Anxiety disorders are highly debilitating mental illnesses. They are characterized by heightened worry, physiological arousal, and avoidance behaviours that manifest as psychological, physiological, and behavioral disturbances. Critically, a large proportion of the population suffers from elevated anxiety symptoms. Physical exercise has been proposed as a potential treatment for managing anxiety symptoms. The present study examined the effect of moderate intensity aerobic exercise training on both general and state anxiety symptoms in young adults. We hypothesized that general anxiety would be significantly lower after nine weeks of aerobic exercise training compared to no exercise training. We also hypothesized that a single bout of exercise would reduce state anxiety, and this reduction would be augmented with training. Fifty-five inactive participants (47 females, 85%) age 18 to 24 (M ± SD = 19.29 ± 1.37 years) were randomized into one of two groups: 1) exercise group, or 2) non-exercise control group. The exercise group completed three moderate intensity continuous aerobic exercise sessions per week for nine weeks, whereas the control group were asked to remain inactive. General anxiety was measured before and after the intervention using the Beck Anxiety Inventory, while state anxiety was measured twice a week using the short-form of the state scale of Spielberger State-Trait Anxiety Inventory. There was a significant interaction between group and baseline anxiety severity (p = .041) when controlling for aerobic fitness. Further exploration of this interaction revealed that the effect of aerobic exercise on post-intervention general anxiety was moderated by baseline anxiety severity [B = -9.84, p = .041, CI = -19.23 to -0.44]. Only the exercise subgroup with functionally-relevant baseline anxiety had lower post-intervention anxiety than the control group [B = -10.66, p = .0033, CI = -17.60 to -3.73]. Furthermore, an acute bout of exercise reduced state anxiety relative to the control group, but the effect did not emerge until weeks 4 to 6 of training (p < .001). Neither anxiety outcome was associated with changes in aerobic fitness, suggesting that some other aspect of the exercise program may have caused the benefits on anxiety. Collectively, these findings point to regular aerobic exercise as an effective tool for young adults to manage anxiety. / Thesis / Master of Science (MSc)

Diabetes is a common chronic disease that affects almost all countries in the world and has continued to increase at an alarming rate in the last decades. It kills a person every seven seconds. Recent thinking treats both types of diabetes as inflammatory diseases. The aim of the thesis was to obtain a better understanding of the relationship between exercise and the management of diabetes by conducting surveys and experimental work. It investigates the effects of exercise on the physiology and metabolic control in Type 1 (T1D) and Type 2 diabetes (T2D), using non-diabetic (ND) people as a control. The management and treatment of T1D and T2D volunteers were first assessed in surveys and the novelty was second to expose both to exercise. In the latter, volunteers were compared biochemically including for inflammatory responses to their illness and to practical exercise. Four studies were undertaken in this thesis involving a mixed approach: questionnaire based studies (first and second surveys) and experimental based studies (first and second exercise studies). The first survey study was about insulin users with opinions gathered from both T1D and T2D (T2I) respondents (n=707). In this survey diabetic people were asked about the condition and coping strategies for the difficulties using insulin in daily life. The first survey does touch on exercise but only as part of the larger picture. The second survey study (n=240) evolved from the first one and was again about opinions but in this case oral anti-hyperglycaemics were included in the management of T2D respondents (T2T). This survey focused more strongly on the role of exercise. The surveys were conducted by post, email and online while detailed statistical analysis followed. Two exercise studies with the same volunteers (n=25; ND=7, T1D=7, T2T=7, T2I=4) were then carried out based on some findings of the surveys. These studies explored the effects of a combination of aerobic (AE) and resistance exercise (RE) components for a six week period on diabetes. The methodology of the first exercise study concentrated on the physiological variables, involving the use of exercise and measurement equipment to monitor for expired gases and anthropometric changes. Substrate oxidation, blood profiles for lipid, blood glucose (BG) and glycated haemoglobin (HbA1c) were also assessed. The second exercise study builds on this with specific inflammatory marker profiles such as tumour necrosis alpha (TNF-α), interleukin-6 (IL-6), leptin and resistin on ND, T1D and T2D volunteers over the same time period as in the first exercise study. The first survey study showed that many respondents (13-47%) lacked adequate professional information about the various separate aspects of their insulin-treated illness. For example, 38% of T1D and 28% of T2I reported that they did not have enough information regarding raised cholesterol levels. The results for diabetes complications revealed that T2I had greater complications compared to T1D (for example angina 18.5% for T2I compared to 4.6% for T1D), although the groups could not be matched for age, reasons for responding to the survey, duration of illness or severity of illness when starting insulin. The second survey revealed that insulin users often had an HbA1c that did not meet best practice expectations of 6.5% - 7.5% (48 -58 mmol/mol). It also showed that those who did exercise regularly were more likely to have acceptable HbA1c values (5-7% or 31-53mmol/mol), than those who did not. This is especially the case for the type 2 groups (eg for T2T 46% exercising compared to 31% non-exercising) who were less likely (19% respondents compared to 25%) to have HbA1c over 8% or 64 mmol/mol. It was of interest to know the risks, barriers and likely recommendations for the two groups. For example, fewer T2I people test BG frequently (12.5% compared to T1D 62%, testing four or more times daily), even when they are insulin basal bolus users, which could foster hypoglycaemic events during exercise. The findings of the first and second surveys showed that managing diabetes in the 21st century remains difficult for many people, despite the availability of diagnostic, monitoring and medication improvements. This leads to anxiety and illness over the short and long term. In the first exercise study, it was clear that for this combined exercise regimen, the chronic effects were notable. The most significant finding was that the effect of 6 weeks was the drop in HbA1c in all groups ND from 5.4-5.2% or 36-33mmol/mol (p ˂ 0.01), T1D 7.0 to 6.7% or 53-50mmol/mol (p ˂ 0.01), T2T 7.6 to 7.2% or 60-55mmol/mol (p ˂ 0.05), T2I 7.3 to 6.8 or 56-51mmol/mol (p ˂ 0.05). This is equivalent to raising insulin or other medication and while clearly very beneficial, especially as occurring as a result of moderate exercise over only 6 weeks. Lipid factors showed improvements, not all significantly but these were likely to be influenced by support medication such as statins. However, the heart rate (HR) and blood pressure (BP) reduced at rest for all groups over the six weeks. The respiratory exchange ratio (RER), a measure of substrates oxidation showed that the carbohydrate metabolism was steady. The muscular strength and the subjective assessment improved after the exercise period. The second exercise study showed the interleukin 6 levels fell with the chronic effects of combined exercise ND (3.97-2.7pg/ml), T1D (2.15-1.02 pg/ml), T2T (3.67-2.72pg/ml) and T2I (3.66-1.17pg/ml) as did TNFα and other cytokine levels which may thus be cardioprotective. This suggests that exercise could be part of the anti-inflammatory treatment of T1D and T2D. To conclude, the findings of the two survey studies showed that the management of diabetes is difficult for many diabetics. Furthermore, the exercise studies demonstrated that a regular combined (RE and AE) exercise trial at moderate intensity for six week could be physiologically beneficial for diabetics. The underlying mechanism for this could be improvements in glycaemic control, lipid profile, cardiovascular fitness level and strength, as well as the inflammatory features of both T1D and T2D.

Juvenile idiopathic arthritis (JIA) is a common chronic disease of childhood. Children with JIA have lower peak oxygen consumption (V0₂ peak) than healthy children. In order to examine the cardiorespiratory response during aerobic exercise and the anaerobic to aerobic ratio (metabolic index), maximal exercise tests were performed in JIA subjects and age- and sex-matched controls (CON). Thirteen children aged 10 to 17 years with JIA and 9 CON participated. Peak powe r(watts, W) and total work (Joules, j) were determined with the Wingate anaerobic cycling test. VO₂ peak was measured by a maximal staged exercise test on a cycle ergometer. Cardiac output (CO, liters/minute) was measured with Doppler echocardiography. Arterial — mixed venous oxygen index (A-V0₂) and systemic vascular resistance (SVR) were calculated. Patient questionnaires included habitual activity, visual analog scale for joint pain and the childhood health assessment questionnaire. Physician completed data included active joint count and articular severity index. Compared to CON and reference age-matched norms, JIA subjects had lower aerobic fitness. VO₂ peak in JIA was 31.3 ml/min/kg (20.2-49.9), Z score -1.4 (-.06--2.4) and in CON was 47.9 ml/min/kg (32.7-54.1), Z score of -0.17 (-1.6-.87). [p = 0.013 V0₂ peak, p=0.011 Z score]. There were no significant differences in CO, A-V0₂ or SVR buttrends towards lower CO and higher SVR in JIA subjects were observed. During anaerobic exercise JIA subjects completed less total work (168.5 j/kg (107-252) JIA, 224 j/kg (180-248) CON, p=.036) but had similar peak power (9.7 W/kg (5.6-13.7) JIA, 11.3 W/kg (9.8-14.5) CON, p=.095). The metabolic index did not differ between JIA and CON. There was no significant correlation between disease activity, function and fitness measures in JIA subjects. Children with JIA have moderate impairments in aerobic fitness. CO and A-V0₂ during aerobic exercise did not significantly differ between JIA subjects and CON. Anaerobic fitness was mildly impaired with less total work completed by JIA subjects. Further research with larger numbers is required to determine factors contributing to limited fitness in JIA.

Juvenile idiopathic arthritis (JIA) is a common chronic disease of childhood. Children with JIA have lower peak oxygen consumption (V0₂ peak) than healthy children. In order to examine the cardiorespiratory response during aerobic exercise and the anaerobic to aerobic ratio (metabolic index), maximal exercise tests were performed in JIA subjects and age- and sex-matched controls (CON). Thirteen children aged 10 to 17 years with JIA and 9 CON participated. Peak powe r(watts, W) and total work (Joules, j) were determined with the Wingate anaerobic cycling test. VO₂ peak was measured by a maximal staged exercise test on a cycle ergometer. Cardiac output (CO, liters/minute) was measured with Doppler echocardiography. Arterial — mixed venous oxygen index (A-V0₂) and systemic vascular resistance (SVR) were calculated. Patient questionnaires included habitual activity, visual analog scale for joint pain and the childhood health assessment questionnaire. Physician completed data included active joint count and articular severity index. Compared to CON and reference age-matched norms, JIA subjects had lower aerobic fitness. VO₂ peak in JIA was 31.3 ml/min/kg (20.2-49.9), Z score -1.4 (-.06--2.4) and in CON was 47.9 ml/min/kg (32.7-54.1), Z score of -0.17 (-1.6-.87). [p = 0.013 V0₂ peak, p=0.011 Z score]. There were no significant differences in CO, A-V0₂ or SVR buttrends towards lower CO and higher SVR in JIA subjects were observed. During anaerobic exercise JIA subjects completed less total work (168.5 j/kg (107-252) JIA, 224 j/kg (180-248) CON, p=.036) but had similar peak power (9.7 W/kg (5.6-13.7) JIA, 11.3 W/kg (9.8-14.5) CON, p=.095). The metabolic index did not differ between JIA and CON. There was no significant correlation between disease activity, function and fitness measures in JIA subjects. Children with JIA have moderate impairments in aerobic fitness. CO and A-V0₂ during aerobic exercise did not significantly differ between JIA subjects and CON. Anaerobic fitness was mildly impaired with less total work completed by JIA subjects. Further research with larger numbers is required to determine factors contributing to limited fitness in JIA.

Juvenile idiopathic arthritis (JIA) is a common chronic disease of childhood. Children with JIA have lower peak oxygen consumption (V0₂ peak) than healthy children. In order to examine the cardiorespiratory response during aerobic exercise and the anaerobic to aerobic ratio (metabolic index), maximal exercise tests were performed in JIA subjects and age- and sex-matched controls (CON). Thirteen children aged 10 to 17 years with JIA and 9 CON participated. Peak powe r(watts, W) and total work (Joules, j) were determined with the Wingate anaerobic cycling test. VO₂ peak was measured by a maximal staged exercise test on a cycle ergometer. Cardiac output (CO, liters/minute) was measured with Doppler echocardiography. Arterial — mixed venous oxygen index (A-V0₂) and systemic vascular resistance (SVR) were calculated. Patient questionnaires included habitual activity, visual analog scale for joint pain and the childhood health assessment questionnaire. Physician completed data included active joint count and articular severity index. Compared to CON and reference age-matched norms, JIA subjects had lower aerobic fitness. VO₂ peak in JIA was 31.3 ml/min/kg (20.2-49.9), Z score -1.4 (-.06--2.4) and in CON was 47.9 ml/min/kg (32.7-54.1), Z score of -0.17 (-1.6-.87). [p = 0.013 V0₂ peak, p=0.011 Z score]. There were no significant differences in CO, A-V0₂ or SVR buttrends towards lower CO and higher SVR in JIA subjects were observed. During anaerobic exercise JIA subjects completed less total work (168.5 j/kg (107-252) JIA, 224 j/kg (180-248) CON, p=.036) but had similar peak power (9.7 W/kg (5.6-13.7) JIA, 11.3 W/kg (9.8-14.5) CON, p=.095). The metabolic index did not differ between JIA and CON. There was no significant correlation between disease activity, function and fitness measures in JIA subjects. Children with JIA have moderate impairments in aerobic fitness. CO and A-V0₂ during aerobic exercise did not significantly differ between JIA subjects and CON. Anaerobic fitness was mildly impaired with less total work completed by JIA subjects. Further research with larger numbers is required to determine factors contributing to limited fitness in JIA. / Education, Faculty of / Kinesiology, School of / Graduate

The largest percentage of mortality from tobacco smoking is cardiovascular-related. It is not known whether regular participation in exercise mitigates the adverse influence of smoking on vasculature. The purpose of this study is to determine if regular aerobic exercise is associated with reduced arterial stiffness in young men who are cigarette smokers. Using a cross-sectional observational study design, the sample included 78 young men (22±5 years) with the following classification: sedentary smokers (n=12); physically active smokers (n=25); sedentary non-smokers (n=20); and physically active non-smokers (n=21). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). There were no group differences in height, body fatness, systolic and diastolic blood pressure. As expected, both physically active groups demonstrated greater VO2max and lower heart rate at rest than their sedentary peers. The sedentary smokers demonstrated greater baPWV than the sedentary non-smokers (1,183±33.5 vs. 1,055±25 cm/sec). baPWV was not different between the physically-active smokers and the physically-active non-smokers (1,084±26 vs. 1,070±28.6 cm/sec). Chronic smoking is associated with arterial stiffening in sedentary men but a significant smoking-induced increase in arterial stiffness was not observed in physically active adults. These results are consistent with the idea that regular participation in physical activity may mitigate the adverse effect of smoking on the vasculature. / text

Evidence shows that consumption of a Mediterranean diet can lower the risk of all-cause and cause-specific mortality suggesting that this diet has an overall effect on health. Antioxidants found within olive oil, the primary source of fat in the Mediterranean diet, may be leading contributors to the decreased disease risk. More specifically, hydroxytyrosol (HT), one of the most active and powerful antioxidants found in olive oil, has the ability to increase total antioxidant status and lower levels of lipid peroxidation. In addition to a healthy diet, physical activity decreases the risk of cardiovascular morbidity and mortality; however, aerobic exercise of sufficient intensity or duration can induce oxidative stress. Therefore, the purpose of this study was to investigate the effects of 6 weeks of HT supplementation on antioxidant status and markers of inflammation in healthy, recreationally active males before and throughout acute aerobic exercise bouts. Using a randomized, double-blind, repeated-measures, placebo-controlled design, sixty-one (n=61) participants were randomly assigned to consume a placebo (PLA), low dose of HT (LHT, 50 mg/day), or high dose of HT (HHT, 150 mg/day). Throughout the course of the study, the participants performed four time trial rides (TT1-TT4) on cycle ergometers. TT1 occurred before supplementation, TT2 halfway through the supplementation period, and TT3 and TT4 occurred in the sixth week and final two days of supplementation. Blood was drawn prior to (pre) and just before termination (end) of each time trial to measure markers of antioxidant status and inflammation during exercise. We did not observe significant main effects for treatment on any of the markers for antioxidant status (TEAC) or for markers of inflammation (oxLDL, CRP, 8IP, TNFα, IL-6, IL-10, IL-1β, or IL-1ra). Significant treatment-by-time interactions occurred for CRP, 8IP, and IL-6 although significant treatment differences in these measures were not detected. We conclude that chronic and acute HT supplementation does not improve antioxidant status nor decrease markers of inflammation in this population at rest, during, or following exercise. / text

Study Objectives. Sleep is regulated by internal mechanisms that respond to environmental cues. Physical activity is one external cue that can affect sleep. It has been suggested that exercise affects sleep in a variety of ways, including influencing neurotransmitter levels and altering circadian rhythms. The purpose of this study was to examine self-reported sleep quality both before and after a well- defined exercise protocol. Design, Setting, and Participants. The TIGER study involves a 15-week aerobic exercise intervention conducted in young adults (n=2,027, mean age 21.8 ± 5 y). Participants were required to engage in 30 minutes of aerobic exercise at 65-85% maximal heart rate reserve three times/week. Multivariate regression was used to identify factors associated with sleep quality and duration. Measurements and Results. Multiple measures of body size/composition, heart rate (HR), and blood pressure (BP) were obtained on all participants. Sleep quality and duration were accessed via a condensed sleep quality profile (SQP). Prior to exercise, age (p<0.001), gender (p<0.008) and overweight/obesity status (p<0.001), but not race/ethnicity, were all significantly associated with SQP score. Age (p<0.002), and race/ethnicity (p<0.05) were significantly associated with sleep duration, with African Americans and Hispanics having significantly shorter sleep times compared to non-Hispanic whites. SQP score was not significantly different following chronic exercise training. Conclusions. Although overweight/obesity groups had significantly different sleep quality scores before and after exercise, sleep quality did not change for subjects after 15 weeks of aerobic exercise intervention. / text

The problem addressed in this study is whether physiologic, hematologic, and performance parameters obtained during and after a long term program of anaerobic and aerobic exercise can be used as markers of chronic fatigue.

Bakgrund: Fibromyalgi är ett långvarigt smärtsyndrom med en prevalens kring 4 % för kvinnor och 1% för män. Träning rekommenderas till patienter som del i behandling. Tidigare sammanställningar av forskning visar på brister i kvalitet och variation i utformning av interventioner. Osäkerhet råder kring vilken typ av aerob träning som har störst effekt på smärta. Syfte: Denna litteraturstudie syftade till att sammanställa det vetenskapliga evidensläget gällande effekten av aerob träning på upplevd smärta hos fibromyalgipatienter. Metod: En litteraturstudie med systematisk litteratursökning i databaserna PEDro och PubMed. Studiernas kvalitet granskades med PEDros granskningsmall och en evidensgradering genomfördes med hjälp av GRADEstud. Resultat: Nio studier, med 529 deltagare totalt, av lägst medelhög kvalitet inkluderades i studien. Studierna visar på en positiv, kliniskt relevant effekt på smärtintensitet, av aerob träning vid jämförelse med kontrollgrupper och liknande effekt jämfört med annan aerob träningsmodalitet, lågintensiv träning eller styrketräning. Evidensstyrkan var måttligt hög för att likvärdig smärtminskning erhålls oberoende av modalitet av aerob träning. Evidensstyrkan var låg för att konkludera att aerob träning är bättre än en kontrollgruppsintervention, lika bra som styrketräning eller lågintensiv träning. Orsakerna till resultatet av evidensgraderingen beror främst på heterogenitet i studiernas interventioner. Konklusion: Det går utifrån granskningen inte att se någon skillnad avseende smärtintensitet mellan aerob träning och en annan aktiv intervention. Studierna är små, har skillnader i interventioner och resultat. Mot bakgrund av detta kan inga säkra slutsatser dras gällande vilken form av träning som är bäst vid fibromyalgi. / Background: Fibromyalgia is a chronic pain syndrome with a prevalence of around 4% for women and 1% for men. Physical exercise is recommended for patients as part of treatment. Earlier reviews indicate a lack of quality and heterogenity in intervention designs. There are uncertainties of which type of aerobic exercise has the biggest effect on pain. Objective: This review aimed to summarize the scientific level of evidence concerning aerobic exercise on pain level for the fibromyalgia population. Method: For this systematic review a structured litterature search was carried out in the databases PubMed and PEDro. Quality was assessed with the PEDro-scale and reliability was evaluated with GRADEstud. Results: Nine RCT's including 529 subjects, with at least 5 points on the PEDro scale were included. The studies show a positive, clinically relevant effect on pain level, of aerobic training when compared to control groups (evidence: low) and similar effects on pain (evidence: moderately high) when compared to other training modality, low intensity aerobic exercise (evidence: low) or strength training (evidence: low). Heterogeneity in the studies reduces the level of evidence in all categories.  Conclusion: The populations are generally small and generally there is a large heterogenity in the interventions. No difference between aerobic training and other active interventions was observed in terms of pain reduction. It is not possible to conclude which modality of training is best for patients with fibromyalgia. To clarify evidence, there is a need for more studies with similar interventions.