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In previous studies, we found an endothelial nitric oxide synthase gene ( NOS3 ) variant rs2070744 associated with the ambulatory blood pressure (BP) response following bouts of moderate and vigorous intensity acute exercise, termed post‐exercise hypotension (PEH). In a validation cohort, we sequenced NOS3 exons for associations with PEH. Obese (30.9 ± 3.6 kg . m −2 ) African American ( n = 14) [AF] and Caucasian ( n = 9) adults 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) performed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects were attached to an ambulatory BP monitor for 19 h. We performed deep‐targeted exon sequencing with the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for additional statistical analysis based upon Bonferonni or Benjamini–Yekutieli multiple testing‐corrected P ‐values under time‐adjusted linear models for 19 hourly BP measurements for each subject. After vigorous intensity over 19 h, among NOS3 variants passing multiple testing thresholds, as the #MA increased in rs891512 ( P = 6.4E‐04), rs867225 ( P = 6.5E‐04), rs743507 ( P = 2.6E‐06), and rs41483644 ( P = 2.4E‐04), systolic (SBP) decreased from 17.5 to 33.7 mmHg; and in rs891512 ( P = 9.7E‐05), rs867225 ( P = 2.6E‐05), rs41483644 ( P = 1.6E‐03), rs3730009 ( P = 2.6E‐04), and rs77325852 ( P = 5.6E‐04), diastolic BP decreased from 11.1 mmHg to 20.3 mmHg among AF only. In contrast, after moderate intensity over 19 h in NOS3 rs3918164, as the #MA increased, SBP increased by 16.6 mmHg ( P = 2.4E‐04) among AF only. NOS3 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. NOS3 should be studied further for its effects on PEH in a large, ethnically diverse sample of adults with hypertension to confirm our findings.

The preparedness of community facilities offering exercise programs to older adults is unknown. On-site evaluations were conducted by trained professionals to assess compliance of community older adult exercise programs with fitness-industry standards. Fourteen facilities were evaluated whose clientele (N = 2,172) were predominantly White (98%) women (87%) over 75 years of age (66%). Few of the 14 facilities required exercise participants to complete preactivity health questionnaires (n = 5), 3 administered informed consents, and none adhered to a medical-clearance policy. Only 2 facilities had defined emergency policies, and none conducted emergency drills. One site conducted exercise programs with instructors trained in cardiopulmonary resuscitation. Professionally certified exercise instructors leading all exercise programs were observed in 1 facility. Most facilities evaluated were noncompliant with existing professional health and fitness standards. The practicality of imposing such standards on community exercise programs for older adult requires further examination.

The authors wish to thank Dr. Weijers (1) for his insightful comments on our article (2). Dr. Weijers is correct that most genetic variants identified using genome-wide association studies (GWAS) are not yet currently used in clinical practice to predict disease risk. Manolio et al. (3) addressed this lack of clinical use in an exquisite review in Nature Reviews Genetics . Their review …

Background:Little information exists regarding the psychometric properties of question 8 (Q8) of the Paffenbarger Physical Activity Questionnaire (PPAQ) to assess exercise. Thus, we conducted 2 studies to assess the validity and test–retest reliability of Q8 among adults.Methods:Study 1 participants (n = 419) were 44.1 ± 16.1 years of age. Validity was determined by comparing self-reported hr·d−1 in sedentary, light, moderate, and vigorous intensity physical activity (PA) and MET-hr·wk−1 on Q8 at baseline to accelerometer and health/fitness measurements using Spearman rank-order correlations. Study 2 participants (n = 217) were 44.7 ± 16.3 years of age and completed Q8 at baseline, 3 months, and 6 months. Test–retest reliability was determined using repeated measures analysis of covariance, intraclass correlations (ICCs), and standard error of the measurement (SEM).Results:Q8 displayed good criterion validity compared with accelerometer measurements (r = .102 to .200, P < .05) and predictive validity compared with health/fitness measurements (r = –.272 to .203, P < .05). No differences were observed in self-reported hr·d−1 in any of the PA categories at baseline, 3 months, and 6 months (ICC: 0.49 to 0.68; SEM: 1.0 to 2.0; P > .05), indicating good reliability.Conclusion:Q8 demonstrates adequate criterion validity, acceptable predictive validity, and satisfactory test–retest reliability and can be used in conjunction with other components of the PPAQ to provide a complete representation of exercise.

to examine the influence of low-intensity, habitual physical activity on blood lipids and lipoproteins and other cardiovascular risk factors in older adults living at home.cross-sectional observational study.a convenience sample of healthy, older adults (n = 155) who were mainly non-Hispanic, white (96.8%), female (65.2%) and on medications for cardiometabolic-related disorders (60.6%) and had an average age of 74.2 +/- 0.5 years.we used a question from the Yale Physical Activity Survey to assess the typical number of hours per day spent in motion during the past month, collapsing responses into5 andor = 5 h/day. We determined blood lipids, lipoproteins and glucose with Kodak Ektachem serum oxidase assays or finger stick using the Cholestech LDX system enzymatic technique, and measured blood pressure by auscultation. Waist circumference was the indicator of abdominal fat distribution and body mass index the measure of overall adiposity.after adjusting for age, sex, adiposity, postprandial state, medication use and method of blood sampling, greater amounts of daily accumulated movement were associated with more favourable blood lipid-lipoprotein profiles. Subjects reportingor = 5 h of daily movement had higher levels of high-density lipoprotein cholesterol [mean difference (95% confidence interval): 0.23 mmol/l (0.07, 0.39); P = 0.002] and a lower ratio of total to high-density lipoprotein cholesterol [average difference: -0.92 (-1.36, -0.48); P = 0.003]. They had lower levels of low-density lipoprotein cholesterol [mean difference: -0.39 mmol/l (-0.80, 0.03); P = 0.074)] and a lower ratio of triglyceride to high-density lipoprotein cholesterol [mean difference: -1.31 (-2.50, -0.12); P = 0.059]. Total cholesterol was similar in the two groups (P0.05). The mean blood glucose was 1.49 mmol/l lower (-2.67, -0.31) in the more active group (P = 0.02), independent of age, sex, adiposity, medication use and postprandial state.low-intensity, habitual physical activity is a sufficient stimulus to enhance blood lipids/lipoproteins and glucose in older adults, independent of abdominal and overall adiposity.

Take home message A behaviourally based lifestyle physical activity intervention in combination with dietary intervention appears as effective as a structured exercise regimen in promoting physical activity in previously sedentary overweight and obese persons, concomitantly improving their cardiometabolic health profile through a healthier body weight. These findings are encouraging because this approach removes many of the commonly reported barriers to sustained participation in structured exercise training programmes in a group of adults in need of its cardiometabolic health benefits. In the last decade, the numbers of overweight (body mass index (BMI) >25 kg/m2) and obese (BMI >30 kg/m2) people have substantially increased in Canada, New Zealand, the United Kingdom, the United States, and Western Samoa.1 The prevalence of obesity in the United States has grown from 12.0% in 1991 to 17.9% in 1998.2 Recent reports indicate that overweight and obese adults now comprise the majority of the American population with 54.9% persons reporting a BMI >25 kg/m2. These alarming trends have led to the declaration of a global obesity epidemic.3,4 Overweight and obesity have become so common that they are replacing the more traditional health problems of undernutrition and infectious diseases as significant causes of poor health world wide.3 Excess weight is associated with numerous diseases and conditions including cardiovascular disease, Type 2 diabetes mellitus, hypertension, dyslipidaemia, osteoarthritis, sleep apnoea, gallbladder disease, infertility, and some cancers.5 The direct and indirect costs of obesity are considerable, with the associated expenses representing 7% of the national health care budget in the United States, 7% in the Netherlands, 4% in France, and 2% in Australia.6 Clearly, overnutrition is a serious health hazard world wide with significant financial expense. Our genetic pool has not been altered dramatically over the past 10 years. Consequently, …

The purpose of this study was to garner expert opinion from health care (HC) (n = 68) and non-HC (n = 15) managers on the issues likely to impact the work of entry level physical therapists and qualities for employment success. Students enrolled in a professional phase physical therapy (PT) course conducted 83 manager interviews. The authors arrived at consensus regarding manager opinions on important HC issues and qualities for employment success with a modified Delphi technique. The Chi-square test was used to determine if HC issues and employment qualities differed among the managers' professions and settings. PT managers (n = 50) found ancillary staff use to be a more important HC issue than did other HC managers (n = 18), 68.0% versus 27.8%, respectively (p = 0.009). Otherwise, PT managers were similar to other HC managers in their opinions on the pertinent HC issues. HC managers reported business skills to be not as essential for career success as non-HC managers did (n = 15), 22.1% versus 66.7%, re...

Dynamic exercise acutely and transiently lowers resting blood pressure in hypertensive men and is termed postexercise hypotension (PEH). We examined 18 premenopausal women (7 hypertensive and 11 normotensive) to determine if PEH occurs in women and to elucidate possible hemodynamic and hormonal mechanisms.Patients wore an ambulatory blood pressure monitor throughout the day after 40 minutes of a rest sham session and 40 minutes of cycle exercise, of which 30 minutes was performed at 60% of maximal oxygen consumption. Cardiac output and total systemic vascular resistance were determined by Doppler echocardiography before and 15 minutes after sham and exercise. Catecholamines, plasma renin activity, and beta-endorphin were measured over this same period. PEH occurred only in the hypertensive women. Systolic, diastolic, and mean arterial blood pressure decreased in the hypertensive women by a mean of 9.5 +/- 2. 8 mm Hg (P.01), 6.7 +/- 2.4 mm Hg (P.05), and 7.7 +/- 2.4 mm Hg (P.05), respectively, for up to 7 hours after versus before exercise, whereas blood pressure was similar in the normotensive women (P.05). After exercise, total systemic vascular resistance was lower (P.01), and cardiac output, catecholamines, and plasma renin activity were greater (P.01) than before exercise in both groups of women.PEH was observed for up to 7 hours after exercise in mildly hypertensive women and was not explained by the hemodynamic and hormonal adjustments that occurred after exercise. The magnitude and duration of PEH may be sufficient to normalize the blood pressure of certain hypertensive women throughout most of the day.

Cardiometabolic disease is a major cause of disability and death among older people. The scientific evidence purporting the cardiometabolic health benefits of moderate intensity, habitual physical activity among older adults has grown in recent years. Regular, moderate intensity physical activity is associated with lower resting blood pressure, less abdominal adiposity, improved blood lipids-lipoproteins and glucose homeostasis and reduced mortality and morbidity from coronary heart disease. Although more vigorous intensity exercise confers similar cardiometabolic health benefits, it predisposes older people to increased risk of injury and sudden death. Older adults prefer to engage in light to moderate intensity physical activities such as walking and activities of daily living. For these reasons, a cardiometabolic approach to exercise prescription is presented emphasising daily accumulated, familiar and enjoyable light to moderate intensity, aerobic physical activity supplemented by resistive exercise for the functionally able older adult.

The purposes of this investigation were to evaluate the characteristics of three consecutive menstrual cycles and to determine the frequency ofluteal phase deficiency (LPD) and anovulation in a sample of sedentary and moderately exercising, regularly menstruating women. For three consecutive menstrual cycles, subjects collected daily urine samples for analysis of FSH, estrone conjugates (E1C), pregnanediol-3-glucuronide (PdG), and creatinine (Cr). Sedentary (n=11) and exercising (n=24) groups were similar in age (27.0+/-1.3 yr), weight (60.3+/-3.1 kg), gynecological age (13.8+/-1.2 yr), and menstrual cycle length (28.3+/-0.8 days). Menstrual cycles were classified by endocrine data as ovulatory, LPD, or anovulatory. No sedentary women (0%) had inconsistent menstrual cycle classifications from cycle to cycle, but 46% of the exercising women were inconsistent. The sample prevalence of LPD in the exercising women was 48%, and the 3-month sample incidence was 79%. In the sedentary women, 90% of all menstrual cycles were ovulatory (SedOvul; n=28), whereas in the exercising women only 45% were ovulatory (ExOvul; n=30); 43% were LPD (ExLPD; n=28), and 12% were anovulatory (ExAnov; n=8). In ExLPD cycles, the follicular phase was significantly longer (17.9+/-0.7 days), and the luteal phase was significantly shorter (8.2+/-0.5 days) compared to ExOvul (14.8+/-0.9 and 12.9+/-0.3 days) and SedOvul (15.9+/-0.6 and 12.9+/-0.4 days) cycles. Luteal phase PdG excretion was lower (P < 0.001) in ExLPD (2.9+/-0.3 microg/mg Cr) and ExAnov (0.8+/-0.1 microg/mg Cr) cycles compared to SedOvul cycles (5.0+/-0.4 microg/mg Cr). ExOvul cycles also had less (P < 0.01) PdG excretion during the luteal phase (3.7+/-0.3 microg/mg Cr) than the SedOvul cycles. E1C excretion during follicular phase days 2-5 was lower (P=0.05) in ExOvul, ExLPD, and ExAnov cycles compared to SedOvul cycles and remained lower (P < 0.02) in the ExLPD and ExAnov cycles during days 6-12. The elevation in FSH during the luteal-follicular transition was lower (P < 0.007) in ExLPD (0.7+/-0.1 ng/mg Cr) cycles compared to SedOvul and ExOvul cycles (1.0+/-0.1 and 1.1+/-0.1 ng/mg Cr, respectively). Energy balance and energy availability were lower (P < 0.05) in ExAnov cycles than in other menstrual cycle categories. The blunted elevation in FSH during the luteal-follicular transition in exercising women with LPD may explain their lower follicular estradiol levels. These alterations in FSH may act in concert with disrupted LH pulsatility as a primary and proximate factor in the high frequency of luteal phase and ovulatory disturbances in regularly menstruating, exercising women.

The purpose of this study was to examine whether leptin levels affect the response of leptin to exercise training (ET) and whether this is also affected by C-reactive protein (CRP) or the three common Apolipoprotein E genotypes (APOE). Ninety-seven (male = 45, female = 52) sedentary individuals underwent 6 months of supervised ET. Blood was sampled before the initiation of ET, and again 24 and 72 hr after completion of the final training session. ET resulted in a small reduction in body mass (80.47 ± 18.03 vs 79.42 ± 17.34 kg, p < .01). Leptin was reduced 24 hr after the final exercise session (p < .01), but returned to normal after 72 hr (p > .05)—Pre: 13.51 ± 12.27, 24hr: 12.14 ± 12.34, 72hr: 12.98 ± 11.40 ng/ml. The most hyperleptinemic individuals had a greater initial response, which was sustained through to 72 hr after the final session in the pooled study population (p < .01), and in both males (p < .05) and females (p < .05) separately. CRP was related to leptin independently of body weight and positively related to the reductions in leptin. APOE genotype was not related to leptin levels and did not affect the response to ET. Leptin levels may only be reduced by ET in those with hyperleptinemia. In addition, both the initial extent of hyperleptinemia and the subsequent reduction in leptin may be related to low grade chronic systemic inflammation.

The purpose of the present report was to examine whether proprotein convertase subtilisin/kexin type 9 (PCSK9) levels differ in individuals who do not exhibit expected reductions in low density lipoprotein cholesterol (LDL-C) with statin therapy. Eighteen nonresponder subjects treated with 80 mg atorvastatin treatment for 6 months without substantial reductions in LDL-C (ΔLDL-C: 2.6 ± 11.4%) were compared to age- and gender-matched atorvastatin responders (ΔLDL-C: 50.7 ± 8.5%) and placebo-treated subjects (ΔLDL-C: 9.9 ± 21.5%). Free PCSK9 was marginally higher in nonresponders at baseline(P=0.07)and significantly higher in atorvastatin responders after 6 months of treatment(P=0.04). The change in free PCSK9 over 6 months with statin treatment was higher(P<0.01)in atorvastatin responders (134.2 ± 131.5 ng/mL post- versus prestudy) than in either the nonresponders (39.9 ± 87.8 ng/mL) or placebo subjects (27.8 ± 97.6 ng/mL). Drug compliance was not lower in the nonresponders as assessed by pill counts and poststudy plasma atorvastatin levels. Serum PCSK9 levels, both at baseline and in response to statin therapy, may differentiate individuals who do versus those who do not respond to statin treatment.

Purpose. The American Association of Cardiopulmonary Rehabilitation (AACVPR) established guidelines for cardiac rehabilitation (CR) personnel regarding educational degree attainment, licensure, and certification. New England hospitalbased CR personnel were surveyed by staff position to determine their adherence to these guidelines. Methods. The New England Hospital-Based CR Program Questionnaire was designed to obtain information regarding program characteristics and personnel credentialing. Initially, 117 program directors agreed to participate, and 108 returned completed questionnaires for a response rate of 92.3%. Results. Of the CR programs surveyed, 41% were within hospitals containing 101 to 250 beds, whereas most of those providing inpatient (66.6%) and outpatient (82.4%) CR enrolled less than 200 patients annually. Overall, 40.7% of personnel (n = 450) by staff position reported that they met the minimum recommendations, whereas 7.0% (n = 470) met the preferred AACVPR recommendations. Registered nurses (n = 67) and physical therapists (n = 58) were most compliant with the minimum guidelines: 89.6% and 84.5%, respectively. In contrast, 10.9% of the program directors/coordinators (PD/C; n = 128) met the minimum qualifications, and 5.5% met the preferred AACVPR qualifications. Most PD/C had Advanced Cardiac Life Support Certification (84.4%), but few (18%) attained American College of Sports Medicine (ACSM) certification. Conclusions. Overall, compliance of New England hospitalbased CR personnel with the AACVPR minimum/preferred guidelines for educational degree and certification was lacking, as was acquisition of ACSM certification. The effect of these findings on the future status of recommended and required CR personnel qualifications for hire merits attention.

OBJECTIVE: We tested the reproducibility of changes in the ambulatory blood pressure (BP) from the initial values, an indicator of BP reactivity and cardiovascular health outcomes, in young, healthy adults. METHOD: The subjects wore an ambulatory BP monitor attached by the same investigator at the same time of day until the next morning on two different days (day 1 and day 2) separated by a week. We compared the ambulatory BP change from the initial values at hourly intervals over 24 waking and sleeping hours on days 1 and 2 using linear regression and repeated measures analysis of covariance. RESULTS: The subjects comprised 88 men and 57 women (mean age±SE 22.4±0.3 years) with normal BP (118.3±0.9/69.7±0.6 mmHg). For the total sample, the correlation between the ambulatory BP change on day 1 vs. day 2 over 24, waking, and sleeping hours ranged from 0.37-0.61; among women, the correlation was 0.38-0.71, and among men, it was 0.24-0.52. Among women, the ambulatory systolic/diastolic BP change was greater by 3.1±1.0/2.4±0.8 mmHg over 24 hours and by 3.0±1.1/2.4±0.8 mmHg over waking hours on day 1 than on day 2. The diastolic ambulatory BP change during sleeping hours was greater by 2.2±0.9 mmHg on day 1 than on day 2, but the systolic ambulatory BP change during sleeping hours on days 1 and 2 did not differ. Among men, the ambulatory BP change on days 1 and 2 did not differ. CONCLUSION: Our primary findings were that the ambulatory BP change from the initial values was moderately reproducible; however, it was more reproducible in men than in women. These results suggest that women, but not men, may experience an alerting reaction to initially wearing the ambulatory BP monitor.

Background The present study was designed to determine the effect of short-term moderate-intensity exercise training on arterial stiffness in patients with chronic kidney disease (CKD) stage 3. Study Design Randomized controlled trial with a parallel-group design. Setting & Participants Testing and training sessions were performed at Springfield College. 46 (treatment group, n=25; control group, n=21) patients with CKD with diabetes and/or hypertension completed the study. Intervention The aerobic training program consisted of 16 weeks of supervised exercise training at 50%-60% peak oxygen uptake (Vo 2peak ) 3 times per week, while the control group remained sedentary. Identical testing procedures were performed following the 16-week intervention. Outcomes The primary outcome was arterial stiffness. Secondary outcomes were aerobic capacity, various blood parameters (endothelin 1, nitrate/nitrite, and high-sensitivity C-reactive protein), and health-related quality of life. Measurements Arterial stiffness was assessed with aortic pulse wave velocity (PWV), aerobic capacity by Vo 2peak , blood parameters by enzyme-linked immunosorbent assays, and health-related quality of life by the 36-Item Short Form Health Survey (SF-36). Participants attended 4 sessions before being randomly assigned to either the treatment or control group. Participants gave consent during the first session, whereas a graded exercise test with measurement of Vo 2peak was completed during the second session. During sessions 3 and 4, aortic PWV was measured at rest prior to 40 minutes of either moderate-intensity exercise training or seated rest. A venous blood sample was obtained prior to exercise or rest and participants completed the SF-36 questionnaire. Results 16 weeks of training led to an 8.2% increase in Vo 2peak for the treatment group ( P =0.05), but no changes in aortic PWV . Limitations Randomization was not concealed and was violated on one occasion; also, use of an indirect measurement of endothelial function and the short duration of the intervention. Conclusions Short-term moderate-intensity exercise training does not alter arterial stiffness in patients with CKD, but seems to reduce endothelin 1 levels.

The present study examined if increases in creatine kinase (CK) levels during high-dose atorvastatin treatment are associated with changes in skeletal muscle function and symptoms.The Effect of Statins on Muscle Performance study (STOMP) investigated the effects of atorvastatin 80 mg daily for 6 months on muscle performance, exercise capacity, and the incidence of statin-associated muscle complaints in healthy adults.CK levels increased with atorvastatin (n = 202) from 132.3 ± 120.9 U/L (mean ± SD) at baseline to 159.7 ± 170.4 and 153.1 ± 139.4 U/L at 3 and 6 months, respectively (P ≤ 0.002 for both). Changes in CK with atorvastatin treatment were not associated with changes in muscle function or the incidence of myalgia. More subjects on atorvastatin (n = 24) compared to placebo (n = 12 of 217) doubled their CK level at 6 months (P = 0.02). No differences in muscle function or physical activity were observed between atorvastatin-treated subjects who did or did not double their CK.Results of the present investigation extend the findings of STOMP by demonstrating that greater increases in CK levels with high-dose atorvastatin treatment did not deleteriously impact skeletal muscle function or predict skeletal muscle complaints. This study was registered at ClinicalTrials.gov (NCT00609063).

AB Purpose: An osteopontin (OPN; SPP1) gene promoter polymorphism modifies disease severity in Duchenne muscular dystrophy, and we hypothesized that it might also modify muscle phenotypes in healthy volunteers. Methods: Gene association studies were carried out for OPN (rs28357094) in the FAMuSS cohort (n = 752; mean +/- SD age = 23.7 +/- 5.7 yr). The phenotypes studied included muscle size (MRI), strength, and response to supervised resistance training. We also studied 147 young adults that had carried out a bout of eccentric elbow exercise (age = 24.0 +/- 5.2 yr). Phenotypes analyzed included strength, soreness, and serum muscle enzymes. Results: In the FAMuSS cohort, the G allele was associated with 17% increase in baseline upper arm muscle volume only in women (F = 26.32; P = 5.32 x 10-7), explaining 5% of population variance. In the eccentric damage cohort, weak associations of the G allele were seen in women with both baseline myoglobin and elevated creatine kinase. The sexually dimorphic effects of OPN on muscle were also seen in OPN-null mice. Five of seven muscle groups examined showed smaller size in OPN-null female mice, whereas two were smaller in male mice. The query of OPN gene transcription after experimental muscle damage in mice showed rapid induction within 12 h (100-fold increase from baseline), followed by sustained high-level expression through 16 d of regeneration before falling to back to baseline. Conclusion: OPN is a sexually dimorphic modifier of muscle size in normal humans and mice and responds to muscle damage. The OPN gene is known to be estrogen responsive, and this may explain the female-specific genotype effects in adult volunteers.

We found variants from the Angiotensinogen‐Converting Enzyme ( ACE ), Angiotensin Type 1 Receptor ( AGTR1 ), Aldosterone Synthase ( CYP11B2 ), and Adducin ( ADD1 ) genes exhibited intensity‐dependent associations with the ambulatory blood pressure (BP) response following acute exercise, or postexercise hypotension (PEH). In a validation cohort, we sequenced exons from these genes for their associations with PEH. Obese (30.9 ± 3.6 kg m −2 ) adults ( n = 23; 61% African Americans [AF], 39% Caucasian) 42.0 ± 9.8 years with hypertension (139.8 ± 10.4/84.6 ± 6.2 mmHg) completed three random experiments: bouts of vigorous and moderate intensity cycling and control. Subjects wore an ambulatory BP monitor for 19 h. We performed deep‐targeted exon sequencing using the Illumina TruSeq Custom Amplicon kit. Variant genotypes were coded as number of minor alleles (#MA) and selected for further statistical analysis based upon Bonferonni or Benjamini–Yekutieli multiple testing corrected p‐values under time adjusted linear models for 19 hourly BP measurements per subject. After vigorous intensity over 19 h among ACE , AGTR1 , CYP11B2 , and ADD1 variants passing multiple testing thresholds, as the #MA increased, systolic (SBP) and/or diastolic BP decreased 12 mmHg ( P = 4.5E‐05) to 30 mmHg ( P = 6.4E‐04) among AF only. In contrast, after moderate intensity over 19 h among ACE and CYP11B2 variants passing multiple testing thresholds, as the #MA increased, SBP increased 21 mmHg ( P = 8.0E‐04) to 22 mmHg ( P = 8.2E‐04) among AF only. In this replication study, ACE , AGTR1 , CYP11B2 , and ADD1 variants exhibited associations with PEH after vigorous, but not moderate intensity exercise among AF only. Renal variants should be explored further with a multi‐level “omics” approach for associations with PEH among a large, ethnically diverse sample of adults with hypertension.

Older adults represent the fastest-growing age demographic of the population. Physiological changes associated with primary aging and concurrent chronic disease adversely impact functional capacity, health outcomes, and quality of life. For these reasons, there is a national emphasis for healthcare providers to improve the health, function, and quality of life of older adults to preserve independent living and psychological well-being. The benefits of regular physical activity or exercise with regard to aging and disease are indisputable, yet many clinicians do not prescribe exercise to older adults. This reluctance may be attributable to a lack of knowledge regarding appropriate exercise prescription for older adults in light of the potential risks and benefits of various doses and types of exercise. In addition, clinicians and patients may have concerns about potential health considerations relevant to older adults such as comprehensive pre-exercise screening and exercise-drug interactions. In light of this, the following review presents (1) guidelines for exercise prescription in older adults and modification of these guidelines for patients with the most common age-associated comorbidities; (2) recommendations for pre-exercise screening prior to initiating an exercise program in older adults; (3) considerations for older adults on one or more medications; and (4) common barriers to adopting and maintaining exercise in an older population. Our goal is to provide a framework that clinicians can follow when prescribing exercise in older adults while considering the unique characteristics and concerns present in this population.

Purpose We investigated the influence of Leptin ( LEP ) and leptin receptor ( LEPR ) SNPs on habitual physical activity (PA) and body composition response to a unilateral, upper body resistance training (RT) program. Methods European-derived American volunteers (men = 111, women = 131, 23.4 ± 5.4 yr, 24.4 ± 4.6 kg·m − 2 ) were genotyped for LEP 19 G>A (rs2167270), and LEPR 326 A>G (rs1137100), 668 A>G (rs1137101), 3057 G>A (rs1805096), and 1968 G>C (rs8179183). They completed the Paffenbarger PA Questionnaire. Arm muscle and subcutaneous fat volumes were measured before and after 12 wk of supervised RT with MRI. Multivariate and repeated measures ANCOVA tested differences among phenotypes by genotype and gender with age and body mass index as covariates. Results Adults with the LEP 19 GG genotype reported more kcal/wk in vigorous intensity PA (1273.3 ± 176.8, p = 0.017) and sports/recreation (1922.8 ± 226.0, p LEP 19 GG genotype spent more h/wk in light intensity PA (39.7 ± 1.6) than A allele carriers (35.0 ± 1.4, p = 0.03). In response to RT, adults with the LEPR 668 G allele gained greater arm muscle volume (67,687.05 ± 3186.7 vs. 52,321.87 ± 5125.05 mm 3 , p = 0.01) and subcutaneous fat volume (10,599.89 ± 3683.57 vs. − 5224.73 ± 5923.98 mm 3 , p = 0.02) than adults with the LEPR 668 AA genotype, respectively. Conclusion LEP 19 G>A and LEPR 668 A>G associated with habitual PA and the body composition response to RT. These LEP and LEPR SNPs are located in coding exons likely influencing LEP and LEPR function. Further investigation is needed to confirm our findings and establish mechanisms for LEP and LEPR genotype and PA and body composition associations we observed.

Ankyrin repeat domain 6 (ANKRD6) is a ubiquitous protein that associates with early development in mammals and is highly expressed in the brain, spinal cord, and heart of humans. We examined the role of 8 ANKRD6 single-nucleotide polymorphisms (SNPs) on muscle performance and habitual physical activity (PA). Single-nucleotide polymorphisms were 545 T>A (rs9362667), 485 M>L (rs61736690), 233 T>M (rs2273238), 128 I>L (rs3748085), 631 P>L (rs61739327), 122 Q>E (rs16881983), 197805 G>A (rs9344950), and 710 L>X (NOVEL). This study consisted of 922 healthy, untrained, European-derived American men (n = 376, 23.6 ± 0.3 years, 25.0 ± 0.2 kg·m-2) and women (n = 546, 23.2 ± 0.2 years, 24.0 ± 0.2 kg·m-2). Muscle strength (maximum voluntary contraction [MVC] and 1 repetition maximum [1RM]) and size (cross-sectional area [CSA]) were assessed before and after 12 weeks of unilateral resistance training (RT). A subsample (n = 536, 23.4 ± 0.2 years, 24.6 ± 0.2 kg·m-2) completed the Paffenbarger Physical Activity Questionnaire. Associations among ANKRD6 genotypes and muscle phenotypes were tested with repeated measure analysis of covariance (ANCOVA) and PA phenotypes with multivariate ANCOVA, with age and body mass index as covariates. ANKRD6 122 Q>E was associated with increased baseline biceps CSA. ANKRD6 545 A>T and ANKRD6 710 L>X were associated with increased 1RM and MVC in response to RT, respectively. ANKRD6 631 P>L was associated with increased biceps CSA response to RT and time spent in moderate-intensity PA among the total sample and women. ANKRD6 genetic variants were associated with the muscle size and strength response to RT and habitual PA levels. Further research is needed to validate our results and explore mechanisms for the associations we observed.

Introduction Orthostatic hypotension (OH) occurs among several populations; elevated temperatures increase an individual's susceptibility, whereas the effect of sleep loss (SL) remains inconclusive. The purpose was: 1) to evaluate the effects of 10 d of heat acclimation (HA) and 28 h of SL on OH; and 2) to determine the best measurements to assess OH in clinical and field settings. Methods There were 11 men (mean +/- SD; age, 20 +/- 1 yr; mass, 81.7 +/- 12.2 kg) who underwent a repeated measures research design. Before and after 90 min of HA, with the 11th day performed in conjunction with SL, subjects performed a lie-to-stand test where blood pressure (BP), heart rate (HR), and OH signs and symptoms were obtained. Results OH incidence and intensity, assessed via acute changes in post-exercise systolic BP (SBP), significantly decreased during HA from Day 2 (15 +/- 12 mmHg) to Day 8 (8 +/- 8 mmHg), while SL showed no effect. As OH responses decreased, concomitant HR increases diminished from Day 2 (113 +/- 15 bpm) to Day 8 (103 +/- 14 bpm). Post-exercise lightheadedness, dizziness, and nausea significantly decreased from Day 2 to Day 8, while no changes were associated with SL. Conclusions During HA, BP control improved and cardiovascular strain was reduced, along with OH signs and symptoms; mild SL had no measurable effect. Acute HR changes may be explained by decreased cardiac output and increased stroke volume. In clinical settings, SBP delta may indicate the threshold at which OH signs and symptoms arise. In the absence of a sphygmomanometer, HR taken upon standing, or ratings of lightheadedness and dizziness may be used as alternative field expedient techniques.

Objective. We examined the influence of missense polymorphism, endothelial nitric oxide synthase (NOS3) +894 G>T (rs1799983), on habitual physical activity (PA) and the muscle strength response to resistance training (RT). Methods. Men (n=354) and women (n=424; 24.3±8.0 yr) were genotyped. Subjects reported hr/wk in vigorous and light intensity PA and sitting on the Paffenbarger PA questionnaire. One repetition maximum assessed muscle strength. Multivariable and repeated measures ANCOVA tested differences among NOS3 +894 G>T and PA and RT phenotypes by gender. Results. hr/wk in vigorous intensity PA (5.4±1.2 versus 8.3±0.4; P=0.019), more hr/wk in light intensity PA (42.1±2.4 versus 35.8±0.7; P=0.011), and less hr/wk sitting (37.6±2.8 versus 45.8±0.9; P=0.006) than those with the G allele. Women with NOS3 +894 TT gained more absolute (4.4±0.3 versus 3.7±0.8 kg; P=0.013) and relative (78.3±5.8 versus 61.9±1.8%; P=0.007) strength than those with the G allele. Conclusions. NOS3 +894 G>T associated with PA among men and women and the muscle strength response to RT among women only. Our findings indicate the need for prospective studies examining the influence of NOS3 variants on PA and the muscle response to RT as well as elucidating underlying mechanistic pathways for the associations observed.