Adrenaline increases skeletal muscle glycogenolysis, pyruvate dehydrogenase activation and carbohydrate oxidation during moderate exercise in humans

# 1.
To evaluate the role of adrenaline in regulating carbohydrate metabolism during moderate exercise, 10 moderately trained men completed two 20 min exercise bouts at 58 ± 2 % peak pulmonary oxygen uptake (̇V_o2,peak). On one occasion saline was infused (CON), and on the other adrenaline was infused intravenously for 5 min prior to and throughout exercise (ADR). Glucose kinetics were measured by a primed, continuous infusion of 6,6-[2H]glucose and muscle samples were obtained prior to and at 1 and 20 min of exercise.

# 2.
The infusion of adrenaline elevated (P < 0.01) plasma adrenaline concentrations at rest (pre-infusion, 0.28 ± 0.09; post-infusion, 1.70 ± 0.45 nmol l−1; means ±s.e.m.) and this effect was maintained throughout exercise. Total carbohydrate oxidation increased by 18 % and this effect was due to greater skeletal muscle glycogenolysis (P < 0.05) and pyruvate dehydrogenase (PDH) activation (P < 0.05, treatment effect). Glucose rate of appearance was not different between trials, but the infusion of adrenaline decreased (P < 0.05, treatment effect) skeletal muscle glucose uptake in ADR.

# 3.
During exercise muscle glucose 6-phosphate (G-6-P) (P = 0.055, treatment effect) and lactate (P < 0.05) were elevated in ADR compared with CON and no changes were observed for pyruvate, creatine, phosphocreatine, ATP and the calculated free concentrations of ADP and AMP.

# 4.
The data demonstrate that elevated plasma adrenaline levels during moderate exercise in untrained men increase skeletal muscle glycogen breakdown and PDH activation, which results in greater carbohydrate oxidation. The greater muscle glycogenolysis appears to be due to increased glycogen phosphorylase transformation whilst the increased PDH activity cannot be readily explained. Finally, the decreased glucose uptake observed during exercise in ADR is likely to be due to the increased intracellular G-6-P and a subsequent decrease in glucose phosphorylation.

Carbohydrate metabolism during exercise in females : effect of reduced fat availability

This study examined the effect of reduced plasma free fatty acid (FFA) availability on carbohydrate metabolism during exercise. Six untrained women cycled for 60 minutes at approximately 58% of maximum oxygen uptake after ingestion of a placebo (CON) or nicotinic acid (NA), 30 minutes before exercise (7.4 ± 0.5 mg·kg⁻¹ body weight), and at 0 minutes (3.7 ± 0.3 mg·kg⁻¹) and 30 minutes (3.7 ± 0.3 mg·kg⁻¹) of exercise. Glucose kinetics were measured using a primed, continuous infusion of [6,6-²H] glucose. Plasma FFA (CON, 0.86 ± 0.12; NA, 0.21 ± 0.11 mmol·L⁻¹ at 60 minutes, P < .05) and glycerol (CON, 0.34 ± 0.05; NA, 0.10 ± 0.04 mmol·L⁻¹ at 60 minutes, P < .05) were suppressed throughout exercise. Mean respiratory exchange ratio (RER) during exercise was higher (P < .05) in NA (0.89 ± 0.02) than CON (0.83 ± 0.02). Plasma glucose and glucose production were similar between trials. Total glucose uptake during exercise was greater (P < .05) in NA (1,876 ± 161 μmol·kg⁻¹) than in CON (1,525 ± 107 μmol·kg⁻¹). Total fat oxidation was reduced (P < .05) by approximately 32% during exercise in NA. Total carbohydrate oxidized was approximately 42% greater (P < .05) in NA (412 ± 40 mmol) than CON (290 ± 37 mmol), of which, approximately 16% (20 ± 10 mmol) could be attributed to glucose. Plasma insulin and glucagon were similar between trials. Catecholamines were higher (P < .05) during exercise in NA. In summary, during prolonged moderate exercise in untrained women, reduced FFA availability results in a compensatory increase in carbohydrate oxidation, which appears to be due predominantly to an increase in glycogen utilization, although there was a small, but significant, increase in whole body glucose uptake.

Effect of epinephrine on glucose disposal during exercise in humans: role of muscle glycogen

This study examined the effect of epinephrine on glucose disposal during moderate exercise when glycogenolytic flux was limited by low preexercise skeletal muscle glycogen availability. Six male subjects cycled for 40 min at 59 ± 1% peak pulmonary O₂ uptake on two occasions, either without (CON) or with (EPI) epinephrine infusion starting after 20 min of exercise. On the day before each experimental trial, subjects completed fatiguing exercise and then maintained a low carbohydrate diet to lower muscle glycogen. Muscle samples were obtained after 20 and 40 min of exercise, and glucose kinetics were measured using [6,6-²H]glucose. Exercise increased plasma epinephrine above resting concentrations in both trials, and plasma epinephrine was higher (P < 0.05) during the final 20 min in EPI compared with CON. Muscle glycogen levels were low after 20 min of exercise (CON, 117 ± 25; EPI, 122 ± 20 mmol/kg dry matter), and net muscle glycogen breakdown and muscle glucose 6-phosphate levels during the subsequent 20 min of exercise were unaffected by epinephrine infusion. Plasma glucose increased with epinephrine infusion (i.e., 20-40 min), and this was due to a decrease in glucose disposal (R_d) (40 min: CON, 33.8 ± 3; EPI, 20.9 ± 4.9 µmol · kg^-1 · min^-1, P < 0.05), because the exercise-induced rise in glucose rate of appearance was similar in the trials. These results show that glucose R_d during exercise is reduced by elevated plasma epinephrine, even when muscle glycogen availability and utilization are low. This suggests that the effect of epinephrine does not appear to be mediated by increased glucose 6-phosphate, secondary to enhanced muscle glycogenolysis, but may be linked to a direct effect of epinephrine on sarcolemmal glucose transport.

Regional specificity of exercise and calcium during skeletal growth in girls: a randomized controlled trial

Combining exercise with calcium supplementation may produce additive or multiplicative effects at loaded sites; thus, we conducted a single blind, prospective, randomized controlled study in pre- and early-pubertal girls to test the following hypotheses. (1) At the loaded sites, exercise and calcium will produce greater benefits than exercise or calcium alone. (2) At non-loaded sites, exercise will have no benefit, whereas calcium with or without exercise will increase bone mass over that in exercise alone or no intervention. Sixty-six girls aged 8.8 ± 0.1 years were randomly assigned to one of four study groups: moderate-impact exercise with or without calcium or low-impact exercise with or without calcium. All participants exercised for 20 minutes, three times a week and received Ca-fortified (434 ± 19 mg/day) or non-fortified foods for 8.5 months. Analysis of covariance (ANCOVA) was used to determine interaction and main effects for exercise and calcium on bone mass after adjusting for baseline bone mineral content and growth in limb lengths. An exercise-calcium interaction was detected at the femur (7.1%, p < 0.05). In contrast, there was no exercise-calcium interaction detected at the tibia-fibula; however, there was a main effect of exercise: bone mineral content increased 3% more in the exercise than non-exercise groups (p < 0.05). Bone mineral content increased 2-4% more in the calcium-supplemented groups than the non-supplemented groups at the humerus (12.0% vs. 9.8%, respectively, p < 0.09) and radius-ulna (12.6% vs. 8.6%, respectively, p < 0.01). In conclusion, greater gains in bone mass at loaded sites may be achieved when short bouts of moderate exercise are combined with increased dietary calcium, the former conferring region-specific effects and the latter producing generalized effects.

Carbohydrate ingestion reduces skeletal muscle acetylcarnitine availability but has no effect on substrate phosphorylation at the onset of exercise in man

This study investigated the effect of reduced acetylcarnitine availability on oxidative metabolism during the transition from rest to steady-state exercise. Eight male subjects completed two randomised exercise trials at 68 % of the peak rate of O2 uptake (V̇O2,peak). On one occasion subjects ingested 1 g (kg body mass)−1 glucose 75 min prior to exercise (CHO), whereas the other trial acted as a control (CON). Muscle samples were obtained pre- and 75 min post-ingestion, and following 1 and 10 min of exercise. Plasma glucose and insulin were elevated (P < 0.05), and plasma free fatty acids (FFA) were lower at the onset of exercise in CHO. Acetylcarnitine (CON, 4.8 ± 1.8; CHO, 1.5 ± 0.9 mmol (kg dry mass (d.m.))−1, P < 0.05) and acetyl CoA (CON, 13.2 ± 2.3; CHO, 6.3 ± 0.6 μmol (kg d.m.)−1, P < 0.05) were lower at rest, whereas pyruvate dehydrogenase activation (PDHa) was greater in CHO compared with CON (CON, 0.78 ± 0.07; CHO, 1.44 ± 0.19 mmol min−1 (kg wet mass (w.m.))−1). Respiratory exchange ratio (RER) was significantly elevated during exercise in CHO. The acetyl groups increased at similar rates at the onset of exercise (1 min) and there was no difference in substrate phosphorylation as determined from lactate accumulation and phosphocreatine degradation between trials. Subsequently, oxidative metabolism during the transition from rest to steady-state exercise was not affected by prior carbohydrate ingestion. Although exercise resulted in the rapid activation of PDH in both trials, PDHa was greater at 1 min in CHO (CON, 2.36 ± 0.22; CHO, 2.91 ± 0.18 mmol min−1 (kg w.m.)−1). No differences in muscle metabolite levels and PDHa were observed after 10 min of moderate exercise between trials. In summary, at rest, carbohydrate ingestion induced multiple metabolic changes which included decreased acetylcarnitine availability and small increases in PDHa. The prior changes in PDHa and acetylcarnitine availability had no effect on substrate phosphorylation and oxidative metabolism at the onset of exercise. These data suggest that acetylcarnitine availability is unlikely to be the site of metabolic inertia during the transition from rest to steady-state moderate intensity exercise.

Where pain = no gain : perspectives on sport, exercise and health, c. 1850-1920

A common perspective today is that sportspeople must train and compete to a level of exertion beyond the ‘pain threshold’ if they are to succeed; a view that has given rise to the popular expression ‘No Pain, No Gain’. Indeed, a common aphorism is that the health and quality of life of individuals and of the wider population is positively correlated with the frequency and vigour of physical exercise. In the period when modern sports were taking on their present characteristics (approximately 1850-1920), the prevailing opinions about the health and well-being effects of exercise were far more cautious, however. While the benefits of moderate exercise for physical and mental well-being went without question, too great an exertion was considered to be as risky as too little, causing ‘strain’ with the potential to inflict lasting and potentially fatal damage, including mental and physical complaints as diverse as neuralgia and ‘athletes’ heart’. The supposedly more strenuous sports, such as football, athletics and rowing, and the training required for them came under particular scrutiny in medical and popular discourses. This paper, an exercise in historical sociology, examines these discourses to demonstrate how advice about the risks on health of participating in sports and of too little or too much exercise more generally, was informed by prevailing physiological models and the interpretation of these within the medical profession and the wider population. The data sources include medical journals and texts, and sports training manuals from the period under investigation.

Role of exercise in the development of bone strength during growth

Exercise during growth may increase peak bone mass; if the benefits are maintained it may reduce the risk of fracture later in life (1). It is hypothesised that exercise will preferentially enhance bone formation on the surface of cortical bone that is undergoing bone modeling at the time (2). Therefore, exercise may increase bone mass accrual on the outer periosteal surface during the pre- and peri-pubertal years, and on the inner endocortical surface during puberty (3). An increase in bone formation on the periosteal surface is, however, more effective for increasing bone strength than medullary contraction (4). While exercise may have a role in osteoporosis prevention, there is little evidential basis to support this notion. It is generally accepted that weight-bearing exercise is important, but it is not known how much, how often, what magnitude or how long children need to exercise before a clinically important increase in bone density is obtained. In this thesis, the effect of exercise on the growing skeleton is investigated in two projects. The first quantifies the magnitude and number of loads associated with and in a moderate and low impact exercise program and non-structured play. The second project examines how exercise affects bone size and shape during different stages of growth. Study One: The Assessment of the Magnitude of Exercise Loading and the Skeletal Response in Girls Questions: 1) Does moderate impact exercise lead to a greater increase in BMC than low impact exercise? 2) Does loading history influence the osteogenic response to moderate impact exercise? 3) What is the magnitude and number of loads that are associated with a moderate and low impact exercise program? Methods: Sixty-eight pre-and early-pubertal girls (aged 8.9±0.2 years) were randomised to either a moderate or low impact exercise regime for 8.5-months. In each exercise group the girls received either calcium fortified (-2000 mg/week) or non-fortified foods for the duration of the study. The magnitude and number of loads associated with the exercise programs and non-structured play were assessed using a Pedar in-sole mobile system and video footage, respectively. Findings: After adjusting for baseline BMC, change in length and calcium intake, the girls in the moderate exercise intervention showed greater increases in BMC at the tibia (2.7%) and total body (1.3%) (p ≤0.05). Girl's who participated in moderate impact sports outside of school, showed greater gains in BMC in response to the moderate impact exercise program compared to the low impact exercise program (2.5 to 4.5%, p ≤0.06 to 0.01). The moderate exercise program included -400 impacts per class, that were applied in a dynamic manner and the magnitude of impact was up to 4 times body weight. Conclusion: Moderate-impact exercise may be sufficient to enhance BMC accrual during the pre-pubertal years. However, loading history is likely to influence the osteogenic response to additional moderate impact exercise. These findings contribute towards the development of school-based exercise programs aimed at improving bone health of children. Study Two: Exercise Effect on Cortical Bone Morphology During Different Stages of Maturation in Tennis Players Questions: 1) How does exercise affect bone mass (BMC) bone geometry and bone strength during different stages of growth? 2) Is there an optimal stage during growth when exercise has the greatest affect on bone strength? Methods: MRI was used to measure average total bone, cortical and medullary areas at the mid- and distal-regions of the playing and non-playing humerii in 47 pre-, peri- and post-pubertal competitive female tennis players aged 8 to 17 years. To assess bone rigidity, each image was imported into Scion Image 4.0.2 and the maximum, minimum and polar second moments of area were calculated using a custom macro. DXA was used to measure BMC of the whole humerus. Longitudinal data was collected on 37 of the original cohort. Findings: Analysis of the entire cohort showed that exercise was associated with increased BMC and cortical area (8 to 14%), and bone rigidity (11 to 23%) (all p ≤0.05). The increase in cortical bone area was associated with periosteal expansion in the pre-pubertal years and endocortical contraction in the post-pubertal years (p ≤0.05). The exercise-related gains in bone mass that were accrued at the periosteum during the pre-pubertal years, did not increase with advanced maturation and/or additional training. Conclusion: Exercise increased cortical BMC by enhancing bone formation on the periosteal surface during the pre-pubertal years and on the endocortical surface in the post-pubertal years. However, bone strength only increased in response to bone acquisition on the periosteal surface. Therefore the pre-pubertal years appear to be the most opportune time for exercise to enhance BMC accrual and bone strength

Adrenergic regulation of carbohydrate metabolism during exercise

1. This series of studies was undertaken to examine the adrenergic regulation of carbohydrate metabolism during exercise. Recreationally active males were tested during moderate to intense exercise on a stationary cycle ergometer. Venous and arterial plasma obtained from indwelling catheters was analysed for hormonal and metabolite responses, and hepatic glucose production and glucose uptake were measured using the tracer-dilution method with stable isotopes. Muscle samples were obtained by the needle biopsy technique to examine muscle glycogen utilisation and the flux of related muscle metabolites using enzymatic, fluorometric and radioisotopic techniques. 2. During moderate exercise adrenaline infusion induced a marked hyperglycemia and this was due to reduced glucose uptake rather than enhanced hepatic glucose production. The reduction in glucose uptake was most likely mediated by a decrease in glucose phosphorylation, as indicated by the accumulation of glucose 6-phosphate with adrenaline infusion. 3. The hyperglycemic response to intense exercise was prevented by the administration of α- and β-adrenergic antagonists. Adrenergic blockade was without effect on hepatic glucose production whereas glucose uptake was enhanced when compared with control subjects. These data support the notion that adrenergic mechanisms are more important in restraining glucose uptake than enhancing hepatic glucose production during intense exercise. Other glucoregulatory factors are responsible for the increase in glucose production during intense exercise. 4. Elevated plasma adrenaline levels during moderate exercise in untrained men increases skeletal muscle glycogen breakdown and PDH activation which results

Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders : a review of current evidence

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity and exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our review found that in respect to treatment of generalized anxiety or specific anxiety disorders, CAM evidence revealed support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the management of anxiety disorders.

Temporal dynamics of the circadian heart rate following low and high volume exercise training in sedentary male subjects

Purpose: Increased risk of arrhythmic events occurs at certain times during the circadian cycle with the highest risk being in the second and fourth quarter of the day. Exercise improves treatment outcome in individuals with cardiovascular disease. How different exercise protocols affect the circadian rhythm and the associated decrease in adverse cardiovascular risk over the circadian cycle has not been shown. Methods: Fifty sedentary male participants were randomized into an 8-week high volume and moderate volume training and a control group. Heart rate was recorded using Polar Electronics and investigated with Cosinor analysis and by Poincaré plot derived features of SD1, SD2 and the complex correlation measure (CCM) at 1-h intervals over the 24-h period. Results: Moderate exercise significantly increased vagal modulation and the temporal dynamics of the heart rate in the second quarter of the circadian cycle (p = 0.004 and p = 0.007 respectively). High volume exercise had a similar effect on vagal output (p = 0.003) and temporal dynamics (p = 0.003). Cosinor analysis confirms that the circadian heart rate displays a shift in the acrophage following moderate and high volume exercise from before waking (1st quarter) to after waking (2nd quarter of day). Conclusions: Our results suggest that exercise shifts vagal influence and increases temporal dynamics of the heart rate to the 2nd quarter of the day and suggest that this may be the underlying physiological change leading to a decrease in adverse arrhythmic events during this otherwise high-risk period.

Benefits of a year-long workplace weight loss program on cardiovascular risk factors

Objective: To assess the effectiveness of a year-long workplace weight loss program in reducing risk factors of coronary heart disease.

Design: A randomised, controlled study of low fat (25% of dietary energy) diet- and/or moderate exercise-induced weight loss interventions in free-living, middle-aged men. Compliance was monitored from food and activity diaries at monthly blood pressure measurement sessions. Blood was sampled and body composition determined from dual energy X-ray absorptiometry before and after 12 months.

Subjects and setting: Fifty-eight overweight men (mean [+ or -] SD age: 43.4 [+ or -] 5.7 years; BMI 29.0 [+ or -] 2.6 kg/[m.sup.2]), recruited from a national corporation, were instructed into diet (n = 18) exercise (a 21) or control (n = 19) groups over 12 months; 16 control subjects combined diet and exercise (n = 16) for the subsequent 12 months.

Main outcome measures: At 12 months, weight, total and regional fat and lean mass, dietary energy and percentage dietary fat intake, physical activity indices, systolic and diastolic blood pressure, serum insulin, blood lipids and lipoproteins.

Statistical analyses: Differences between groups were tested using analysis of variance with Scheffe post hoc test. Differences between pre- and post-intervention variables were tested using Students' paired t-tests. Pearson's correlation coefficient and univariate linear regression identified association between dependent variables, multiple stepwise regression identified specific predictors.

Results: Weight loss with either diet or exercise resulted in a reduction in systolic blood pressure (-3.3 [+ or -] 1.7%), diastolic blood pressure (-4.8 [+ or -] 1.3%) and LDL cholesterol (-3.9 [+ or -] 2.8%), a rise in HDL cholesterol (+10.0 [+ or -] 3.8%) and a change in the LDL/HDL ratio (-8.9 [+ or -] 3.5%). Abdominal fat loss (-26.8 [+ or -] 3.6% after diet; -16.6 [+ or -] 4.5% after exercise; -21.0 [+ or -] 4.7% after diet and exercise) was the strongest predictor of change in blood pressure: twenty percent abdominal fat loss predicted a percentage fall of 2.4 [+ or -] 0.05% in systolic blood pressure and 5.4 [+ or -] 0.07% in diastolic blood pressure. Greater abdominal fat loss was associated with the greatest decrease in serum insulin (P < 0.05).

Conclusion: Modest changes in diet and exercise effected by a low cost workplace-based education program achieved weight loss, loss of abdominal fat, reduced blood pressure and serum insulin and improved blood lipid concentrations. (Nutr Diet 2002;59:87-96)

Splanchnic blood flow and hepatic glucose production in exercising humans : role of renin-angiotensin system

The study examined the implication of the renin-angiotensin system (RAS) in regulation of splanchnic blood flow and glucose production in exercising humans. Subjects cycled for 40 min at 50% maximal O2 consumption (VO2 max) followed by 30 min at 70% VO2 max either with [angiotensin-converting enzyme (ACE) blockade] or without (control) administration of the ACE inhibitor enalapril (10 mg iv). Splanchnic blood flow was estimated by indocyanine green, and splanchnic substrate exchange was determined by the arteriohepatic venous difference. Exercise led to an ~20-fold increase (P < 0.001) in ANG II levels in the control group (5.4 ± 1.0 to 102.0 ± 25.1 pg/ml), whereas this response was blunted during ACE blockade (8.1 ± 1.2 to 13.2 ± 2.4 pg/ml) and in response to an orthostatic challenge performed postexercise. Apart from lactate and cortisol, which were higher in the ACE-blockade group vs. the control group, hormones, metabolites, VO2, and RER followed the same pattern of changes in ACE-blockade and control groups during exercise. Splanchnic blood flow (at rest: 1.67 ± 0.12, ACE blockade; 1.59 ± 0.18 l/min, control) decreased during moderate exercise (0.78 ± 0.07, ACE blockade; 0.74 ± 0.14 l/min, control), whereas splanchnic glucose production (at rest: 0.50 ± 0.06, ACE blockade; 0.68 ± 0.10 mmol/min, control) increased during moderate exercise (1.97 ± 0.29, ACE blockade; 1.91 ± 0.41 mmol/min, control). Refuting a major role of the RAS for these responses, no differences in the pattern of change of splanchnic blood flow and splanchnic glucose production were observed during ACE blockade compared with controls. This study demonstrates that the normal increase in ANG II levels observed during prolonged exercise in humans does not play a major role in the regulation of splanchnic blood flow and glucose production.

Forearm blood flow in individuals with CHF and age-matched healthy volunteers : a study and historical review

This study examined forearm blood flow (FBF) in individuals with chronic heart failure (CHF) at rest, moderate exercise, and following limb occlusion. FBF was measured by venous occlusion plethysmography in CHF patients (n = 43) and healthy age-matched volunteers (n = 8) at rest and during exercise consisting of intermittent isometric hand squeezing at 15, 30, and 45% of maximum voluntary contraction (MVC). Peak vasodilatory capacity was also determined following the release of an occluding arm cuff. FBF was lower in CHF patients during exercise and during peak reactive hyperemia (PRH) compared to healthy volunteers, but there was no significant difference between groups at rest. Peak vasodilatory capacity was significantly higher in healthy volunteers than the CHF group ((30.6 ± 8.6 ml±100 mL^-1±min^-1 and 18.3 ± 6.9 ml±100 mL^-1±min^-1, respectively). Local blood flow stimulation in response to exercise or limb occlusion is reduced in individuals with CHF, however, there was no difference in resting flows between the two groups, suggesting vasodilatory medication may restore resting blood flow to healthy values.

Nutritional intervention to prevent weight gain in patients commenced on olanzapine: a randomized controlled trial

Objective: Olanzapine is the most commonly prescribed atypical antipsychotic medication in Australia. Research reports an average weight gain of between 4.5 and 7 kg in the 3 months following its commencement. Trying to minimize this weight gain in a population with an already high prevalence of obesity, mortality and morbidity is of clinical and social importance. This randomized controlled trial investigated the impact of individual nutrition education provided by a dietitian on weight gain in the 3 and 6 months following the commencement of olanzapine.


Method: Fifty-one individuals (29 females, 22 males) who had started on olanzapine in the previous 3 months (mean length of 27 days ± 20) were recruited through Peninsula Health Psychiatric Services and were randomly assigned to either the intervention (n = 29) or the control group (n = 22). Individuals in the intervention group received six 1 hour nutrition education sessions over a 3-month period. Weight, waist circumference, body mass index (BMI) and qualitative measures of exercise levels, quality of life, health and body image were collected at baseline at 3 and 6 months.


Results: After 3 months, the control group had gained significantly more weight than the treatment group (6.0 kg vs 2.0 kg, p ≤ 0.002). Weight gain of more than 7% of initial weight occurred in 64% of the control group compared to 13% of the treatment group. The control group's BMI increased significantly more than the treatment group's (2 kg/m2vs 0.7 kg/m2, p ≤ 0.03). The treatment group reported significantly greater improvements in moderate exercise levels, quality of life, health and body image compared to the controls. At 6 months, the control group continued to show significantly more weight gain since baseline than the treatment group (9.9 kg vs 2.0 kg, p ≤ 0.013) and consequently had significantly greater increases in BMI (3.2 kg/m2vs 0.8 kg/m2, p ≤ 0.017).

Effects of strength, flexibility and moderate intensity cardiovascular exercise on measures of fitness in sedentary women

The maintenance of functional physical fitness across the lifespan depends upon the presence or absence of disease, injury, and the level of habitual physical activity. The prevalence of sedentariness rises with increasing age culminating in 31% of elderly women being classified as leading a sedentary lifestyle. Exercise prescription that involves easily accomplished physical activity may result in the maintenance of mobility into old age through a reduction in the risk of premature death and disablement from cardiovascular disease and a reduction in the risk of falls and injuries from falls. It may be that short bouts of physical activity are more appealing to the sedentary and to those in full time employment than longer bouts, and it may be that short bouts of exercise, performed three times per day, can improve physical fitness. The purpose of this study was therefore to examine the problem: Does exercise session duration, initial cardiovascular fitness, and age group effect changes in functional physical fitness in sedentary women training for strength, flexibility and aerobic fitness? Twenty-three, sedentary women aged between 19 and 54 years who were employed at a major metropolitan hospital undertook six weeks of moderate intensity physical activity in one of two training groups. Participants were randomly allocated to either short duration (3 x 10 minute), or long duration (30 minute), exercise groups. The 3 x 10 minute group (n=13), participated in three, 10 minute sessions per day separated by at least 2 hours, 3 days per week. The 30 minute group (n=10), participated in three 30 minute sessions per week. The total amount of work was similar, with an average of 129 and 148 kcal training day for the 3 x 10 minute and 30 minute groups, respectively. The training program incorporated three walking and stair climbing courses for aerobic conditioning, a series of eleven static stretches for joint flexibility, and isotonic and isometric strength exercises for lower and upper body muscular strength. Measures of functional strength, functional flexibility and cardiovascular fitness were assessed prior to training, and immediately following the six week exercise program. A two way analysis of variance (Group x Time) was used to examine the effect of training and group on the dependent variables. The level of significance, 0.05 was adopted for all statistical tests. Mean hand grip strength showed for both groups no significant change over time for the 3 x 10 minute group (30.7kg to 31.7kg) and 30 minute group (30.2kg to 32.4kg). Leg strength showed a trend for improvement (p=0.098) in both the 3 x 10 minute and 30 minute training groups representing a 15% and 18% improvement, respectively. Combined right and left neck rotation significantly improved in the 3 x 10 minute group (82.8° to 92.0°) and 30 minute group (82.5° to 91.5°). Wrist flexion and extension improved significantly in 3 out of the 4 measurements. Left wrist flexion improved significantly by an average of 7.0% for the 3 x 10 minute and 4.9% for the 30 minute group. Right and left wrist extension improved significantly in the 3 x 10 minute and 30 minute training groups (5.9% and 6.8%, respectively). Hip and spine flexibility improved 3.4cm (35.2cm to 38.6cm) in the 3 x 10 minute group, and 6.6cm (37.4cm to 44.0cm) in the 30 minute group. There was a significant improvement in cardiovascular fitness for both groups representing a 22% improvement in the 3 x 10 minute group (27.2 to 33.2 ml kg min), and a 25% improvement in the 30 minute group (27.5 to 34.4 ml -kg min). No significant difference was shown in the degree of improvement in cardiovascular fitness over six weeks of training for subjects of either low or moderate initial aerobic fitness. Grip strength showed no significant changes over time for either the young-aged (19-35 years) or middle-aged (36-54 years) groups. Leg strength showed a trend for improvement (p=0.093) in the young-aged group (63.5kg to 71.9kg) and middle-aged group (69.3kg to 85.8kg). Neck rotation flexibility improved a similar amount in both the young and middle aged groups representing an improvement of 9.9° and 8.0° respectively. There was significant improvement in two of the four measures of wrist flexibility. Hip and spine flexibility was significantly greater in the young-aged group compared to the middle-aged group (38.5cm and 30.7cm, respectively). There was a significant improvement in hip and spine flexibility over the six week training program representing an increase in reach of 6.5cm for the young age group and 4.9cm for the older group. The middle-aged subjects had significantly lower cardiovascular fitness than their younger peers, scoring 22.8 and 30.7 ml -kg min, respectively. Cardiovascular fitness improved a similar amount in both age groups representing a significant improvement of 23.8% and 28.1% for the younger-aged and middle-aged subjects, respectively. The findings of this study suggest that short bouts of exercise may be equally as effective as longer bouts of exercise for improving the flexibility and cardiovascular components of functional physical fitness in sedentary young and middle aged women. Additionally short bouts of exercise may be more attractive than longer bouts of exercise for the beginning exerciser as they may more easily fit into the busy lifestyle encountered by many people in today's society. Sedentary young and middle-aged women should benefit from static flexibility exercises designed to improve and/or maintain functional flexibility and thus maintain mobility and reduce the incidence of muscular injury. Regular, brisk walking, incorporating some stair climbing, is likely to be beneficial in improving cardiovascular health and perhaps also in improving leg strength, thereby helping to improve and maintain functional physical fitness for both young and middle-aged sedentary women.