JDERM JMIR Dermatol JMIR Dermatology 2562-0959 JMIR Publications Toronto, Canada v7i1e51962 38483460 10.2196/51962 Review Review The Potential of Exercise on Lifestyle and Skin Function: Narrative Review Dellavalle Robert Gasmi Maha Batrakoulis Alexis Oizumi Ryosuke PhD 1
Faculty of Nursing Shijonawate gakuen University Gakuen-cyo, 6-45 Osaka Daito-shi, 574-0001 Japan 81 72 813 2601 r-oizumi@un.shijonawate-gakuen.ac.jp
https://orcid.org/0000-0001-5402-2115 Sugimoto Yoshie PhD 2 https://orcid.org/0000-0003-1136-7898 Aibara Hiromi PhD 3 https://orcid.org/0000-0003-0347-7173 Faculty of Nursing Shijonawate gakuen University Daito-shi Japan Osaka Metropolitan University Habikino-shi Japan Ehime University Toon-shi Japan Corresponding Author: Ryosuke Oizumi r-oizumi@un.shijonawate-gakuen.ac.jp 2024 14 3 2024 7 e51962 18 8 2023 27 12 2023 24 1 2024 6 2 2024 ©Ryosuke Oizumi, Yoshie Sugimoto, Hiromi Aibara. Originally published in JMIR Dermatology (http://derma.jmir.org), 14.03.2024. 2024

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.

 Background

The skin is an important organ of the human body and has moisturizing and barrier functions. Factors such as sunlight and lifestyle significantly affect these skin functions, with sunlight being extremely damaging. The effects of lifestyle habits such as smoking, diet, and sleep have been studied extensively. It has been found that smoking increases the risk of wrinkles, while excessive fat and sugar intake leads to skin aging. Lack of sleep and stress are also dangerous for the skin’s barrier function. In recent years, the impact of exercise habits on skin function has been a focus of study. Regular exercise is associated with increased blood flow to the skin, elevated skin temperature, and improved skin moisture. Furthermore, it has been shown to improve skin structure and rejuvenate its appearance, possibly through promoting mitochondrial biosynthesis and affecting hormone secretion. Further research is needed to understand the effects of different amounts and content of exercise on the skin.

 Objective

This study aims to briefly summarize the relationship between lifestyle and skin function and the mechanisms that have been elucidated so far and introduce the expected effects of exercise on skin function.

 Methods

We conducted a review of the literature using PubMed and Google Scholar repositories for relevant literature published between 2000 and 2022 with the following keywords: exercise, skin, and life habits.

 Results

Exercise augments the total spectrum power density of cutaneous blood perfusion by a factor of approximately 8, and vasodilation demonstrates an enhancement of approximately 1.5-fold. Regular exercise can also mitigate age-related skin changes by promoting mitochondrial biosynthesis. However, not all exercise impacts are positive; for instance, swimming in chlorinated pools may harm the skin barrier function. Hence, the exercise environment should be considered for its potential effects on the skin.

 Conclusions

This review demonstrates that exercise can potentially enhance skin function retention.

 skin function lifestyle exercise reviews knowledge synthesis Review methods review methodology literature review literature reviews narrative review narrative reviews skin dermatology exercise physical activity fitness lifestyles smoking diet sleep sugar intake life habits skin barrier Introduction

The skin is the largest human organ that acts as a barrier between the body and the environment. Its role is to protect the body from the invasion of pathogens and to shield it from chemical and physical stimuli originating from the external environment; furthermore, it also prevents dehydration by mitigating water loss from the body [1,2]. The stratum corneum primarily serves as this barrier [1]. Skin functionality declines with age, a process evidenced not only in appearance, such as fine wrinkles, but also in quantitative indicators such as reduced skin elasticity and a decrease in the water content of stratum corneum [3-5].

A complex variety of factors, beyond age-related changes, influence the functional decline of the skin. Typical examples of influencing factors include lifestyle habits such as sun exposure, smoking, and diet [3,6,7]. Various studies have been conducted on the relationship between lifestyle habits and skin function. Specific lifestyle habits that are associated with skin function include daily moisturizing [8], bathing habits [8], stress [9,10], and sleep quality [11]. Improvement of these lifestyle habits is expected to prevent the functional decline of the skin.

In addition to the lifestyle habits mentioned above, exercise is gaining attention as a way to prevent skin dysfunction and improve aesthetics [12]. It is widely known that regular exercise not only aids in the prevention of various diseases but also plays a significant role in maintaining mental health [13-15]. However, the impact of exercise on skin function remains largely unexplored. In this review, we will briefly summarize the relationship between lifestyle and skin function and the mechanisms that have been elucidated so far. Additionally, we will introduce the expected effects of exercise on skin functionality.

 Methods

A review of the literature was conducted using PubMed and Google Scholar repositories for relevant literature published between 2000 and 2022 using the following keywords: exercise, skin, and life habits. The search was expanded to discover relevant literature on specific lifestyle habits. To discover relevant literature showing the effects of specific lifestyle habits on skin function, searches were conducted using the following keywords: smoking, dietary habits, ultraviolet light, hormones, and stress.

However, articles on the relationship between skin diseases such as atopic dermatitis and lifestyle habits were excluded.

 Results Skin Function

Preserving moisture and acting as a barrier are important functions of the skin [2]. These functions are mainly performed by the stratum corneum, which consists of keratinocytes stacked in a brick-like structure (brick and mortar model), with the cells being akin to bricks and intercellular lipids acting as the mortar, filling the spaces between the cells. These cells are further interconnected by desmosomes [2]. The natural moisturizing factors in the keratinocytes and intercellular lipids maintain skin hydration [16]. In addition, the dermis layer beneath the stratum corneum contains elastic fibers, such as collagen and elastin, which make the skin elastic and provide a barrier against physical stimuli [6]. When the skin’s moisturizing and barrier functions are compromised, it can lead to issues such as skin dryness and infections, which are caused by microorganisms entering the body’s defenses [17]. Hormones such as estrogen and growth hormones play an important role in maintaining these skin functions, including supporting skin elasticity and moisture retention. As we age, the secretion of these hormones declines, leading to a decrease in skin elasticity and hydration [18,19].

 Internal Factors Related to Skin Function Aging

Age-related declines in skin functions, such as loss of elasticity, are explained by a decrease in collagen synthesis due to fewer fibroblasts in the dermis, a decrease in the number of sebaceous and sweat glands, and diminished blood flow to the skin [6,20,21]. These factors cause skin changes characteristic of older adults, such as coarse and dry skin, spots and dullness, wrinkles, and sagging. Various hypotheses have been made about the causes of age-related changes. Leading hypotheses include the generation of reactive oxygen species (ROS) or free radicals by normal endogenous metabolic processes, telomere shortening, and the accumulation of advanced glycation end products [22-25]. These age-related changes vary greatly in their intensity, depending on the individual’s race, personal characteristics, and different sites within the same person’s body [4,26]. The reasons for this variation are thought to be related to differences in the number of cells in the stratum corneum, the amount of melanin, and the amount of light exposure [26,27].

 Hormone Balance (Estrogen and Growth Hormone)

Various hormones are associated with skin function. Of these, estrogen and growth hormones have been the focus of many studies as they are associated with age-related declines in skin functionality [17,28,29]. Changes in the secretion of these hormones occur with aging. The effects of decreased estrogen secretion on the skin are more pronounced in postmenopausal women because women secrete less estrogen after menopause [30]. Two important roles of estrogen for the skin are collagen production and wound healing [28,31]. Research has demonstrated that the decrease in estrogen levels associated with menopause results in reduced collagen levels in the skin. Conversely, estrogen replacement therapy in postmenopausal women has been shown to increase these collagen levels [32,33]. Collagen plays a crucial role in skin elasticity and skin thickness; consequently, a decrease in collagen content leads to skin wrinkling and thinning [28,31]. Although the direct relationship between skin elasticity and skin hydration is not clear, skin elasticity and skin hydration act as similar indicators of skin function, as skin elasticity and skin hydration decrease with reduced skin function [6]. The role of estrogen in wound healing is to suppress the inflammatory response and promote epithelialization in the wound [34]. The wound healing process encompasses several stages, starting with hemostasis and coagulation, followed by the inflammatory phase, and then the proliferative phase. An excessive inflammatory response can delay the inflammatory phase. Estrogen has been shown to regulate and suppress the inflammatory response in wounds [34,35]. In addition, since collagen production is active during the proliferative phase, estrogen administration has been shown to increase the amount of collagen in the wound and promote wound healing [34].

The secretion of growth hormone is involved in the synthesis of collagen [36]. It has been shown that excessive secretion of growth hormone causes thickening of the skin, while a deficiency in growth hormone causes skin thinning and a loss of elasticity [37,38]. In addition, growth hormone is involved in the development of sweat glands. An excess or deficiency in this hormone has been shown to cause excessive sweating or decreased sweating, respectively [19].

 External Factors Related to Skin Function Sunlight

The most significant external factor affecting skin aging is ultraviolet radiation (UVR) from sunlight. Since most of the sun’s UVR (290-400 nm) is blocked by the Earth’s atmosphere, UVR reaching the Earth’s surface consists of >95% ultraviolet A (320-400 nm) and approximately 5% ultraviolet B (290-320 nm) [39,40]. UV energy is absorbed by skin cells and generates ROS that cause oxidative stress and damage various molecules, including DNA, in cells and tissues [39]. Additionally, UV light damages the collagen in the skin [41]. As a result, skin with prolonged and repeated exposure to sunlight becomes yellowish in tone, more stained, has an increase in fine and deep wrinkles, and loses its luster, becoming rough and dry [6].

 Lifestyle Habits Diet

Dietary habits refer to preferences for food and beverages, and various studies have revealed the effects of diet on the skin, albeit in rats.

One specific diet known to affect the skin is a high-fat diet. Dietary fat intake is closely related to the lipid composition of body adipose tissue and skin [42]. A high-fat diet can potentially induce oxidative stress and inflammatory responses in the skin, delay skin healing by decreasing protein synthesis, and cause morphological changes in the skin [43]. A close association has also been established between the consumption of sugars and fried foods and the acceleration of skin aging. The metabolism of sugars and proteins generates advanced glycation end products, and their accumulation accelerates skin aging [44]. Therefore, limiting the intake of sugars and proteins can be expected to delay skin aging [44].

Alcohol consumption may also expedite skin aging. Ethanol and acetone, byproducts of alcohol metabolism, may promote the proliferation of keratinocytes in the skin, thereby increasing its permeability and impairing its barrier function [45]. Additionally, the degree of facial aging increases in correlation with alcohol intake and time [46].

 Smoking

Smoking is the most common lifestyle habit that adversely affects skin function. Studies examining the effect of past smoking history on current skin condition have shown that each pack-year increases the risk of wrinkle development by more than 5-fold. Additionally, smoking has also been shown to alter skin thickness and promote skin pigmentation [47-49]. Smoking constricts skin blood vessels and deteriorates skin blood flow, thereby reducing the oxygen supply to skin tissues. This promotes a decline in skin function, including a decrease in skin elasticity and skin hydration [50,51].

 Stress and Sleep

The impact of stress and sleep quality on skin function has been evaluated using skin hydration and transepidermal water loss (TEWL) [9,11]. Stress can undermine the integrity of the stratum corneum by decreasing the production and secretion of lamellar body and keratinocyte proliferation, leading to a weakened skin barrier function and structural damage to the skin [52]. Stressed individuals have also been found to have delayed recovery from changes in TEWL due to stratum corneum removal by tape stripping [9]. The effects of sleep on the skin have been shown to occur in individuals with poor sleep quality and sleep deprivation. These individuals typically exhibit higher TEWL, reduced skin barrier function, and cosmetic changes [11,53,54]. These studies were cross-sectional or included results reported immediately after stressful exposure, and the effects of long-term stressful exposure on the skin are not clear.

 The Relationship Between Exercise and Skin

Exercise has been shown to increase cutaneous blood flow, with acute maximal exercise increasing the cutaneous blood perfusion total spectrum power density approximately 8-fold [55,56]. This is a physiological function of skin vasodilation, which is accompanied by an increase in skin temperature, to dissipate the heat generated by exercise [57]. The dilation of skin vessels is attenuated by nonexercise habits and aging, and it is affected by the moisture levels in the skin. Interestingly, there are no sex differences in the pattern of skin temperature changes [55,57-59]. However, regular exercise in older and postmenopausal women has been shown to improve cutaneous vasodilation by approximately 1.5-fold [60,61]. This is thought to be due to the increased responsiveness to nitric oxide in the dilation of cutaneous blood vessels [60]. In other words, having an exercise routine not only increases cutaneous blood flow during exercise but also improves cutaneous vasodilatory function. Since skin hydration occurs through a moisture gradient between the deeper layers and the surface of the skin, maintaining adequate skin blood flow is an important factor in preserving skin hydration [16]. Although there is no direct evidence that exercise promotes skin hydration, various cross-sectional studies have shown that the skin of regularly exercising adults and hospitalized older people is more hydrated than the skin of those who do not [62,63]. Additionally, exercise can reduce hot flashes in postmenopausal women [64]. Hot flashes are thought to be caused by a dysfunction in the body’s thermoregulatory control system [65], as well as vascular dysfunction [66]. Exercise has the potential to improve these functions.

Exercise can also improve age-related changes in sedentary older adults’ skin structure [67]. One possible cause of systemic dysfunction due to aging, including skin, is increased ROS production due to age-related mitochondrial dysfunction [68]. Exercise has received significant attention because it can prevent mitochondrial dysfunction and promote mitochondrial biosynthesis, thereby helping to prevent systemic functional decline [67,69]. It has been shown that exercise stimulates the secretion of interleukin-15, which activates mitochondrial biosynthesis in muscles. This mechanism is expected to prevent age-related changes in middle-aged women’s skin [69]. In fact, in mice that exercised, there was an improvement in skin structure due to an increase in the amount of collagen in the dermis layer. Moreover, it has been shown that when older adults exercise twice a week for 12 weeks, the stratum corneum of the skin, which has thickened with age, becomes thinner [67]. In middle-aged women, daily facial exercises for 8 weeks have caused cosmetic changes in facial appearance [70], and changes in skin structure can lead to cosmetic changes as well. Exercise also affects hormone secretion, including stimulating the secretion of growth hormone and estrogen [71-73]. As mentioned in the Hormone Balance section, growth hormone and estrogen are involved in the production of cutaneous collagen [28,36]. In the skin, collagen is involved in skin elasticity and skin thickness [28,31], and a decrease in collagen content leads to skin wrinkling and thinning. Therefore, it can be inferred that it may also affect skin elasticity and other factors. Future research is expected in these areas.

However, exercise does not always have a positive effect on the skin. An example of this is the risk of skin eczema due to the composition of swimming pools [74,75]. Although this is not a direct effect of swimming exercise, it has been suggested that the chlorine used in pool disinfection may damage the skin barrier function [76]. Therefore, it is necessary to consider the possibility that the environment in which exercise is performed may adversely affect the skin.

Finally, Table 1 shows which exercises improve skin function.

Exercise needed to improve skin function.

Improved skin function Exercise details
Skin blood flow Acute maximal exercise [55,56]Aerobic Training [56]
Vasodilator function in cutaneous microvessels Aerobic Training [60,61]
Moisturizing function Daily activity level [62,63]
Postmenopausal hot flushes Moderate-intensity exercise training [64]
Structural of skin Endurance exercise [67]
Facial appearance Facial exercise [69]
Discussion

Skin aging is a complex and lengthy biological process influenced by genetic and environmental factors. Although there are various therapeutic approaches to combat skin aging, such as hyaluronic acid injections and hormone replacement therapy, each method has its drawbacks. With people’s increasing demands for effective, safe, and sustainable treatment methods, the prevention and mitigation of skin aging through lifestyle management has become a trend.

It is undeniable that the skin is affected by lifestyle habits, and a consensus exists around lifestyle habits that negatively affect skin function. However, numerous questions remain unanswered regarding the effects of dietary and stress-coping interventions on skin function. This is likely due to ethical issues and the lack of guaranteed uniformity in clinical experimental conditions, which can lead to ambiguous results.

Exercise interventions have a relatively small potential for ethical problems and can have uniform experimental conditions. This review demonstrates that exercise can potentially enhance skin function retention. Although the design of the studies that were conducted varied, it was clear that exercise increases skin blood flow, increases keratin water content, and changes skin structure. The effects of exercise on the skin have previously been shown piecemeal, but this review has allowed us to synthesize the findings. These findings suggest the effectiveness of habitual exercise in improving skin function. Future studies should investigate the effects of exercise on the skin under different experimental conditions, such as varied exercise content and duration, as well as the physiological mechanisms involved.

 Abbreviations ROS

reactive oxygen species

 TEWL

transepidermal water loss

 UVR

ultraviolet radiation

This study was funded by a research grant from the Institute of Health Science, Shijonawate University.

None declared.

 Madison KC Barrier function of the skin: "la raison d'être" of the epidermis J Invest Dermatol 2003 121 2 231 241 10.1046/j.1523-1747.2003.12359.x 12880413 S0022-202X(15)30356-0 Proksch E Brandner JM Jensen JM The skin: an indispensable barrier Exp Dermatol 2008 17 12 1063 1072 10.1111/j.1600-0625.2008.00786.x 19043850 Landau M Exogenous factors in skin aging Curr Probl Dermatol 2007 35 1 13 10.1159/000106405 17641486 000106405 Krueger N Luebberding S Oltmer M Streker M Kerscher M Age-related changes in skin mechanical properties: a quantitative evaluation of 120 female subjects Skin Res Technol 2011 17 2 141 148 10.1111/j.1600-0846.2010.00486.x 21281361 Berardesca E Loden M Serup J Masson P Rodrigues LM The revised EEMCO guidance for the in vivo measurement of water in the skin Skin Res Technol 2018 24 3 351 358 10.1111/srt.12599 29923639 Tobin DJ Introduction to skin aging J Tissue Viability 2017 26 1 37 46 10.1016/j.jtv.2016.03.002 27020864 S0965-206X(16)00028-0 Cao C Xiao Z Wu Y Ge C Diet and skin aging-from the perspective of food nutrition Nutrients 2020 12 3 870 10.3390/nu12030870 32213934 nu12030870 PMC7146365 Iizaka S Skin hydration and lifestyle-related factors in community-dwelling older people Arch Gerontol Geriatr 2017 72 121 126 10.1016/j.archger.2017.05.016 28624752 S0167-4943(17)30031-6 Altemus M Rao B Dhabhar FS Ding W Granstein RD Stress-induced changes in skin barrier function in healthy women J Invest Dermatol 2001 117 2 309 317 10.1046/j.1523-1747.2001.01373.x 11511309 S0022-202X(15)41329-6 Hunter HJA Momen SE Kleyn CE The impact of psychosocial stress on healthy skin Clin Exp Dermatol 2015 40 5 540 546 10.1111/ced.12582 25808947 Yoshizaki T Kimira Y Mano H Ota M Iwatsuki K Oishi Y Yamane T Association between skin condition and sleep efficiency in Japanese young adults J Nutr Sci Vitaminol (Tokyo) 2017 63 1 15 20 10.3177/jnsv.63.15 28367921 Kercher VM Kercher K Levy P Bennion T Alexander C Amaral PC Batrakoulis A Chávez LFJG Cortés-Almanzar P Haro JL Zavalza ARP Rodríguez LEA Franco S Santos-Rocha R Ramalho F Simões V Vieira I Ramos L Veiga OL Valcarce-Torrente M Romero-Caballero A 2023 fitness trends from around the globe ACSMs Health Fit J 2023 27 1 19 30 10.1249/fit.0000000000000836 F.A.S.T materials American Stroke Association 2021 2024-02-09 https://www.stroke.org/en/help-and-support/resource-library/fast-materials Inoue M Yamamoto S Kurahashi N Iwasaki M Sasazuki S Tsugane S Group J Daily total physical activity level and total cancer risk in men and women: results from a large-scale population-based cohort study in Japan Am J Epidemiol 2008 168 4 391 403 10.1093/aje/kwn146 18599492 kwn146 Stubbs B Vancampfort D Rosenbaum S Firth J Cosco T Veronese N Salum GA Schuch FB An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis Psychiatry Res 2017 249 102 108 10.1016/j.psychres.2016.12.020 28088704 S0165-1781(16)30909-X Verdier-Sévrain S Bonté F Skin hydration: a review on its molecular mechanisms J Cosmet Dermatol 2007 6 2 75 82 10.1111/j.1473-2165.2007.00300.x 17524122 JCD300 Elias PM Stratum corneum defensive functions: an integrated view J Invest Dermatol 2005 125 2 183 200 10.1111/j.0022-202X.2005.23668.x 16098026 S0022-202X(15)32393-9 Samaras N Papadopoulou MA Samaras D Ongaro F Off-label use of hormones as an antiaging strategy: a review Clin Interv Aging 2014 9 1175 1186 10.2147/CIA.S48918 25092967 cia-9-1175 PMC4116364 Tanriverdi F Karaca Z Unluhizarci K Kelestimur F Unusual effects of GH deficiency in adults: a review about the effects of GH on skin, sleep, and coagulation Endocrine 2014 47 3 679 689 10.1007/s12020-014-0276-0 24816469 Kosmadaki MG Gilchrest BA The role of telomeres in skin aging/photoaging Micron 2004 35 3 155 159 10.1016/j.micron.2003.11.002 15036269 S0968432803001859 Waller JM Maibach HI Age and skin structure and function, a quantitative approach (I): blood flow, pH, thickness, and ultrasound echogenicity Skin Res Technol 2005 11 4 221 235 10.1111/j.0909-725X.2005.00151.x 16221138 SRT151 Sanz A Pamplona R Barja G Is the mitochondrial free radical theory of aging intact? Antioxid Redox Signal 2006 8 3-4 582 599 10.1089/ars.2006.8.582 16677102 Aubert G Lansdorp PM Telomeres and aging Physiol Rev 2008 88 2 557 579 10.1152/physrev.00026.2007 18391173 88/2/557 Farrar MD Advanced glycation end products in skin ageing and photoageing: what are the implications for epidermal function? Exp Dermatol 2016 25 12 947 948 10.1111/exd.13076 27193836 Nilsson MI Tarnopolsky MA Mitochondria and aging-the role of exercise as a countermeasure Biology (Basel) 2019 8 2 40 10.3390/biology8020040 31083586 biology8020040 PMC6627948 Vashi NA de Castro Maymone MB Kundu RV Aging differences in ethnic skin J Clin Aesthet Dermatol 2016 9 1 31 38 26962390 PMC4756870 Berardesca E Maibach H Ethnic skin: overview of structure and function J Am Acad Dermatol 2003 48 6 Suppl S139 S142 10.1067/mjd.2003.273 12789167 S0190-9622(03)00342-6 Thornton MJ Estrogens and aging skin Dermatoendocrinol 2013 5 2 264 270 10.4161/derm.23872 24194966 2012DE0194R PMC3772914 Böhm M Makrantonaki E Zouboulis CC Dermatoendocrinology [Article in German] Hautarzt 2020 71 10 739 740 10.1007/s00105-020-04683-3 32989471 10.1007/s00105-020-04683-3 Lephart ED Naftolin F Menopause and the skin: old favorites and new innovations in cosmeceuticals for estrogen-deficient skin Dermatol Ther (Heidelb) 2021 11 1 53 69 10.1007/s13555-020-00468-7 33242128 10.1007/s13555-020-00468-7 PMC7859014 Wilkinson HN Hardman MJ The role of estrogen in cutaneous ageing and repair Maturitas 2017 103 60 64 10.1016/j.maturitas.2017.06.026 28778334 S0378-5122(17)30635-7 Affinito P Palomba S Sorrentino C Di Carlo C Bifulco G Arienzo MP Nappi C Effects of postmenopausal hypoestrogenism on skin collagen Maturitas 1999 33 3 239 247 10.1016/s0378-5122(99)00077-8 10656502 S0378512299000778 Sauerbronn AV Fonseca AM Bagnoli VR Saldiva PH Pinotti JA The effects of systemic hormonal replacement therapy on the skin of postmenopausal women Int J Gynaecol Obstet 2000 68 1 35 41 10.1016/s0020-7292(99)00166-6 10687834 S0020-7292(99)00166-6 Ashcroft GS Greenwell-Wild T Horan MA Wahl SM Ferguson MW Topical estrogen accelerates cutaneous wound healing in aged humans associated with an altered inflammatory response Am J Pathol 1999 155 4 1137 1146 10.1016/S0002-9440(10)65217-0 10514397 S0002-9440(10)65217-0 PMC1867002 Ashcroft GS Ashworth JJ Potential role of estrogens in wound healing Am J Clin Dermatol 2003 4 11 737 743 10.2165/00128071-200304110-00002 14572296 4112 Edmondson SR Thumiger SP Werther GA Wraight CJ Epidermal homeostasis: the role of the growth hormone and insulin-like growth factor systems Endocr Rev 2003 24 6 737 764 10.1210/er.2002-0021 14671001 Rudman D Feller AG Nagraj HS Gergans GA Lalitha PY Goldberg AF Schlenker RA Cohn L Rudman IW Mattson DE Effects of human growth hormone in men over 60 years old N Engl J Med 1990 323 1 1 6 10.1056/NEJM199007053230101 2355952 Jabbour SA Skin manifestations of hormone-secreting tumors Dermatol Ther 2010 23 6 643 650 10.1111/j.1529-8019.2010.01369.x 21054708 Yaar M Gilchrest BA Photoageing: mechanism, prevention and therapy Br J Dermatol 2007 157 5 874 887 10.1111/j.1365-2133.2007.08108.x 17711532 BJD8108 Seité S Fourtanier A Moyal D Young AR Photodamage to human skin by suberythemal exposure to solar ultraviolet radiation can be attenuated by sunscreens: a review Br J Dermatol 2010 163 5 903 914 10.1111/j.1365-2133.2010.10018.x 20977441 Rittié L Fisher GJ Natural and sun-induced aging of human skin Cold Spring Harb Perspect Med 2015 5 1 a015370 10.1101/cshperspect.a015370 25561721 5/1/a015370 PMC4292080 Meksiarun P Maeda Y Hiroi T Andriana BB Sato H Analysis of the effects of dietary fat on body and skin lipids of hamsters by Raman spectroscopy Analyst 2015 140 12 4238 4244 10.1039/c5an00076a 25920444 Rosa DF Sarandy MM Novaes RD da Matta SLP Gonçalves RV Effect of a high-fat diet and alcohol on cutaneous repair: a systematic review of murine experimental models PLoS One 2017 12 5 e0176240 10.1371/journal.pone.0176240 28493875 PONE-D-16-16397 PMC5426595 Nguyen HP Katta R Sugar Sag: glycation and the role of diet in aging skin Skin Therapy Lett 2015 20 6 1 5 27224842 AGEs, advanced glycation end products, collagen, dietary sucrose, fibroblasts, nutrition, skin aging Farkas A Kemény L Széll M Dobozy A Bata-Csörgo Z Ethanol and acetone stimulate the proliferation of HaCaT keratinocytes: the possible role of alcohol in exacerbating psoriasis Arch Dermatol Res 2003 295 2 56 62 10.1007/s00403-003-0399-2 12720008 Goodman GD Kaufman J Day D Weiss R Kawata AK Garcia JK Santangelo S Gallagher CJ Impact of smoking and alcohol use on facial aging in women: results of a large multinational, multiracial, cross-sectional survey J Clin Aesthet Dermatol 2019 12 8 28 39 31531169 PMC6715121 Yin L Morita A Tsuji T Skin aging induced by ultraviolet exposure and tobacco smoking: evidence from epidemiological and molecular studies Photodermatol Photoimmunol Photomed 2001 17 4 178 183 10.1034/j.1600-0781.2001.170407.x 11499540 Sandby-Møller J Poulsen T Wulf HC Epidermal thickness at different body sites: relationship to age, gender, pigmentation, blood content, skin type and smoking habits Acta Derm Venereol 2003 83 6 410 413 10.1080/00015550310015419 14690333 DDT2W185ABE4P8PT Haresaku S Hanioka T Tsutsui A Watanabe T Association of lip pigmentation with smoking and gingival melanin pigmentation Oral Dis 2007 13 1 71 76 10.1111/j.1601-0825.2006.01249.x 17241433 ODI1249 Leow YH Maibach HI Cigarette smoking, cutaneous vasculature, and tissue oxygen Clin Dermatol 1998 16 5 579 584 10.1016/s0738-081x(98)00042-x 9787969 S0738-081X(98)00042-X Yazdanparast T Hassanzadeh H Nasrollahi SA Seyedmehdi SM Jamaati H Naimian A Karimi M Roozbahani R Firooz A Cigarettes smoking and skin: a comparison study of the biophysical properties of skin in smokers and non-smokers Tanaffos 2019 18 2 163 168 32440305 PMC7230126 Choi EH Demerjian M Crumrine D Brown BE Mauro T Elias PM Feingold KR Glucocorticoid blockade reverses psychological stress-induced abnormalities in epidermal structure and function Am J Physiol Regul Integr Comp Physiol 2006 291 6 R1657 R1662 10.1152/ajpregu.00010.2006 16857896 00010.2006 Axelsson J Sundelin T Ingre M Van Someren EJW Olsson A Lekander M Beauty sleep: experimental study on the perceived health and attractiveness of sleep deprived people BMJ 2010 341 c6614 10.1136/bmj.c6614 21156746 bmj.c6614 PMC3001961 Oyetakin-White P Suggs A Koo B Matsui MS Yarosh D Cooper KD Baron ED Does poor sleep quality affect skin ageing? Clin Exp Dermatol 2015 40 1 17 22 10.1111/ced.12455 25266053 Rossi M Santoro G Maurizio S Carpi A Spectral analysis of skin blood flowmotion before and after exercise in healthy trained and in sedentary subjects Int J Sports Med 2006 27 7 540 545 10.1055/s-2005-865825 16802249 Simmons GH Wong BJ Holowatz LA Kenney WL Changes in the control of skin blood flow with exercise training: where do cutaneous vascular adaptations fit in? Exp Physiol 2011 96 9 822 828 10.1113/expphysiol.2010.056176 21602295 expphysiol.2010.056176 PMC3754812 Vargas NT Chapman CL Sackett JR Johnson BD Gathercole R Schlader ZJ Thermal behavior differs between males and females during exercise and recovery Med Sci Sports Exerc 2019 51 1 141 152 10.1249/MSS.0000000000001756 30095750 Vargas NT Chapman CL Johnson BD Gathercole R Schlader ZJ Skin wettedness is an important contributor to thermal behavior during exercise and recovery Am J Physiol Regul Integr Comp Physiol 2018 315 5 R925 R933 10.1152/ajpregu.00178.2018 30134737 Ho CW Beard JL Farrell PA Minson CT Kenney WL Age, fitness, and regional blood flow during exercise in the heat J Appl Physiol (1985) 1997 82 4 1126 1135 10.1152/jappl.1997.82.4.1126 9104849 Black MA Green DJ Cable NT Exercise prevents age-related decline in nitric-oxide-mediated vasodilator function in cutaneous microvessels J Physiol 2008 586 14 3511 3524 10.1113/jphysiol.2008.153742 18483071 jphysiol.2008.153742 PMC2538814 Hodges GJ Sharp L Stephenson C Patwala AY George KP Goldspink DF Tim Cable N The effect of 48 weeks of aerobic exercise training on cutaneous vasodilator function in post-menopausal females Eur J Appl Physiol 2010 108 6 1259 1267 10.1007/s00421-009-1330-0 20039056 Ryosuke O Yoshie S Hiromi A The association between activity levels and skin moisturising function in adults Dermatol Reports 2021 13 1 8811 10.4081/dr.2021.8811 33824705 PMC8018252 Jiang Q Wang Y Liu Y Zhu D Xie Y Zhao J Weng Y Tang Y Feng H Li Y Wang J Cai Y Kang Z Ou Y Chen D Prevalence and associated factors of dry skin among older inpatients in hospitals and nursing homes: a multicenter cross-sectional study Int J Nurs Stud 2022 135 104358 10.1016/j.ijnurstu.2022.104358 36152467 S0020-7489(22)00187-0 Bailey TG Cable NT Aziz N Atkinson G Cuthbertson DJ Low DA Jones H Exercise training reduces the acute physiological severity of post-menopausal hot flushes J Physiol 2016 594 3 657 667 10.1113/JP271456 26676059 PMC5341707 Freedman RR Menopausal hot flashes: mechanisms, endocrinology, treatment J Steroid Biochem Mol Biol 2014 142 115 120 10.1016/j.jsbmb.2013.08.010 24012626 S0960-0760(13)00153-2 PMC4612529 Sassarini J Krishnadas R Cavanagh J Nicol A Pimlott SL Ferrell W Lumsden MA Venlafaxine alters microvascular perfusion, [¹²³I]-beta-CIT binding and BDI scores in flushing postmenopausal women Maturitas 2014 77 3 267 273 10.1016/j.maturitas.2013.12.003 24411555 S0378-5122(13)00375-7 Crane JD MacNeil LG Lally JS Ford RJ Bujak AL Brar IK Kemp BE Raha S Steinberg GR Tarnopolsky MA Exercise-stimulated interleukin-15 is controlled by AMPK and regulates skin metabolism and aging Aging Cell 2015 14 4 625 634 10.1111/acel.12341 25902870 PMC4531076 Lu CY Lee HC Fahn HJ Wei YH Oxidative damage elicited by imbalance of free radical scavenging enzymes is associated with large-scale mtDNA deletions in aging human skin Mutat Res 1999 423 1-2 11 21 10.1016/s0027-5107(98)00220-6 10029667 S0027-5107(98)00220-6 Safdar A Bourgeois JM Ogborn DI Little JP Hettinga BP Akhtar M Thompson JE Melov S Mocellin NJ Kujoth GC Prolla TA Tarnopolsky MA Endurance exercise rescues progeroid aging and induces systemic mitochondrial rejuvenation in mtDNA mutator mice Proc Natl Acad Sci U S A 2011 108 10 4135 4140 10.1073/pnas.1019581108 21368114 1019581108 PMC3053975 Alam M Walter AJ Geisler A Roongpisuthipong W Sikorski G Tung R Poon E Association of facial exercise with the appearance of aging JAMA Dermatol 2018 154 3 365 367 10.1001/jamadermatol.2017.5142 29299598 2666801 PMC5885810 Wideman L Weltman JY Hartman ML Veldhuis JD Weltman A Growth hormone release during acute and chronic aerobic and resistance exercise: recent findings Sports Med 2002 32 15 987 1004 10.2165/00007256-200232150-00003 12457419 321503 Kraemer WJ Ratamess NA Hormonal responses and adaptations to resistance exercise and training Sports Med 2005 35 4 339 361 10.2165/00007256-200535040-00004 15831061 3544 Gharahdaghi N Phillips BE Szewczyk NJ Smith K Wilkinson DJ Atherton PJ Links between testosterone, oestrogen, and the growth hormone/insulin-like growth factor axis and resistance exercise muscle adaptations Front Physiol 2020 11 621226 10.3389/fphys.2020.621226 33519525 PMC7844366 Font-Ribera L Kogevinas M Zock JP Nieuwenhuijsen MJ Heederik D Villanueva CM Swimming pool attendance and risk of asthma and allergic symptoms in children Eur Respir J 2009 34 6 1304 1310 10.1183/09031936.00180608 19443529 09031936.00180608 Fernández-Luna Á Burillo P Felipe JL del Corral J García-Unanue J Gallardo L Perceived health problems in swimmers according to the chemical treatment of water in swimming pools Eur J Sport Sci 2016 16 2 256 265 10.1080/17461391.2014.1001877 25604467 Paciência I Rodolfo A Leão L Silva D Rufo JC Mendes F Padrão P Moreira P Boechat JL Delgado L Moreira A Effects of exercise on the skin epithelial barrier of young elite athletes-swimming comparatively to non-water sports training session Int J Environ Res Public Health 2021 18 2 653 10.3390/ijerph18020653 33466624 ijerph18020653 PMC7828688