High-Intensity Training Reduces CVD Risk Factors among Rotating Shift Workers

[Full title: High-Intensity Training Reduces CVD Risk Factors among Rotating Shift Workers: An Eight-Week Intervention in Industry]

[Find the meaning and references behind the names: Every, Mamen, Plant, Doi, June, Bht, Work, Nielsen, Worker, Hunger, Max, Int, Anton, Europe, Risk, Reidun, Long, Pia, Hospital, Million, Marit, Part, Labor, Heart, Blood, High, Moss, Ness, Sti, Sessions, Cell, Market, Due, Rate, Meta, Hours, Strong, Weeks, Hba, Min, Tel, Oslo, Short, Box]

International Journal of Environmental Research and Public Health Article High-Intensity Training Reduces CVD Risk Factors among Rotating Shift Workers: An Eight-Week Intervention in Industry Asgeir Mamen 1, * , Reidun Øvstebø 2 , Per Anton Sirnes 3 , Pia Nielsen 4 and Marit Skogstad 4 1 School of Health Sciences, Kristiania University College, Box 1190, Sentrum, 0107 Oslo, Norway 2 The Blood Cell Research Group, Department of Medical Biochemistry, Oslo University Hospital, 0450 Ullevaal, Norway; reidun.ovstebo@medisin.uio.no 3 Østlandske Hjertesenter, 1523 Moss, Norway; pas@cardio.no 4 Ringvoll BHT, 1523 Moss, Norway; pia.nielsen@ringvollbht.no (P.N.); marit.skogstad@ringvollbht.no (M.S.) * Correspondence: asgeir.mamen@kristiania.no; Tel.: + 47-93-00-80-98 Received: 5 May 2020; Accepted: 30 May 2020; Published: 2 June 2020 Abstract: Rotating shift work is associated with risk factors for cardiovascular disease (CVD). We have studied the e ff ect of 17 min high-intensity training three times a week over eight weeks on CVD risk factors among shift workers. Sixty-five shift workers from two plants were recruited. They were all deemed healthy at the initial health screening and in 100% work. From plant A, 42 workers, and plant B, 23 workers participated. After the intervention, 56 workers were retested. The intervention group consisted of 19 participants from plant A who had participated in at least 10 sessions. Twenty workers from plant B and 17 workers from plant A that not had taken part in the training were included in the control group. All workers reported physical activity (PA) by questionnaires before and after the training intervention. We measured blood pressure, heart rate, lipids, glycated hemoglobin (HbA 1 c), and C-reactive protein (CRP) and arterial sti ff ness. Maximal oxygen uptake ( ˙VO 2 max ) was assessed by bicycle ergometry. The intervention group favorably di ff ered significantly from the control group in improvement of systolic and diastolic blood pressure and glycated hemoglobin (HbA 1 c). Short training sessions with 4 min of high-intensity PA, three times a week, for eight weeks among rotating shift workers reduced some CVD risk factors. PA interventions in occupational settings may thus decrease coronary heart disease and stroke incidences in this vulnerable group of workers Keywords: shift work; cardiovascular; occupational health; physical activity 1. Introduction Economic globalization a ff ects the labor market and work organizations. This could result in more use of long working hours and night shifts [ 1 ]. In Europe, 21 % of the workforce is engaged in shift work and 19% work at night [ 2 ]. An increased risk for cardiovascular disease (CVD) among shift workers has been known for many decades. Recent systematic reviews and meta-analysis encompassing more than 2 million individuals reveal an association between shift work and CVD [ 3 , 4 ], even demonstrating CVD events increasing by 7.1% for every five years of exposure after the first five years as a shift worker [ 4 ]. CVD risk factors in shift workers could be due to disturbances of the endocrine system including unfavorable catecholamine, ghrelin (“hunger hormone”), and adipokine excretion, dyslipidemia, metabolic syndrome, insulin resistance and melatonin reduction, and ultimately diabetes [ 5 , 6 ], but also an increased systemic inflammation [ 7 – 9 ]—even due to circadian misalignment per se [ 10 ]—and changes to the immune system [ 11 ]. Int. J. Environ. Res. Public Health 2020 , 17 , 3943; doi:10.3390 / ijerph 17113943 www.mdpi.com / journal / ijerph

[Find the meaning and references behind the names: Daily, Four, Pack, Less, Aim, Day, Low, Present, Wave, Time, Central, Running, Comes, Data, Lack, Age, Cross, Mean, Given, Table, Female, See, Knowledge, Study, Early, Shown]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 2 of 13 In a study running for three years, we initially examined early manifestation of CVD risk factors in shift workers in two industrial plants in Norway [ 12 ]. We studied blood parameters including lipids (cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL)), glycated hemoglobin (HbA 1 c), C-reactive protein (CRP), brachial blood pressure, resting heart rate and central blood pressure, augmentation pressure and index, pulse wave velocity, and ultrasound measurement of the carotid arteries. In addition, we assessed maximal oxygen uptake ( ˙VO 2 max ) [ 12 ]. The shift workers reported less physical activity (PA) of a high degree of intensity compared to the day workers [ 12 ], but the ˙VO 2 max was within expected values for a corresponding population of Norwegians [ 13 ]. In this cross-sectional study of workers in industry, the number of years of shift work was associated with early manifestations of CVD, with an increased intima media thickness (IMT) in the carotid artery and increasing CRP. This could imply an increased risk for coronary heart disease and stroke among these workers. We will follow the present cohort for three years As for CVD risk factors, we found increased carotid intima media thickness (cIMT) and CRP associated with number of years as a shift worker [ 12 ]. In order to reduce the cancer risk of shift work, a concern for lack of knowledge, practical advice, and evaluated interventions for workers has been voiced [ 14 ]. The same applies when it comes to reducing risk for CVD. Longitudinal studies on shift work in industry and PA are scarce and generally cross-sectional studies are not conclusive when it comes to assessing di ff erences between shift workers in industry and day workers on engagement in PA during leisure time [ 15 ]. Furthermore, there is a lack of PA intervention studies among shift workers One study reports increased ˙VO 2 max along with decreased heart rate after a four-month intervention program among female shift workers working day, evening, and night shifts [ 16 ]. Otherwise, we have not detected interventions addressing CVD risk factors in this group of workers High-intensity PA (e.g., running once a week or 50 min / week) has been shown to reduce the risk of all-cause and CVD mortality [ 17 ]. Generally, high-intensity training a ff ects early manifestation of CVD such as lowering blood pressure and a ff ecting blood lipids and blood glucose favorably, but also decreasing systemic inflammation [ 18 ]. Aim of the study: Given our results of CVD risk factors among shift workers [ 12 ] and a worry that shift workers tend to exercise less than other workers [ 6 ], the Occupational Health Service wanted to study if high-intensity PA could modify the risk of early manifestations of CVD in this group of industrial workers 2. Material and Methods We collected background data and medical history by questionnaire. We have described the present cohort in a recent paper [ 12 ], but in short, we recruited 94 participants from two insulation-producing plants (A + B) in Norway. From plant A, 42 out of 51 shift workers agreed to participate (82%), and from plant B, the corresponding figures were 23 of 55 shift workers (42%). Here, 29 dayworkers (75 eligible) were also included in the cohort. Thirteen of the 94 workers were female (14%) (Table 1 ). See also Table 2 for baseline description of the two groups Table 1. Demographic characteristics among shift workers (N = 65) participating in the study Variables Shift Workers Plant A (N = 42) Shift Workers Plant B (N = 23) Number Mean SD Number Mean SD Age (years) 40.5 11.0 40.0 12.5 Women 5 1 BMI (kg / m 2 ) 27.2 5.2 26.4 4.4 Pack-years 9.2 14.4 5.0 8.0 Daily smokers 11 3 College / University 2 1 No. of years as shift worker 14.5 10.1 15.0 9.9 Physical activity, high intensity (min) 90.1 145 67.0 69.0

[Find the meaning and references behind the names: Start, Left, Peer, Spring, Body, Vital, Arm, August, Rest, Put, Mass, Place, Tru, Canada, Autumn, Look]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 3 of 13 The shift workers worked rotating shifts with day, evening, and night shifts even lasting for 12 h [ 12 ]. An intervention group consisted of volunteers from plant A, and the workers from plant B made up the control group. Seventeen of the workers in plant A preferred to do PA by themselves and were thus analyzed among the control group; see Figure 1 . Int. J. Environ. Res. Public Health 2020 , 17 , x FOR PEER REVIEW 3 of 13 Physical activity, high intensity (min) 90.1 145 67.0 69.0 The shift workers worked rotating shifts with day, evening, and night shifts even lasting for 12 h [12] An intervention group consisted of volunteers from plant A, and the workers from plant B made up the control group Seventeen of the workers in plant A preferred to do PA by themselves and were thus analyzed among the control group; see Figure 1 All eligible shift workers: N = 106 Plant A: n = 51 Plant B: n = 55 Baseline registrations: N = 65 Plant A: n = 42 Plant B: n = 23 Eight ‐ week follow ‐ up: N = 56 Plant A: n = 36 Intervention group with ≥ 10 training sessions: 19 Control group with < 10 training sessions: 17 Plant B: n = 20 Intervention group: n = 19 Control group: n = 17 + 20 = 37 Figure 1. Selection process 106 shift workers were available for the project, 51 from plant A and 55 from plant B At project start, 42 shift workers from plant A accepted the invitation with three weekly trainings sessions, with 23 workers from plant B as “activity as usual” controls At follow ‐ up eight weeks later, 19 participants from the intervention group had participated in at least 10 training sessions and were included in the analyses as intervention group The remaining 17, who had less than 10 training sessions logged, were put in the control group, together with the 20 workers from plant B, giving 37 in this group Table 2. Baseline data for the control and intervention groups Group Variable Minimum Maximum Mean SD Control Age (yr) 21.0 57.0 38.4 11.5 Height (cm) 160.0 198.0 181.8 7.3 Body Mass (kg) 55.0 130.0 89.8 19.1 Intervention Age (yr) 28.0 58.0 43.1 10.5 Height (cm) 155.0 190.0 175.5 9.2 Body Mass (kg) 48.0 123.0 82.8 18.8 The examinations took place in August 2018 and then after an eight ‐ week PA initiative during autumn 2018 and spring 2019 The Regional Ethics Committee in Oslo approved of the study (2018/1258) We informed the participants about the study and they gave their written consent to participate (ISRCTN 42416837) While the participants were sitting, we measured blood pressure and resting heart rate (RHR) to look for signs of cardiovascular disease The measurements took place after five minutes of rest, on the left arm three times in intervals of one minute, and the mean values of three measurements of the systolic (SBP) and diastolic pressure (DBP) were used in the statistical analysis in both occasions Figure 1. Selection process. 106 shift workers were available for the project, 51 from plant A and 55 from plant B. At project start, 42 shift workers from plant A accepted the invitation with three weekly trainings sessions, with 23 workers from plant B as “activity as usual” controls. At follow-up eight weeks later, 19 participants from the intervention group had participated in at least 10 training sessions and were included in the analyses as intervention group. The remaining 17, who had less than 10 training sessions logged, were put in the control group, together with the 20 workers from plant B, giving 37 in this group Table 2. Baseline data for the control and intervention groups Group Variable Minimum Maximum Mean SD Control Age (yr) 21.0 57.0 38.4 11.5 Height (cm) 160.0 198.0 181.8 7.3 Body Mass (kg) 55.0 130.0 89.8 19.1 Intervention Age (yr) 28.0 58.0 43.1 10.5 Height (cm) 155.0 190.0 175.5 9.2 Body Mass (kg) 48.0 123.0 82.8 18.8 The examinations took place in August 2018 and then after an eight-week PA initiative during autumn 2018 and spring 2019. The Regional Ethics Committee in Oslo approved of the study (2018 / 1258). We informed the participants about the study and they gave their written consent to participate (ISRCTN 42416837) While the participants were sitting, we measured blood pressure and resting heart rate (RHR) to look for signs of cardiovascular disease. The measurements took place after five minutes of rest, on the left arm three times in intervals of one minute, and the mean values of three measurements of the systolic (SBP) and diastolic pressure (DBP) were used in the statistical analysis in both occasions. Using the mean is the current practice at our laboratory. We used a BpTRU Vital Signs Monitor ™ BPM-100 (Bp TRU Medical Devices, Coquitlam, BC, Canada) We assessed central blood pressure (CBP), which is the pressure in the ascending aorta, augmentation pressure (AP), augmentation index (AIx), pulse pressure (PP), and pulse wave velocity

[Find the meaning and references behind the names: Sydney, Change, Roche, Srl, Basel, San, Oro, Polar, Sweden, Plus, Mann, Belt, Cobas, Gym, Francisco, Shawnee, Cadence, Main, Hans, Rudolph, Person, Bike, Gel, Mask, Acid, Coe, Slice, Row, Company, Chol, Median, Pai, Rome, Ort, Leader, End]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 4 of 13 (PWV) with a SphygmoCor XCEL ® (AtCor Medical Pty Ltd., Sydney, Australia). The participants were in supine position during this examination and we used HR from this examination as RHR when setting up the HR monitor. We performed the measurements according to the manufacturer’s recommendations ( www.atcormedical.com ). Blood for serum investigations of glycated hemoglobin (HbA 1 c) and lipids (cholesterol (CHOL), low-density lipoprotein (LDL), high-density lipoprotein (HDL)) was drawn from the participants using ethylene diamine tetra acetic acid (EDTA) tubes. We used whole blood gel tubes for C-reactive protein (CRP). The tubes were centrifuged at 30 × 1000 RPM for 10 min within 60 min of the blood being drawn from a vein. Samples were transported to the Department of Medical Biochemistry, Oslo University Hospital and analyzed within 48 h. HbA 1 c (EDTA blood) was analyzed with a Tosoh G 7 HPLC analyzer (Tosoh Bioscience, Inc. San Francisco, CA, USA) using the “high-performance liquid chromatography” separation principle. The analytical variation was 1.7%. CHOL, LDL, and HDL in serum were analyzed by enzymatic colorimetric method in a Cobas 8000 Modular Analyzer (Ho ff mann-La Roche, Basel, Switzerland). Analytical variation coe ffi cients were 3.0%, 4.0%, and 3.5%, respectively. CRP was assessed in serum by particle enhanced immunoturbidimetric method on the Cobas 8000. The analytical variation was 8.0% We tested the participants with a graded exercise test on a cycle ergometer (Monark 874 E, Monark Exercise AB, Vansbro, Sweden). The starting load was 70 W with a cadence of 70 RPM. The subjects were instructed to maintain a cadence of between 68 and 72 RPM during the test. Every minute, the resistance was increased by 28 W (0.4 Kg), until voluntary exhaustion or if the cadence dropped below 60 RPM despite verbal encouragement to increase cadence. The subject wore a heart rate belt and transmitter from Polar (Polar OY, Kempele, Finland). The signal from this transmitter was presented on the bike’s screen and recorded every minute during the test. A K 5 metabolism analyzer (Cosmed Srl, Rome, Italy) was attached to the test subject through a Hans Rudolph 7400 Vmask oro-nasal face mask (Hans Rudolph Inc, Shawnee, KS, USA), which was fitted to the subject and then checked for leakage before the test started. Oxygen uptake was measured continuously with the K 5 using the unit’s mixing chamber and 10 s measurement intervals. ˙VO 2 max was defined as the median of the three highest successive 10 s measurements at the end of the test. Criteria for a valid test included a respiratory exchange ratio of > 1.05 or heart rate > 95% of age predicted maximal heart rate, together with the test leader’s evaluation of fatigue. Time to exhaustion and end load were also recorded. The highest heart rate recorded, plus five bpm, was considered maximal heart rate (HR max ) [ 19 ] and used when setting the maximal heart rate in the heart rate device. This value was so increased by 5–10 bpm for running HR max We assessed physical activity (PA) by the question: “How often do you normally exercise?”, with the response alternatives of “never or less than once per week”, “once per week”, “two to three times per week”, or “almost every day” [ 20 ]. Furthermore, we asked participants to report, in minutes per week, the total amount they were engaged in PA with high intensity (e.g., running, Spinning ® ) Physical activity was also measured by a Mio Slice wrist-worn heart rate monitor (Mio Global Inc., Vancouver, Canada) that calculated PA from heart rate and personal information and presented it as Personalized Activity Intelligence (PAI) [ 21 ]. All participants were asked to acquire 100 PAI per week An eight-week PA intervention with supervised PA by an experienced occupational physiotherapist was organized by the Occupational Health Service. The company had provided a gym at the plant with treadmills, bicycles, and row machines. The workers met before or after a work shift for PA One responsible person in each shift recorded the presence of the participants in a compliance form We adapted the PA program by Tjønna et al. [ 22 ] lasting for 17 min in total. The main phase was a four-minute work session at near maximal e ff ort (~90% of HR max). This was performed three times a week. Except for ultrasound measurement of the carotid artery, all measurements at the eight-week follow-up were similar to that of baseline registrations [ 12 ]. Statistical analysis. Descriptive data are presented as mean with (SD) unless otherwise noted. The di ff erences in change between intervention and control group, and between baseline

[Find the meaning and references behind the names: Mol, Ibm, Hedge, Gosset, Excel, Show, Development, Size, Post, Corp, Station, Cohen, Asp, Bar, Line, Positive, Sem]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 5 of 13 and post-intervention results were assessed with Gosset (Student) independent / paired t-tests and with E ff ect Size (Cohen’s d with Hedge’s g correction). Analyses were carried out using SPSS v 26 (IBM SPSS, Armonk, NY, USA) and Stata IC 16 (Stata Corp LLC, College Station, TX, USA). Cohen’s d e ff ect size with Hedge’s g correction (ES) analyses were done with an Excel spreadsheet ( http: // www.cemcentre.org / renderpage.asp?linkID = 30325017 ). Bar graphs show mean and SD. In box plots, the whiskers are the ± 95 percentiles and the horizontal line the median Ethical considerations. The Regional Ethics Committee in Oslo approved of the study (2018 / 1258) We informed the participants about the study and they gave their written consent to participate (ISRCTN 42416837) 3. Results In Table 3 , the development from baseline (BL) to post-intervention (PO) is shown for the two groups. The control and intervention groups both develop favorably from BL to PO on SBP, DBP, aorta systolic blood pressure (ASBP), PP, AP, CHOL, HbA 1 c, and Vigorous Physical Activity (VPA). In addition, the intervention group had a positive development on body mass (BM), aorta diastolic blood pressure (ADBP), CRP, and LDL. The control group had a positive development of r ˙VO 2 max and a ˙VO 2 max not present in the intervention group. PWV developed negatively in both groups, and the control group also had a negative development of BM, ADBP, CRP, and LDL. The development in BM and HbA 1 c was statistically significant for the control group ( p < 0.05 and p < 0.01). In the intervention group, PO and BL values for ASBP, ADBP, and HbA 1 c were statistically significant ( p < 0.05 for ASBP and ADBP and 0.01 for HbA 1 c). Concerning the size of change between control and intervention groups, they di ff ered on BM and CHOL ( p < 0.05). See Table 3 . Table 3. Baseline and post-intervention results for control and intervention groups Variables Control Intervention n Mean SD SEM n Mean SD SEM BL BM (kg) 31 88.8 18.6 3.3 19 82.8 18.8 4.3 PO BM (kg)# 31 89.5 * 18.7 3.4 19 81.7 17.8 4.1 BL SBP (mmHg) 30 126.0 14.5 2.6 19 124.4 10.6 2.4 PO SBP (mmHg) 31 124.2 14.3 2.6 19 120.1 12.3 2.8 BL DBP (mmHg) 30 82.4 7.6 1.4 19 83.6 6.4 1.6 PO DBP (mmHg) 31 80.6 9.3 1.7 19 80.3 9.5 2.2 BL ASBP (mmHg) 31 111.3 13.0 2.3 19 112.8 10.2 2.4 PO ASBP (mmHg) 31 109.2 18.3 3.3 19 109.3 * 8.4 1.9 BL ADBP (mmHg) 31 72.0 11.8 2.1 19 75.2 8.1 1.9 PO ADBP (mmHg) 30 73.8 8.8 1.6 19 72.2 * 8.0 1.8 BL PP (mmHg) 31 38.1 6.2 1.1 19 37.6 5.6 1.3 PO PP (mmHg) 31 37.9 8.5 1.5 19 37.1 4.5 1.0 BL PWV (m / s) 29 7.6 1.4 0.3 18 7.7 1.4 0.3 PO PWV (m / s) 30 7.8 1.8 0.3 19 7.9 1.3 0.3 BL AP (mmHg) 31 9.0 5.7 1.0 19 10.0 3.9 0.9 PO AP (mmHg) 31 8.1 4.8 0.9 19 9.4 3.6 0.8 BL CRP (mg / L) 31 1.6 2.4 0.4 19 2.3 2.6 0.6 PO CRP (mg / L) 30 2.7 4.5 0.8 18 2.1 1.9 0.4 BL CHOL (mmol / L) 31 4.7 0.8 0.1 19 5.2 0.9 0.2 PO CHOL (mmol / L)# 30 4.9 1.0 0.2 18 4.8 0.8 0.2 BL HDL (mmol / L) 31 1.2 0.2 0.0 19 1.3 0.4 0.1 PO HDL (mmol / L) 30 1.2 0.2 0.0 18 1.3 0.4 0.1 BL LDL (mmol / L) 31 3.0 0.7 0.1 19 3.3 0.9 0.2 PO LDL (mmol / L) 30 3.2 0.9 0.7 18 3.1 0.9 0.2 BL HbA 1 c (mmol / mol) 31 34.3 3.9 0.7 19 34.4 4.0 0.9 PO HbA 1 c (mmol / mol) 30 32.8 ** 4.6 0.8 18 32.5 ** 3.5 0.8 BL VPA (min / week) 31 69.0 73.5 13.2 19 85.8 126.8 29.0 PO VPA (min / week) 29 84.2 118.9 22.1 18 106.2 53.0 12.5

[Find the meaning and references behind the names: Cont, Self, Ess, Small]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 6 of 13 Table 3. Cont Variables Control Intervention n Mean SD SEM n Mean SD SEM BL r ˙VO 2 max (mL / kg / min) 11 44 9 3 14 44 8 2 PO r ˙VO 2 max (mL / kg / min) 11 45 9 3 14 44 7 2 BL a ˙VO 2 max (mL / min) 11 3609 523 158 14 3509 436 117 PO a ˙VO 2 max (mL / min) 11 3646 381 115 14 3489 469 125 BM = body mass, SBP = systolic blood pressure, DBP = diastolic blood pressure, ASBP = aorta systolic blood pressure, ADBP = aorta diastolic blood pressure, PP = pulse pressure, AP = augmented pressure, CRP = C-reactive protein, CHOL = total cholesterol, HDL = high-density lipoprotein, LDL = low-density lipoprotein, HbA 1 c = glycated hemoglobin, VPA = vigorous physical activity, r ˙VO 2 max = maximal oxygen uptake relative to body mass, a ˙VO 2 max = maximal oxygen uptake. BL = baseline, PO = post-intervention. * = p < 0.05, ** = p < 0.01 between BL and PO values, # = p < 0.05 between C and I changes Self-reported training frequency changed during the intervention. At baseline, a majority of the participants trained one or less than one session per week. After the intervention, all members (100%) of the intervention group reported training two to three times a week. The control group members reduced the number that trained one or less than one time per week after intervention and increased the numbers that reported training two or more times per week. Self-reported weekly VPA increased by 11.4 (83.2) min in the control group and 15.6 (116.1) min in the intervention group (Figure 2 A,B). We had technical problems evaluating the PAI results, but the intervention group reached an average of 100 PAI per week during the intervention period, statistically significantly more than that of the control group (results not shown) ˙VO 2 max relative to body mass did not change much for either groups, but interestingly, the control group had a small increase in mean absolute ˙VO 2 max as seen in Figure 3 . An ES analysis showed that for BM, ADBP, CHOL, and LDL, ESs were > 0.50, often described as clinically relevant, showing that the intervention group had in all a more favorable development Di ff erences between the groups in blood pressure, cholesterol, arterial sti ff ness markers, and inflammation / diabetes markers are shown in Figure 4 . Int. J. Environ. Res. Public Health 2020 , 17 , x FOR PEER REVIEW 6 of 13 PO VPA (min/week) 29 84.2 118.9 22.1 18 106.2 53.0 12.5 BL r V̇ O 2 max (mL/kg/min) 11 44 9 3 14 44 8 2 PO r V̇ O 2 max (mL/kg/min) 11 45 9 3 14 44 7 2 BL a V̇ O 2 max (mL/min) 11 3609 523 158 14 3509 436 117 PO a V̇ O 2 max (mL/min) 11 3646 381 115 14 3489 469 125 BM = body mass, SBP = systolic blood pressure, DBP = diastolic blood pressure, ASBP = aorta systolic blood pressure, ADBP = aorta diastolic blood pressure, PP = pulse pressure, AP = augmented pressure, CRP = C ‐ reactive protein, CHOL = total cholesterol, HDL = high ‐ density lipoprotein, LDL = low ‐ density lipoprotein, HbA 1 c = glycated hemoglobin, VPA = vigorous physical activity, r V̇ O 2 max = maximal oxygen uptake relative to body mass, a V̇ O 2 max = maximal oxygen uptake. BL = baseline, PO = post ‐ intervention An ES analysis showed that for BM, ADBP, CHOL, and LDL, ESs were > 0.50, often described as clinically relevant, showing that the intervention group had in all a more favorable development Differences between the groups in blood pressure, cholesterol, arterial stiffness markers, and inflammation/diabetes markers are shown in Figure 4 Figure 2. Self ‐ reported change in VPA ( A ), self ‐ reported training frequency ( B ) Self ‐ reported training frequency changed during the intervention At baseline, a majority of the participants trained one or less than one session per week After the intervention, all members (100%) of the intervention group reported training two to three times a week The control group members reduced the number that trained one or less than one time per week after intervention and increased the numbers that reported training two or more times per week Self ‐ reported weekly VPA increased by 11.4 (83.2) min in the control group and 15.6 (116.1) min in the intervention group (Figure 2 A and B) We had technical problems evaluating the PAI results, but the intervention group reached an average of 100 PAI per week during the intervention period, statistically significantly more than that of the control group (results not shown) Figure 2. Self-reported change in VPA ( A ), self-reported training frequency ( B ).

[Find the meaning and references behind the names: Cho, Minor]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 7 of 13 Int. J. Environ. Res. Public Health 2020 , 17 , x FOR PEER REVIEW 7 of 13 V̇ O 2 max relative to body mass did not change much for either groups, but interestingly, the control group had a small increase in mean absolute V̇ O 2 max as seen in Figure 3 Figure 3. Change in maximal oxygen uptake, A relative to body mass, B absolute, in L/min Figure 4. Changes in BP ( A ), CHO ( B ), markers of arterial stiffness ( C ), and ( D ) markers of inflammation and diabetes from baseline to post ‐ intervention Horizontal line inside box is median, whiskers are 5 and 95 percentiles, dots outliers SBP = systolic blood pressure, DBP = diastolic blood pressure, ASBP = aorta systolic blood pressure, ADBP = aorta diastolic blood pressure, PP = pulse pressure, AP = augmented pressure, CRP = C ‐ reactive protein, CHOL = total cholesterol, HDL = high ‐ density lipoprotein, LDL = low ‐ density lipoprotein, HbA 1 c = glycated hemoglobin, C = control group, I = intervention group Dots are outliers Figure 3. Change in maximal oxygen uptake, ( A ) relative to body mass, ( B ) absolute, in L / min Int. J. Environ. Res. Public Health 2020 , 17 , x FOR PEER REVIEW 7 of 13 V̇ O 2 max relative to body mass did not change much for either groups, but interestingly, the control group had a small increase in mean absolute V̇ O 2 max as seen in Figure 3 Figure 3. Change in maximal oxygen uptake, A relative to body mass, B absolute, in L/min Figure 4. Changes in BP ( A ), CHO ( B ), markers of arterial stiffness ( C ), and ( D ) markers of inflammation and diabetes from baseline to post ‐ intervention Horizontal line inside box is median, whiskers are 5 and 95 percentiles, dots outliers SBP = systolic blood pressure, DBP = diastolic blood pressure, ASBP = aorta systolic blood pressure, ADBP = aorta diastolic blood pressure, PP = pulse pressure, AP = augmented pressure, CRP = C ‐ reactive protein, CHOL = total cholesterol, HDL = high ‐ density lipoprotein, LDL = low ‐ density lipoprotein, HbA 1 c = glycated hemoglobin, C = control group, I = intervention group Dots are outliers Figure 4. Changes in BP ( A ), CHO ( B ), markers of arterial sti ff ness ( C ), and ( D ) markers of inflammation and diabetes from baseline to post-intervention. Horizontal line inside box is median, whiskers are 5 and 95 percentiles, dots outliers. SBP = systolic blood pressure, DBP = diastolic blood pressure, ASBP = aorta systolic blood pressure, ADBP = aorta diastolic blood pressure, PP = pulse pressure, AP = augmented pressure, CRP = C-reactive protein, CHOL = total cholesterol, HDL = high-density lipoprotein, LDL = low-density lipoprotein, HbA 1 c = glycated hemoglobin, C = control group, I = intervention group. Dots are outliers 4. Discussion We found minor di ff erences in important CVD risk factors between a group of rotating shift workers that had participated in an eight-week training intervention with 1 x 4 min high-intensity

[Find the meaning and references behind the names: John Henry, Sugar, Own, Level, Bias, Life, Normal, Active, John, Large, Henry, Manner, Sample, Case, Still, Factor, Right, Able, Need, Ones]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 8 of 13 bouts, three times a week, and colleagues that had not followed this training, but kept their normal activity level. The intervention group favorably di ff ered significantly from the control group on improvement of systolic and diastolic blood pressure and glycated hemoglobin (HbA 1 c). The groups’ post-intervention values were not statistically significantly di ff erent for any variable, but the size of the change was significantly di ff erent for BM and CHOL ( p < 0.05), with the intervention group having the largest changes, in a positive direction A strength of the present paper is its prospective design in which the participants are their own control, eliminating the variation between subjects. This design also gives the opportunity to assess each participant’s health outcome after an intervention. The same researchers / technicians performed the tests at both occasions using the same devices and instructing the participants in the same manner The participants were all rotating shift workers but still self-selection of healthy and highly motivated individuals into the study could not be ruled out A limitation of the study could be misclassification of exercise level since the most motivated participants in the study could tend to report PA sessions more often than less compliant participants Furthermore, stronger associations between PA and e ff ects of health outcome are probable in laboratory settings with individuals not working as rotating shift workers. As the criterium for being admitted to the intervention group was only to have attended at least 10 sessions, the training e ff ect in that group may have been low. Both the intervention group and the control group were asked to have an active life, and to accumulate 100 PAI per week, so the di ff erence between the two groups in PA level was not maximized Self-reported training did increase for both groups (Figure 2 ). The control group reduced their number of less active participants (training one or less times per week) and increased the number in the more active groups. This is what they were asked to do and is not a John Henry e ff ect. We wanted as many as possible to achieve 100 PAI per week through the intervention period as this may have a positive e ff ect on cardiovascular health [ 23 ], but due to technical problems with the hardware, we were not able to use the results from this registration in further analysis, but a motivating factor of the use of these items could not be ruled out. For the intervention group, all participants (100%) reported training two to three times a week at intervention end, thereby reducing the number that had trained more than three times a week from 9% to 0%, but at the same time increasing the number of participants that trained less than three times per week substantially. This shows that the intervention group did follow the project’s training o ff er to a large extent, and that this training was regarded as su ffi cient and thus created no need for more training sessions, even if the training time per session was only 17 min in total. The participants were also asked to report the amount of VPA per week, and both groups reported increased activity, but the intervention group was at both times reporting a higher number of minutes engaged in VPA than the control group. Self-reported activity should be looked upon with caution, as it is easy to overlook training, especially low-intensity activity. As we asked about high-intensity activity, the answers may be more accurate [ 24 – 26 ]. Intervention studies have shown that those who engage in PA on a regular basis are more easily convinced to participate in PA initiatives compared to sedentary ones [ 27 ]. This may thus induce a bias in the sample that can make the e ff ect larger than it really is. However, the participating rate was high in the intervention group as seen in Figure 1 . We also know that sedentary workers were included in the present intervention as demonstrated in the case presentation, Table 4 . This case had, with the exception of CRP, a favorable change in all parameters after eight weeks of training: resting heart rate, blood pressure, measures of arterial sti ff ness, blood sugar, and ˙VO 2 max Among rotating shift workers, increased blood pressure [ 28 ], most pronounced among workers with mostly night work and frequent rotations [ 29 ], and arterial sti ff ness have been described [ 30 , 31 ]. In the present study, blood pressure decreased after an eight-week high-intensity training intervention focusing on cardiorespiratory performance. The reduction was small, but represents a change in the right direction. PA has a protective e ff ect on sti ff ness of the arteries [ 32 ]. Both augmentation

[Find the meaning and references behind the names: Man, Transport, Final, Great, Cut, Might, Sleep, Young]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 9 of 13 pressure and pulse wave velocity were associated with self-reported high-intensity PA at baseline and post-intervention in the present cohort Table 4. Case characteristics and selected outcomes in a young man with more than 10 years as a shift worker performing 2–3 recorded weekly PA interventions during follow-up Baseline Post-Intervention BMI (kg / m 2 ) 34.7 34.0 RHR a (bpm) 73 55 SBP a (mmHg) 133 114 b DBP a (mmHg) 90 72 b ASBP (mmHg) 121 109 b ADBP (mmHg) 76 69 b AP (mmHg) 11 8 AIx 25 19 b PWV (m / s) 9.0 7.9 CRP (mg / L) 6.2 7.5 Cholesterol / HDL (mmol / L) 4.2 4.0 HbA 1 c (mmol / mol) 32 30 ˙VO 2 max (ml / kg / min) 33.8 34.9 a Best of three measurements after 5 min rest; b clear health improvement, below cut-o ff values; BMI = body mass index, RHR = resting heart rate, Aix = augmentation index (see Abbreviations) Low HDL is reported among shift workers [ 33 – 35 ] and associated with the metabolic syndrome In addition, sleep deprivation downregulates cholesterol / lipid metabolism and transport [ 36 ]. In the present study, we found that regular weekly high-intensity PA for eight weeks yielded an elevation of HDL and a reduction of total cholesterol among those participating in guided PA (intervention group) Disruption of the circadian rhythm increases the risk for diabetes and metabolic syndrome [ 28 ]. Two large cohort studies of female nurses have found that rotating night shift work as such is associated with diabetes II [ 37 ]. Any measure that could result in decreased risk for this disease, and thus counteract its cardiometabolic consequences, is essential. Therefore, regular high-intensity PA of short duration, leading to a reduced HbA 1 c as demonstrated in the present study, is of great importance as a CVD preventive strategy among rotating shift workers Systemic inflammation expressed as elevated high-sensitivity CRP is known to increase vascular risk. Shift work could cause sleep deprivation which again a ff ects the immune system, resulting in increased inflammation [ 36 , 38 ]. This phenomenon could explain that number of years as a shift worker is associated with increasing CRP levels initially in the present cohort [ 12 ]. Leisure time PA among workers with long working hours, however, resulted in reduced CRP after 15 months of follow-up [ 12 ]. The present eight-week PA intervention did not a ff ect this parameter. Thus, the duration of this PA initiative might be too short to reduce inflammation among shift workers Shift work is associated with increased carotid intima-media thickness (CIMT) and thus possibly early manifestation of atherosclerosis [ 12 , 39 ]. PA reduces CIMT progression among patients with diabetes II and coronary heart disease [ 40 ]. The present study suggests beneficial e ff ects of PA educational programs on protection of early manifestation of CVD risk factors and atherosclerosis, as depicted in Table 5 . The cohort will be subjected to three years of follow-up in which CIMT will be repeated at final follow-up.

[Find the meaning and references behind the names: Read, Mercury, Meter, Sign, Thank, Author]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 10 of 13 Table 5. Number of people that have moved from having an unhealthy value to a healthy value during the intervention Variable Control Intervention CHOL − 4 2 HDL 2 0 LDL 1 2 CRP − 3 0 CHOL = total cholesterol, HDL = high-density lipoprotein, LDL = low-density lipoprotein, CRP = C-reactive protein A – sign indicates a decrease in number of people in the healthy group. HbA 1 c not shown because all participants were in the healthy group at both times 5. Conclusions In this study, we found that a PA intervention focusing on cardiorespiratory health among rotating shift workers in industry can modify early manifestations of CVD. This could imply that regular, short bouts of PA could counteract the increased risk for coronary heart disease and stroke among these workers. PA interventions in occupational settings may thus decrease coronary heart disease and stroke incidences in this vulnerable group of workers. The present cohort will be subjected to follow-up for three years Author Contributions: A.M., R.Ø., P.A.S., P.N. and M.S. participated in the planning of the project, data collection, and writing the paper. A.M. and M.S. analyzed the data. A.M. and M.S. drafted the paper. All authors have read and agreed to the published version of the manuscript Funding: This research received no external funding Acknowledgments: We thank the workers at Glava and Rockwool plants for participating in the study and Industri Energi for financial support. The case gave the authors permission to publish the results of the PA intervention Conflicts of Interest: The authors declare no conflict of interest Abbreviations ADBP Aorta diastolic blood pressure ASBP Aorta systolic blood pressure AIx Augmentation index (AIx) AP Augmentation pressure (AP) BL Baseline BM Body mass BMI Body mass index CRP Control group CBP Central blood pressure CHOL Cholesterol-total CRP C-reactive protein DBP Diastolic blood pressure EDTA Ethylene diamine tetra acetic acid HbA 1 c Glycated hemoglobin HDL High-density lipoprotein I Intervention group kg Kilogram LDL Low-density lipoprotein HRmax Maximal heart rate ˙VO 2 max Maximal oxygen uptake m / s meter per second mg / L milligram per liter mL Milliliter mmHg millimeter mercury mmol / L millimole per. liter

[Find the meaning and references behind the names: Van Leeuwen, Nilsen, Kolbe, Adm, Matikainen, Garg, Plan, Aass, Leeuwen, Nardini, Sum, Campisi, Burgos, Standard, Fukuda, Gene, Mistretta, Moreno, Parraga, Engl, Dose, Leone, Mantovani, Morris, Sci, Puttonen, Boschetto, Ireland, Alexander, Brown, Bonci, Bottazzi, Front, Pavanello, Dobson, Lunde, Rantanen, Amano, Vyas, Dublin, Mastrangelo, Scheer, Matre, Tell, Stendardo, Aho, Cherrie, Med, Ollila, Mielke, Lehto, Donner, Ellingsen, Serv, Harma, Purvis, Crawford, Peak, Hope]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 11 of 13 min Minute PAI Personalized activity intelligence PA Physical activity PO Post-intervention PP Pulse pressure PWV Pulse wave velocity RHR Resting heart rate RPM Rotation per minute s Second SD Standard deviation SBP Systolic blood pressure VPA Vigorous physical activity References 1 Schnall, P.L.; Dobson, M.; Landsbergis, P. Globalization, work, and cardiovascular disease Int. J. Health Serv Plan. Adm. Eval 2016 , 46 , 656–692. [ CrossRef ] 2 Eurofond First findings: Sixth European Working Conditions Survey—R é sum é ; Eurofond: Dublin, Ireland, 2015; p. 8 3 Vyas, M.V.; Garg, A.X.; Iansavichus, A.V.; Costella, J.; Donner, A.; Laugsand, L.E.; Janszky, I.; Mrkobrada, M.; Parraga, G.; Hackam, D.G. Shift work and vascular events: Systematic review and meta-analysis BMJ 2012 , 345 , 4800. [ CrossRef ] 4 Torquati, L.; Mielke, G.I.; Brown, W.J.; Kolbe-Alexander, T. Shift work and the risk of cardiovascular disease A systematic review and meta-analysis including dose-response relationship Scand. J. Work. Environ. Health 2018 , 44 , 229–238. [ CrossRef ] 5 Theorell, T.; Akerstedt, T. Day and night work: Changes in cholesterol, uric acid, glucose and potassium in serum and in circadian patterns of urinary catecholamine excretion. A longitudinal cross-over study of railway workers Acta Med. Scand 1976 , 200 , 47–53. [ CrossRef ] 6 Ulh ô a, M.A.; Marqueze, E.C.; Burgos, L.G.A.; Moreno, C.R.C. Shift work and endocrine disorders Int. J. Endocrinol 2015 , 2015 , 826249. [ CrossRef ] 7 Amano, H.; Fukuda, Y.; Yokoo, T.; Yamaoka, K. Interleukin-6 Level among Shift and Night Workers in Japan: Cross-Sectional Analysis of the J-HOPE Study J. Atheroscler. Thromb 2018 , 25 , 1206–1214. [ CrossRef ] [ PubMed ] 8 Pavanello, S.; Stendardo, M.; Mastrangelo, G.; Bonci, M.; Bottazzi, B.; Campisi, M.; Nardini, M.; Leone, R.; Mantovani, A.; Boschetto, P. Inflammatory Long Pentraxin 3 is Associated with Leukocyte Telomere Length in Night-Shift Workers Front. Immunol 2017 , 8 , 516. [ CrossRef ] [ PubMed ] 9 Puttonen, S.; Viitasalo, K.; Harma, M. E ff ect of Shiftwork on Systemic Markers of Inflammation Chronobiol. Int 2011 , 28 , 528–535. [ CrossRef ] [ PubMed ] 10 Morris, C.J.; Purvis, T.E.; Mistretta, J.; Hu, K.; Scheer, F.A.J.L. Circadian misalignment increases C-reactive protein and blood pressure in chronic shift workers J. Biol. Rhythms 2017 , 32 , 154–164. [ CrossRef ] [ PubMed ] 11 Aho, V.; Ollila, H.M.; Rantanen, V.; Kronholm, E.; Surakka, I.; van Leeuwen, W.M.A.; Lehto, M.; Matikainen, S.; Ripatti, S.; Härmä, M.; et al. Partial sleep restriction activates immune response-related gene expression pathways: Experimental and epidemiological studies in humans PLoS ONE 2013 , 8 , e 77184. [ CrossRef ] 12 Skogstad, M.; Mamen, A.; Lunde, L.-K.; Ulvestad, B.; Matre, D.; Aass, H.C.D.; Øvstebø, R.; Nielsen, P.; Samuelsen, K.N.; Skare, Ø.; et al. Shift Work Including Night Work and Long Working Hours in Industrial Plants Increases the Risk of Atherosclerosis Int. J. Environ. Res. Public Health 2019 , 16 , 521. [ CrossRef ] [ PubMed ] 13 Aspenes, S.T.; Nilsen, T.I.L.; Skaug, E.-A.; Bertheussen, G.F.; Ellingsen, Ø.; Vatten, L.; Wislø ff , U. Peak oxygen uptake and cardiovascular risk factors in 4631 healthy women and men Med. Sci. Sports Exerc 2011 , 43 , 1465–1473. [ CrossRef ] [ PubMed ] 14 McElvenny, D.M.; Crawford, J.O.; Cherrie, J.W. What should we tell shift workers to do to reduce their cancer risk? Occup. Med. Oxf. Engl 2018 , 68 , 5–7. [ CrossRef ]

[Find the meaning and references behind the names: Van Mechelen, Van Poppel, Zhang, Liu, Cullen, Alfonso, Bradshaw, Bauman, Gain, Better, Arch, Hunt, Costello, Balmes, Gianotti, Nord, Ferguson, Clin, Kie, Single, Ann, Greenwald, Yeh, Ropponen, Blankenberg, Nes, Bus, Gonz, Hour, Jankowiak, Biddle, Munk, Lackner, Sun, Wong, Mayo, Halle, Chan, Bueno, Fern, Milton, Alvarez, Back, Rodrigues, Pirola, Ermacora, Schulz, Last, Zhou, Eisen, Gemma, Ramos, Chen, Tung, Oja, Grgic, Shrestha, Coombes, Flanders, Koskinen, Lower, Lavie, Oksanen, Shiu, Nauman, Cheng, Bmc]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 12 of 13 15 Cheng, W.-J.; Härmä, M.; Ropponen, A.; Karhula, K.; Koskinen, A.; Oksanen, T. Shift work and physical inactivity: Findings from the Finnish Public Sector Study with objective working hour data Scand. J. Work Environ. Health 2019 , 46 , 293–301. [ CrossRef ] 16 Härmä, M.I.; Ilmarinen, J.; Knauth, P.; Rutenfranz, J.; Hänninen, O. Physical training intervention in female shift workers: I. The e ff ects of intervention on fitness, fatigue, sleep, and psychosomatic symptoms Ergonomics 1988 , 31 , 39–50. [ CrossRef ] 17 Pedisic, Z.; Shrestha, N.; Kovalchik, S.; Stamatakis, E.; Liangruenrom, N.; Grgic, J.; Titze, S.; Biddle, S.J.; Bauman, A.E.; Oja, P. Is running associated with a lower risk of all-cause, cardiovascular and cancer mortality, and is the more the better? A systematic review and meta-analysis Br. J. Sports Med 2019 , 0 , 1–9. [ CrossRef ] [ PubMed ] 18 Ramos, J.S.; Dalleck, L.C.; Tjonna, A.E.; Beetham, K.S.; Coombes, J.S. The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: A systematic review and meta-analysis Sports Med 2015 , 45 , 679–692. [ CrossRef ] 19 Ingjer, F. Factors influencing assessment of maximal heart rate Scand. J. Med. Sci. Sports 1991 , 1 , 134–140 [ CrossRef ] 20 Moholdt, T.; Wislø ff , U.; Lydersen, S.; Nauman, J. Current physical activity guidelines for health are insu ffi cient to mitigate long-term weight gain: More data in the fitness versus fatness debate (The HUNT study, Norway) Br. J. Sports Med 2014 , 48 , 1489–1496. [ CrossRef ] 21 Nes, B.M.; Gutvik, C.R.; Lavie, C.J.; Nauman, J.; Wislø ff , U. Personalized Activity Intelligence (PAI) for Prevention of Cardiovascular Disease and Promotion of Physical Activity Am. J. Med 2017 , 130 , 328–336 [ CrossRef ] 22 Tjønna, A.E.; Ramos, J.S.; Pressler, A.; Halle, M.; Jungbluth, K.; Ermacora, E.; Salvesen, Ø.; Rodrigues, J.; Bueno, C.R.; Munk, P.S.; et al. EX-MET study: Exercise in prevention on of metabolic syndrome—A randomized multicenter trial: Rational and design BMC Public Health 2018 , 18 , 437. [ CrossRef ] [ PubMed ] 23 Kie ff er, S.K.; Zisko, N.; Coombes, J.S.; Nauman, J.; Wislø ff , U. Personal Activity Intelligence and Mortality in Patients with Cardiovascular Disease: The HUNT Study Mayo Clin. Proc 2018 , 93 , 1191–1201. [ CrossRef ] [ PubMed ] 24 van Poppel, M.N.M.; Chinapaw, M.J.M.; Mokkink, L.B.; van Mechelen, W.; Terwee, C.B. Physical activity questionnaires for adults: A systematic review of measurement properties Sports Med 2010 , 40 , 565–600 [ CrossRef ] [ PubMed ] 25 Milton, K.; Clemes, S.; Bull, F. Can a single question provide an accurate measure of physical activity? Br. J Sports Med 2013 , 47 , 44–48. [ CrossRef ] 26 Kurtze, N.; Rangul, V.; Hustvedt, B.-E.; Flanders, W.D. Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study (HUNT 2) Eur. J. Epidemiol 2007 , 22 , 379–387. [ CrossRef ] 27 Skogstad, M.; Lunde, L.-K.; Skare, Ø.; Mamen, A.; Alfonso, J.H.; Øvstebø, R.; Ulvestad, B. Physical activity initiated by employer and its health e ff ects; an eight week follow-up study BMC Public Health 2016 , 16 , 377 [ CrossRef ] 28 Sookoian, S.; Gemma, C.; Fern á ndez Gianotti, T.; Burgueño, A.; Alvarez, A.; Gonz á lez, C.D.; Pirola, C.J E ff ects of rotating shift work on biomarkers of metabolic syndrome and inflammation J. Intern. Med 2007 , 261 , 285–292. [ CrossRef ] 29 Ferguson, J.M.; Costello, S.; Neophytou, A.M.; Balmes, J.R.; Bradshaw, P.T.; Cullen, M.R.; Eisen, E.A. Night and rotational work exposure within the last 12 months and risk of incident hypertension Scand. J. Work Environ. Health 2019 , 45 , 256–266. [ CrossRef ] 30 Jankowiak, S.; Back é , E.; Liebers, F.; Schulz, A.; Hegewald, J.; Garthus-Niegel, S.; Nübling, M.; Blankenberg, S.; Pfei ff er, N.; Lackner, K.J.; et al. Current and cumulative night shift work and subclinical atherosclerosis: Results of the Gutenberg Health Study Int. Arch. Occup. Environ. Health 2016 , 89 , 1169–1182. [ CrossRef ] 31 Chen, C.-C.; Shiu, L.-J.; Li, Y.-L.; Tung, K.-Y.; Chan, K.-Y.; Yeh, C.-J.; Chen, S.-C.; Wong, R.-H. Shift work and arteriosclerosis risk in professional bus drivers Ann. Epidemiol 2010 , 20 , 60–66. [ CrossRef ] 32 Zhang, Y.; Qi, L.; Xu, L.; Sun, X.; Liu, W.; Zhou, S.; van de Vosse, F.; Greenwald, S.E. E ff ects of exercise modalities on central hemodynamics, arterial sti ff ness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials PLoS ONE 2018 , 13 , e 0200829 [ CrossRef ] [ PubMed ]

[Find the meaning and references behind the names: Heiskanen, Lindahl, Knutsson, Porkka, Luukkonen, Soininen, Male, Jonnier, Perret, Shan, Zong, Strain, Kettunen, Manson, Vahtera, Lindholm, Karlsson, Under, Rep, Kangas, Open, Job, Solheim, Guo, Pons, Sallinen, Willett, Arnesen, Wolf]

Int. J. Environ. Res. Public Health 2020 , 17 , 3943 13 of 13 33 Karlsson, B.H.; Knutsson, A.K.; Lindahl, B.O.; Alfredsson, L.S. Metabolic disturbances in male workers with rotating three-shift work. Results of the WOLF study Int. Arch. Occup. Environ. Health 2003 , 76 , 424–430 [ CrossRef ] [ PubMed ] 34 Esquirol, D.Y.; Bongard, V.; Mabile, L.; Jonnier, B.; Soulat, J.-M.; Perret, B. Shift Work and Metabolic Syndrome: Respective Impacts of Job Strain, Physical Activity, and Dietary Rhythms Chronobiol. Int 2009 , 26 , 544–559 [ CrossRef ] [ PubMed ] 35 Karlsson, B.; Knutsson, A.; Lindahl, B. Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people Occup. Environ. Med 2001 , 58 , 747–752 [ CrossRef ] 36 Aho, V.; Ollila, H.M.; Kronholm, E.; Bondia-Pons, I.; Soininen, P.; Kangas, A.J.; Hilvo, M.; Seppälä, I.; Kettunen, J.; Oikonen, M.; et al. Prolonged sleep restriction induces changes in pathways involved in cholesterol metabolism and inflammatory responses Sci. Rep 2016 , 6 , 1–14. [ CrossRef ] 37 Shan, Z.; Li, Y.; Zong, G.; Guo, Y.; Li, J.; Manson, J.E.; Hu, F.B.; Willett, W.C.; Schernhammer, E.S.; Bhupathiraju, S.N. Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: Results from two large US cohorts of female nurses BMJ 2018 , 363 . [ CrossRef ] 38 van Leeuwen, W.M.A.; Lehto, M.; Karisola, P.; Lindholm, H.; Luukkonen, R.; Sallinen, M.; Härmä, M.; Porkka-Heiskanen, T.; Alenius, H. Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL-17 and CRP PLoS ONE 2009 , 4 , e 4589. [ CrossRef ] 39 Puttonen, S.; Kivimäki, M.; Elovainio, M.; Pulkki-Råback, L.; Hintsanen, M.; Vahtera, J.; Telama, R.; Juonala, M.; Viikari, J.S.A.; Raitakari, O.T.; et al. Shift work in young adults and carotid artery intima-media thickness: The Cardiovascular Risk in Young Finns study Atherosclerosis 2009 , 205 , 608–613. [ CrossRef ] 40 Byrkjeland, R.; Stensæth, K.-H.; Anderssen, S.; Njerve, I.U.; Arnesen, H.; Seljeflot, I.; Solheim, S. E ff ects of exercise training on carotid intima-media thickness in patients with type 2 diabetes and coronary artery disease. Influence of carotid plaques Cardiovasc. Diabetol 2016 , 15 , 13. [ CrossRef ] © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http: // creativecommons.org / licenses / by / 4.0 / ).

Other Environmental Sciences Concepts:

[back to top]

Discover the significance of concepts within the article: ‘High-Intensity Training Reduces CVD Risk Factors among Rotating Shift Workers’. Further sources in the context of Environmental Sciences might help you critically compare this page with similair documents:

Physical activity, Active life, Mortality, Longitudinal studies, Medical history, Endocrine system, Immune system, Blood-pressure, Statistical analysis, Control group, Ethical consideration, Body mass index, Ethics committee, Insulin resistance, Heart rate, Metabolic syndrome, Systolic blood pressure, Total cholesterol, High-density lipoprotein, Cross-sectional study, Cardiovascular disease, Arterial stiffness, C-Reactive Protein, Meta analysis, Stroke, Blood sugar, Coronary heart disease, Intervention group, Cancer risk, Blood glucose, Written consent, Supine Position, Occupational health, Sleep Deprivation, Night shift, Systemic inflammation, Cardiovascular health, Pulse Wave Velocity, Pulse Pressure, Baseline data, Carotid Arteries, Glycated Hemoglobin, Diastolic pressure, Maximal oxygen uptake, Shift workers, Shift work, Resting heart rate, Vigorous physical activity, Carotid intima-media thickness, All-cause mortality, Body mass, Carotid artery, Effect Size, Training session, Respiratory exchange ratio, Prospective design, Baseline, Long working hours, Industry, Blood lipid, Industrial setting, Cycle ergometer, Intima-media thickness, Selection process, Physical activity intervention, Demographic characteristic, Intervention program, Stroke incidence, Oxygen uptake, Misclassification, Occupational health service, Lipid, CVD risk factor, Economic globalization, Labor market, Cardiorespiratory performance, Laboratory setting, High intensity training, CVD event, Blood parameter, Training frequency, Work organization, Self-selection, Positive development, Daily smokers, PA intervention, PA level, Industrial plant, Cardiorespiratory health, School of Health Science.