Acute exercise is associated with a transient suppression of appetite. The effects of regular exercise on appetite are not well understood. We aimed to determine the effects of active commuting and leisure-time exercise on appetite. One hundred thirty physically inactive women and men (20–45 yr) with overweight and obesity were randomized to 6 mo of habitual lifestyle (CON, n = 18), active commuting (BIKE, n = 35), or leisure-time exercise of moderate [MOD, 50% peak oxygen uptake (V̇o2peak)-reserve, n = 39] or vigorous (VIG, 70% V̇o2peak-reserve, n = 38) intensity. Appetite ratings, acylated ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and glucagon were assessed in the basal state and in response to meal and exercise challenges at baseline and 3 and 6 mo. Ad libitum energy intake was determined during test meals. Data from 90 participants (per protocol) were available, and results are comparisons with CON. At 3 mo, ad libitum energy intake was lower in VIG (−22%, P < 0.01), basal glucagon was lower in BIKE ( P < 0.05) and VIG ( P = 0.01), and postprandial ratings of prospective food consumption were lower in MOD ( P = 0.02) and VIG ( P < 0.001). In VIG, ratings of hunger ( P = 0.01) and prospective food consumption ( P = 0.03) were lower after acute exercise at 3 mo. At 6 mo, basal and postprandial GLP-1 were higher ( P ≤ 0.04) whereas postexercise PYY was lower ( P = 0.03) in VIG and postexercise CCK was lower in BIKE ( P = 0.03). Vigorous-intensity exercise training leads to a transient suppression of energy intake and subjective appetite (3 mo) but a more long-term increase in basal and postprandial GLP-1 (6 mo) in individuals with overweight and obesity. NEW & NOTEWORTHY This is the first randomized controlled trial, to our knowledge, investigating long-term effects of exercise domain and intensity on subjective and hormonal markers of appetite and ad libitum energy intake in individuals with overweight and obesity. Appetite was assessed in response to meal and exercise challenges at baseline and at 3 and 6 mo. Anorexigenic effects of exercise vary with the duration of intervention and are restricted to regular leisure-time exercise of vigorous intensity in individuals with overweight and obesity.

Background and objectiveDietary beetroot juice (BR) supplementation has been shown to reduce the oxygen (O2) consumption of standardized exercise and reduce resting blood pressure (BP) in healthy individuals. However, the physiological response of BR in chronic obstructive pulmonary disease (COPD) remains controversial. The objective was to test exercise performance in COPD, supplementing with higher doses of BR for a longer duration compared to previous trials in this patient group.MethodsFifteen COPD patients consumed concentrated BR (2×70 mL twice daily, each containing 300 mg nitrate) or placebo (PL) (2×70 mL twice daily, nitrate-negligible) in a randomized order for 6 consecutive days. On day 7, participants consumed either BR or PL 150 min before testing. BP was measured before completing 6-minute walk test (6MWT) and two trials of submaximal cycling. The protocol was repeated after a minimum washout of 7 days.ResultsPlasma nitrite concentration was higher in the BR condition compared to PL (P<0.01). There was no difference between the BR and PL conditions regarding the covered distance during the 6MWT (mean ± standard error of the mean: 515±35 m (BR) vs 520±38 m (PL), P=0.46), O2 consumption of submaximal exercise (trial 1 P=0.31 vs trial 2 P=0.20), physical activity level (P>0.05), or systolic BP (P=0.80). However, diastolic BP (DBP) was reduced after BR ingestion compared to baseline (mean difference: 4.6, 95% CI: 0.1–9.1, P<0.05).ConclusionSeven days of BR ingestion increased plasma nitrite concentrations and lowered DBP in COPD patients. However, BR did not increase functional walking capacity, O2 consumption during submaximal cycling, or physical activity level during the intervention period.

BackgroundThere is limited knowledge of physical activity (PA) patterns among high school students. High schools plays an important role as context for the students, but it is uncertain to what extent schools influence student participation in PA during leisure time. The purpose of this study is to describe patterns of PA and assess variations between schools and classes in PA, in a large cohort of Danish high school students.MethodsSelf-reported cross-sectional data came from The Danish National Youth Study, comprising a total of 70,674 students attending 119 different schools and 3213 classes. Multilevel logistic regressions were applied to evaluate the association between socio-demographic variables and patterns of PA, and to assess the impact of schools and classes on PA measures.ResultsStudents whose parents have achieved a lower level of education, older students and girls of perceived ethnic minority generally participated less in several forms of PA during leisure time. Substantial variations between schools were observed in terms of participation in PA at school during leisure time and in terms of use of active transportation to and from school. The school-level accounted for 9% (intra-class correlation coefficient (ICC) = 0.09 (95% CI: 0.06–0.11)) and 8% (ICC = 0.08 (95% CI: 0.07–0.11)) of the variation for participation in PA during leisure time and active transportation.ConclusionOverall, students whose parents achieved a lower level of education, older students and girls of perceived ethnic minority represent vulnerable groups in relation to participation in several forms of PA during leisure time. The ICCs indicate that schools, in particular, have the potential to influence participation in PA at school during leisure time and active transportation to and from school. Thus, high schools should encourage and facilitate activities aimed at engaging students in PA during leisure time as well as encourage active transportation.

Background Treatment of acute severe ulcerative colitis (ASUC) comprising iv steroids, second line infliximab or cyclosporin, and finally colectomy, has remained unchanged for nearly two decades and without improvements in colectomy rates. Tofacitinib (TOFA), a pan JAK-inhibitor, has emerged as a potential new treatment option for ASUC. We conducted a systematic review to assess efficacy, safety, and integration in current ASUC algorithms. Methods Systematic search in MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov until August 17, 2022, including all studies reporting original observations on JAK-inhibitor use, notably tofacitinib, for ASUC defined according to Truelove and Witts criteria. Primary outcome was colectomy-free survival. Individual patient data from case reports were pooled and collectively analyzed. Results Of 853 publications identified, 20 studies (seven single case reports and eight case series resulting in data from 42 patients; one combined retrospective and prospective GETAID cohort study of 55 patients; one retrospective study of 40 cases and 113 matched controls; one pediatric retrospective cohort study of 11 patients; two ongoing trials) involving 148 patients (female 44-60%, age median 28-34 years, disease duration 5-10 years) treated with second- or third line tofacitinib for ASUC were included. Colectomy-free survival was 78% from 90-day onwards in the pooled cohort of individual cases (Figure); GETAID cohort 85% 30-day, 79% 90-day, 74% 180-day; and 63% in the pediatric cohort. The case-control study observed lower 90-day colectomy risk among TOFA treated (HR 0.28 [0.10-0.28], p=0.018). The majority received second line TOFA rescue therapy after initial failure to iv steroids (n=65), and with previous failure to one or more biologics, notable infliximab (n=62, 95%). There was no difference in colectomy rates between patients treated with second or third line TOFA (n=15 (23%) vs. n=1 (8%), p=0.44). Tofacitinib persistence at follow-up was 68-91%, clinical remission 35-69%, endoscopic remission 55%, and without reports of novel or severe safety signals (Table). Conclusion Tofacitinib appears to result in high short-term colectomy-free survival among refractory ASUC patients and may have potential in the future treatment of patients otherwise deemed for colectomy. Efficacy was comparable to first line ASUC therapy with iv steroids, but observations are limited, uncontrolled and with short follow-up. High-quality studies are needed.