[Prevention of cardiovascular diseases through sport and physical activity: A question of intensity?]

Controversies in the association of cardiorespiratory fitness and arterial stiffness in children and adolescents

The relationship between cardiorespiratory fitness and arterial compliance in children and adolescents remains controversial. The aim of this study was to assess this association with a quantitative approach. A total of 646 healthy children and adolescents (316 females, age 13.9±2.1 years) were cross-sectionally investigated in seven school settings in and around Munich for their cardiorespiratory fitness and demographic, anthropometric and hemodynamic parameters. Surrogates of arterial stiffness, such as pulse wave velocity (PWV), Augmentation Index normalized to a heart rate of 75 (AI@75), and peripheral and central systolic blood pressures were measured in a supine position using the oscillometric Mobil-O-Graph. Cardiopulmonary fitness was measured by 6-min indoor run tests. After correction for age, sex, body weight, body height, heart rate and mean arterial pressure, controversial findings were produced. PWV increased with higher cardiorespiratory fitness (Beta=0.173; P<0.001), which represented an unfavorable relationship, whereas AI@75 declined with higher cardiorespiratory fitness (Beta=-0.106; P=0.025). Therefore, in contrast to PWV, higher cardiorespiratory fitness seems beneficial for AI@75. The third surrogate of arterial stiffness, central systolic blood pressure, showed no association with cardiorespiratory fitness (Beta=0.066; P=0.052). These controversial outcomes remain almost unchanged when the boys and girls were analyzed separately. Different surrogates of arterial stiffness have different relationships with cardiorespiratory fitness in children and adolescents after correcting for multiple confounders. More research is needed in this field to understand the functioning of the juvenile vessels, and measurements and methodological approaches should be reconsidered.

[Exercise training in the therapy of heart diseases: Current evidence and future options]

Exercise training has been firmly established as an additional therapeutic strategy in addition to pharmacological and interventional treatment in patients with cardiovascular disease. Benefits for quality of life as well as prognosis have been confirmed for cardiovascular risk factors, ischemic heart disease, after myocardial infarction, in heart failure with preserved as well as reduced ejection fraction, in atrial fibrillation and in patients after catheter-assisted aortic valve implantation (TAVI), with an implantable cardioverter defibrillator (ICD) or with left ventricular assist devices (VAD). Training programs have to be tailored according to the disease, stage of disease, comorbidities, age of the patient, medication as well as exercise capacity. For prescribing exercise mode and intensity, a maximum exercise test has to be performed. Ideally, this is accompanied by spirometry to assess maximum values such as maximum oxygen consumption. Training intensity will then be prescribed according to the optimal training range and maximum training intensity.

The potential role of endogenous bacteriophages in controlling invading pathogens

Bacteriophages (phages) are omnipresent in our environment, and recent studies highlight their potential impact on the microbial world. Phages can also be present in mammalian organisms, including man (intestines, oral cavity, urine, sputum and serum). Data are available which suggest that those endogenous phages could play an important role in eliminating bacteria and regulating the body ecosystem. Furthermore, our most recent findings suggest that phages can exert immunosuppressive action in the gut, helping control local inflammatory and autoimmune reactions, and demonstrate anticancer activity. We hypothesize that phages could act in concert with the immune system in immunosurveillance against bacteria, viruses and cancer.