Thesis (M Sport Sc (Sport Science))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: It is well-known that acute and chronic aerobic and resistance exercise results in decreased blood pressure (BP) in hypertensive individuals. There is little evidence that water exercise has a similar effect on BP response. There is also no certainty regarding the magnitude and duration of post exercise hypotension (PEH) after either land or water-based exercise. Most studies were also performed under controlled laboratory conditions and very few characterised the PEH response under real life conditions. The current study endeavoured to examine the magnitude and duration of PEH after an acute session of water- and land-based exercise during free living conditions in persons with mild to moderate hypertension. Twenty-one men and women (aged 52 ± 10 years) volunteered for the study. All participants were pre-hypertensive or hypertensive. Participants completed a no exercise control session, a water exercise session and a combined aerobic and resistance land exercise session in random order. After all three sessions, participants underwent 24 hour monitoring using an Ergoscan ambulatory BP monitoring device. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were monitored to determine changes from resting values after each session and to compare the PEH responses between land and water exercise. Overall, the land exercise treatment caused a 3.6 mmHg lower average SBP over 24 hours than the control treatment (P = 0.04). The average difference over 24 hours between the water and control treatments was 2.2 mmHg and between land and water exercise it was 1.5 mmHg (P > 0.05). During daytime, both land and water exercise resulted in significantly lower SBP (12.7 and 11.3 mmHg) compared to the control session (2.3 mmHg). The PEH response lasted for 24 hours after land exercise and nine hours after water exercise. There was no difference in the daytime DBP for the three treatments (P > 0.05). Although all three groups showed significant reductions during night time, both exercise treatments showed greater nocturnal falls in SBP, DBP and MAP than the control treatment. / AFRIKAANSE OPSOMMING: Dit is alombekend dat akute en chroniese aërobiese- en weerstandsoefening tot ‘n afname in bloeddruk (BD) lei in persone met hipertensie. Daar is egter min getuienis dat wateroefening dieselfde effek op die bloeddruk respons het. Daar is ook nie sekerheid oor die grootte en duur van post-oefening hipotensie na water- of landoefening nie. Die meeste studies is onder gekontrolleerde laboratorium omstandighede gedoen en min resultate is beskikbaar onder alledaagse lewensomstandighede. Die huidige studie het gepoog om die grootte en duur van die post-oefening hipotensie respons in persone met ligte tot matige hipertensie onder alledaagse omstandighede na ‘n akute sessie van water- en landgebaseerde oefening te ondersoek. Een-en-twintig mans en vrouens (ouderdom 52 ± 10 jaar) het ingewillig om aan die studie deel te neem. Alle deelnemers was hipertensief of pre-hipertensief. Alle deelnemers het ‘n kontrolesessie, ‘n wateroefeningsessie en ‘n gekombineerde aërobiese en weerstands landoefensessie, in lukrake volgorde, voltooi. Na elke sessie het die deelnemers 24 uur bloeddrukmonitering met ‘n Ergoscan wandelende bloeddruk monitor ondergaan. Sistoliese bloeddruk (SBD), diastoliese bloeddruk (DBD), gemiddelde arteriële bloeddruk en harttempo (HT) is gemonitor om die veranderinge vanaf rustende waardes na elke sessie te bepaal en om die hipotensiewe respons na land- en wateroefening te vergelyk. Landoefening het ‘n 3.6 mmHg laer gemiddelde SBD oor 24 uur tot gevolg gehad in vergelyking met die kontrolesessie (P = 0.04). Die gemiddelde verskil oor 24 uur tussen die water- en kontrolesessies was 2.2 mmHg en 1.5 mmHg tussen die land en water oefensessies (P > 0.05). Gedurende die dag het beide die land- and wateroefening gelei tot beduidende laer SBD (12.7 en 11.3 mmHg) in vergelyking met die kontrolesessie (2.3 mmHg). Die post-oefening hipotensie het 24 uur geduur na die landoefening en nege uur na die wateroefening. Daar was geen verskil in DBD gedurende die dag tussen die drie groepe nie (P > 0.05).

No description available.

Abstract Physical activity with regular physical exercise (PE) has long been advocated because it lowers morbidity and mortality. However, there have been concerns about a transiently increased risk of adverse cardiac events such as sudden cardiac death (SCD) during PE. Our aim was to identify risk factors related to SCD during PE and clarify the effect of PE on cardiovascular well-being in the general population. In study I we found out that male gender as well as coronary artery disease (CAD), cardiac hypertrophy and myocardial scarring as autopsy-findings were clearly more common among exercise-related SCD. Typical northern activities in skiing and snow shoveling were among the three most common types of PE alongside cycling. In study II we analyzed the previously recorded electrocardiograms (ECG) of victims of SCD. Fragmented QRS complex (fQRS) in anterior leads was a common finding among subjects who died during exercise, especially among subjects with a prior diagnosis of CAD. In study III, we collected retrospectively out-of-hospital sudden cardiac arrest (SCA) data in Northern Ostrobothnia between the years 2007 and 2012. The subjects who suffered SCA in relation to PE were younger and previously healthier, and they had more often a shockable rhythm as the initial rhythm. There was a markedly better prognosis for hospital discharge when SCA occurred during PE. In study IV, we noticed a decrease in cardiac mortality in subjects who were physically active or became active during follow-up in a population of 1,746 stable CAD patients. A similar effect could be seen affecting SCD mortality. No increase in cardiac mortality could be seen among those with the highest levels of habitual PE. In conclusion, ischemic heart disease and male gender, especially when fQRS is present in anterior leads, are characteristics related to exercise-related SCD. On the other hand, when SCA takes place during PE, the prognosis is markedly better compared to SCA occurring at rest. An active lifestyle is also linked to decreased cardiac mortality. / Tiivistelmä Säännöllinen aktiivinen elämäntapa on yhteydessä pienempään fyysisten ja psyykkisten sairauksien riskiin. Tutkimuksissa on kuitenkin havaittu raskaampaan liikuntaan liittyvä väliaikaisesti lisääntynyt akuutin sydäntapahtuman, kuten äkkikuoleman, riski. Väitöskirjatutkimuksessa tutkitaan rasitukseen liittyvän sydänperäisen äkkikuoleman erityispiirteitä ja fyysisen aktiivisuuden merkitystä hyvinvoinnille. Ensimmäisessä osajulkaisussa havaittiin, että rasitukseen liittyvissä kuolemissa oli ruumiinavauslöydöksenä merkittävästi enemmän sepelvaltimotautia, sydänlihaksen arpeutumista ja sydänlihaksen liikakasvua verrattuna äkkikuolemiin levossa. Miessukupuoli oli selkeästi yliedustettuna rasituspopulaatiossa, sillä peräti 94 % oli miehiä. Yleisimmät rasitusmuodot olivat hiihto, pyöräily ja lumenluonti. Toisessa osatutkimuksessa tutkittiin edeltävien EKG-muutosten yhteyttä rasitusperäisiin äkkikuolemiin. Havaitsimme, että QRS-kompleksin pirstoutuminen etuseinäkytkennöissä oli selkeästi yleisempi löydös rasitusryhmässä. Tämä löydös oli erityisen merkittävä sepelvaltimotautipotilailla. Kolmas julkaisu sisältää tiedot sairaalan ulkopuolisista sydänpysähdyksistä Pohjois-Pohjanmaalla vuosina 2007–2012. Tässä aineistossa havaitsimme, että rasitukseen liittyvän sydänpysähdyksen alkurytmi oli useammin defibrilloitava, potilaat olivat nuorempia ja terveempiä, ja maallikkoelvytys aloitettiin useammin. Rasituksessa elottomaksi menneillä oli suhteellisen hyvä selviämisennuste. Neljännessä tutkimuksessa havaitsimme selkeästi paremman ennusteen niillä stabiilia sepelvaltimotautia sairastaneilla, jotka olivat liikunnallisesti aktiivisia. Sydänperäinen kuolleisuus oli pienempi myös niillä potilailla, jotka onnistuivat lisäämään liikunnallista aktiivisuuttaan. Samankaltainen tulos todettiin sydänperäisten äkkikuolemien osalta. Sepelvaltimotauti ja miessukupuoli ovat hyvin yleisiä löydöksiä, kun sydänperäinen äkkikuolema tapahtuu rasituksessa. Myös QRS-kompleksin pirstoutuminen etuseinäkytkennöissä liittyi rasitusperäisiin kuolemiin. Toisaalta potilaan ennuste selvitä on selkeästi parempi sydänpysähdyksen tapahtuessa rasituksessa. Osoitimme myös, että liikunnallinen aktiivisuus ja sen pienikin lisäys parantavat sepelvaltimotautipotilaiden ennustetta.

Thesis, Aix-Marseille. / Includes bibliographical references.

Proefschrift Maastricht. / Auteursnaam op omslag: Jack van der Meulen. Met lit. opg. - Met een samenvatting in het Nederlands.

Proefschrift Universiteit Maastricht. / Auteursnaam op omslag: Adwin Hoogeveen. Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.

Fortschreitendes Alter geht häufig mit Leistungsabnahmen in kognitiven Aufgaben einher. Eine steigende Anzahl Studien zeigt, dass regelmäßige körperliche Aktivität negativen Alterseffekten entgegenwirken kann und somit zur Erhaltung kognitiver und zerebraler Funktionen im Alter beiträgt. Die vorliegende Dissertation untersuchte im Rahmen eines Ausdauertrainings die Zusammenhänge zwischen Veränderungen in der körperlichen Fitness und Veränderungen in Gehirn und Verhalten bei älteren Erwachsenen. Studie I zeigt, dass zuvor gefundene Vergrößerungen des Hippocampus auf Änderungen der Mikrostruktur des zugrundeliegenden Gewebes zurückgeführt werden können. Die Probanden, die ihre Fitness am meisten verbesserten, zeigten auch die stärkste Verdichtung des Hippocampusgewebes. Die Verdichtung des Gewebes stand wiederum in positivem Zusammenhang mit der Veränderung im Hippocampusvolumen. Diese Ergebnisse weisen darauf hin, dass Veränderungen im Volumen aus einer Vermehrung der Zellmembranen resultieren und nicht aus der Ausdehnung bereits vorhandener Zellen. In Studie II hingen Veränderungen in der Fitness zusammen mit Veränderungen in der Mikrostruktur eines präfrontalen Traktes der weißen Substanz, nämlich dem Forceps minor. Gleichermaßen hingen die Veränderungen in der Mikrostruktur des Forceps minor mit Veränderungen in einem zusammengesetzten Maß fluider kognitiver Fähigkeiten zusammen. Dieses Ergebnis zeigt, dass Veränderungen in der Mikrostruktur der weißen Substanz möglicherweise zu den positiven Auswirkungen von körperlicher Aktivität auf kognitive Fähigkeiten beitragen. Studie III zeigt, dass Veränderungen der Fitness positiv mit Veränderungen der neuronalen Spezifität korrelieren, welches als indirektes Maß für dopaminerge Neuromodulation angenommen wird. Zusammenfassend erweitern die Ergebnisse dieser Dissertation die Literatur über positive Effekte von körperlicher Aktivität auf Alterungsprozesse und stärken den Kenntnisstand über zugrundeliegende Mechanismen. / Advanced age has been consistently linked to performance deterioration in cognitive tasks targeting the ability to mentally manipulate information. A growing body of literature suggests that regular physical exercise alleviates the adverse effects of age and helps to preserve cognitive and cerebral capacities in old age. The present dissertation investigated associations between changes in fitness and changes in cerebral and cognitive measures within a group of older adults who participated in an exercise intervention. Paper I shows that previously reported increases in hippocampal volume can be linked to exercise-induced changes in the underlying tissue microstructure. The participants who improved most in fitness showed most increments in hippocampal tissue density. Changes in tissue density were in turn positively associated with changes in hippocampal volume. This finding suggests that volumetric changes result from an increase in the bulk of cell membranes, and not from a mere dilation of existing cells. In Paper II, changes in fitness were associated with changes in the microstructure of a prefrontal white matter tract, namely the forceps minor. Likewise, changes in forceps minor microstructure were related to changes in a composite score of fluid cognitive abilities. This result indicates that changes in white matter microstructure may contribute to the beneficial effects of exercise on cognition. Paper III demonstrates that changes in fitness are positively correlated with changes in neural specificity, presumably an indirect marker of dopaminergic neuromodulation. In summary, findings from the present dissertation extend the literature on beneficial effects of exercise on age-related deterioration and add knowledge regarding the underlying mechanisms.

No description available.

Il lavoro ha affrontato la tematica riguardante la disciplina del trasferimento delle azioni. In particolare, l'attenzione si è concentrata sulla formalità dell'iscrizione nel libro soci. A tale riguardo, si è posto il problema di comprendere se essa costituisca ancora il mezzo necessario per il conseguimento dello status socii. Con riferimento alle s.p.a. che emettono titoli, si è ravvisato nel possesso qualificato del titolo l'unico indice di legittimazione necessario e sufficiente in caso di trasferimento a mezzo girata, riconoscendo all'iscrizione nel libro soci la funzione di elemento necessario (ma comunque insufficiente, se isolatamente considerato) all'acquisto della legittimazione in caso di trasferimento dell'azione per atto separato e di circolazione mortis causa. Si è, comunque, escluso che le novità introdotte abbiano surrettiziamente trasformato le azioni in titoli all'ordine. In assenza di titoli, si è evidenziato che l'iscrizione ha sempre funzione legittimante come accade in caso di trasferimento di quote di s.r.l. In presenza di azioni dematerializzate, si è sottolineato che l'iscrizione nel libro soci perde ogni funzione legittimante, posto che l'avente causa acquista lo status di socio tramite registrazione sul conto tenuto dall'intermediario. Si è giunti alla conclusione che, al di là della funzione cartolare, a-cartolare o scritturale, l'annotazione nel libro soci rappresenta, esaltando il suo ruolo organizzativo, l'unico strumento che l'emittente ha a disposizione per riconoscere i propri soci ed avere contezza dei suoi assetti proprietari e delle vicende relative alle partecipazioni dallo stesse emesse. / The work concerned the issue about the circulation of shares. In particular, the attention is concentrated around the registration on shareholders' book. In this respect, the difficulty lied in understanding if the registration is still the instrument for the achievement of status socii. About the corporations which issue paper securities, the only instrument (necessary and sufficient) for the ability to exercise the shareholders' rights if the share is transferred by endorsement is the security's qualified possession. The registration on shareholders' book is the necessary, but not sufficient, instrument for the ability to exercise the shareholders' rights if the share is transferred by separate contract and if the share is transferred mortis causa. Anyway, the recent reform confirmed that the shares are registered securities. About the corporations which don't issue paper securities, the registration is always the instrument for the ability to exercise the shareholders' rights, like it happens in case of circulation of unlimited liability company's stakes. About the corporations which issue dematerialized securities (in particular, listed companies), the registration isn't the instrument for the ability to exercise the shareholders' rights, because the buyer achieves status socii by the registration on intermediary's account. In short, the registration on shareholders' book is the only instrument which the legal system puts at corporation's disposal to know its shareholders and the events about its shares.

Maksimalt oksygenopptak (VO2peak) er rekna som ein av dei viktigaste prognostiske markørane for framtidig hjarte-/karsjukdom og tidleg død. Ettersom direkte måling av VO2peak er tidkrevjande og kostbart har implementeringa i førebyggjande helsearbeid og klinisk praksis vore begrensa. Både VO2peak og ei rekkje andre sentrale helseparameter, kan betrast ved ei viss mengd fysisk aktivitet i kvardagen, og dagens globale anbefalingar er at alle vaksne bør utføre minst 150 minutt med moderat intensitet eller minst 75 minutt med høg intensitet per veke. Utforminga av anbefalingane inneber at det totale energiforbruket, og dermed helsegevinstane, kan oppnås ved ulike tilnærmingar der kortare varigheit kan kompenserast med høgare intensitet og vice versa. I dette prosjektet nytta me data på direkte målt VO2peak frå 4631 deltakarar i den siste Helseundersøkelsen i Nord-Trøndelag (HUNT 3, 2006-08) til først å utvikle ein prediksjonsmodell for å kunne estimere VO2peak og vidare undersøke om denne modellen kunne predikere framtidig hjerte-/kardødeligheit og død uansett årsak i ein stor befolkning. Me såg vidare på korleis ulike tilnærmingar til dagens anbefalingar for fysisk aktivitet var assosiert med direkte målt VO2peak i utvalet frå HUNT. Hovedfunna i avhandlinga er at VO2peak kan estimerast relativt nøyaktig ved ein regresjonsmodell med lett tilgjengelige variablar som alder, kroppssamansetning, fysisk aktivitetsnivå og kvilepuls og at modellen kan nyttast til å kategorisere personar med låg eller høg direkte målt VO2peak. Denne modellen vart nytta til å estimere VO2peak i eit stort utval friske deltakarar frå HUNT 1 (1984-86) som vart fulgt fram til registrert dødsdato eller slutten av 2010. For kvar 3,5 mL∙kg-1∙min-1 høgare estimert VO2peak var risikoen for død av hjarte- /karsjukdom 21 % lågare for personar av begge kjønn som var under 60 år ved undersøkelsen, medan risikoen uansett dødsårsak var henholdsvis 15 % og 8 % lågare for menn og kvinner. Vidare viser me at grupper som rapporterer fysisk aktivitetsvanar i tråd med dagens anbefalingar, anten ved moderat relativ intensitet over lengre tid eller høg intensitet over kortare tid, i gjennomsnitt hadde tilfredsstillande høg og tilnærma lik VO2peak. Samtidig viser me at eit relativt begrensa antal personar som rapporterte ein tidsbruk under minimum anbefaling, men med svært høg relativ intensitet, også hadde tilsvarande høg VO2peak. Også når tidsbruken eller det samla energiforbruket var konstant fann me at dei som rapporterte høg intensitet hadde høgare VO2peak enn dei som rapporterte låg eller moderate intensitet. / Directly measured peak oxygen uptake (VO2peak) is established as an important prognostic marker of cardiovascular disease and premature mortality, but is rarely evaluated for prevention purposes or in primary care settings due to costly and time-consuming procedures. Both VO2peak and several other health parameters can, however, be improved and maintained by regular exercise, and today`s recommendations suggest that all adults should do at least 150 minutes of moderate intensity or 75 minutes or vigorous intensity exercise per week. Hence, the total recommended volume or energy expenditure may be reached by strictly different approaches. In the current thesis, data on directly measured VO2peak in 4631 individuals from the third wave of the Nord-Trøndelag Health Study (HUNT 3, 2006-08), were used to first derive a simple prediction model for VO2peak that potentially could supplement direct measurements in healthcare settings and for research purposes. Next, the clinical utility of this model was examined by its ability to predict all-cause and cardiovascular mortality in a large sample of healthy men and women from the HUNT 1 (1984-86) cohort. Furthermore, we examined how different combinations of intensity and total time spent at habitual exercise were associated with VO2peak in apparently healthy, community dwelling individuals from HUNT 3. The findings in this thesis indicate that VO2peak can be predicted with reasonable accuracy by using easily available clinical and selfreported variables such as age, body composition, self-reported physical activity and resting heart rate, and that the model can be used to correctly classify subjects in the correct tail of the VO2peak distribution. For each metabolic equivalent (i.e. MET, ~3.5 mL∙kg-1∙min-1) higher CRF, the risk of CVD mortality was 21% lower in both men and women who were below 60 years at baseline, while the corresponding risk of all-cause mortality was 15% and 8% lower in men and women, respectively, for each MET higher CRF. Furthermore, we demonstrate that habitual exercise patterns of moderate intensity for a long total duration or vigorous intensity for a relatively short duration, adding up to the total volume as recommended by the health authorities, both were associated with a beneficial VO2peak –level. However, a higher VO2peak was observed among those reporting vigorous intensity compared to low and moderate intensity for a similar time spent, and energy expenditure used during exercise.