effects of exercise conditioning on vital age in hyperlipidemic women

Journal of

PHYSIOLOGICALANTHROPOLOGYand Applied Human Science

Original

Effects of Exercise Conditioning on Vital Age in Hyperlipidemic Women

Ryosuke Shigematsu1), Kiyoji Tanaka1), Hosung Nho2), Masaki Nakagaichi3),Masaki Takeda4), Tsugio Tomita5), Hideya Unno6) and Shuichi Ohkawa5)

1) Institute of Health and Sport Sciences and Center for Tsukuba AdvancedResearch Alliance (TARA), University of Tsukuba

2) College of Physical Education & Sport Science, University of Kyunghee3) Foundation for Advancement of International Science4) Department of Health and Exercise, Doshisha University5) Division of Cardiology, Higashi Toride Hospital6) Ushiku Aiwa Sogo Hospital

Abstract We attempted to determine the effectiveness ofexercise prescription for women with hyperlipidemia(HL), because some HL women showed no significantimprovement in serum lipid and lipoprotein profilesdespite the continuation of exercise conditioning. Wetherefore tested the hypothesis that exercise can beclinically beneficial even when there are no alterations intotal cholesterol (TC), low-density lipoprotein cholesterol(LDLC), and/or triglycerides (TG). Twenty-three womenwith HL (aged 54.3 ± 7.6 yr) participated in ouroutpatient-supervised exercise conditioning program for90 minutes each session, twice a week for 1 year, and alsodid home-based exercise three days a week. Vital age(VA) is a useful index for assessing functional status,especially the risk of coronary heart disease (CHD) and iscomputed from 11 independent variables measured notonly when a person is at rest but also during exercise.Although TC and LDLC did not change significantly afterthe exercise conditioning, TG decreased significantly (P <0.05). Furthermore, when we computed the corrected VA(VAc) assuming no changes in TC, LDLC, and TG, VAcwas found to decrease significantly from 64.0 ± 9.9 yr to58.4 ± 9.0 yr (P < 0.05). In conclusion, these resultsindicate the effectiveness of exercise conditioning on riskof CHD in HL women, irrespective of alterations in theconcentrations of serum lipid and lipoprotein. J PhysiolAnthropol 19 (6): 279-285, 2000 http://www.jstage.jst.go.jp/en/

Keywords: exercise, prescription, health status,hyperlipidemia, vital age

Introduction

Plasma lipids profiles, total cholesterol (TC), low-

density lipoprotein cholesterol (LDLC), and triglycerides(TG), are associated with an increased risk of coronaryheart disease (CHD) (Hartung et al., 1981). Variousnational organizations have established related goals andincreased their efforts to educate the public regarding therisks of hyperlipidemia (HL), part icularly whenassociated with atherosclerotic CHD (Expert Panel onDetection, Evaluation, and Treatment of High BloodCholesterol in Adults, 1993; Shibuya et al., 1996; StudyGroup, European Atherosclerosis Society, 1987). Acombination of diet and drug therapies may be useful toinduce beneficial changes in the concentrations ofcirculating lipid and lipoprotein. Exercise conditioninghas also been used to improve the concentrations ofserum lipid and lipoprotein. Numerous studies haveexamined the effects of exercise conditioning on theconcentrations of serum lipid and lipoprotein in middle-and old-aged men and women (Higuchi et al., 1988;Lampman and Schteingart, 1991; Seals et al., 1984).However, some HL women in previous studies (Leon etal., 1979; Motoyama et al., 1995) as well as in our recentobservation show no remarkable improvement in theseconcentrations despite the continuation of exerciseconditioning.

Biological or functional age (Chodzko-Zajko, 1994;Nakamura et al., 1988) has been proposed as an index ofhealth or aging status. Although these measures areimportant for identifying basic aging, they are based onthe assessment of various physiological factors. Recently,Tanaka et al. (1990) developed the concept of vital age(VA) which was a kind of biological age, and definedaging as the result of an interaction among many specificcharacteristics within an individual rather than that of asingle process. VA is derived from information not onlyin the resting state but also during exercise. Wepreviously reported its effectiveness in evaluating

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Effects of Exercise Conditioning on Vital Age in Hyperlipidemic Women280

exercise prescription in patients with CHD (Takeda et al.,1996; Tanaka et al., 1991; Tanaka et al., 1992; Tanaka etal., 1994) and hypertension (Nho et al., 1996). Thesedemonstrate that VA is useful for assessing functionalstatus, especially risk of CHD, not only for healthy peoplebut also for chronic disease patients with atherosclerosis,stroke, hypertension, diabetes, obesity, and so on.

In this study, we therefore tested the hypothesis, byusing the VA concept, that exercise can be clinicallybeneficial, even when there are no modifications inserum lipid and lipoprotein concentrations. Thisevaluation may provide a new approach to betterunderstanding the c l in ica l e f f icacy of exerc iseconditioning for reduction of risk of CHD in patient withHL.

Methods

SubjectsTwenty-three Japanese women (aged 41–71 yr) with HL

who were hospital outpatients of the division ofcardiology in Higashi Toride Hospital served as subjects.The study was approved by the Tsukuba Health FitnessEthics Committee, which was established in the abovehospital. All subjects signed informed consent thatsatisfied the ethical standards and described the nature ofthe study. They were diagnosed as having anginapectoris, myocardial infarction, hypertension, and/ortheir complexity (Table 1). The inclusion criteria for HLhaving CHD or HL having risks of CHD, which were basedupon the need for intervention, included a TC level of atleast 200 mg/dl, LDLC level of at least 130 mg/dl, and TGlevel of at least 150 mg/dl (Shibuya et al., 1996). Thecriteria for exclusion of the subjects were their criticalillness. Eighteen subjects were taking one or moremedications for HL, CHD, and hypertension, but theregimens were not significantly altered in any of thesubjects during the study.

In this study, we set two groups for statistical analyses,which were 4 months (4-mo) group and 1 year (1-yr)

Table 1 Distribution of clinical diagnoses and medications in thepresent subjects

Diagnosis Number Percentage

Angina pectoris 11 47.8Hypertension 10 43.5Angina pectoris & Hypertension 1 4.3Myocardial infarction & Hypertension 1 4.3

Medications Number Percentage

Diuretics (Thiazides) 7 30.4Calcium blockers 4 13.3ACE inhibitors 4 13.3Beta receptor blockers 3 10.0

group. Seven women continued for only 4 months,according to their wishes, and the other women (n = 16)continued for 1 year. This means the 4-mo groupconsisted of all the subjects (n = 23), and the 1-yr groupconsisted of 16 women. We collected the data at baseline,4 months, and 1 year. Controls were not recruited in thisstudy, because we attempted to compare two kinds ofdata intra-individually: one was a result that excludedalterations in the concentrations of serum lipid andlipoprotein, the other was a result that included thosealterations.

Experimental designBefore starting the exercise conditioning program, the

subjects underwent a symptom-limited graded exercisetest. Following two-minute of warm-up on a Monark cycleergometer at 0 watt, the power output was set at 15 wattsand then increased 15 watts every minute until thesubject experienced indications for termination of theexercise test (American College of Sports Medicine,1995). For detection of the lactate threshold (LT), venousblood samples (0.5 ml each) were taken each minuteduring the exercise test. The samples were drawn fromthe antecubital vein of the arm while the subjects werepedaling in the upright position. Blood lactate wasdetermined by the enzymatic-electrode method with alactate analyzer (YSI 1500 Sport, YSI Incorporation,Tokyo, Japan). The LT was conceptually defined as thepoint at which the rate of lactate production and diffusionexceeded the rate of its removal. This point wasdetermined graphically from a plot of the lactate levels bythe same laboratory technician, and taken as the workrate at which lactate increased in a non-linear manner.After completion of the exercise conditioning program,each patient underwent a protocol similar to the initialprogram evaluation and assessment.

Blood sampling and analysesAfter the subject fasted for a minimum of 12 hours,

blood samples of approximately 10 ml were collected inthe early morning by venipuncture from the antecubitalvein. The samples were then centrifuged to obtain theserum, which was stored at 4°C. All analyses werecompleted within 48 hours of the collection of the bloodsamples. The concentrations of both TC and TG in theserum were measured using enzymatic assays (DAOS,Wako Shiyaku). The high-density lipoprotein cholesterol(HDLC) in the serum was measured by heparin-manganese precipitation procedure (DAOS, KyowaMedics). The LDLC was calculated according to themethod of Friedewald et al. (1972) which assumes thatvery low-density lipoprotein cholesterol (VLDLC) is equalto TG/5 and that LDLC = TC – (HDLC + VLDLC). LDLC/HDLC ratio was calculated as atherogenetic index (AI).

281Shigematsu, R et al.

Experimental conditioningThe exercise conditioning program (Takeda et al., 1996;

Tanaka et al., 1992; Tanaka et al., 1994) consisted of 90minutes of supervised exercise two days a week and ahome-based program similar to that of the supervisedprogram done three days a week. The supervisedprogram consisted of five phases: (1) warm-up periodwith light calisthenics and stretching, (2) continuousupright aerobic and dynamic exerc ise (variouscombinations of walking, ergometer cycling, benchstepping, etc.) with exercise intensities corresponding tothe individual’s heart rate (± 10 b/min) and rating ofperceived exertion (± 2) (Borg, 1973) at the LT, (3) lowimpact aerobic dancing or ball games, (4) light muscularexercise, and (5) cool-down period with stretching. Thehome-based exercise program consisted of l ightcalisthenics, stretching, and walking that they wereinstructed during supervised exercise. The subjects wereasked to maintain their usual diet until post-test wascompleted.

Computation of vital ageTo test the hypothesis that exercise can be beneficial

even when there are no alterations in TC, LDLC, and TG,we used the concept of VA (Table 2) (Tanaka et al., 1990;Tanaka et al., 1994). The VA had been determined byusing a principal component analysis on 34 physical andphysiological variables in order to determine the primaryfactors responsible for the maintenance of health statusand/or aging. The VA is considered a more completeindex than either biological or functional age because VAincludes physiological measurements taken not only atrest but also during exercise. Tanaka et al. (1992)reported that VA was effective for evaluating not onlyhealth status but also the risk of CHD, and also suggestedthat exercise conditioning might improve physical healthstatus and reduce the risk of CHD as indicated by theindividual’s VA. In this study, we also computed thec or rec ted V A (VA c) , which was o bta ined a f terconsideration of no changes in TC, LDLC, and TG. Thismeans we calculated the VAc with results of TC, LDLC,

Table 2 Equation for calculating vital age (VA) of Ja

VA = 8.9VS + 49.0 + ZVS = – 1.035 + 0.016X1 + 0.011X2 – 0.064X3 – 0.01

0.037X9 – 0.005X10 – 0.367X11Z = 0.33CA – 16.17 (for age correction)

where X1 = abdominal girth (cm), X2 = systoliclactate threshold (ml/kg/min), X4 = heart rcholesterol (mg/dl), X6 = low-density lipoprotX8 = hematocrit (%), X9 = side-to-side stepping(s), and X11 = forced expiratory volume for 1 s

VS: vital score, Z: correction factor.

and TG in pre-exercise, and results of 8 other items inpost-exercise.

Followings are the test items and methods needed tocompute VA except those items we showed in theprevious sections.

Abdominal girth: The subject was asked to standupright with only outerwear. Abdominal girth wasassessed as the horizontal girth through the umbilicus byusing a tape measure.

Systolic blood pressure (SBP): Blood pressuremeasurements at rest were taken from the right brachialartery by the auscultatory method using a mercurysphygmomanometer. The subject was seated for at least 5min with their arms resting comfortably on a solidsurface. The systolic blood pressure was recorded at themoment when the first sound was heard.

Hematocrit : Samples were co llected from theantecubital vein into a single ethylene diamine-tetra-acetic acid tube. Hematocrit was measured by using thestandard centrifuge technique from the whole blood.

Side-to-side stepping: The subject stood astride themiddle line of three lines positioned at intervals of 1.0 m.The subject was instructed to step onto or beyond the left-side line. Next, the subject returned to the startingposition, following which the task was repeated with theright-side line. Performance was assessed by the numberof lines correctly stepped in 20 s.

Single-leg balance with eyes closed: The subject wasasked to put her hands at her waist, then gradually raisedh e r p r e f e r r e d f o o t , w i t h t h e k n e e e x t e n d e d ,approximately 20 cm above the floor, and then held thatposition. Performance was assessed in terms of time fromthe hold position until either a) the raised foot touchedeither her supporting leg or the ground, b) the supportingleg shifted, or c) either one or both hands came off herwaist.

Forced expiratory volume for 1 second: The subjectwas asked to exhale the volume of air inhaled as soon asand as much as possible. This was measured by using aFleisch pneumotachograph (ST-200, Fukuda Sangyo,Chiba, Japan).

panese women (Tanaka et al., 1990 &1994)

2X4 + 0.004X5 + 0.004X6 + 0.004X7 + 0.034X8 –

blood pressure (mmHg), X3 = oxygen uptake at theate at the lactate threshold (b/min), X5 = total

ein cholesterol (mg/dl), X7 = triglycerides (mg/dl), (n/20 s), X10 = single-leg balance with eyes closedecond (l).


Statistical analysisStatistically significant differences between mean VA

and mean chronological age (CA) in each group, andbetween the two VA means (pre- vs. post-) for each group,were tested using the Student’s paired t-test. They wereaccepted as statistically significant when the P value wasless than 0.05.

Results

The reductions in TG induced by the exerciseconditioning were significant for 4-mo and 1-yr groups (P

Table 3 Effects of the exercise conditioning progequation, serum lipids and lipoproteins, and mo

Variable 4-mo group

preAbdominal girth (X1) (cm) 88.2 ± 8.6SBP (X2) (mmHg) 150.6 ± 17.8VO2LT (X3) (ml/kg/min) 12.5 ± 2.3HRLT (X4) (b/min) 113.4 ± 21.1Hematocrit (X8) (%) 40.4 ± 4.1Stepping (X9) (n/20 s) 27.7 ± 6.9Balance (X10) (s) 14.2 ± 15.9FEV1.0 (X11) (l) 2.09 ± 0.36TC (X5) (mg/dl) 233.2 ± 29.5TG (X7) (mg/dl) 140.6 ± 61.5LDLC (X6) (mg/dl) 153.1 ± 33.1HDLC (mg/dl) 46.4 ± 14.9LDLC/HDLC 3.30 ± 1.50Height (cm) 152.0 ± 3.9Weight (kg) 54.6 ± 6.6

SBP: systolic blood pressure; Stepping: side-to-sidclosed. FEV1.0: forced expiratory volume for 1 secontein cholesterol; TG: triglycerides; HDLC: high-densi

.

Fig. 1 Pre-post comparisons of vital age in 4-mo

< 0.05), while no significant changes occurred in TC,LDLC, HDLC and AI (Table 3).

Both groups showed significant improvements in SBP,oxygen uptake at the LT (VO2LT), side-to-side stepping,and forced expiratory volume in 1 second (P < 0.05, Table3). The 4-mo group also showed significant improvementin single-leg balance with eyes closed (P < 0.05).

Before the exercise conditioning program in groups of4-mo and 1-yr, mean VA (pre-VA) (64.1 ± 9.8 yr and 63.9± 10.5 yr, respectively) was about 10 years higher thanmean CA (54.3 ± 7.8 yr and 53.9 ± 8.2 yr, respectively) (P< 0.05, Fig. 1). After the completion of the exercise

ram on composite variables (Xn) in the vital agerphological variables

(n = 23) 1-yr group (n = 16)

post pre post87.5 ± 7.6 87.0 ± 7.4 85.9 ± 7.2

140.1 ± 17.3* 147.9 ± 18.3 137.3 ± 16.9*15.1 ± 2.5* 12.6 ± 2.6 15.2 ± 2.9*

115.1 ± 15.6 108.7 ± 18.2 115.1 ± 15.940.4 ± 3.6 40.9 ± 3.7 40.3 ± 3.031.8 ± 6.4* 28.1 ± 6.6 34.9 ± 6.2*19.4 ± 13.2* 11.6 ± 15.0 22.0 ± 20.42.17 ± 0.33* 2.06 ± 0.39 2.09 ± 0.36*

230.4 ± 25.5 235.1 ± 28.7 236.9 ± 30.9106.1 ± 44.9* 130.2 ± 53.8 103.0 ± 50.5*155.8 ± 29.2 154.5 ± 32.8 153.4 ± 25.9

48.7 ± 14.3 49.5 ± 16.3 58.3 ± 18.73.20 ± 1.30 3.12 ± 1.27 2.63 ± 0.90

152.3 ± 3.854.0 ± 6.4 59.2 ± 11.3 58.0 ± 10.0

e stepping; Balance: single-leg balance with eyesd; TC: total cholesterol, LDLC: low-density lipopro-

ty lipoprotein cholesterol. *P < 0.05.

and 1-yr groups. *P < 0.05.

.


conditioning program, both groups showed significantreductions in VA (post-VA) (58.3 ± 8.7 yr and 56.9 ± 9.3yr, respectively) (P < 0.05). At post-test there were nosignificant differences between CA and post-VA in bothgroups.

Following the exercise program there were significantdifferences between pre-VA and VAc in both groups (P <0.05). These VAc in both groups (59.5 ± 8.9 yr and 57.9 ±9.7 yr, respectively) were higher than CA at post-test.However, differences were not significant (Fig. 1).

Discussion

The primary purpose of this study was to test thehypothesis that exercise could have a beneficial effect onthe VAc even when there were no alterations in TC,LDLC, and TG. We evaluated this hypothesis using twogroups: one group was observed for 4 months, and theother group for 1 year. This design could produce lessbias (e.g., avoidance of seasonal influences). Analysis ofthe data obtained in this study indicated that followingthe exercise conditioning program, the change in VAc forthe HL women reached a statistical significance.

In previous studies, regular exercise has been shown tolower TC, LDLC and TG (Despres et al., 1988; Despres etal., 1991; Lopez et al., 1974; Tremblay et al., 1991). Forinstance, Despres et al. (1991) found that at the end of a14-month protocol, obese premenopausal women showedsignificant decreases in TC (– 0.39 mmol) and LDLC (–0.39 mmol). Tremblay et al. (1991) found that at the endof a 29-month aerobic exercise program, obese womenshowed a mean decrease in TC of 40.5 mg/dl, a meandecrease in LDLC of 41.1 mg/dl, and a mean decrease inTG of 17.3 mg/dl (P < 0.05).

However, exercise conditioning does not always seemto improve serum lipids and lipoproteins. Leon et al.(1979) observed little improvement in these variablesamong obese young men after a vigorous walkingprogram. Motoyama et al. (1995) also reported non-significant changes for older men and women afterexercise training with an intensity at LT. It was suggestedfrom these studies that the reasons for no changes inserum lipids and lipoproteins were either (1) low exerciseintensity or (2) relatively normal ranges for thesevariables, or both. Takeda et al. (1996) reported thatfemale patients with CHD showed a significant reductionin TG at the 4-month period. However, the levels of TC,HDLC, and LDLC did not decrease significantly even aftera 1-year exercise conditioning program. These results aresimilar to our results. Furthermore, it should be kept inmind that these variables are affected, to some extent, bydrugs , heredity , reduced sensit iv ity to exerciseconditioning, and complexity of disease status. Althoughthe above reasons may be plausible, the specificmechanisms by which serum cholesterol levels change

with exercise remain unclear.The fact that serum lipids and lipoproteins have not

been favorably altered does not mean ineffectiveness ofthe exercise program. Because exercise training isdesigned to recover physical function and maintain thephysical condition (Tanaka et al., 1992; Tanaka et al.,1994), there may be the need to evaluate holistically theclinical outcomes. Indeed, some physical or physiologicalitems (e.g., SBP, VO2LT) would improve in such HLpatients as tested in this study. Epidemiological studiessuggest these variables such as SBP and VO2LT weresignificantly related to the risk of CHD (McMurray et al.,1998; Paffenbarger et a l. , 1993). Therefore, thesignificant decrease in VAc, which was calculatedassuming that there were no alterations in serum lipidsand lipoproteins throughout the exercise conditioning,also means the reduction in CHD risk.

Physicians or health care professionals, however,usually tend to focus on the primary factors of anydisease. Since the deviation from the improvement inhealth status ranges widely, it is important to evaluate theentire clinical profile changes as well as primary factorsof any disease. In this context, VAc as used in our studymay serve as a good clinical index for this purpose. Thesignificant decrease in VAc after exercise conditioning isalso suggestive of reduction in CHD risk. Our results alsoshowed a significant improvement in side-to-sidestepping and in forced expiratory volume, which mayhave important implications for physical status. Thesefindings agree well with our previous studies usingpatients with CHD (Takeda et al., 1996; Tanaka et al.,1991).

It should be noted that this study has two limitations.First, there was no control group to compare the effects ofour exercise conditioning program in 4-mo and/or 1-yrgroups. In this study we considered post-VA as the resultsof the control group, which was used for evaluating thechanges in TC, LDLC, and TG. This means that weevaluated the magnitude of the difference between post-VA (assumed as a control group) and VAc (assumed as anintervention group). As a result, it was found that themean differences (1.2 yr in 4-mo and 1.0 yr in 1-yr) werenot significant. Another limitation was that we did notdetect the influences of medications on changes in eachvariable. Recently, however, it is a usual approach tojudge the effects of an exercise conditioning programunder the influences of medications, because it is almostimpossible to thoroughly separate the influences ofmedications. In further research, it may be necessary tose t a contro l group consis t ing of sub jec ts wi thmedications and no exercise.

In summary, our findings support the hypothesis thatexercise conditioning is beneficial for HL women even inthe absence of any changes in the concentrations ins e r u m l ip i d a n d l i p o p r o t e i n l e v e l s . W e h a v e

.

.


demonstrated an alternative method for judging thesuccess of exercise conditioning in HL women. Theseresults can apply to the assessment of the effectiveness inthe routine exercise group as well as in chronic diseasepatients.

Acknowledgments Special thanks are given to al lmembers of Tsukuba Health Fitness Research Group fortheir tremendous aid in leading exercise and collectingthe data. This study was partly supported by TanakaProject of TARA (Tsukuba Advance Research Alliance) atUniversity of Tsukuba, and by a Grant-in-Aid for ScientificResearch, the Japan Ministry of Education, Science,Sports and Cul tu re (1995 -1996 Tanaka Pro ject#07458013 and 1997-1999 Tanaka Project #09480011).

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Received: June 21, 2000Accepted: October 6, 2000Correspondence to: Ryosuke Shigematsu, Institute ofHealth and Sport Sciences, University of Tsukuba, 1-1-1Tennodai, Tsukuba, Ibaraki 305-8574, Japane-mail: ryosuke@ taiiku.tsukuba.ac.jp

effects of exercise conditioning on vital age in hyperlipidemic women

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