Moderate-to-high-intensity training and a hypocaloric Mediterranean diet enhance endothelial progenitor cells and fitness in subjects with the metabolic syndrome

Abstract

A reduction in EPC (endothelial progenitor cell) number could explain the development and progression of atherosclerosis in the MetS (metabolic syndrome). Although much research in recent years has focused on the Mediterranean dietary pattern and the MetS, the effect of this diet with/without moderate-to-high-intensity endurance training on EPCs levels and CrF (cardiorespiratory fitness) remains unclear. In the present study, the objective was to assess the effect of a Mediterranean diet hypocaloric model with and without moderate-to-high-intensity endurance training on EPC number and CrF of MetS patients. Thus 45 MetS patients (50-66 years) were randomized to a 12-week intervention with the hypocaloric MeD (Mediterranean diet) or the MeDE (MeD plus moderate-to-high-intensity endurance training). Training included two weekly supervised sessions [80% MaxHR (maximum heart rate); leg and arm pedalling] and one at-home session (65-75% MaxHR; walking controlled by heart rate monitors). Changes in: (i) EPC number [CD34(+)KDR(+) (kinase insert domain-containing receptor)], (ii) CrF variables and (iii) MetS components and IRH (ischaemic reactive hyperaemia) were determined at the end of the study. A total of 40 subjects completed all 12 weeks of the study, with 20 in each group. The MeDE led to a greater increase in EPC numbers and CrF than did the MeD intervention (P ≤ 0.001). In addition, a positive correlation was observed between the increase in EPCs and fitness in the MeDE group (r=0.72; r(2)=0.52; P ≤ 0.001). Body weight loss, insulin sensitivity, TAGs (triacylglycerols) and blood pressure showed a greater decrease in the MeDE than MeD groups. Furthermore, IRH was only improved after the MeDE intervention. In conclusion, compliance with moderate-to-high-intensity endurance training enhances the positive effects of a model of MeD on the regenerative capacity of endothelium and on the fitness of MetS patients.

Exercise and oxidative stress: Potential effects of antioxidant dietary strategies in sports

“…Moderate wine supplementation to a high-fat diet increases plasma antioxidant capacity, decreases oxidative DNA damage, and normalizes endothelial function [56,58]. Adhesion to the Mediterranean diet together with moderate-to-high-intensity endurance training improve endothelial function in subjects with metabolic syndrome [59]. Specifically, a Mediterranean diet combined with moderate-to-high-intensity endurance training induced a greater decrease of body weight, insulin sensitivity, and blood pressure, while the number of endothelial progenitor cells and cardiorespiratory fitness showed a more marked increase, compared to the improvement of such M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 13 indices with adoption of the Mediterranean diet alone [59].…”

“…Adhesion to the Mediterranean diet together with moderate-to-high-intensity endurance training improve endothelial function in subjects with metabolic syndrome [59]. Specifically, a Mediterranean diet combined with moderate-to-high-intensity endurance training induced a greater decrease of body weight, insulin sensitivity, and blood pressure, while the number of endothelial progenitor cells and cardiorespiratory fitness showed a more marked increase, compared to the improvement of such M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 13 indices with adoption of the Mediterranean diet alone [59]. Data from the same group also confirm that the Mediterranean diet adoption combined with moderate-to-high intensity training may lead to greater improvement in quality of life indices and a marked weight loss, with a better physiological response to submaximal effort than the diet alone [60].…”

Specific Role of Impaired Glucose Metabolism and Diabetes Mellitus in Endothelial Progenitor Cell Characteristics and Function

“…86 In addition, a combination of statin and angiotensin receptor blocker seems to have a synergistic effect to increase the number and function of EPCs in DM. 85,87 Lifestyle modifications, including exercise 88 and weight reduction, 89 have also been shown to increase EPC number and function in patients with cardiovascular disease or DM.…”

Endothelial progenitor cells and vascular health: effects of lifestyle’s modifications

“…Tali dati sono stati poi confermati in una casistica più ampia di soggetti non diabetici con sindrome metabolica che hanno seguito un periodo di 12 settimane di dieta Mediterranea ipocalorica combinata o meno con un periodo di training fisico dimostrando un significativo aumento delle CEP circolanti dopo il periodo di dieta. Nel gruppo che applicava oltre alla dieta anche il protocollo di esercizio fisico l'incremento delle CEP risultava essere ancora più importante rispetto a coloro che applicavano solo la dieta [44].…”