Exercise

A review of 200 studies on depression and inflammation has concluded that depression and inflammation fuel one another, with inflammation playing a key role in the development of depression in some people, and depression priming greater physiological responses to stress.

Moreover, depression that is caused by chronic inflammation is resistant to traditional therapy methods. However, it is more responsive to activities such as yoga, meditation, omega-3 fatty acids, NSAIDS and exercise.

The review indicates that treatment for depression needs to consider its pathway. The researcher suggests that chronic inflammation is most common in individuals who have experienced stress in their lives, including lower socio-economic status or those who experienced abuse or neglect as children. Other contributing factors are a high-fat diet and high body mass index.

If inflammation is a significant factor, it needs to be treated in tandem with the depression.

http://www.eurekalert.org/pub_releases/2015-12/ru-icf121815.php

Kiecolt-Glaser, J. K., Derry, H. M., & Fagundes, C. P. (2015). Inflammation: Depression Fans the Flames and Feasts on the Heat. American Journal of Psychiatry, 172(11), 1075–1091. http://doi.org/10.1176/appi.ajp.2015.15020152

Stress, including sleep disturbance, is a major contributor to inflammation in the body. Insomnia is associated with increased risk for depression, medical comorbidities, and mortality.

A study involving 123 older adults (55+) with insomnia randomly assigned them to one of 3 types of classes: cognitive behavioral therapy for insomnia, tai chi, or a sleep seminar (the control condition).

Cognitive behavioral therapy for insomnia reduced insomnia symptoms and levels of the inflammation marker C-reactive protein, and reversed activation of molecular inflammatory signaling pathways. These benefits were maintained for 16 months.

Tai chi also reduced inflammation, reducing the expression of inflammation at the cellular level and reversing activation of inflammatory signaling pathways. It marginally reduced levels of C-reactive protein. Again, these benefits were maintained for 16 months.

Those participants assigned to the sleep seminar classes showed no significant changes in inflammatory markers, as expected.

http://www.eurekalert.org/pub_releases/2015-11/e-bsa110515.php

Irwin, M. R., Olmstead, R., Breen, E. C., Witarama, T., Carrillo, C., Sadeghi, N., … Cole, S. (2015). Cognitive Behavioral Therapy and Tai Chi Reverse Cellular and Genomic Markers of Inflammation in Late-Life Insomnia: A Randomized Controlled Trial. Biological Psychiatry, 78(10), 721–729. http://doi.org/10.1016/j.biopsych.2015.01.010

Telomeres are the protective caps at the ends of chromosomes that affect how quickly cells age. With age, they shorten, and as their structural integrity weakens, the cells age and die quicker. Telomere length thus is a biomarker of cellular age. Stress is also thought to shorten telomere length.

A year-long study that looked at the effects of three healthy behaviors in 239 post-menopausal, non-smoking women has found that women who engaged in lower levels of healthy behaviors showed a significantly greater telomere shortening for every major life stressor that occurred. However, stress didn't lead to greater shortening in those women who maintained active lifestyles, healthy diets, and good quality sleep.

Shorter telomeres have become associated with a broad range of aging-related diseases, including stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis diabetes, and many forms of cancer.

http://www.eurekalert.org/pub_releases/2014-07/uoc--hlm072414.php

Puterman, E., Lin, J., Krauss, J., Blackburn, E. H., & Epel, E. S. (2015). Determinants of telomere attrition over 1 year in healthy older women: stress and health behaviors matter. Molecular Psychiatry, 20(4), 529–535. http://doi.org/10.1038/mp.2014.70

A review of trials of interventions that sought to reduce sitting time has found the following strategies, among others, were 'promising':

• having sit-stand desks at work
• keeping records of your sitting time
• setting individual goals for limiting sitting time
• having prompts and cues to remind you to stop sitting
• learning about the health benefits of reducing sitting time
• getting feedback on your behavior
• restructuring your physical and social environment to support the behavior changes
• practising the new behavior
• working out how to solve any problems that arise from shifting to less sitting time
• having social support.

The researchers did note that the overall standard of the studies was poor, so we can't yet point to any clear strategy, but these provide a guide for action. They also noted that the more promising interventions involved a greater number of strategies — in other words, to be successful, you need to tackle this behavior change from a number of angles.

http://www.eurekalert.org/pub_releases/2015-09/kcl-sft092115.php

Gardner, B., Smith, L., Lorencatto, F., Hamer, M., & Biddle, S. J. (2016). How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults. Health Psychology Review, 10(1), 89–112. http://doi.org/10.1080/17437199.2015.1082146

A small study involving 11 non-obese, healthy men aged 20-35, has found that blood flow in leg arteries is significantly impaired after three hours of sitting, but not if they walk for five minutes every hour.

When people sit, slack muscles do not contract to effectively pump blood to the heart. Blood can pool in the legs and affect the endothelial function of arteries, or the ability of blood vessels to expand from increased blood flow. Impaired endothelial function is an early marker of cardiovascular disease.

In the study, participants sat for three hours without moving their legs, while the functionality of the femoral artery was taken at baseline and every hour. This showed that the expansion of the femoral artery as a result of increased blood flow was impaired by as much as 50% after just one hour.

In another session, they again sat for three hours, but also walked on a treadmill for 5 minutes at a speed of 2 mph at the 30-minute mark, 1.5-hour mark and 2.5-hour mark. In this case, arterial function stayed the same throughout the session.

http://www.eurekalert.org/pub_releases/2014-09/iu-tsw090514.php

Thosar, S. S., Bielko, S. L., Mather, K. J., Johnston, J. D., & Wallace, J. P. (2015). Effect of Prolonged Sitting and Breaks in Sitting Time on Endothelial Function: Medicine & Science in Sports & Exercise, 47(4), 843–849. http://doi.org/10.1249/MSS.0000000000000479

A Czech study involving 146 people with mild to moderate risk of cardiovascular disease has found that moderate wine drinking was only protective in people who exercised.

Participants were randomly assigned to one year of moderate consumption of red wine (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic. They had to keep a logbook on their consumption of wine and other alcoholic beverages, medication use, and amount and type of exercise. They were required to return the corks from the wine bottles to confirm that they had drank the wine rather than sold it.

The study was looking for a rise in HDL cholesterol, indicating a protective effect against cardiovascular disease. However, there was no change in HDL cholesterol levels by the end of the study in either the red or white wine groups. Nor did it appreciably affect blood glucose, triglycerides, or levels of inflammatory markers like C-reactive protein, although LDL cholesterol was lower in both groups while total cholesterol was lower only in the red wine group.

However, those participants who engaged in regular exercise at least twice a week did show an increase in HDL cholesterol, as well as a decrease in LDL and total cholesterol. This occurred in both red and white wine groups.

Of course, the study didn't include a control group of people engaging in regular exercise who didn't drink, so all we can really say (and it's certainly worth saying) is that moderate wine drinking doesn't seem to help protect against cardiovascular disease, and that despite all the hype around red wine, with its greater antioxidants and resveratol, there's no evidence it's any healthier than white wine.

http://www.eurekalert.org/pub_releases/2014-08/esoc-wop082614.php

http://www.theatlantic.com/health/archive/2014/09/working-with-the-wine-not-against-it/379504/

Taborsky M, Ostadal P, Petrek M. A pilot randomized trial comparing long-term effects of red and white wines on biomarkers of atherosclerosis (in vino veritas: IVV trial). Bratisl Lek Listy. 2012;113(3):156-158.

One big issue for which there is as yet no clear answer, is the question of whether it's the intensity or the amount of exercise which is more important.

One study involving 300 obese adults aimed to test this in a 6-month trial comparing those who maintained their usual activity level, those who did a low amount (around 30 minutes) of low-intensity exercise, those who did a high amount (around an hour) of low-intensity exercise, and those who did around 40 minutes of high-intensity exercise. All had five exercise sessions every week.

After 24 weeks of this, all the exercise groups showed smaller mean waist circumference and greater mean weight loss, compared to the control group, but there was no difference between the exercise groups in these measures. However, only the high-high group had lower 2-hour glucose levels than the controls, and only the two groups who did a higher amount of exercise had better insulin sensitivity.

Ross R et al. Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: A randomized trial. Ann Intern Med 2015 Mar 3; 162:325. (http://dx.doi.org/10.7326/M14-1189)

A study looking at the workout habits of more than 55,000 individuals for 15 years has concluded that running can reduce a person’s all-cause mortality rate by 30% and cardiovascular mortality rate by 45%. This equated to a difference of about three years of life.

But the really exciting news is that people who ran less than an hour each week showed the same mortality benefits compared to those who ran more than three hours in each week. Note that this is more about running, say, ten minutes every day, than only running once a week for a longer time! You don't have to run fast, either. Those running more slowly (< 6 miles/hour) got the same benefits.

Not running had about the same negative effect on life expectancy as having hypertension.

Around 24% of the participants did some running. The average age was 44.

http://www.futurity.org/even-short-slow-running-can-extend-lifespan/

Lee D, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk. J Am Coll Cardiol. 2014;64(5):472-481. doi:10.1016/j.jacc.2014.04.058.

A Canadian study involving 129 sedentary adults (aged 18-64) found that they tended to underestimate how hard they should be working to achieve levels of moderate and vigorous intensity while moving on a treadmill. This is despite being given commonly used exercise intensity descriptors.

The finding suggests that, while considerable thought has been given in developing physical activity guidelines, most people don't understand them well enough to use them.

For adults to achieve a moderate intensity, their heart rates should be within the range of 64-76% of their maximum heart rate and between 77-83% for vigorous intensity, according to the Canadian and global physical activity guidelines.

http://www.eurekalert.org/pub_releases/2014-06/yu-moe061614.php

Canning KL, Brown RE, Jamnik VK, Salmon A, Ardern CI, Kuk JL (2014) Individuals Underestimate Moderate and Vigorous Intensity Physical Activity. PLoS ONE 9(5): e97927. doi:10.1371/journal.pone.0097927

A small study involving 15 adults with moderate-to-severe obstructive sleep apnea and 19 controls with mild or no sleep apnea has found that predicted peak oxygen uptake (VO2), a measure of aerobic physical fitness, was significantly lower in those people with moderate to severe obstructive sleep apnea. Moreover, the number of times a person stopped breathing, for 10-seconds or more, per hour of sleep, predicted 16% of the variability observed in the group's peak VO2.

People who suffer from apnea are more likely to be obese and thus would be expected to be less fit as well, but even compared to people with similar BMI, the apnea patients had a reduced aerobic fitness. It's suggested that the sleep apnea itself causes structural changes in muscle that contributes to exercise problems.

VO2 max measurements may be an early marker for those who are at higher risk of stroke and heart attack

http://www.eurekalert.org/pub_releases/2014-12/aaos-sls120114.php

http://www.eurekalert.org/pub_releases/2014-11/uoc--sal112414.php

Beitler JR, Awad KM, Bakker JP, Edwards BA, DeYoung P, Djonlagic I, Forman DE, Quan SF, Malhotra A. Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study. J Clin Sleep Med 2014;10(11):1199-1204.