Stensvold D, Tjønna AE, Skaug EA, Aspenes S, Stølen T, Wisløff U, Slørdahl SA. Strength training versus aerobic interval training to modify risk factors of metabolic syndrome. J Appl Physiol 108: 804-810, 2010. First published January 21, 2010 doi:10.1152/japplphysiol.00996.2009.-Metabolic syndrome is characterized by central obesity, elevated blood pressure, high fasting glucose and triglyceride levels, and low HDL levels. Regular physical activity can improve the metabolic profile and reduce the risks of cardiovascular diseases and premature mortality. However, the optimal training regime to treat metabolic syndrome and its associated cardiovascular abnormalities remains undefined. Fortythree participants with metabolic syndrome were randomized to one of the following groups: aerobic interval training (AIT; n ϭ 11), strength training (ST; n ϭ 11), a combination of AIT and ST (COM; n ϭ 10) 3 times/wk for 12 wk, or control (n ϭ 11). Risk factors comprising metabolic syndrome were evaluated before and after the intervention. Waist circumference (in cm) was significantly reduced after AIT [95% confidence interval (CI): Ϫ2.5 to Ϫ0.04], COM (95% CI: Ϫ2.11 to Ϫ0.63), and ST (95% CI: Ϫ2.68 to Ϫ0.84), whereas the control group had an increase in waist circumference (95% CI: 0.37-2.9). The AIT and COM groups had 11% and 10% increases in peak O2 uptake, respectively. There were 45% and 31% increases in maximal strength after ST and COM, respectively. Endothelial function, measured as flow-mediated dilatation (in %), was improved after AIT (95% CI: 0.3-3), COM (95% CI: 0.3-3), and ST (95% CI:

These data represent the largest reference material of objectively measured VO2peak in healthy men and women age 20-90 yr. Even in people considered to be fit, VO2peak was clearly associated with levels of conventional cardiovascular risk factors.

The distribution of FMD in this study is representative of the respective age and gender groups of a healthy population and may be a useful reference for future studies. The high proportion of endothelial dysfunction came as a surprise. Its age and gender distribution suggest that FMD ≤0% precedes cardiovascular disease and that it may be a powerful non-invasive biomarker for identifying high-risk individuals.

BackgroundSeveral studies suggest that cardiovascular risk factors comprising the metabolic syndrome have larger effects on the development of cardiovascular disease in women than in men. A recent study in self-reported healthy subjects demonstrated a marked gender difference in endothelial dysfunction that may be an important precursor of manifest cardiovascular disease. The aim of the present study was to determine whether the association between endothelial function and cardiovascular risk factors is different in self-reported healthy women compared to self-reported healthy men.Methods and ResultsAssociations between endothelial function (flow mediated dilation, FMD, of the brachial artery measured by ultrasound), anthropometric variables, peak oxygen uptake (VO2peak), blood pressure, serum lipids, blood glucose and a questionnaire on general health and lifestyle including smoking status were studied by logistic and linear regression in 2 528 women and 2 211 men aged 20–89 years, free from self-reported cardiovascular disease. In women with hyperglycemia, endothelial dysfunction (FMD ≤0%) occurred twice as frequently as in male counterparts. The presence of the metabolic syndrome, high blood pressure and low VO2peak increased the prevalence of endothelial dysfunction more in women than in men.ConclusionEndothelial dysfunction is more strongly associated with cardiovascular risk factors in self-reported healthy women than in self-reported healthy men. This finding could explain why the metabolic syndrome, and especially hyperglycemia, is associated with higher cardiovascular risk and a worse prognosis in women.

To investigate whether C-reactive protein (CRP, a general marker of inflammation), neopterin (activated macrophages), lactoferrin (activated neutrophils), and endothelial function (flowmediated vasodilation, FMD) are associated with cardiorespiratory fitness (peak oxygen uptake, VO2peak), gender, BMI and the metabolic syndrome in a healthy adult population. Patients and Methods:This was a cross-sectional association study based on the population-based HUNT3 Fitness Study performed from 05/15/2007 through 06/23/2008. Seven hundred and forty self-reported healthy respondents (307 women) identified with the metabolic syndrome were age-and sexmatched with 692 controls (327 women) from the same cohort. Associations between the inflammatory biomarkers and VO2peak, FMD, and the metabolic syndrome, were analyzed by multivariate linear and logistic regression. Results:CRP was negatively associated with VO2peak (P<.001), positively associated with the metabolic syndrome with a stronger effect in men (P<.001), positively associated with BMI with a stronger effect in women (P<.01), but not with FMD (P=.34). Lactoferrin was positively associated with the metabolic syndrome (P<.001), but neither neopterin nor lactoferrin were associated with VO2peak or FMD. Conclusion:CRP was strongly associated with VO2peak and the metabolic syndrome, but not with FMD.The associations between inflammation, VO2peak and the metabolic syndrome were strongly Alphabetical list of abbreviations BMI body mass index CAD coronary artery disease CRP C-reactive protein FMD flow-mediated dilation MetSyn metabolic syndrome VO2peak peak oxygen uptake

PurposePrevious studies show that the hospital environment and the behavior of health care personnel may predict patients’ perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients’ perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital.Patients and methodsA comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients’ care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05).ResultsThe patients rated PR of all four quality dimensions (the care organization’s physical-technical conditions and sociocultural approach and the caregivers’ medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients’ SI than on patients’ PR of the care in the new hospital, indicating a quality deficiency from the patients’ perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed.ConclusionThe increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients’ perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients’ perspective.

BackgroundOral tobacco (snuff) is taking a large market share in Scandinavia, especially with young users. However, long-term health effects are unknown. Small studies show association between snuff and reduced endothelial function, representing an early stage of vascular injury that often precedes manifest cardiovascular disease by several years. We therefore determined the associations between snuff and endothelial function in a large sample of healthy Norwegian men.Methods and DesignIn the Fitness substudy of the Nord-Trøndelag Health Study (HUNT3), endothelial function was measured by flow-mediated dilation (FMD). Aerobic fitness was measured by peak oxygen uptake (VO2peak). A cross-sectional design including 1 592 self-reported healthy men compared these observations with records of present tobacco use, standard cardiovascular risk factors, and socioeconomic status, using general linear models.ResultsFMD was lower in snuff users (FMD: 4.12%, 3.63, 4.61) compared to non-users (FMD: 4.52%, 4.27, 4.78) after adjustment for age (difference: -0.57%, -1.12, -0.01). After further adjustment for potential confounders, FMD still tended to be lower in snuff users than in non-users (difference: -0.53%, -1.09, 0.02). This difference was even more pronounced in the inactive snuff users (-0.83%, -1.59, -0.06) and in the low fit snuff users (-0.74%, CI -0.55, 0.079).ConclusionsOral tobacco is associated with a tendency towards reduced endothelial function, indicating vascular changes that precede cardiovascular disease. The strongest associations were found in men with low physical activity or reduced aerobic fitness.

BackgroundInsomnia is associated with increased risk of coronary heart disease (CHD), but the underlying mechanisms are not understood. To our knowledge, no previous studies have examined insomnia in relation to endothelial function, an indicator of preclinical atherosclerosis. Our aim was to assess the association of insomnia with endothelial function in a large population based study of healthy individuals.MethodsA total of 4 739 participants free from known cardiovascular or pulmonary diseases, cancer, and sarcoidosis, and who were not using antihypertensive medication were included in the study. They reported how often they had experienced difficulties falling asleep at night, repeated awakenings during the night, early awakenings without being able to go back to sleep, and daytime sleepiness. Endothelial function was measured by flow mediated dilation (FMD) derived from the brachial artery.ResultsWe found no consistent association between the insomnia symptoms and endothelial function in multiadjusted models, but individual insomnia symptoms may be related to endothelial function. Among women who reported early awakenings, endothelial function may be lower than in women without this symptom (p = 0.03).ConclusionsThis study provided no evidence that endothelial function, an early indicator of atherosclerosis, is an important linking factor between insomnia and CHD. Further studies are needed to explore the complex interrelation between sleep and cardiovascular pathology.