suggest that in sedentary individuals with MetS and low initial CRF level any aerobic training program of 16 wk with a frequency of three times per week is sufficient stimulus to raise CRF. However, the more intense but shorter 1HIIT training program is not effective on improving MetS Z score, and thus we caution its recommendation for health promotion purposes in this population.
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http://dx.doi.org/10.1249/MSS.0000000000001983DOI Listing
September 2019

Training intensity relative to ventilatory thresholds determines cardiorespiratory fitness improvements in sedentary adults with obesity.

Eur J Sport Sci 2019 May 31;19(4):549-556. Epub 2018 Oct 31.

b Exercise Physiology Lab at Toledo , University of Castilla-La Mancha , Toledo , Spain.

The aim of the present study was to study if training intensity relative to ventilatory thresholds (VTs) determines the improvements in cardiorespiratory fitness (CRF) in middle-aged sedentary individuals with obesity. Before and after 16-weeks of HIIT (43-min alternating bouts at 70/90% of HR), oxygen consumption ( O) and heart rate (HR) at ventilatory threshold 1 ( O HR), ventilatory threshold 2 ( O, HR) and at maximal effort ( O, HR) were assessed during a graded cycle-ergometer exercise test. Retrospectively, participants were divided into two groups based on whether training intensities were under (UNDER; n = 39) or over (OVER; n = 37) VT and VT. At baseline, age, body composition, O O, and HR were similar in both groups. However, O was higher in OVER (P = 0.033), whereas HR and HR were higher in UNDER (P < 0.05). O (9.0%) and HR (2.2%) improved similarly in both groups. O and O improved with training in both groups (P < 0.001) but the improvement was larger in OVER versus UNDER in O (P = 0.013) and tended to be higher in O (P = 0.068). HR increased only in OVER (P < 0.001), whereas HR did not change in any group (P = 0.248). A 16-week programme of HIIT improves O similarly in individuals training at intensities over or under their VTs. However, individuals training over their VTs showed a larger improvements in O expanding exercise workloads fuelled by oxidative metabolism.
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http://dx.doi.org/10.1080/17461391.2018.1540659DOI Listing
May 2019

Exercise Periodization over the Year Improves Metabolic Syndrome and Medication Use.

Med Sci Sports Exerc 2018 Oct;50(10):1983-1991

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, SPAIN.

Purpose: We aimed to determine if yearly repeated exercise training reduces metabolic syndrome (MetS) and the use of medicines to control MetS components.

Methods: Fifty-five MetS individuals were randomized into a TRAIN group that underwent two yearly programs of 16-wk high-intensity interval training or a nonexercising CONT group. We measured the evolution of all five MetS components, cardiorespiratory fitness (assessed by V˙O2PEAK) and medicine use, at baseline (0 months), mid (12 months), and end-point (24 months). Testing took place 8 months after the last training session to assess the chronic effects of training.

Results: Daily physical activity (wristband activity monitors) and calorie intake (3-d nutritional diary) remained similar to baseline at 1 and 2 yr in each group and were not different between groups. Blood triglycerides and glucose concentrations did not significantly vary in any group. However, waist circumference increased only in CONT after 2 yr (107 ± 2 cm to 111 ± 3 cm; P = 0.004). Mean arterial pressure decreased in TRAIN (101 ± 2 mm Hg to 94 ± 2 mm Hg; P = 0.002), whereas it remained unchanged in CONT (98 ± 2 mm Hg to 99 ± 2 mm Hg; P = 1.000) after 2 yr. Starting from similar levels at baseline, after 2 yr V˙O2PEAK was higher (2.32 ± 0.14 L·min vs 1.98 ± 0.11 L·min; P = 0.049) and medicine use lower (1.27 ± 0.22 vs 2.23 ± 0.43; P = 0.043) in TRAIN than CONT. The reduction in MAP in TRAIN commanded a parallel reduction in MetS Z-score from baseline to 2 yr (0.30 ± 0.1 to 0.07 ± 0.1; P = 0.013).

Conclusions: Two yearly 16-wk high-intensity interval training programs are enough exercise to chronically lower MetS while preventing the reductions in cardiorespiratory fitness associated to aging. Of clinical relevance, yearly exercise training halts the increase in medicine use that occurs in non-exercising MetS individuals.
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http://dx.doi.org/10.1249/MSS.0000000000001659DOI Listing
October 2018

Intense aerobic exercise lowers blood pressure in individuals with metabolic syndrome taking antihypertensive medicine.

Blood Press Monit 2018 Oct;23(5):230-236

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo.

Objective: There is a growing tendency for physicians to prescribe exercise in accordance with the 'exercise is medicine' global health initiative. However, the exercise-pharmacologic interactions for controlling blood pressure are not well described. Our purpose was to study whether angiotensin II receptor type 1 blocker (ARB) antihypertensive medicine enhances the blood pressure-lowering effects of intense exercise.

Participants And Methods: Fifteen hypertensive individuals with metabolic syndrome chronically medicated with ARB underwent two exercise trials in a blind randomized order. One trial was conducted after taking their habitual dose of ARB (ARB MED trial) and another after 48 h of placebo medicine (i.e. dextrose; PLAC trial).

Results: After placebo medication, brachial systolic blood pressure increased by 5.5 mmHg [P=0.009; effect size (ES)=0.476] and diastolic by 2.5 mmHg (P=0.030; ES=0.373). Exercise reduced systolic and diastolic blood pressures to the same extent in ARB MED and PLAC trials (7 and 8 mmHg, respectively, for systolic and 5 and 4 mmHg, respectively, for diastolic, all P<0.05). Pulsatile measures of arterial stiffness did not reveal an interaction effect between exercise and medication. However, postocclusion reactive hyperemia increased after exercise only in the ARB MED trial (361±169 to 449±240% from baseline; P=0.033; ES=0.429).

Conclusion: ARBs and a bout of intense exercise each have an independent effect on lowering blood pressure in hypertensive individuals, and these effects are additive.
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http://dx.doi.org/10.1097/MBP.0000000000000328DOI Listing
October 2018

Effects of aerobic interval training on arterial stiffness and microvascular function in patients with metabolic syndrome.

J Clin Hypertens (Greenwich) 2018 01 6;20(1):11-18. Epub 2017 Nov 6.

Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, Spain.

The authors determined the effect of high-intensity aerobic interval training on arterial stiffness and microvascular dysfunction in patients with metabolic syndrome with hypertension. Applanation tonometry was used to measure arterial stiffness and laser Doppler flowmetry to assess microvascular dysfunction before and after 6 months of stationary cycling (training group; n = 23) in comparison to a group that remained sedentary (control group; n = 23). While no variable improved in controls, hypertension fell from 79% (59%-91%) to 41% (24%-61%) in the training group, resulting in lower systolic and diastolic pressures than controls (-12 ± 3 and -6 ± 2 mm Hg, P < .008). Arterial stiffness declined (-17% augmentation index, P = .048) and reactive hyperemia increased (20%, P = .028) posttreatment in the training group vs controls. Blood constituents associated with arterial stiffness and a prothrombotic state (high-sensitivity C-reactive protein, fibrinogen, platelets, and erythrocytes) remained unchanged in the training and control groups. In summary, 6 months of an intense aerobic exercise program reduced both arterial stiffness and microvascular dysfunction in patients with metabolic syndrome despite unchanged blood-borne cardiovascular risk factors. Training lowers blood flow resistance in central and peripheral vascular beds in a coordinated fashion, resulting in clinically relevant reductions in hypertension.
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http://dx.doi.org/10.1111/jch.13130DOI Listing
January 2018

Effects of repeated yearly exposure to exercise-training on blood pressure and metabolic syndrome evolution.

J Hypertens 2017 10;35(10):1992-1999

aExercise Physiology Lab at Toledo, University of Castilla-La Mancha bServicio de Salud de Castilla-La Mancha (SESCAM), Toledo, Spain.

Objective: To study if repeated yearly training programs consolidate the transient blood pressure (BP) improvements of one exercise program into durable adaptations.

Methods: Obese middle-age individuals with metabolic syndrome (MetS) underwent high-intensity aerobic interval training during 16 weeks (November to mid-March) in 3 consecutive years [training group (TRAIN); N = 23]. Evolution of MetS components was compared with a matched-group that remained sedentary [control group (CONT); N = 26].

Results: At the end of the first training program (0-4 months), TRAIN lowered systolic arterial pressure, blood glucose, waist circumference and MetS Z-score below CONT (-8.5 ± 2.5 mmHg; -19.9 ± 2.6 mg/dl; -3.8 ± 0.1 cm and -0.3 ± 0.1, respectively, all P < 0.05). With detraining (month 4-12) TRAIN adaptations relapsed to the levels of baseline (month 0) except for BP. A second exercise program (month 12-16) lowered blood glucose and waist circumference below CONT (-19.0 ± 2.0 mg/dl; -4.1 ± 0.1 cm). After detraining (month 16-24) BP, blood glucose and Z-score started below CONT values (-6.8 ± 0.9 mmHg; -24.6 ± 2.5 mg/dl and -0.4 ± 0.05, respectively, all P < 0.05) and those differences enlarged with the last training program (month 24-28). Ten-year atherosclerotic cardiovascular disease risk estimation increased only in CONT (8.6 ± 1.1-10.1 ± 1.3%; year 2-3; P < 0.05).

Conclusion: At least two consecutive years of 4-month aerobic interval training are required to chronically improve MetS (Z-score). The chronic effect is mediated by BP that does not fully return to pretraining values allowing a cumulative improvement. On the other hand, sedentarism in MetS patients during 3 years increases their predicted atherosclerotic diseases risk. CLINICALTRIALS.

Gov Identifier: NCT03019796.
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http://dx.doi.org/10.1097/HJH.0000000000001430DOI Listing
October 2017

Acute Hypotension after High-Intensity Interval Exercise in Metabolic Syndrome Patients.

Int J Sports Med 2017 Jul 8;38(7):560-567. Epub 2017 May 8.

Sport Sciences, Universidad de Castilla-La Mancha, Toledo, Spain.

The purpose of this study was to compare the magnitude of post-exercise hypotension (PEH) after a bout of cycling exercise using high-intensity interval training (HIIT) in comparison to a bout of traditional moderate-intensity continuous exercise (CE). After supine rest 14 obese (31±1 kg·m) middle-age (57±2 y) metabolic syndrome patients (50% hypertensive) underwent a bout of HIIT or a bout of CE in a random order and then returned to supine recovery for another 45 min. Exercise trials were isocaloric and compared to a no-exercise trial (CONT) of supine rest for a total of 160 min. Before and after exercise we assessed blood pressure (BP), heart rate (HR), cardiac output (Q), systemic vascular resistance (SVR), intestinal temperature (T), forearm skin blood flow (SBF) and percent dehydration. HIIT produced a larger post-exercise reduction in systolic blood pressure than CE in the hypertensive group (-20±6 vs. -5±3 mmHg) and in the normotensive group (-8±3 vs. -3±2 mmHg) while HIIT reduced SVR below CE (P<0.05). Percent dehydration was larger after HIIT, and post-exercise T and SBF increased only after HIIT (all P<0.05). Our findings suggest that HIIT is a superior exercise method to CE to acutely reduce blood pressure in MSyn subjects.
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http://dx.doi.org/10.1055/s-0043-101911DOI Listing
July 2017

Cardiovascular Drift during Training for Fitness in Patients with Metabolic Syndrome.

Med Sci Sports Exerc 2017 03;49(3):518-526

1Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, SPAIN; and 2Human Performance and Sport Science Lab, University of Murcia, SPAIN.

Purpose: The health benefits of a training program are largely influenced by the exercise dose and intensity. We sought to determine whether during a training bout of continuous versus interval exercise the workload needs to be reduced to maintain the prescribed target heart rate (HR).

Methods: Fourteen obese (31 ± 4 kg·m) middle-age (57 ± 8 yr) individuals with metabolic syndrome, underwent two exercise training bouts matched by energy expenditure (i.e., 70 ± 5 min of continuous exercise [CE] or 45 min of interval exercise, high-intensity interval training [HIIT]). All subjects completed both trials in a randomized order. HR, power output (W), percent dehydration, intestinal and skin temperature (TINT and TSK), mean arterial pressure, cardiac output (CO), stroke volume (SV), and blood lactate concentration (La) were measured at the initial and latter stages of each trial to assess time-dependent drift.

Results: During the HIIT trial, power output was lowered by 30 ± 16 W to maintain the target HR, whereas a 10 ± 11 W reduction was needed in the CE trial (P < 0.05). Energy expenditure, CO, and SV declined with exercise time only in the HIIT trial (15%, 10%, and 13%, respectively). During HIIT, percent dehydration, TINT, and TSK increased more than during the CE trial (all P = 0.001). Mean arterial pressure and La were higher in HIIT without time drift in any trial.

Conclusion: Our findings suggests that while CE results in mild power output reductions to maintain target HR, the increasingly popular HIIT results in marked reductions in power output, energy expenditure, and CO (21%, 15%, and 10%, respectively). HIIT based on target HR may result in lower than expected training adaptations because of workload adjustments to avoid HR drift.
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http://dx.doi.org/10.1249/MSS.0000000000001139DOI Listing
March 2017

Dietary supplementation with omega-3 fatty acids and oleate enhances exercise training effects in patients with metabolic syndrome.

Obesity (Silver Spring) 2016 08 29;24(8):1704-11. Epub 2016 Jun 29.

Exercise Physiology Lab, University of Castilla-La Mancha, Toledo, Spain.

Objective: We studied the effects of exercise training alone or combined with dietary supplementation of omega-3 polyunsaturated fatty acids (Ω-3PUFA) and oleate on metabolic syndrome (MSyn) components and other markers of cardiometabolic health.

Methods: Thirty-six patients with MSyn underwent 24 weeks of high-intensity interval training. In a double-blind randomized design, half of the group ingested 500 mL/day of semi-skim milk (8 g of fat; placebo milk) whereas the other half ingested 500 mL/day of skim milk enriched with 275 mg of Ω-3PUFA and 7.5 g of oleate (Ω-3 + OLE).

Results: Ω-3 + OLE treatment elevated 30% plasma Ω-3PUFA but not significantly (P = 0.286). Improvements in VO2peak (12.8%), mean blood pressure (-7.1%), waist circumference (-1.8%), body fat mass (-2.9%), and trunk fat mass (-3.3%) were similar between groups. However, insulin sensitivity (measured by intravenous glucose tolerance test), serum concentration of C-reactive protein, and high-density lipoprotein improved only in the Ω-3 + OLE group by 31.5%, 32.1%, and 10.3%, respectively (all P < 0.05). Fasting serum triacylglycerol, glucose, and plasma fibrinogen concentrations did not improve in either group after 24 weeks of intervention.

Conclusions: Diet supplementation with Ω-3PUFA and oleate enhanced cardiometabolic benefits of intense aerobic exercise training in patients with MSyn.
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http://dx.doi.org/10.1002/oby.21552DOI Listing
August 2016
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